References of "Scheen, André"
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See detailRole limite des medicaments hypoglycemiants oraux dans le diabete de type 1.
SCHEEN, André ULg

in Revue Médicale de Liège (2013), 68(1), 16-21

Management of type 1 diabetes essentially relies upon intensive insulin therapy adjusted according to careful home blood glucose monitoring. The potential role of oral antidiabetic agents is controversial ... [more ▼]

Management of type 1 diabetes essentially relies upon intensive insulin therapy adjusted according to careful home blood glucose monitoring. The potential role of oral antidiabetic agents is controversial and what so ever is limited in type 1 diabetes. Nevertheless, metformin may still be useful in the presence of obesity and/or insulin resistance while acarbose could reduce the amplitude of glycaemic fluetuations, namely postprandial hyperglycaemia and late postmeal glycaemic nadir. Both drugs may also minimize weight gain that results from intensive insulin therapy. Finally, inhibitors of dipeptidyl peptidase-4 (glitpins), by inhibiting glucagon secretion, and inhibitors of renal SGLT2 cotransporters, thus promoting glucosuria independently of insulin, might also be beneficial in type 1 diabetes, although specific studies are still ongoing to verify this hypothesis. [less ▲]

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See detailEfficacy and safety of Jentadueto(R) (linagliptin plus metformin).
SCHEEN, André ULg

in Expert Opinion on Drug Safety (2013), 12(2), 275-89

INTRODUCTION: Metformin is the first-choice drug in the management of type 2 diabetes. However, most patients require a combined therapy to reach and/or maintain targets of glucose control. Dipeptidyl ... [more ▼]

INTRODUCTION: Metformin is the first-choice drug in the management of type 2 diabetes. However, most patients require a combined therapy to reach and/or maintain targets of glucose control. Dipeptidyl peptidase-4 (DPP-4) inhibitors offer new options for combined therapy with metformin. Linagliptin shares a similar pharmacodynamic (PD) profile with other gliptins, but has a unique pharmacokinetic (PK) profile characterized by negligible renal excretion. AREAS COVERED: An extensive literature search was performed to analyze the potential PK/PD interactions between linagliptin and metformin. They are not prone to PK drug-drug interactions. The two compounds may be administered together, either separately or using a fixed-dose combination (FDC) as shown by bioequivalence studies. The addition of linagliptin in patients not well controlled with metformin alone has proven its efficacy in improving glucose levels with a good safety profile. Initial co-administration of linagliptin plus metformin improves glucose control more potently than either compound separately, without hypoglycemia, weight gain or increased metformin-related gastrointestinal side effects. EXPERT OPINION: The linagliptin plus metformin combination may offer some advantages over the classical sulfonylurea-metformin combination. Even if linagliptin is safe in patients with renal impairment, the use of metformin (and thus of the linagliptin plus metformin FDC) is still controversial in this population. [less ▲]

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See detailLinagliptin plus metformin: a pharmacokinetic and pharmacodynamic evaluation.
SCHEEN, André ULg

in Expert Opinion on Drug Metabolism & Toxicology (2013), 9(3), 363-77

INTRODUCTION: The first-choice drug therapy in the management of type 2 diabetes is metformin . However, most patients require a combined therapy to reach and/or maintain targets of glucose control ... [more ▼]

INTRODUCTION: The first-choice drug therapy in the management of type 2 diabetes is metformin . However, most patients require a combined therapy to reach and/or maintain targets of glucose control. Dipeptidyl peptidase-4 (DPP-4) inhibitors, commonly referred to as gliptins, offer new options for combined therapy with metformin. Linagliptin is the most recently launched gliptin, with a unique pharmacokinetic (PK) profile characterized by negligible renal excretion and is now also available as a fixed-dose combination (FDC) with metformin. AREAS COVERED: An extensive literature search was performed to analyze the potential PK and pharmacodynamic interactions between linagliptin and metformin. Linagliptin and metformin may be administered together, either separately or as FDC supported by bioequivalence studies. Linagliptin and metformin are not prone to PK drug-drug interactions. Their coadministration improves blood glucose control more potently than either compound separately, without hypoglycemia and without increasing metformin-related gastrointestinal side effects. EXPERT OPINION: The combination linaglitpin plus metformin, if not contraindicated (renal failure), may be used as first-line or second-line therapy in the management of type 2 diabetes. That being said, the durability of the glucose-lowering effect of this combination needs to be further explored in long-term controlled trials. [less ▲]

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See detailComment j’explore …Une différence de risque de survenue d’un événement dans les études cliniques
SCHEEN, André ULg; ERNEST, Philippe ULg; JANDRAIN, Bernard ULg

in Revue Médicale de Liège (2012), 67(11), 597-602

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or ... [more ▼]

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or at least a non-inferiority (versus an active reference) concerning a primary endpoint that has been defined a priori (occurrence of a major clinical event, for instance). The difference in the occurrence of such an event between two treatments may be statistically analyzed by absolute risk reduction, relative risk reduction, hazard ratio or odds ratio. The present article discusses the nuances, sometimes of importance, concerning the significance of these various indices and analyses the cautions to be taken and the pitfalls to be avoided in their interpretation and use in practice. The clinician is, indeed, increasingly confronted to results of clinical trials, but is generally poorly informed regarding the nuances of these various statistical analyses. [less ▲]

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See detailAgonistes des récepteurs du GLP-1 ou inhibiteurs de la DPP-4 : comment orienter le choix du clinicien ?
SCHEEN, André ULg

Conference given outside the academic context (2012)

Le traitement pharmacologique du diabète de type 2 s’est enrichi, ces dernières années, de l’apport des médicaments à effet incrétine ciblant le glucagon-like peptide-1 (GLP-1). Ces médicaments ... [more ▼]

Le traitement pharmacologique du diabète de type 2 s’est enrichi, ces dernières années, de l’apport des médicaments à effet incrétine ciblant le glucagon-like peptide-1 (GLP-1). Ces médicaments comprennent soit des agonistes des récepteurs au GLP-1, à courte (injection 1 ou 2 x par jour : exénatide, liraglutide, lixisénatide) ou longue durée d’action (injection hebdomadaire : exénatide à libération prolongée, albiglutide, dulaglutide, taspoglutide) ; soit des agents inhibant l’enzyme inactivant le GLP-1, la dipeptidyl peptidase-4 (DPP-4), actifs par voie orale, les gliptines (sitagliptine, vildagliptine, saxagliptine, linagliptine, alogliptine). Bien que ces approches pharmacologiques ciblent toutes deux le GLP-1, elles se différencient par leur mode d’administration (injection sous-cutanée versus prise orale), leur efficacité (meilleure avec les GLP-1 agonistes), leurs effets sur le poids corporel et sur la pression artérielle systolique (diminution avec les agonistes versus neutralité avec les gliptines), leur profil de tolérance (risque de nausées ou vomissements avec les agonistes) et leur coût (supérieur avec les agonistes du GLP-1). Toutes deux pourraient être bénéfiques sur le plan cardiovasculaire. Il apparaît qu’une gliptine est une excellente alternative à un sulfamide ou une glitazone après échec d’une monothérapie par metformine alors qu’un analogue des récepteurs au GLP-1 est une bonne alternative à l’insuline (surtout chez les sujets obèses) après échec d’une bithérapie orale. Ce schéma est sans doute trop restrictif et les modalités d’utilisation sont nombreuses, à quasi tous les stades du diabète de type 2. Le choix pourra s’orienter selon les caractéristiques cliniques, les objectifs fixés ou simplement les préférences du patient. [less ▲]

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See detailVignette thérapeutique de l'étudiant. Quelles cibles tensionnelles viser chez un patient diabétique de type 2?
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale de Liège (2012), 67

L'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif ... [more ▼]

L'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif essentiel dans cette population. Cependant, les valeurs de pression systolique et diastolique à atteindre restent controversées et la cible doit sans doute être ajustée en fonction des caractéristiques individuelles du patient ("médecine personnalisée"). Cette vignette clinique résume les principaux arguments à propos du choix des cibles tensionnelles, en termes de rapport bénéfices/risques, selon que le patient diabétique présente un syndrome métabolique sans complications, une néphropathie ou une insuffisance coronaire. [less ▲]

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See detailLes maladies chroniques complexes. Du nouveau paradigme medical au gigantesque defi societal!
SCHEEN, André ULg

in Revue Médicale Suisse (2012), 8(351), 1579-80

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See detailControversy about the relative efficacy of dipeptidyl peptidase IV inhibitors.
SCHEEN, André ULg

in Diabetologia (2012), 55

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See detailLe diabete de type 2: voyage au coeur d'une maladie complexe.
SCHEEN, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2012), 67(5-6), 326-31

The prevalence of type 2 diabetes is rapidly growing worldwide and this metabolic disease nowadays represents a major public health concern. Besides the effects of aging, such a progression results from ... [more ▼]

The prevalence of type 2 diabetes is rapidly growing worldwide and this metabolic disease nowadays represents a major public health concern. Besides the effects of aging, such a progression results from the interaction of several phenomena among which (1) a rather common genetic (polygenic) predisposing pattern, (2) epigenetic mechanisms, at least partially linked to nutritional disturbances during gestation influencing fetal programming, and especially, (3) a deleterious societal environment promoting the development of obesity by giving free access to excess food (rich in calories, sucrose and lipids) and markedly limiting spontaneous physical activity, or exposing to pollutants that could exert a toxic effect on the B cell. Such an obesogenic environment, already present in young age, leads to an epidemics of "diabesity". A better knowledge of the natural history of type 2 diabetes opens perspectives for the prevention of this complex disease. When type 2 diabetes is already present, a global therapeutic approach targeting environment by the promotion of lifestyle changes and the correction of all risk factors is mandatory to reduce the incidence of complications, essentially cardiovascular diseases. [less ▲]

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See detailEpigenetique, interface entre environnement et genes: ro1e dans les maladies complexes.
SCHEEN, André ULg; Junien, C.

in Revue Médicale de Liège (2012), 67(5-6), 250-7

Epigenetics is the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence. Epigenetics is one of the major mechanisms ... [more ▼]

Epigenetics is the study of heritable changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence. Epigenetics is one of the major mechanisms explaining the "Developmental Origin of Health and Diseases" (DOHaD). Besides genetic background inherited from parents, which confers susceptibility to certain pathologies, epigenetic changes constitute the memory of previous events, either positive or negative, along the life cycle, including at the in utero stage. The later exposition to hostile environment may reveal such susceptibility, with the development of various pathologies, among them numerous chronic complex diseases. The demonstration of such a sequence of events has been shown for metabolic diseases as obesity, metabolic syndrome and type 2 diabetes, cardiovascular disease and cancer. In contrast to genetic predisposition, which is irreversible, epigenetic changes are potentially reversible, thus giving targets not only for prevention, but possibly also for the treatment of certain complex diseases. [less ▲]

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See detailRole de l'environnement dans les maladies complexes: pollution atmospherique et contaminants alimentaires.
SCHEEN, André ULg; Giet, Didier ULg

in Revue Médicale de Liège (2012), 67(5-6), 226-33

Our polluted environment exposes human beings, along their life, to various toxic compounds that could trigger and aggravate different complex diseases. Such a phenomenon is well recognized for ... [more ▼]

Our polluted environment exposes human beings, along their life, to various toxic compounds that could trigger and aggravate different complex diseases. Such a phenomenon is well recognized for cardiovascular diseases, respiratory diseases and cancers, but other chronic inflammatory disorders may also been implicated. The most common factors, but also the most toxic, and thereby the most extensively investigated, are air pollutants (both indoor and outdoor pollution) and various contaminants present in drinking water and food (organic compounds, chemical products, heavy metals, ...). The complex interrelationships between food and pollutants, on the one hand, and between gene and environmental pollutants, including the influence of epigenetics, on the other hand, deserve further careful studies. [less ▲]

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See detailMaladies complexes: des interactions genes-environnement au probleme de sante publique.
SCHEEN, André ULg; Bours, Vincent ULg

in Revue Médicale de Liège (2012), 67(5-6), 217-9

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See detailRecommandations 2012 en diabetologie Prise en charge de l’hyperglycémie dans le diabète de type 2 : une approche centrée sur le patient
SCHEEN, André ULg; Mathieu, Chantal

in Revue Médicale de Liège (2012), 67(12), 623-631

The pharmacological therapy of type 2 diabetes has become increasingly complex and the goals are now more diverse and, in general, more stringent. The glycaemic target (glycated haemoglobin or HbA1c ) and ... [more ▼]

The pharmacological therapy of type 2 diabetes has become increasingly complex and the goals are now more diverse and, in general, more stringent. The glycaemic target (glycated haemoglobin or HbA1c ) and the medications to be prescribed to reach it should be selected according to the individual characteristics of the patient and, if possible, in agreement with him/her. The most relevant criteria to be taken into account are the glucose-lowering efficacy, the risk of hypoglycaemia, the effect on body weight, the side effects and the costs. We summarize here the strategy proposed in the joint «position statement» published in 2012 by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). We will more particularly focus our attention on the practical aspects useful for the clinician [less ▲]

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See detailQuelles cibles glycémiques et lipidiques viser chez un patient diabétique de type 2 ?
PAQUOT, Nicolas ULg; SCHEEN, André ULg

in Revue Médicale de Liège (2012), 67(2), 98-103

Patients with type 2 diabetes are at high cardiovascular risk and require a global management targeting all risk factors. Target values for blood pressure have been discussed in a previous paper. The ... [more ▼]

Patients with type 2 diabetes are at high cardiovascular risk and require a global management targeting all risk factors. Target values for blood pressure have been discussed in a previous paper. The present clinical case summarizes the most important arguments concerning the choice of the target values for glucose control (glycated haemoglobin or HbA1c) and lipid management. As far as glucose control is concerned, the objective should be individually adjusted, based on the benefits/risks ratio, with a less stringent HbA1c level in presence of coronary heart disease and risk of severe hypoglycaemia. However, in absence of these two risks factors, the objective should be reinforced (HbA1c < 7%), essentially to prevent or retard microangiopathic lesions. As far as lipid management is concerned, the most crucial goal remains LDL cholesterol lowering, with a target value < 100 mg/dL in patients at high cardiovascular risk and <70 mg/dL in patients at very high risk, according to the recent European guidelines. Dyslipidaemia related to the metabolic syndrome (hypertriglyceridaemia, low HDL cholesterol) may also represent a therapeutic target (non-HDL cholesterol), although evidence is mostly missing in the literature. [less ▲]

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See detailInfluence du poids corporel sur l'histoire naturelle et les approches therapeutiques du diabete de type 1.
Franck, M.; Paquot, Nicolas ULg; SCHEEN, André ULg

in Revue Médicale de Liège (2012), 67(9), 461-7

Obesity, whose prevalence is increasing in industrialized countries, is recognized as a major risk factor for the development of type 2 diabetes. In contrast, the role of excess adiposity in the natural ... [more ▼]

Obesity, whose prevalence is increasing in industrialized countries, is recognized as a major risk factor for the development of type 2 diabetes. In contrast, the role of excess adiposity in the natural history of type 1 diabetes (T1DM) and its impact on therapeutic approaches are by far less known and most probably largely underestimated. The following items will be most particularly considered: 1) the accelerator role of obesity in the development of T1DM in young predisposed individuals; 2) the difficult diagnosis in presence of hybrid or double diabetes combining insulin secretory defect and insulin resistance; 3) the problem of managing both body weight and glucose control, especially in young females and adolescents; 4) the possible deleterious effects of intensive insulin therapy on body weight and some markers of the metabolic syndrome; 5) the worse cardiovascular prognosis of T1DM patients when obesity is present; 6) the possible role of other medications as adjunct therapy to insulin in insulin resistant obese T1DM patients; and finally 7) the expected benefit of bariatric surgery in some well selected T1DM patients with severe obesity. [less ▲]

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See detailY a-t-il encore une place pour la double inhibition du système rénine-angiotensine en 2012?
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale Suisse (2012), 8(351), 1598-1603

The blockade of the renin-angiotensin system (RAS) improves the prognosis of patients with complications related to diabetes, hypertension or, in general, atherosclerosis. Several observational studies ... [more ▼]

The blockade of the renin-angiotensin system (RAS) improves the prognosis of patients with complications related to diabetes, hypertension or, in general, atherosclerosis. Several observational studies have suggested the use of a dual blockade of the RAS to benefit from a better cardiorenal protection. However, recent randomized controlled studies failed to demonstrate that a dual blockade exert a better protection than single blockade, but showed a higher risk for renal complications and hyperkalemia. To decrease the residual risk, other opportunities may be recommended such as reinforcement of low salt diet, use of supraphysiological dose of a monotherapy inhibiting the RAS (perhaps prescribed at the evening) or addition of an aldosterone antagonist. However, all these approaches, as dual therapy, may also increase the risk of hypotension and renal insufficiency and thus require to be used under strict medical supervision. [less ▲]

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See detailChirurgie metabolique: une place croissante dans le traitement du diabete.
De Flines, J.; Franck, M.; Rorive, M. et al

in Revue Médicale Suisse (2012), 8(351), 1621-41626-7

Bariatric surgery becomes more and more important in the management of the obese patient with type 2 diabetes, especially in case of failure of medical approaches. Metabolic improvement results not only ... [more ▼]

Bariatric surgery becomes more and more important in the management of the obese patient with type 2 diabetes, especially in case of failure of medical approaches. Metabolic improvement results not only from weight loss and the subsequent reduction in insulin resistance, but also from modifications of digestive hormones (especially incretins) that contribute to promote insulin secretion. This new paradigm, moving from bariatric surgery to metabolic surgery, opens new perspectives. The present article briefly describes innovative surgical techniques focusing on endocrine and metabolic improvement rather than on weight loss, the preliminary results of metabolic surgery in patients with type 2 diabetes and a body mass index <35 kg/m2 and, finally, some data regarding the surgical management of obese patients with type I diabetes not well treated with classical medical means. [less ▲]

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