Quelle place pour le pharmacien clinicien en nutrition parentérale ? Etude rétrospective au CHU de Liège.

Poster (2013, March 02)

Metformin revisited: A critical review of the benefit-risk balance in at-risk patients with type 2 diabetes.

in Diabètes & Métabolism (2013)

Metformin is unanimously considered a first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of numerous ... [more ▼]

Metformin is unanimously considered a first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of numerous contraindications that could lead to an increased risk of lactic acidosis. Various observational data from real-life have shown that many diabetic patients considered to be at risk still receive metformin and often without appropriate dose adjustment, yet apparently with no harm done and particularly no increased risk of lactic acidosis. More interestingly, recent data have suggested that type 2 diabetes patients considered at risk because of the presence of traditional contraindications may still derive benefit from metformin therapy with reductions in morbidity and mortality compared with other glucose-lowering agents, especially sulphonylureas. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely, patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, congestive heart failure, renal impairment or chronic kidney disease, hepatic dysfunction and chronic respiratory insufficiency, all conditions that could in theory increase the risk of lactic acidosis. Special attention is also paid to elderly patients with type 2 diabetes, a population that is growing rapidly, as older patients can accumulate several comorbidities classically considered contraindications to the use of metformin. A review of the recent scientific literature suggests that reassessment of the contraindications of metformin is now urgently needed to prevent physicians from prescribing the most popular glucose-lowering therapy in everyday clinical practice outside of the official recommendations. [less ▲]

Effects of an artificial hypercaloric and hyperproteic feeding on nutritionnal status in post-surgery head and neck cancer patients.

Poster (2012, July)

Chirurgie metabolique: une place croissante dans le traitement du diabete.

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 ▲]

Le diabete de type 2: voyage au coeur d'une maladie complexe.

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 ▲]

La vignette therapeutique de l'etudiant: Quelles cibles glycemiques et lipidiques viser chez un patient diabetique de type 2?

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 ▲]

Effets cliniques et biologiques d'une alimentation artificielle hypercalorique et hyperprotéinée sur le statut nutritionnel de 30 patients opérés d'un cancer ORL

in Nutrition Clinique et Metabolisme (2011, December), 25(suppl.2), 129

Diagnostic d'une perte de poids involontaire chez l'adulte.

in Revue Médicale de Liège (2011), 66(7-8), 456-60

Significant non intentional weight loss in adults is a problem encountered frequently in clinical practice that poses a diagnostic challenge for the clinician. Causes are quite diverse, as are the ... [more ▼]

Significant non intentional weight loss in adults is a problem encountered frequently in clinical practice that poses a diagnostic challenge for the clinician. Causes are quite diverse, as are the prognostic implications. Cancer, gastrointestinal disease, and psychiatric problems were the three most common diagnoses, but a significant proportion of patients had no clear cause of their weight loss. The prognosis of this subset is generally favourable. Ruling out malignancy is one of the prime tasks. The investigation is based on a rational stepwise approach with a detailed history, a meticulous physical examination and a simple, non-invasive screening battery of tests (laboratory tests and medical imaging). A completely normal laboratory screening argues against severe organic disease in general and malignancy in particular. Additional testing should be targeted towards areas of concern raised by the initial evaluation. If this baseline examination is normal and reassuring, a strategy of careful clinical follow-up is preferred to non-targeted additional more invasive or expensive investigations. [less ▲]

La chirurgie metabolique, vers une (r)evolution de la chirurgie bariatrique ?

in Revue Médicale de Liège (2011), 66(4), 183-90

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

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improves metabolic control in obese patients. The frequently observed remission of type 2 diabetes occurs very early, before any marked 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. 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. Such type of surgery is currently evaluated in patients with type 2 diabetes, but with only a moderate obesity (BMI < 35 kg/m2), or even without obesity (BMI < 30 kg/m2). The Belgian Metabolic Intervention (BMI) Study Group would like to contribute very soon to this evaluation in a multidisciplinary approach. [less ▲]

La 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.

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 ▲]