References of "Scheen, André"
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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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See detailContinuous glucose monitoring reduces both hypoglycaemia and HbA1c in hypoglycaemia-prone type 1 diabetic patients treated with a portable pump.
Radermecker, Régis ULg; Saint-Remy, Annie ULg; Scheen, André ULg et al

in Diabètes & Métabolism (2010), 36(5), 409-13

AIM: This study aimed to assess the effectiveness of continuous glucose monitoring (CGM) for glucose control in type 1 diabetic patients treated by continuous subcutaneous insulin infusion (CSII) and ... [more ▼]

AIM: This study aimed to assess the effectiveness of continuous glucose monitoring (CGM) for glucose control in type 1 diabetic patients treated by continuous subcutaneous insulin infusion (CSII) and presenting with frequent hypoglycaemic episodes. METHODS: Thirteen patients with type 1 diabetes (diabetes duration: 25+/-15 years; CSII duration: 5.5+/-7.0 years), with more than six recorded capillary blood glucose (CBG) values <60 mg/dL, according to their metres for the past 14 days, were offered the permanent use of a CGM device (Guardian RT((R)), Medtronic) plus ongoing self-monitoring of blood glucose (SMBG) for 12 weeks, followed by a 12-week crossover period of SMBG only, or vice versa. Glucose control, determined by recorded 14-day CBG values <60 mg/dL and HbA(1c) levels, and quality of life according to the Diabetes Quality of Life (DQOL) questionnaire, were assessed at baseline, and after 12- and 24-week follow-ups. RESULTS: Four patients withdrew from the study during the first period (of whom three were using CGM). In the nine study completers, the number of low CBG values decreased significantly from 13.9+/-9.2 to 7.6+/-6.8 (P=0.011) when patients used CGM, in either the initial or final trial period, while a decrease in HbA(1c) from 8.3+/-0.7 to 7.7+/-0.6% (P=0.049) was also observed, in contrast to the absence of any significant differences during the SMBG-only period. DQOL scores were also essentially unaffected. CONCLUSION: This pilot observational study supports the hypothesis that CGM use can significantly improve overall glucose control while reducing hypoglycaemic episodes in hypoglycaemia-prone type 1 diabetic patients treated by CSII. [less ▲]

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See detailMieux traiter le diabète : combattre l’inertie et améliorer l’adhésion au traitement.
SCHEEN, André ULg; PHILIPS, Jean-Christophe ULg; PAQUOT, Nicolas ULg

in Association belge du diabète (2010), 53

Le diabète est une maladie chronique par excellence. Comme beaucoup d’autres maladies chroniques, le diabète, qu’il soit de type 1 ou plus encore de type 2, est d’origine complexe, combinant l’infl uence ... [more ▼]

Le diabète est une maladie chronique par excellence. Comme beaucoup d’autres maladies chroniques, le diabète, qu’il soit de type 1 ou plus encore de type 2, est d’origine complexe, combinant l’infl uence de facteurs génétiques et environnementaux. Le but du traitement est de corriger au mieux l’hyperglycémie chronique, mais aussi d’autres facteurs de risque (hypertension artérielle, hypercholestérolémie,…), de façon à prévenir la survenue de complications, garantir une bonne qualité de vie et améliorer l’espérance de vie. [less ▲]

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See detailReduction du risque metabolique associe a l'obesite en modulant l'exposition tissulaire au cortisol.
Iovino, Alessandra ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Revue Médicale Suisse (2010), 6(260), 1608-12

The 11-beta-hydroxysteroid dehydrogenase type 1 (11HSD1) enzyme promotes the local conversion from cortisone to cortisol, especially in the liver and the adipose tissue. It may play a role in the ... [more ▼]

The 11-beta-hydroxysteroid dehydrogenase type 1 (11HSD1) enzyme promotes the local conversion from cortisone to cortisol, especially in the liver and the adipose tissue. It may play a role in the pathophysiology of abdominal obesity and the metabolic syndrome, both showing some similarities with the Cushing syndrome. Considering experimental results obtained in rodents, the inhibition of this enzyme could exert favourable metabolic effects, with significant reductions in plasma glucose, insulin resistance and dyslipidaemia. Synthetic inhibitors of 11HSD1 are currently in development with encouraging preliminary results, first in animals, and more recently in humans. Selective inhibitors of 11HSD1 may represent an innovative approach in the pharmacological management of obesity, metabolic syndrome and type 2 diabetes in a near future. [less ▲]

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See detailApproche multirisque du patient diabetique de type 2: desaccord sur les valeurs cibles suite a l'etude ACCORD.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale Suisse (2010), 6(260), 1582-7

The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk ... [more ▼]

The ACCORD trial investigated the effects of intensifying the global management of 10,251 type 2 diabetic patients, with established cardiovascular disease or at least two other cardiovascular risk factors, on a composite endpoint (non fatal myocardial infarction, stroke and cardiovascular death). The attempt to reduce HbA1c level below 6% was associated with an increased cardiovascular mortality (despite a reduction in non fatal myocardial infarcts); lowering systolic blood pressure below 120 mmHg instead of 140 mmHg did not provide any additional benefit; finally, the control of atherogenic dyslipidaemia, with fenofibrate added to a statin, did not modify the composite endpoint (despite a positive effect in the subgroup of patients with high triglycerides and low HDL cholesterol). These rather disappointing results should be interpreted to provide practical guidelines. [less ▲]

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See detailL’hyperglycémie provoquée par voie orale (HGPO) revisitée 2e partie : Indices d’insulinosécrétion, d’insulinosensibilité et de disposition orale
SCHEEN, André ULg; LUYCKX, Françoise ULg

in Médecine des Maladies Métaboliques (2010), 4(6), 684-690

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of impaired glucose tolerance, diabetes mellitus and gestational diabetes. Simultaneous measurements of plasma glucose and insulin ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of impaired glucose tolerance, diabetes mellitus and gestational diabetes. Simultaneous measurements of plasma glucose and insulin (or more rarely C-peptide) levels allow to derive indices of insulin secretion and insulin sensitivity that are helpful for the understanding of disturbances in glucose metabolism and, especially, for the prediction of progression from normal glucose tolerance to impaired glucose tolerance or type 2 diabetes. Certain indices, quite simple, may be used in clinical practice (“insulinogenic index” to assess early insulin secretion, Matsuda index to assess insulin sensitivity) while others, more complex (and most often based on modelling procedures), are essentially used in research. The oral disposition index, a recently introduced marker that integrates insulin secretion and insulin sensitivity, raises increasing interest, more particularly for the prediction of type 2 diabetes. [less ▲]

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See detailCentral nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia.
Scheen, André ULg

in Diabètes & Métabolism (2010), 36S3

Recent evidence suggests that the brain has a key role in the control of energy metabolism, body fat content and glucose metabolism. Neuronal systems, which regulate energy intake, energy expenditure, and ... [more ▼]

Recent evidence suggests that the brain has a key role in the control of energy metabolism, body fat content and glucose metabolism. Neuronal systems, which regulate energy intake, energy expenditure, and endogenous glucose production, sense and respond to input from hormonal and nutrient-related signals that convey information regarding both body energy stores and current energy availability. In response to this input, adaptive changes occur that promote energy homeostasis and the maintenance of blood glucose levels in the normal range. Defects in this control system are implicated in the link between obesity and type 2 diabetes mellitus. The central nervous system may be considered the conductor of an orchestra involving many peripheral organs involved in these homeostatic processes. However, the brain is mainly a glucose-dependent organ, which can be damaged by both hypoglycaemia and hyperglycaemia. Hypoglycaemia unawareness is a major problem in clinical practice and is associated with an increased risk of coma. Stroke is another acute complication associated with diabetes mellitus, especially in elderly people, and the control of glucose level in this emergency situation remains challenging. The prognosis of stroke is worse in diabetic patients and both its prevention and management in at-risk patients should be improved. Finally, chronic diabetic encephalopathies, which may lead to cognitive dysfunction and even dementia, are also recognized. They may result from recurrent hypoglycaemia and/or from chronic hyperglycaemia leading to cerebral vascular damage. Functional imaging is of interest for exploring diabetes-associated cerebral abnormalities. Thus, the intimate relationship between the brain and diabetes is increasingly acknowledged in both research and clinical practice. [less ▲]

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See detailChanges in pulse pressure, heart rate and the pulse pressure x heart rate product during squatting in Type 1 diabetes according to age.
Philips, Jean-Christophe ULg; Marchand, Monique ULg; Scheen, André ULg

in Diabetic Medicine : A Journal of the British Diabetic Association (2010), 27(7), 753-61

AIMS: We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and ... [more ▼]

AIMS: We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and sex in patients with Type 1 diabetes mellitus. METHODS: We evaluated 160 diabetic patients, divided into four groups of 20 men and 20 women according to age (G1, 20-30 years old; G2, 31-40 years old; G3, 41-50 years old; and G4, 51-60 years old), and 160 non-diabetic matched control subjects. Each subject underwent a 3 min posture test (standing-squatting-standing) with continuous measurement of arterial blood pressure and heart rate by a Finapres device. Overall values throughout the test, baseline levels in initial standing position and squatting-induced changes in pulse pressure, heart rate and the pulse pressure x heart rate product were compared between diabetic patients and healthy control subjects. RESULTS: In the standing position, a greater increase in pulse pressure and lower reduction in heart rate with age led to a significantly higher pulse pressure x heart rate product in diabetic patients compared with control subjects. In the squatting position, a more marked pulse pressure increase in the absence of appropriate reduction in heart rate resulted in a greater rise in the pulse pressure x heart rate product in diabetic patients than in healthy subjects. No major differences were noted between the sexes, with the exception of a stronger relationship between pulse pressure and age in the female population with diabetes. Squatting-derived indices of cardiovascular autonomic neuropathy were also noted with increasing age in diabetic patients. CONCLUSIONS: The marked increase in the pulse pressure x heart rate product ('pulsatile stress') according to age, combined with cardiovascular autonomic neuropathy, may contribute to the higher cardiovascular risk of patients with Type 1 diabetes. [less ▲]

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See detailPulse pressure and pulsatile stress in overweight/obese patients versus lean subjects in absence of hypertension or diabetes.
Scheen, André ULg; Philips, Jean-Christophe ULg; Marchand, Monique ULg

in Obesity Reviews : An Official Journal of the International Association for the Study of Obesity (2010)

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See detailPulse pressure and pulsatile stress in overweight/obese nonhypertensive patients with versus without type 2 diabetes.
Scheen, André ULg; Philips, Jean-Christophe ULg; Marchand, Monique ULg

in Obesity Reviews : An Official Journal of the International Association for the Study of Obesity (2010)

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See detailAttempt to improve glucose control in type 2 diabetic patients by education about real-time glucose monitoring.
Thielen, Vinciane ULg; Scheen, André ULg; Bringer, J. et al

in Diabètes & Métabolism (2010), 36(3), 240-3

The effectiveness of a specific educational programme involving the use of a real-time glucose-sensor system (Guardian RT) to improve glucose control was investigated in patients with poorly controlled ... [more ▼]

The effectiveness of a specific educational programme involving the use of a real-time glucose-sensor system (Guardian RT) to improve glucose control was investigated in patients with poorly controlled type 2 diabetes despite insulin therapy. Ten patients participated in a randomized crossover study comparing two 3-month periods, during which glucose levels were monitored by either self-monitoring of blood glucose (SMBG) alone or by Guardian RT (restricted to 1 week per month) in addition to SMBG. Only four of the enrolled patients completed both periods, while dropouts were mainly due to technical difficulties in using the device. All six patients who completed the first 3-month period showed a reduction in glycated haemoglobin (HbA(1c)) level whatever the mode of glucose monitoring (study effect). A further reduction in HbA(1c) level was observed in two of the three patients using the Guardian RT during the second period. Less frequent symptomatic hypoglycaemic episodes were noted during the 3-month period with the device in the four patients who completed both study periods. These limited, but promising, results of this pilot study appear to justify the initiation of a larger study to assess the use of a real-time glucose sensor in carefully selected patients with type 2 diabetes. [less ▲]

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See detailControversy about the cardiovascular safety of sibutramine.
Scheen, André ULg

in Drug Safety : An International Journal of Medical Toxicology & Drug Experience (2010), 33(7), 615-8

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See detailCost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population.
Annemans, L.; Marbaix, S.; Webb, K. et al

in Clinical Drug Investigation (2010), 30(2), 133-42

BACKGROUND AND OBJECTIVE: Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has ... [more ▼]

BACKGROUND AND OBJECTIVE: Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has been demonstrated in several randomized, controlled trials, including the CARDS clinical trial. Based on the clinical CARDS data, the favourable cost effectiveness of atorvastatin 10 mg in patients with type 2 diabetes has been demonstrated in countries such as the UK and France. This study aimed to estimate the cost effectiveness in the Belgian setting of atorvastatin 10 mg compared with no treatment for the primary prevention of CV events in type 2 diabetes patients without a history of CV disease. METHODS: A Markov model with 1-year cycles was developed to simulate the CV event and death risk according to the therapeutic approach initiated. The transition probabilities for CV events in the 'no statin treatment' group were derived from the risk equations reported from the large UKPDS. Risk reductions from the CARDS clinical trial were used to adjust these CV event probabilities in the atorvastatin 10 mg treatment group. The characteristics of type 2 diabetes patients without a CV history were derived from the Belgian OCAPI survey. The public healthcare payers' perspective was taken into account for costing. The direct medical costs of CV events were based on the Public Health Authorities' hospital database for acute care costs and on the literature for the follow-up costs. The impact on the reimbursement system of generic entry to the market was considered in the drug cost. Costs were valued as at year 2009; costs and outcomes were discounted at 3% and 1.5%, respectively. RESULTS: Based on a 5-year time horizon, atorvastatin was demonstrated to be cost effective with an incremental cost/quality-adjusted life-year (QALY) of euro 16,681. Over a lifetime horizon (25 years), atorvastatin was demonstrated to be a cost-saving therapeutic intervention. At a threshold of euro 30,000/QALY, atorvastatin had a 98.8% probability of being cost effective. CONCLUSION: Compared with 'no treatment', use of atorvastatin 10 mg as a primary prevention intervention in Belgian type 2 diabetes patients not only improves CV outcomes, but also appears to be cost saving over a lifetime horizon. [less ▲]

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