Insuffisance cardiaque et diabete de type 2: une relation a double sens.

in Revue Médicale de Liège (2007), 62(2), 112-7

The present article analyses the intimate relationship between diabetes mellitus and congestive heart failure. This relationship is indeed "bidirectional". On the one hand, it is well known that diabetes ... [more ▼]

The present article analyses the intimate relationship between diabetes mellitus and congestive heart failure. This relationship is indeed "bidirectional". On the one hand, it is well known that diabetes mellitus, especially type 2 diabetes, predisposes to congestive heart failure due to intricated mechanisms. In most cases, there is a combination of various well-known risk factors, such as obesity, arterial hypertension and coronary heart disease, with a specific diabetic cardiomyopathy, whose pathophysiology is complex. On the other hand, several studies showed that congestive heart failure increases the risk of new type 2 diabetes, probably due to decreased muscular perfusion and excessive neurohumoral response. Remarkably, such a risk could be reduced by a drug capable of inhibiting the renin-angiotensin system, as previously reported in patients with arterial hypertension. The recent launch and the increasing use of thiazolidinediones (glitazones) raise the interest for congestive heart failure in diabetic patients. Indeed, because of their positive effect on insulin resistance and various pleiotropic effects, glitazones may exert some cardiovascular protection; however, both rosiglitazone and pioglitazone are associated with fluid retention, which could reveal or aggravate episodes of congestive heart failure. [less ▲]

A propos de la plus-value therapeutique.

in Revue Médicale de Liège (2007), 62(5-6), 241-3

Actualites therapeutiques dans le domaine de l'obesite.

in Revue Médicale de Liège (2007), 62(5-6), 329-34

The management of an obese patient aims not only at obtaining a durable weight loss, but also at attenuating various associated risk factors. This latter objective may already be obtained with a rather ... [more ▼]

The management of an obese patient aims not only at obtaining a durable weight loss, but also at attenuating various associated risk factors. This latter objective may already be obtained with a rather moderate weight reduction (5-10% of initial body weight). The first step should favour life-style changes (diet and physical exercise), eventually together with a psychological support. In case of insufficient success, a pharmacological approach may be considered, in addition to life-style advices. Pharmacotherapy currently includes drugs that act on the central nervous system to decrease appetite (sibutramine), in the gastrointestinal tract to diminish fat absorption (orlistat) or at both central and peripheral sites (rimonabant). In case of extreme obesity or severe obesity associated with comorbidities, refractory to medical approaches, bariatric surgery may represent the only solution to obtain a major and sustained weight loss, together with a significant improvement of associated risk factors. Gastroplasty, especially laparoscopic gastric banding, has become very popular in our country. However, because of several limitations, it is increasingly replaced by derivative procedures, especially gastric bypass. In all cases, a multidisciplinary, integrated and individualized approach should be recommended, using realistic goals and targeting long-term weight reduction and improved health. [less ▲]

La consommation reguliere de cafe reduirait le risque de diabete de type 2.

in Revue Médicale de Liège (2007), 62(9), 554-9

The prevention of type 2 diabetes has become a major public health objective. Cross-sectional studies have shown a lower prevalence of type 2 diabetes among coffee drinkers. The present article ... [more ▼]

The prevention of type 2 diabetes has become a major public health objective. Cross-sectional studies have shown a lower prevalence of type 2 diabetes among coffee drinkers. The present article synthesizes results of recent prospective studies, which assessed the relative risk of developing type 2 diabetes according to coffee consumption. Most studies confirm a protective effect against type 2 diabetes, with some dose-response in function of the degree of daily coffee consumption. The observed effect is rather impressive (relative risk reduced to almost 0.70-0.40) and is present whatever the type of population. It appears equal, or event greater, with decaffeinated coffee as compared to regular coffee. These results suggest that the protective effect could not be attributed exclusively to caffeine, but rather that it should be explained by other components, most probably chlorogenic acid and/or various anti-oxidants. The precise mechanism explaining the protection of coffee against type 2 diabetes and its potential relevance in public health remain to be specified. [less ▲]

Le medicament du mois. Combinaison fixe ezetimibe/simvastatine (Inegy).

in Revue Médicale de Liège (2007), 62(9), 585-90

Inegy, recently launched by Merck Sharp & Dohme and Schering Plough, is a fixed combination of simvastatin, which inhibits hepatic cholesterol synthesis, and ezetimibe, which selectively inhibits the ... [more ▼]

Inegy, recently launched by Merck Sharp & Dohme and Schering Plough, is a fixed combination of simvastatin, which inhibits hepatic cholesterol synthesis, and ezetimibe, which selectively inhibits the intestinal absorption of cholesterol and phytosterols. The two mechanisms of action are complementary and result in a synergistic cholesterol-lowering effect. Three formulations of Inegy are commercialized and reimbursed in Belgium, ezetimibe 10 mg/simvastatin 20 mg, ezetimibe 10 mg/simvastatin 40 mg and ezetimibe 10 mg/ simvastatin 80 mg. By blocking both synthesis and absorption of cholesterol, the fixed combination exerts a cholesterol-lowering effect as important as, or even greater than, that observed with the highest dosage of simvastatin and other statins, with a good tolerance profile. Inegy is indicated, as adjuvant treatment to diet, in patients with primary hypercholesterolaemia (homozygote or heterozygote familial form and non-familial polygenic form) not well controlled with a statin alone. Ongoing trials aim at proving the efficacy of such a fixed combination in reducing cardiovascular morbidity and mortality. [less ▲]

L'etude clinique du mois. ADVANCE: amelioration de la survie et reduction des complications vasculaires et renales avec la combinaison fixe perindopril-indapamide chez le patient diabetique de type 2.

in Revue Médicale de Liège (2007), 62(10), 639-43

The controlled ADVANCE trial compared the incidence of major macrovascular and microvascular complications in 5,569 type 2 diabetic patients randomised to a fixed combination of perindopril and indapamide ... [more ▼]

The controlled ADVANCE trial compared the incidence of major macrovascular and microvascular complications in 5,569 type 2 diabetic patients randomised to a fixed combination of perindopril and indapamide and in 5,571 patients randomised to placebo, followed for a mean duration of 4.3 years. Compared with patients assigned placebo, those assigned active therapy had a mean reduction in systolic blood pressure of 5.6 mm Hg and diastolic blood pressure of 2.2 mm Hg, despite the fact physicians were allowed to adjust antihypertensive therapy ad libitum. The relative risk of a major macrovascular and microvascular event (primary endpoint) was reduced by 9% (p = 0.041) in the active group. The separate reductions in macrovascular and microvascular events were similar but were not independently statistically significant. The relative risk of death was significantly reduced by 14% (p = 0.025), essentially due to a lower death rate from cardiovascular diseases (-18%; p = 0.027). The incidence of any coronary event was also significantly reduced (-14 %; p = 0.020), while only a trend was observed for all cerebrovascular events. Finally, renal events were significantly less frequent (-21%; p < 0.0001) whereas all ocular events were only slightly reduced (-5%; NS) in the active group as compared to the placebo group. The fixed combination of perindopril and indapamide was well tolerated and easy to administer. Overall one death due to any cause would be averted among every 79 diabetic patients assigned active therapy for 5 years. There was no evidence that the effects of the study treatment differed by initial blood pressure level or concomitant use of other treatments at baseline. [less ▲]

Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: Evaluation of incidence and screening methods

in Journal of Clinical Psychiatry (2006), 67(10), 1493-1500

Objective: To assess the diagnostic properties of 2 different screening guidelines for the detection of diabetes in patients diagnosed with schizophrenia. Method: Over a 2-year period (November 2003 ... [more ▼]

Objective: To assess the diagnostic properties of 2 different screening guidelines for the detection of diabetes in patients diagnosed with schizophrenia. Method: Over a 2-year period (November 2003-November 2005), 415 patients with schizophrenia were screened with a full laboratory screening and a 75-g oral glucose tolerance test (OGTT). The sensitivity of 2 screening strategies was compared with the "gold standard": the OGTT. The 2 strategies were (1) assessing fasting glucose in all patients, as suggested by the American Psychiatric Association/American Diabetes Association (APA/ADA), and (2) a screening strategy derived from the guidelines of the World Health Organization of assessing fasting glucose in all patients (step 1) and subsequently performing an OGTT in patients with impaired fasting glucose (step 2). Results: Of the total sample, 6.3% (N = 26) met criteria for diabetes, resulting in a mean annual incidence of diabetes of 3.15% (6.3% incident cases/2 years). A screening based on the APA/ADA guidelines detected diabetes in 12 (46.2%) of the 26 cases identified by the OGTT. The proposed 2-step strategy detected 25 (96.2%) of 26 cases. Conclusion: The data suggest a high incidence of diabetes in patients diagnosed with schizophrenia. However, the guidelines to detect diabetes as proposed by the APA/ADA did not sufficiently detect diabetes in this specific high-risk group. The alternative 2-step strategy was able to detect the vast majority of diabetes cases and should therefore be considered in the clinical routine of screening and monitoring patients with schizophrenia. [less ▲]

Screening for metabolic abnormalities in patients with schizophrenia treated with antipsychotics: are we doing enough?

in European Neuropsychopharmacology (2006, September), 16(Suppl. 4), 398

Evaluation of the metabolic safety of aripiprazole

in European Neuropsychopharmacology (2006, September), 16(Suppl. 4), 399

Long-term glycaemic effects of pioglitazone in triple oral therapy: Results from PROactive

in Diabetologia (2006, September), 49(Suppl. 1), 488-489