Approches thérapeutiques des hyperlipidémies associées aux pathologies rénales.
PAQUOT, Nicolas ; SCHEEN, André ; DECHENNE, Charles et al
in Médecine et Hygiène (1992), 50Detailed reference viewed: 6 (0 ULg)
Acute functional iron deficiency in obese subjects during very-low-energy all- protein diet.
; BEGUIN, Yves ; et al
Poster (1992)Detailed reference viewed: 9 (1 ULg)
Insulin secretion and action in various populations with type 2 (non-insulin-dependant) diabetes mellitus
Scheen, André ; ; et al
in Diabetologia (1992), 16 ( suppl 1)(29), 116Detailed reference viewed: 8 (0 ULg)
Improvement of the metabolic clearance rate of insulin after a protein-supplemented fast in obese subjects.
PAQUOT, Nicolas ; SCHEEN, André ; et al
in International Journal of Obesity (1992)Detailed reference viewed: 12 (0 ULg)
Management of non-insulin-dependent diabetes mellitus.
Lefebvre, Pierre ; Scheen, André
in Drugs (1992), 44 Suppl 3
The initial management of non-insulin-dependent diabetes mellitus (NIDDM) should include patient education, dietary counselling and, when feasible, individualised physical activity. It is only when such ... [more ▼]
The initial management of non-insulin-dependent diabetes mellitus (NIDDM) should include patient education, dietary counselling and, when feasible, individualised physical activity. It is only when such measures fail that drug therapy should be considered. Dietary management of NIDDM includes a restriction in calories, and these should be appropriately distributed as carbohydrates, lipids and proteins. Supplementation of the diet with soluble fibre and supplementation with magnesium salts if hypomagnesaemia is demonstrated, is recommended. However, supplementation with fish oils or with fish oil-derived omega-3 fatty acids is not currently recommended. Oral drug therapies used in NIDDM include sulphonylurea derivatives, which are a first-line treatment in patients who are not grossly obese, metformin, which is the treatment of choice for obese patients, and alpha-glucosidase inhibitors such as acarbose, which are used mainly to reduce postprandial blood glucose peaks. These types of drugs can be used alone or in combination. Insulin therapy may be required to achieve adequate control of blood glucose levels in some patients. In several instances, it is suggested that insulin therapy be combined with sulphonylureas (essentially when residual insulin secretion is present), with metformin, or with alpha-glucosidase inhibitors. The treatment of disorders associated with NIDDM, such as obesity, hypertension or hyperlipidaemia, requires particular attention in diabetic patients, since some drugs can adversely affect glycaemic control. Oral drugs for the treatment of NIDDM include sulphonylurea derivatives used in first-line treatment in patients who are not grossly obese, metformin, which is often the treatment of choice for obese patients and, more recently, the alpha-glucosidase inhibitors, such as acarbose, which are effective in reducing the postprandial rise in blood glucose. [less ▲]Detailed reference viewed: 51 (1 ULg)
Assessment of insulin resistance in vivo: application to the study of type 2 diabetes.
Scheen, André ; Lefebvre, Pierre
in Hormone Research (1992), 38(1-2), 19-27
Besides insulin secretion, insulin sensitivity plays a key role in the feedback glucose-insulin closed loop. It can be altered in numerous physiological, pathological and pharmacological conditions. It ... [more ▼]
Besides insulin secretion, insulin sensitivity plays a key role in the feedback glucose-insulin closed loop. It can be altered in numerous physiological, pathological and pharmacological conditions. It can be estimated in vivo using methods that open the feedback loop (insulin suppression test, glucose clamp) or that analyze the closed loop by employing mathematical models of glucose kinetics. The most popular method is the euglycemic hyperinsulinemic glucose clamp. This test should be ideally coupled with a priming-constant infusion of a glucose tracer together with indirect calorimetry. This combination allows to study the glucose kinetics (Ra and Rd, and thus endogenous-mainly hepatic-glucose production) and its metabolism (oxidation or storage as glycogen), respectively. One alternative approach is the frequently sampled intravenous glucose tolerance test where the dynamic changes in plasma insulin and glucose levels are analyzed using the so-called 'minimal model' method. Noninsulin-dependent or type 2 diabetes is characterized by a significant defect in both insulin secretion and action. The insulin resistance is located at the liver site (increased glucose production) and at the peripheral tissues (decreased oxidation and, even more, defective storage of glucose in the muscles). This insulin resistance, which predominates at the postreceptor level, seems to be genetically determined but is worsened by weight excess and by hyperglycemia itself. This contributes to a vicious circle which aggravates progressively the severity of the disease. [less ▲]Detailed reference viewed: 14 (0 ULg)
Devices for the treatment of diabetes: today.
in Artificial Organs (1992), 16(2), 163-6
Although single or multiple daily subcutaneous injections of insulin with syringes are the mainstay of insulin delivery techniques for the treatment of diabetes mellitus, several other methods are now ... [more ▼]
Although single or multiple daily subcutaneous injections of insulin with syringes are the mainstay of insulin delivery techniques for the treatment of diabetes mellitus, several other methods are now available. The present paper will review the main problems occurring with the classical subcutaneous insulin therapy and the possible solutions given by the use of new devices, including more particularly insulin jet injectors, pens, and portable pumps. This review has to be considered as an introduction to the presentations of this symposium devoted to implantable pumps, glucose sensors, and artificial pancreas, respectively. [less ▲]Detailed reference viewed: 15 (0 ULg)
From obesity to type 2 diabetes.
in Acta Clinica Belgica. Supplementum (1992), 14
Obesity is a well-known risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Both insulin resistance and concomitant B-cell dysfunction are necessary for the development of ... [more ▼]
Obesity is a well-known risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Both insulin resistance and concomitant B-cell dysfunction are necessary for the development of NIDDM. Insulin resistance, probably genetically determined but worsened by obesity, appears to be the primary defect that leads to impaired glucose tolerance. However, B-cell dysfunction plays a critical role during progressive deterioration from mild impaired glucose tolerance to severe NIDDM. [less ▲]Detailed reference viewed: 14 (0 ULg)
Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections.
Moutschen, Michel ; Scheen, André ; Lefebvre, Pierre
in Diabète & Métabolisme (1992), 18(3), 187-201
The reasons why diabetic patients present with an increased susceptibility to frequent and protracted infections remain unclear. The virtual absence of epidemiological studies of the independent risk ... [more ▼]
The reasons why diabetic patients present with an increased susceptibility to frequent and protracted infections remain unclear. The virtual absence of epidemiological studies of the independent risk factors involved contrasts with the multitude of in vitro models focused on the metabolism and function of immune cells from diabetic patients. This review analyzes some of these models and their clinical relevance. The different levels of diabetes pathogenesis: genetic (Type 1), autoimmune (Type 1) and metabolic (Type 1 and Type 2) are responsible for immune abnormalities demonstrated in in vitro models. The participation of genetic and autoimmune factors has been mainly characterized on T lymphocyte function. The B8 DR3 haplotype is associated with several minor immunologic abnormalities in vitro. However, the high frequency of this haplotype in healthy individuals argues against its involvement in significant defects of antimicrobial immunity. Genetic deficiency of C4, present in 25% of Type 1 diabetic patients could, on the other hand, be responsible for opsonization defects against encapsulated pathogens. Several immunological abnormalities related to the autoimmune process preceding the onset of Type 1 diabetes mellitus, such as the depletion of memory CD4+ cells and the defective natural killer activity could transiently impair host defences against viral diseases. Several in vitro functional defects of the immune system have been correlated with the metabolic control of diabetic patients. This suggests the involvement of insulinopenia in some of the abnormalities observed. Insulinopenia-induced enzymatic defects have often been proposed to inhibit energy-requiring functions of phagocytes and lymphocytes. However, the relevance of this mechanism could be confined to patients with extremely severe metabolic abnormalities. The importance of systemic consequences of insulinopenia such as hyperglycaemia and ketosis has also been addressed. Usually, the defects induced in vitro by these factors are slight and require supraphysiologic concentrations of glucose or ketone bodies. Recent studies have shown abnormalities of signal transduction mechanisms in which insulinopenia itself and other factors such as circulating immune complexes could be involved. Despite numerous controversies, many in vitro studies of the immune cells of diabetic patients have demonstrated significant defects which bear quantitative similarities with abnormalities described in other immunodeficiency syndromes. Furthermore, several mechanisms have been proposed to link the different defects observed with the specific infections encountered in diabetic patients. [less ▲]Detailed reference viewed: 48 (3 ULg)
Insulin effects on glucose kinetics in non-insulin-dependent diabetic patients with secondary failure to hypoglycaemic agents: role of different modes and rates of delivery.
; ; et al
in European Journal of Medicine (The) (1992), 1(5), 261-7
OBJECTIVES: This study aimed at investigating the effects of pulsatile and continuous insulin delivery on glucose kinetics in non-insulin-dependent (type 2) diabetic patients with secondary failure to ... [more ▼]
OBJECTIVES: This study aimed at investigating the effects of pulsatile and continuous insulin delivery on glucose kinetics in non-insulin-dependent (type 2) diabetic patients with secondary failure to oral hypoglycaemic agents. METHODS: Seven type 2 diabetic patients underwent a 585 minute glucose-controlled glucose intravenous infusion using the Biostator. The endogenous pancreas secretion was inhibited by somatostatin. Three experiments were performed in each patient on different days and in random order. In all cases, glucagon was replaced (58 ng/min). The amounts of insulin infused were: a) 0.15 mU/kg x min continuously; b) 0.20 mU/kg x min continuously and c) 1.0 mU/kg x min in 2 minute pulses every 13 minutes. D-[3-3H]-glucose infusion allowed determination of glucose kinetics. RESULTS: Infusion of identical amounts of insulin (A vs C) demonstrated that pulsatile insulin delivery exerted greater metabolic effects (higher glucose infusion rate and, mainly at the beginning of the experiment, lower endogenous glucose production) than continuous infusion; furthermore pulsatile insulin delivery (C) exerted metabolic effects similar to those of a greater dose of insulin (B) infused continuously. CONCLUSIONS: In type 2 diabetic patients with secondary failure to oral hypoglycaemic agents, pulsatile insulin delivery exerts greater metabolic effects than continuous hormone delivery. [less ▲]Detailed reference viewed: 5 (0 ULg)
Squatting to standing: an unusual but powerful postural manoeuvre to investigate human arterial blood pressure regulation
; ; et al
in Archives of Physiology & Biochemistry (1992), 100(5), 31-51Detailed reference viewed: 15 (3 ULg)
Fluoxetine therapy in obese diabetic and glucose intolerant patients.
; ; et al
in International Journal of Obesity & Related Metabolic Disorders (1992), 16 Suppl 4
A double-blind placebo-controlled trial was conducted, involving 97 obese diabetic and glucose intolerant patients receiving either 60 mg fluoxetine daily (47 patients) or a placebo (50 patients); a ... [more ▼]
A double-blind placebo-controlled trial was conducted, involving 97 obese diabetic and glucose intolerant patients receiving either 60 mg fluoxetine daily (47 patients) or a placebo (50 patients); a similar calorie-restricted diet was prescribed to all patients. Weight loss was significantly higher in the fluoxetine-treated patients, whose diabetic status improved. Drop-out rate was not significantly different for both groups of patients. [less ▲]Detailed reference viewed: 20 (1 ULg)
Atherosclerosis risk factors and macroangiopathy in type 1 versus type 2 diabetic patients
PAQUOT, Nicolas ; ; Scheen, André et al
Poster (1991, October)Detailed reference viewed: 4 (0 ULg)
Effets du blocage des récepteurs beta-adrenergiques sur l'hyperlactacidémie induite par des exercices d'intensités différentes
Scheen, André ; ; Fossion, Anny
in Archives Internationales de Physiologie, de Biochimie et de Biophysique (1991), 99(4), 331-4
The effects of beta-adrenergic blockade on the exercise-induced hyperlactatemia (Lap) have been studied in 31 adult male subjects [age: 25 +/- 1 years; body weight: 69 +/- 1 kg; VO2max: 54 +/- 1 ml O2.kg ... [more ▼]
The effects of beta-adrenergic blockade on the exercise-induced hyperlactatemia (Lap) have been studied in 31 adult male subjects [age: 25 +/- 1 years; body weight: 69 +/- 1 kg; VO2max: 54 +/- 1 ml O2.kg-1.min-1 (mean values +/- SEM)] randomly divided in 3 groups. All exercises were performed on a 10% inclined treadmill. In group 1 (n = 11), the subjects were walking during 20 minutes at 5 km.h-1 (55.6 +/- 1.4% VO2max). In group 2 (n = 10), they were running during 9 minutes at 8 km.h-1 (79.4 + 1.5% VO2max). The subjects of the third group (n = 10) were submitted to a 4 minutes run at 9.5 km.h-1 92 +/- 1.6% VO2max). These exercises were performed 1 hour after ingestion of a placebo or a single dose of 40 mg propranolol, in a double-blind randomized order. Blood samples were drawn at regular time intervals from an antecubital vein. Exercise tachycardia was reduced by about 20% (P less than 0.001) by propranolol in each group. Lap was significantly reduced by 15% by propranolol (P less than 0.005) at the lowest exercise intensity (55.6% VO2max), remained unchanged at 79.4% VO2max and was significantly enhanced by 16% during the recovery period following the run at 92% VO2max. These results clearly showed that the effects of acute beta-adrenergic blockade on Lap depend on exercise intensity. [less ▲]Detailed reference viewed: 18 (1 ULg)
La cellule B dans le diabète de type 2: coupable ou victime ?
SCHEEN, André ; PAQUOT, Nicolas ;
in Journées Annuelles de Diabetologie de l'Hôtel-Dieu (1991)Detailed reference viewed: 3 (0 ULg)
Diabète, hypertension artérielle et angiopathie: comparaison chez les patients diabétiques insulino-dépendants et non insulino-dépendants.
PAQUOT, Nicolas ; SCHEEN, André ; et al
in Archives des Maladies du Coeur et des Vaisseaux (1991), 84(suppl 1), 35Detailed reference viewed: 3 (0 ULg)
Transfert des insulines U40 aux insulines U100: comparaison des profils insulinémiques et glycémiques chez des patients diabétiques de type 1 et de type 2 traités par insuline Monotard HM et Actrapid HM matin et soir.
Scheen, André ; ; JANDRAIN, Bernard et al
in Diabètes & Métabolism (1991), 17(suppl), 31Detailed reference viewed: 5 (0 ULg)
Insulin sensitivity measured by the "minimal model" method: reproductibility in the normal subject and acute effect of a very low calorie diet in the obese subject
Scheen, André ; ; et al
in Diabetes (1991), 40(su), 37Detailed reference viewed: 3 (0 ULg)
Pulsatile insulin delivery has greater metabolic effects than continuous hormone administration in man: importance of pulse frequency.
; Scheen, André ; et al
in Journal of Clinical Endocrinology and Metabolism (1991), 72(3), 607-15
The aim of this study was to see if the greater effect of insulin on hepatic glucose output when insulin is given using 13-min pulses in man remains when the same amount of insulin is delivered using 26 ... [more ▼]
The aim of this study was to see if the greater effect of insulin on hepatic glucose output when insulin is given using 13-min pulses in man remains when the same amount of insulin is delivered using 26-min pulses. The study was performed on nine male healthy volunteers submitted to a 325 min glucose-controlled glucose iv infusion using the Biostator. The endogenous secretion of pancreatic hormones was inhibited by somatostatin. Three experiments were performed in each subject on different days and in random order. In all cases glucagon was replaced (58 ng min-1). The amounts of insulin infused were identical in all instances and were 0.2 mU kg-1 min-1 (continuous), 1.3 mU kg-1 min-1, 2 min on and 11 min off (13-min pulses) or 2.6 mU kg-1 min-1, 2 min on and 24 min off (26-min pulses). Blood glucose levels and glucose infusion rate were monitored continuously by the Biostator, and classic methodology using D-[3-3H] glucose infusion allowed to study glucose turnover. When compared with continuous insulin, 13-min insulin pulses induced a significantly greater inhibition of endogenous glucose production. This effect disappeared when insulin was delivered in 26-min pulses. We conclude that, in man, an adequate pulse frequency is required to allow the appearance of the greater inhibition of pulsatile insulin on endogenous glucose production. [less ▲]Detailed reference viewed: 12 (0 ULg)