References of "Scheen, André"
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See detailControle glycemique avant et apres sitagliptine en medecine generale: analyse des facteurs determinants dans l'etude observationnelle belge "SUGAR".
SCHEEN, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2011), 66(7-8), 440-6

Sitagliptin (Januvia), the first selective inhibitor of dipeptidylpeptidase-4 with a so-called incretin effect, has been evaluated in SUGAR, a large Belgian prospective observational study carried out in ... [more ▼]

Sitagliptin (Januvia), the first selective inhibitor of dipeptidylpeptidase-4 with a so-called incretin effect, has been evaluated in SUGAR, a large Belgian prospective observational study carried out in general practice. Sitagliptin, at a dose of 100 mg once daily, was added to previous treatment of not well controlled type 2 diabetic patients (> 95% on metformin monotherapy). Among 605 patients analysed in intention to treat, the worse the glycaemic control at entry, the greatest the reduction in glycated haemoglobin (HbA1c) and fasting plasma glucose levels after the addition of sitagliptin (p < 0.001). No specific factor was associated with the quality of initial glucose control among age, body mass index, the duration of diabetes or the modalities of its pharmacological treatment. Similarly, among these factors, none was significantly associated with the reduction in HbA1c or fasting plasma glucose levels observed with the addition of sitagliptin. Thus, sitagliptin was as active in older as in younger subjects, in obese as in nonobese people and in patients with diabetes of long versus short duration. In particular, SUGAR recruited data on 191 patients above 70 years in whom sitagliptin was as effective and safe as in younger patients with type 2 diabetes. [less ▲]

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See detailQuelle combinaison d'antidiabétiques oraux pour contrôler l'hyperglycémie chez un patient diabétique de type 2 insuffisamment équilibré sous metformine?
SCHEEN, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2011), 66(3), 170-5

Patients with type 2 diabetes should improve lifestyle habits combined with metformin as first pharmacological compound (in absence of contra-indications). In case of failure of metformin monotherapy (due ... [more ▼]

Patients with type 2 diabetes should improve lifestyle habits combined with metformin as first pharmacological compound (in absence of contra-indications). In case of failure of metformin monotherapy (due to the progression of the disease secondary to B-cell exhaustion), another oral glucose-lowering agent should be added. Several medications may be used, with some advantages and disadvantages for each of them. The present clinical case illustrates this dilemma and should help the reasoning leading to the best pharmacological combination according to individual patient's profile. [less ▲]

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See detailLa vignette therapeutique de l'etudiant. Options therapeutiques pour controler l'hyperglycemie chez un patient diabetique de type 2 insuffisamment equilibre sous l'association metformine-sulfamide.
SCHEEN, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2011), 66(4), 215-21

Beyond lifestyle changes, the management of type 2 diabetes comprises the administration of oral glucose-lowering agents, especially the classical metformin-sulfonylurea combination. If such a dual oral ... [more ▼]

Beyond lifestyle changes, the management of type 2 diabetes comprises the administration of oral glucose-lowering agents, especially the classical metformin-sulfonylurea combination. If such a dual oral therapy could not (any more) obtain an adequate glucose control, intensified management becomes mandatory. Several therapeutic approaches may be proposed at this stage, with some advantages and disadvantages of each of them. The present clinical case aims at illustrating such difficult therapeutic choice. We will provide the pro-contra arguments concerning each therapeutic alternative and describe the practical modalities of an appropriate management according to the patient's characteristics. [less ▲]

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See detailManagement of familial hypercholesterolemia in children and young adults: Consensus paper developed by a panel of lipidologists, cardiologists, paediatricians, nutritionists, gastroenterologists, general practitioners and a patient organization.
Descamps, O. S.; Tenoutasse, S.; Stephenne, X. et al

in Atherosclerosis (2011), 218(2), 272-80

Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a ... [more ▼]

Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a clear consensus on the management of this disease in young patients is necessary. In Belgium, a panel of paediatricians, specialists in (adult) lipid management, general practitioners and representatives of the FH patient organization agreed on the following common recommendations. Conclusion: The aim of this consensus statement is to achieve more consistent management in the identification and treatment of children with HeFH in Belgium. [less ▲]

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See detailDe la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2
SCHEEN, André ULg; DE FLINES, Jenny ULg; DE ROOVER, Arnaud ULg et al

in Médecine des Maladies Métaboliques (2011), 5(3),

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these ... [more ▼]

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures and to propose them to patients with type 2 diabetes but without severe obesity (body mass index <35 kg/m² or even <30 kg/m²). Therefore, we may progress in a near future from bariatric surgery to a so-called metabolic surgery, which may open a new paradigm for the management of type 2 diabetes. This innovative approach, promising but still insufficiently validated yet, deserves further careful evaluation in a multidisciplinary approach involving digestive surgeons, gastroenterologists, endocrinologists and diabetologists. [less ▲]

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See detailLe tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique
SCHEEN, André ULg; DE FLINES, Jenny ULg; DE ROOVER, Arnaud ULg et al

in Médecine des Maladies Métaboliques (2011), 5(2), 155-161

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission ... [more ▼]

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission of diabetes occurs very early, before any significant weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. These hormonal changes result from partial stomach amputation (leading to reduced ghrelin secretion), from bypass of duodenal-jejunal foregut (leading to reduced secretion of still unknown factors that may counteract insulin secretion and/or action) and from an earlier contact of food with hindgut (leading to enhanced secretion of incretin hormones such as glucagon-like peptide-1 [GLP-1] by the ileal L cells, neuropeptide YY and oxyntomodulin). The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery. [less ▲]

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See detailLes statines dans la prise en charge des dyslipidémies
SCHEEN, André ULg

in Revue du Praticien (La) (2011), 61(8), 1120-1126

Statins, combined with life-style advices, have a key position in the prevention of cardiovascular diseases. By inhibiting HMG-CoA reductase enzyme, these medications reduce total and LDL cholesterol ... [more ▼]

Statins, combined with life-style advices, have a key position in the prevention of cardiovascular diseases. By inhibiting HMG-CoA reductase enzyme, these medications reduce total and LDL cholesterol levels in a dose-dependent manner. They also exert various pleiotropic effects that may contribute to the cardiovascular protection. Although some differences exist between available statins, a class effect seems predominant. Statins have proven their efficacy in numerous controlled randomized trials (recently pooled in meta-analyses), both in primary and secondary prevention, including various specific populations, among them patients with diabetes. Tolerance and safety profile is rather good even if muscular and hepatic adverse events may occur. The prescription of statins should target high-risk individuals and both therapeutic inertia and drug non-compliance should be avoided. [less ▲]

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See detailSquatting test: a dynamic postural manoeuvre to study baroreflex sensitivity.
SCHEEN, André ULg; PHILIPS, Jean-Christophe ULg

in Clinical autonomic research : official journal of the Clinical Autonomic Research Society (2011)

INTRODUCTION: Squatting is an active posture test that can be used to assess baroreflex sensitivity. Indeed, the shift from squatting to standing imposes a major orthostatic stress leading to rapid and ... [more ▼]

INTRODUCTION: Squatting is an active posture test that can be used to assess baroreflex sensitivity. Indeed, the shift from squatting to standing imposes a major orthostatic stress leading to rapid and large changes in arterial blood pressure (BP) and heart rate (HR) allowing precise baroreflex assessment. MATERIAL AND METHODS: BP and HR can be continuously and non-invasively monitored with a Finapres device. RESULTS: The standing to squatting transition is accompanied by rises in BP, pulse pressure and cardiac output, mainly due to increased venous return, and by a secondary reduction in HR. Conversely, the squatting to standing transition is associated with an immediate drop in BP and both reflex tachycardia and vasoconstriction. This mirror changes in BP and HR, mimicking those observed with the classical pharmacological approach using vasopressor/vasodilating agents, allows the calculation of the so-called baroreflex gain. DISCUSSION: The present review describes the haemodynamic changes occurring in normal subjects during the shifts from standing to squatting and from squatting to standing and discusses the underlying cardiovascular and autonomic mechanisms. CONCLUSION: This careful analysis in healthy individuals should help in the understanding of disturbances that may be observed in patients with autonomic dysfunction, such as in diabetic patients with cardiovascular autonomic neuropathy. [less ▲]

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See detailDiagnostic differentiel d'un malaise: hypoglycemie, hypotension ou spasmophilie?
SCHEEN, André ULg; PHILIPS, Jean-Christophe ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2011), 66(1), 48-54

The consultation for dizziness is a common problem in clinical practice. Because of the apparent lack of specificity of the complaints, there is a rather high risk to prescribe a variety of sophisticated ... [more ▼]

The consultation for dizziness is a common problem in clinical practice. Because of the apparent lack of specificity of the complaints, there is a rather high risk to prescribe a variety of sophisticated exams, which will not be very helpful in absence of a well oriented anamnesis and a pertinent clinical examination. The present paper aims at describing a global medical approach, essentially based upon a detailed anamnesis (semiological, chronological and therapeutical arguments), to which may be added a few simple clinical and technical complementary data. This strategy should allow obtaining quite easily pertinent arguments for a differential diagnosis between reactive hypoglycaemia, (orthostatic) hypotension, and hyperventilation crisis (spasmophilia). [less ▲]

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See detailSquatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction.
PHILIPS, Jean-Christophe ULg; SCHEEN, André ULg

in Autonomic neuroscience : basic & clinical (2011)

The squatting test is an active posture manoeuvre that imposes one of the most potent orthostatic stresses. In normal subjects, the changes in blood pressure and heart rate are transient because of ... [more ▼]

The squatting test is an active posture manoeuvre that imposes one of the most potent orthostatic stresses. In normal subjects, the changes in blood pressure and heart rate are transient because of appropriate baroreflex homeostasis and do not provoke symptoms. However, in various pathological conditions, both the increase in blood pressure during squatting and the decrease in blood pressure during standing may be more important and sustained, potentially leading to complaints and adverse events. Squatting has been used to evaluate patients with tetralogy of Fallot, heart transplant, dysautonomia, including diabetic cardiovascular autonomic neuropathy, and individuals prone to vasovagal syncope. Careful analysis of changes in blood pressure and heart rate during the transition from standing to squatting and from squatting to standing allows the early detection of altered vagal and/or sympathetic function. Of note squatting position has been proposed as a therapeutic means to counteract the fall in blood pressure in patients suffering from dizziness due to dysautonomia and orthostatic hypotension or presenting pre-syncope symptoms, such as soon after exercise. The aims of the present review are to analyse the haemodynamic pattern during a squatting test in various pathological situations and to describe what may be the negative and positive haemodynamic changes associated with this posture. We were especially interested in using the squatting test for the assessment of cardiovascular autonomic neuropathy associated with diabetes mellitus. [less ▲]

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See detailEtude de la pression artérielle, rigidité artérielle et neuropathie autonome cardiovasculaire chez les patients diabétiques de type 1
Philips, Jean-Christophe ULg; Xhignesse, Patricia ULg; Marchand, Monique ULg et al

in Vaisseaux, Coeur, Poumons (2010), 15(3), 70-73

Nous avons récemment eu l'honneur de recevoir l'Hypertension Young Investigator Award 2009 adressé par le Comité belge de Lutte contre l'Hypertension et soutenu par la fondation Astra Zeneca. Notre projet ... [more ▼]

Nous avons récemment eu l'honneur de recevoir l'Hypertension Young Investigator Award 2009 adressé par le Comité belge de Lutte contre l'Hypertension et soutenu par la fondation Astra Zeneca. Notre projet propose d'étudier différents indices cardiovasculaires au sein d'une population constituée de patients diabétiques de type 1. L'étude de la pression artérielle, estimée par différentes méthodes, ainsi que l'estimation de la rigidité artérielle chez ces patients pourraient être utiles afin d'apprécier le statut cardiovasculaire chez ces patients à haut risque. Notre service possède une certaine expérience dans la recherche et l'estimation de la neuropathie autonome cardiovasculaire (NAC) chez les patients diabétiques de type 1. Cette complication du diabète est associée à une morbi-mortalité d'origine cardiovasculaire accrue. Nous allons proposer une batterie de tests classiquement effectués dans le cadre de la recherche d'une NAC (en utilisant la technique du Finapress°). Ceux-ci seront combinés à d'autres explorations réalisées par nos confrères néphrologues (mesure ambulatoire de 24 heures de la pression artéielle ou MAPA et Sphygmocor°). Tous ces examens ont l'avantage d'être non-invasifs et peuvent être réalisés en routine clinique. Le recrutement de cette étude devrait permettre d'inclure une soixantaine de patients diabétiques de type 1 âgés de 20 à 50 ans et dont la durée de diabète varie entre 10 et 30 années. Cette population sera comparée à une cohorte de sujet sains apariés pour l'âge, l'indice de masse corporelle et le sexe. Plusieurs mesures sont effectuées et certains indices pourront être calculés après la réalisation des différents examens. Une comparaison entre les deux cohortes (diabétiques versus non-diabétiques) sera effectuée. L'évolution de certains paramètres au sein de la population diabétique sera aussi analysée (en fonction de l'âge et la durée du diabète par exemple). [less ▲]

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See detailEffect of sibutramine on cardiovascular outcomes in overweight and obese subjects.
James, W. P.; Caterson ID, I.D.; Coutinho, W. et al

in New England Journal of Medicine [=NEJM] (2010), 363

BACKGROUND: The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. METHODS: We ... [more ▼]

BACKGROUND: The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. METHODS: We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). RESULTS: The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. CONCLUSIONS: Subjects with preexisting cardiovascular conditions who were receiving long-term sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.) [less ▲]

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See detailSuspension de la commercialisation de la sibutramine et de la rosiglitazone en Europe
Scheen, André ULg

in Revue Médicale de Liège (2010), 65(10), 574-9

The European Medicines Agency (EMA) recommended the suspension of the marketing authorisations for sibutramine, a centrally-acting anti-obesity agent, and of rosiglitazone, an oral glucose-lowering ... [more ▼]

The European Medicines Agency (EMA) recommended the suspension of the marketing authorisations for sibutramine, a centrally-acting anti-obesity agent, and of rosiglitazone, an oral glucose-lowering compound of the thiazolidinedione family. This decision was taken because of a possible increased cardiovascular risk, mainly ischaemic heart disease, associated with the use of sibutramine or rosiglitazone in patients with pathologies prone to develop cardiovascular complications. The conclusion was that the benefits no longer outweigh the risks. The present paper summarizes the up- and -down history of these two pharmacological compounds, analyzes the data that resulted in such a decision and briefly discusses the future implications regarding the pharmacotherapy of cardiometabolic diseases. [less ▲]

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See detailL'etude clinique du mois. ACCORD-LIPID et ACCORD-EYE: vers un nouveau positionnement du fenofibrate chez le patient diabetique de type 2.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2010), 65(9), 533-9

Fenofibrate has been evaluated in the ACCORD trial, in combination with a statin, to prevent vascular complications in patients with type 2 diabetes. In ACCORD-Lipid, the addition of fenofibrate was not ... [more ▼]

Fenofibrate has been evaluated in the ACCORD trial, in combination with a statin, to prevent vascular complications in patients with type 2 diabetes. In ACCORD-Lipid, the addition of fenofibrate was not able to significantly reduce the incidence of a composite cardiovascular endpoint (no positive effect was also observed with the intensification of blood glucose or blood pressure control in this population). However, an interaction effect was observed according to basal lipid profile, suggesting a better protection by fenofibrate in patients with hypertriglyceridaemia and low HDL cholesterol (so-called atherogenic dyslipidaemia). In ACCORD-Eye, the addition of fenofibrate to a basal statin therapy resulted in a significant reduction of the progression of diabetic retinopathy, in a similar manner as that observed with intensifying blood glucose control (but with a good safety profile and without increasing the risk of hypoglycaemia). These observations, confirming earlier results from FIELD also with this fibrate, open new perspectives for a useful prescription of fenofibrate in patients with type 2 diabetes. [less ▲]

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See detailManagement of blood glucose in patients with stroke.
Radermecker, Régis ULg; Scheen, André ULg

in Diabètes & Métabolism (2010), 36S3

Stroke is a leading cause of death worldwide and the most common cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension. Increasing ... [more ▼]

Stroke is a leading cause of death worldwide and the most common cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension. Increasing evidence suggests that disordered physiological variables following acute ischaemic stroke, especially hyperglycaemia, adversely affect outcomes. Post-stroke hyperglycaemia is common (up to 50% of patients) and may be rather prolonged, regardless of diabetes status. A substantial body of evidence has demonstrated that hyperglycaemia has a deleterious effect upon clinical and morphological stroke outcomes. Therefore, hyperglycaemia represents an attractive physiological target for acute stroke therapies. However, whether intensive glycaemic manipulation positively influences the fate of ischaemic tissue remains unknown. One major adverse event of management of hyperglycaemia with insulin (either glucose-potassium-insulin infusions or intensive insulin therapy) is the occurrence of hypoglycaemia, which can also induce cerebral damage. Novel insights into post-stroke hyperglycaemia management have been derived from continuous glucose monitoring systems (CGMS). This article aims: 1) to describe the adverse effects of hyperglycaemia following acute ischaemic stroke and the risk associated with iatrogenic hypoglycaemia; 2) to summarise the evidence from current glucose-lowering treatment trials; and 3) to show the usefulness of CGMS in both non-diabetic and diabetic patients with acute stroke. [less ▲]

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