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See detailL'initiative pour la promotion de la qualite et epidemiologie du diabete sucre (IPQED).
Nobels, F.; Debacker, Nathalie ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 624-7

Since 2001, the "Diabetes Convention Centres" in Belgium participated to a survey, called IPQED ("Initiative for the Promotion of Quality and Epidemiology of Diabetes mellitus), every 12-18 months. This ... [more ▼]

Since 2001, the "Diabetes Convention Centres" in Belgium participated to a survey, called IPQED ("Initiative for the Promotion of Quality and Epidemiology of Diabetes mellitus), every 12-18 months. This project aims at systematically and anonymously collecting a limited but significant set of data (anamnesis, clinical examination, clinical chemistry: according to DiabCare) in a large sample (about 10%) of type 1 or type 2 diabetic patients followed in the Diabetes Convention Centres (inclusion criteria: at least two injections of insulin per day). IPQED has three main objectives: 1) to optimise the quality of care using a benchmarking process and the creation of quality circles; 2) to provide to health authorities some general advise concerning care for diabetic patients, in general, and in the Convention Diabetes Centres, in particular; and 3) to collect Belgian data among a large cohort of diabetic patients (around 8.000 per survey) that could be used for epidemiological studies. [less ▲]

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See detailLe role des centres de convention du diabete en Belgique.
Nobels, F.; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 619-23

We briefly present the modes of functioning of Diabetes Convention Centres in Belgium. In those hospital centres, patients with both type 1 or type 2 diabetes, treated by at least two insulin injections ... [more ▼]

We briefly present the modes of functioning of Diabetes Convention Centres in Belgium. In those hospital centres, patients with both type 1 or type 2 diabetes, treated by at least two insulin injections per day, benefit of an intensive educational programme by a multidisciplinary team and receive free of charge material for home blood glucose monitoring, in order to optimize diabetes management. The collaboration between convention centres and general practitioners should be reinforced (share-care), especially to improve the management of type 2 diabetic patients, who are increasingly treated with various insulin regimens. [less ▲]

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See detailLe diabete de type 2 au coeur du syndrome metabolique: plaidoyer pour une prise en charge globale.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2005), 60(5-6), 566-71

Type 2 diabetes is frequently associated with other comorbidities among which abdominal obesity, arterial hypertension, dyslipidaemia and a prothrombotic state. All these cardiovascular risk factors ... [more ▼]

Type 2 diabetes is frequently associated with other comorbidities among which abdominal obesity, arterial hypertension, dyslipidaemia and a prothrombotic state. All these cardiovascular risk factors belong to the so-called metabolic syndrome. The appropriate management of a patient with type 2 diabetes requires a global approach targeting each risk factor in order to reduce cardiovascular morbidity and mortality. Microalbuminuria is correlated with markers of the metabolic syndrome in diabetic patients as shown by the DANA survey performed among general practitioners from the areas of Liege and Antwerp and, in this type of patients, is considered as a prognostic factor of cardiovascular complications. The OCAPI study, performed among Belgian internists and diabetologists, demonstrated that two thirds of diabetic patients have a metabolic syndrome and that the objectives are far from being reached in clinical practice, especially as far as lipid and arterial pressure control is concerned. Interestingly, the Danish STENO-2 study demonstrated that an intensive multi-risk approach reduces the incidence of both micro- and macroangiopathic complications by more than 50%. This challenge represents a major public health issue considering the high and increasing prevalence of type 2 diabetes and the major burden associated to this disease. [less ▲]

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See detailLa neuropathie autonome cardiaque diabetique.
Philips, Jean-Christophe ULg; Marchand, Monique ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 498-504

Cardiac autonomic neuropathy (CAN) is a common complication of diabetes mellitus, which is associated with a higher risk of morbidity and mortality. It can be detected by analyzing spontaneous (Holter) or ... [more ▼]

Cardiac autonomic neuropathy (CAN) is a common complication of diabetes mellitus, which is associated with a higher risk of morbidity and mortality. It can be detected by analyzing spontaneous (Holter) or provoked (Ewing's test battery) changes in heart rate and arterial blood pressure. Baroreflex gain is a specific index of great interest. Our laboratory has acquired a large experience in the assessment of CAN in diabetic patients. We use the Finapres, a device that allows continuous noninvasive monitoring of blood pressure and heart rate, and a special and discriminative active orthostatic manoeuvre, the "squatting" test (standing-squatting-standing). [less ▲]

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See detailDiabete sucre iatrogene: l'exemple des anti-psychotiques atypiques.
Scheen, André ULg; De Hert, M.

in Revue Médicale de Liège (2005), 60(5-6), 455-60

As an example of iatrogenic diabetes, we discuss the problem of diabetes mellitus in patients receiving atypical antipsychotics. The risk of diabetes mellitus appears to be different according to various ... [more ▼]

As an example of iatrogenic diabetes, we discuss the problem of diabetes mellitus in patients receiving atypical antipsychotics. The risk of diabetes mellitus appears to be different according to various molecules with, by decreasing order, clozapine, olanzapine, risperidone and quetiapine, and finally amisulpride, aripiprazole and ziprasidone. A careful analysis of published case reports and series indicates the existence of two different problems: 1) the rather common development of impaired glucose tolerance or diabetes mellitus (often associated with metabolic syndrome) related to weight gain in individuals at risk for type 2 diabetes; and 2) the occurrence of rare cases of acute metabolic episodes with severe ketoacidosis and/or pancreatitis whose pathophysiological mechanisms remain largely unknown. Generally speaking, the pathophysiology involves both increased insulin resistance and deficient insulin secretion. Cautious metabolic monitoring of patients receiving atypical antipsychotics is recommended, and the selection of the appropriate drug should be influenced by the metabolic profile of the various molecules and the metabolic risk of the patients who should be treated with atypical antipsychotics. [less ▲]

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See detailHemochromatose et diabete sucre: approche diagnostique et evolution clinique.
Thielen, Vinciane ULg; Radermecker, Régis ULg; Philips, Jean-Christophe ULg et al

in Revue Médicale de Liège (2005), 60(5-6), 448-54

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a ... [more ▼]

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a recent article. Early diagnosis and treatment by phlebotomy can improve blood glucose control in the early stages of the disease. If diagnosis occurs later, when the patient already needs insulin therapy, diabetes will not be improved by phlebotomy anymore. [less ▲]

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See detailReduction comparable des nouveaux cas de diabete de type 2 sous sartan et sous inhibiteur de l'enzyme de conversion de l'angiotensine: comparaison des meta-analyses des essais prospectifs randomises.
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 424-8

This paper aims at comparing two meta-analyses of clinical trials having investigated the effect of the inhibition of the renin-angiotensin system either with an angiotensin converting enzyme inhibitor ... [more ▼]

This paper aims at comparing two meta-analyses of clinical trials having investigated the effect of the inhibition of the renin-angiotensin system either with an angiotensin converting enzyme inhibitor (ACEI) or with a selective angiotensin receptor blocker (ARB) on the incidence of new cases of type 2 diabetes mellitus in subjects with arterial hypertension or with congestive heart failure. The protection appears similar with ACEIs in six trials in a total of 24.623 patients (hazard ratio: 0.77; CI 95% 0.72-0.81; p < 0.00001 and with ARBs in five trials in a total of 14.344 patients (hazard ratio: 0.79; CI 95% 0.73-0.85; p < 0.00001). It is consistent whatever the comparator, a thiazide diuretic agent, a beta-blocker, a dihydropyridine calcium channel blocker or a placebo. The large ongoing ONTARGET controlled study will allow a direct comparison between an ACEI, ramipril, and an ARB, telmisartan, and will also investigate the potential benefit of a combined treatment with both drugs. The inhibition of the renin-angiotensin system should be considered among pharmacological strategies of prevention of type 2 diabetes mellitus. [less ▲]

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See detailVers une tritherapie orale dans le traitement pharmacologique du diabete de type 2?
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 414-8

Type 2 diabetes is a complex disease combining several disturbances in various organs, especially a defect of insulin secretion by the pancreas, an increased production of glucose by the liver and a ... [more ▼]

Type 2 diabetes is a complex disease combining several disturbances in various organs, especially a defect of insulin secretion by the pancreas, an increased production of glucose by the liver and a reduced insulin-mediated glucose uptake by the skeletal muscle. Each of these abnormalities can be, at least partially, reversed by a specific pharmacological approach, an agent promoting insulin secretion (sulphonylurea, glinide), metformin and a thiazolidinedione (glitazone), respectively. A triple oral therapy with "sulphonylurea (glinide)--metformin--glitazone", targeting simultaneously the three main metabolic abnormalities of type 2 diabetes, deserves special attention. Promising results have been observed in recent clinical trials as far as blood glucose control and some other cardiovascular risk factors are concerned. The precise place of such oral triple therapy remains to be specified, at a late stage to delay the shift to insulin or earlier in the natural history of the disease, to avoid the decline of the number and/or function of beta cells and the resulting metabolic deterioration. [less ▲]

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See detailLes insulinosensibilisateurs.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(5-6), 409-13

Insulin resistance has a genetic background and its phenotypic expression is triggered by fat diet, lack of physical activity and obesity. It provokes a stress on B cells, tends to increase blood glucose ... [more ▼]

Insulin resistance has a genetic background and its phenotypic expression is triggered by fat diet, lack of physical activity and obesity. It provokes a stress on B cells, tends to increase blood glucose levels, is intimately associated with the metabolic syndrome and represents a major cardiovascular risk factor. Insulin resistance may be favourably influenced by simple life-style changes. If necessary, drugs may be prescribed, such as metformin, the first choice antidiabetic oral agent in overweight individuals, or thiazolidinediones (glitazones), new insulin sensitizers with promising effects. New molecules are currently developed, especially PPAR alpha/gamma or pan-agonists. Targeting insulin resistance has several objectives: reducing hyperglycaemia in type 2 diabetic patients, protecting B cells in order to prevent type 2 diabetes in at risk individuals and limiting the progressive metabolic deterioration in diabetic patients, finally, and perhaps most importantly, ameliorating the global cardiovascular prognosis. [less ▲]

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See detailPrevention du diabete de type 2: un nouveau defi de sante publique.
Scheen, André ULg; Giet, Didier ULg

in Revue Médicale de Liège (2005), 60(5-6), 383-90

Owing to the epidemics of type 2 diabetes, it is important to develop strategies of prevention of the disease. The first step should detect patients at risk, in function of simple anamnesis, clinical and ... [more ▼]

Owing to the epidemics of type 2 diabetes, it is important to develop strategies of prevention of the disease. The first step should detect patients at risk, in function of simple anamnesis, clinical and biological criteria. Afterwards, those individuals should be encouraged to follow a prevention programme, which essentially comprises better lifestyle habits (diet and physical exercise), especially to prevent or correct weight excess. In at very high risk subjects, for instance because of moderately increased fasting or post-glucose load glucose levels, eventually in a context of family history of type 2 diabetes, a pharmacological approach could be considered. Various drugs (metformin, acarbose, glitazones, orlistat, inhibitors of the renin-angiotensin system) have proven their efficacy in reducing the incidence of type 2 diabetes, in particular in individuals with impaired glucose tolerance, with obesity and/or with arterial hypertension. [less ▲]

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See detailL'insulinotherapie par pompe externe a perfusion continue d'insuline.
Radermecker, Régis ULg; Hermans, M. P.; Legrand, Delphine ULg et al

in Revue Médicale de Liège (2005), 60(5-6), 329-34

Type I diabetes mellitus requires an exogenous supply of insulin that ideally mimics physiological insulin secretion. The treatment goal is to achieve normoglycaemia in order to prevent or delay chronic ... [more ▼]

Type I diabetes mellitus requires an exogenous supply of insulin that ideally mimics physiological insulin secretion. The treatment goal is to achieve normoglycaemia in order to prevent or delay chronic complications, while limiting the risk of hypoglycaemia. Numerous advances have been performed in the last 10 years, as far as nature of insulin formulations, home blood glucose monitoring devices and modes of insulin delivery. Among the latter, continuous subcutaneous insulin infusion (CSII) using portable pumps represents the most sophisticated treatment capable of best mimicking normal insulin secretion. Such treatment provides better glucose control and glucose stability as compared to conventional multiple injection insulin therapy. However, it is essential to respect well defined indications and to organize a structured management by a multidisciplinary team in order to get the best metabolic results. The present paper describes recommendations, advantages and limits as well as cost of CSII with portable pumps in type 1 diabetic patients. [less ▲]

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See detailLe cout du diabete de type 2: resume de l'enquete europeenne CODE-2 et analyse de la situation en Belgique.
Wallemacq, Caroline ULg; Van Gaal, L. F.; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 278-84

Type 2 diabetes mellitus is a common chronic disease whose economic impact on both patients and society is constantly increasing. "The Cost of Diabetes in Europe--Type 2 study" is the first coordinated ... [more ▼]

Type 2 diabetes mellitus is a common chronic disease whose economic impact on both patients and society is constantly increasing. "The Cost of Diabetes in Europe--Type 2 study" is the first coordinated attempt to measure total healthcare costs of type 2 diabetes mellitus in Europe. On average, 3% of the population with type 2 diabetes accounted for 5% of the total healthcare expenditure. Complications have a substantial impact on the costs of managing type 2 diabetes. The prevention of complications, especially cardiovascular disease, will potentially reduce overall healthcare expenditure. [less ▲]

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See detailLe diabete sucre: une maladie exemplative a bien des egards. Preambule.
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2005), 60(5-6), 269-72

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See detailL'etude clinique du mois. Treating to New Targets": plaidoyer pour une valeur cible de cholesterol LDL egale ou inferieure a 75 mg/dl chez tout patient coronarien."
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(4), 264-7

The "Treating to New Targets" (TNT) trial compared atorvastatin 80 mg (aiming at reducing LDL cholesterol < or = 75 mg/dl) and atorvastatin 10 mg (LDL < or = 100 mg/dl as target) in 10,001 patients with ... [more ▼]

The "Treating to New Targets" (TNT) trial compared atorvastatin 80 mg (aiming at reducing LDL cholesterol < or = 75 mg/dl) and atorvastatin 10 mg (LDL < or = 100 mg/dl as target) in 10,001 patients with stable coronary heart disease followed up for 5 years. A reduction of major cardiovascular events of 22% was observed in the atorvastatin 80 mg group as compared to the atorvastatin 10 mg group (hazard ratio: 0.78; 95 % interval of confidence: 0.69-0.89; p < 0.001). Such clinical efficacy was obtained while a good drug safety profile was maintained. Total mortality was not significantly different between the two groups. However, and remarkably, cardiovascular death was not the first cause of death anymore in this atorvastatin-treated population. The results of TNT in patients with stable coronary heart disease thus confirm the results of PROVE-IT in patients with acute coronary syndrome. These two randomised controlled trials should encourage considering a LDL cholesterol level of 75 mg/dl (rather than 100 mg/dl) as a new target in any patient with coronary heart disease. [less ▲]

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See detailRecommandations relatives a la prevention des maladies cardio-vasculaires en pratique clinique. Groupe de Travail Belge de Prevention des Maladies cardio-vasculaires.
De Backer, G.; De Bacquer, D.; Brohet, C. et al

in Revue Médicale de Liège (2005), 60(3), 163-72

These recommandations are largely based on the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European and other Societies on ... [more ▼]

These recommandations are largely based on the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice". The model used to assess the overall risk was adapted for Belgium. Otherwise, very few things were changed from the Exectutive Summary of the European Guidelines. [less ▲]

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See detailL'etude clinique du mois. Chirurgie bariatrique: les resultats a 10 ans de la Swedish Obese Subjects Study"."
Scheen, André ULg; Letiexhe, Michel ULg; Rorive, Marcelle ULg et al

in Revue Médicale de Liège (2005), 60(2), 121-5

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese ... [more ▼]

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. The follow-up rate for laboratory examinations was 74.5 percent at 10 years. At that time, data of 627 patients of the control group (mean age of 48 years, body mass index of 41 kg/m2) were compared to those of 641 patients who were submitted to surgery (banding n = 156, vertical banded gastroplasty n = 451 and gastric bypass n =34). At 10 years, the body weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group (p < 0.001), and similar changes were observed for waist circumference (+2.8 percent versus -10.1 percent, respectively, p < 0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Ten-year rates of recovery from diabetes, hypertriglyceridaemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricaemia were more favourable in the surgery than in the control group. The surgery group had lower 10-year incidence rates of diabetes, hypertriglyceridaemia, and hyperuricaemia (but not of hypertension) than the control group. In conclusion, as compared with conventional therapy, bariatric surgery appears to be a valuable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolaemia that was not significantly affected, amelioration in cardiovascular risk factors that were elevated at baseline. Obtaining long-term data concerning the effect of weight loss on overall mortality and on the incidence rates of myocardial infarction, stroke, and cancer remains a key-objective of this landmark study. [less ▲]

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See detailRecepteurs PPAR-gamma, nouvelle cible therapeutique dans les pathologies metaboliques et cardio-vasculaires.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(2), 89-95

PPARs ("Peroxisome Proliferator-Activated Receptors") belong to a superfamily of nuclear receptors with several isoforms, among which PPAR-alpha mainly located in the liver and PPAR-gamma mainly located ... [more ▼]

PPARs ("Peroxisome Proliferator-Activated Receptors") belong to a superfamily of nuclear receptors with several isoforms, among which PPAR-alpha mainly located in the liver and PPAR-gamma mainly located in the adipose tissue. These receptors are considered as major pharmacological targets since the discovery of their activation by specific agonists, which lead to various favourable metabolic effects. Improvement of lipid profile by fibrates is explained by the activation of liver PPAR-alpha receptors. However, PPAR-gamma receptors have focused most fundamental and clinical research in recent years after the demonstration of their activation by thiazolidinediones (pioglitazone, rosiglitazone), a new class of antidiabetic agents. Beyond their effects on insulin sensitivity, glitazones exert pleiotropic effects that may result in cardiovascular protection in high risk patients. It has been recently demonstrated that certain angiotensin AT1 receptor blockers (sartans) can also exert a partial agonist activity on PPAR-gamma. Among the molecules of this class, telmisartan appears to exert this effect at the lower concentrations. Thus, PPAR-y, as common pharmacological target, may, at least partially, explain some of the effects observed with both thiazolidinediones and inhibitors of the renin-angiotensin system, in particular the improvement in insulin sensitivity (in particular via an increase in adiponectin levels), the protection against type 2 diabetes, the reduction in arterial blood pressure and the prevention of cardiovascular complications. There is currently a major interest from the pharmaceutical industry in the development of new molecules able to activate both PPAR-alpha and PPAR-gamma. [less ▲]

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See detailEditorial
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(1), 1-4

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See detailRecommandations relatives a la prevention des maladies cardiovasculaires en pratique clinique. Groupe de Travail Belge de Prevention des Maladies Cardiovasculaires.
De Backer, G.; De Bacquer, D.; Brohet, C. et al

in Revue Médicale de Bruxelles (2005), 26(2), 77-87

These recommendations are largely based on the Executive Summary of the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European ... [more ▼]

These recommendations are largely based on the Executive Summary of the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice". The model used to assess the overall risk was adapted for Belgium. Otherwise, very few things were changed from the Executive Summary of the European Guidelines. [less ▲]

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