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See detailRole specifique du controle glycemique dans la prevention de l'angiopathie du patient diabetique de type 2.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2003), 58(5), 265-70

Even if type 2 diabetes is a complex disease combining hyperglycaemia and various other metabolic abnormalities. Reduction of chronic hyperglycemia, assessed by glycated haemoglobin (HbA1c), allows the ... [more ▼]

Even if type 2 diabetes is a complex disease combining hyperglycaemia and various other metabolic abnormalities. Reduction of chronic hyperglycemia, assessed by glycated haemoglobin (HbA1c), allows the prevention or the delay of vascular complications. Evidence-based medicine already provided numerous data regarding the risk of microangiopathy, especially retinopathy and nephropathy but also neuropathy. The evidence is less obvious as far as macroangiopathy, especially coronary artery disease, is concerned. This observation should encourage a global approach of the type 2 diabetic patient, taking into account all vascular risk factors. It also provides further arguments in favour of alternative therapeutic modalities, such as the use of hypoglycaemic agents that improve postprandial hyperglycaemia and/or insulin resistance. This latter approach appears to be promising in view of the favourable results with metformin in the United Kingdom Prospective Diabetes Study. It should be confirmed in large prospective ongoing clinical trials with new insulin sensitizers like thiazolidinediones. [less ▲]

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See detailStrategies de prevention du diabete de type 1: le point en 2003.
Philips, Jean-Christophe ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(4), 211-9

Type 1 diabetes is caused by a progressive autoimmune destruction of insulin-producing B cells of the pancreatic islets of Langerhans. The autoimmune process begins years before the B-cell destruction ... [more ▼]

Type 1 diabetes is caused by a progressive autoimmune destruction of insulin-producing B cells of the pancreatic islets of Langerhans. The autoimmune process begins years before the B-cell destruction becomes complete, thereby providing an opportunity for early intervention. Genetic susceptibility markers have been identified and autoantibody assays make possible the identification of individuals at high risk of the disease. Prevention strategies could be implemented in first-degree relatives of type 1 diabetic patients at high risk of developing the disease because of the presence of several autoantibodies. Alternatively, they may also be considered at time of clinical diagnosis of type 1 diabetes mellitus in order to maintain residual endogenous insulin secretion that markedly contributes to long-term better glycaemic stability. Thus, the goals of prevention are to preserve B cells during the preclinical period and/or after early diagnosis by modifying immunological pathogenic processes. Several molecules have been administered or are currently investigated to achieve this protection. This article summarizes the hopes and deceptions of previous clinical trials and describes the rationale and protocols of ongoing trials dealing with the prevention of type 1 diabetes. [less ▲]

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See detailPrevention du diabete de type 2: style de vie ou medicaments?
Scheen, André ULg; Letiexhe, Michel ULg; Ernest, Philippe ULg

in Revue Médicale de Liège (2003), 58(4), 206-10

The World Health Organisation strongly recommends strategies for the prevention of type 2 diabetes, knowing the epidemics of the disease and its strong association with that of obesity. Several ... [more ▼]

The World Health Organisation strongly recommends strategies for the prevention of type 2 diabetes, knowing the epidemics of the disease and its strong association with that of obesity. Several intervention studies, in China ("Da-Qing Study"), in Europe ("Malmo study", "Finnish Diabetes Prevention Study") and in the United States ("Diabetes Prevention Program"), showed that lifestyle change are able to reduce by around 50% the incidence of type 2 diabetes in at risk individuals. Various pharmacological approaches have also proven their efficacy in preventing type 2 diabetes, but in most cases with less impressive reductions, between 25% and 35%. It is the case for metformin, acarbose, orlistat or various inhibitors of the renin-angiotensin system. After the report of promising results with troglitazone, large prospective studies are ongoing to test the efficacy of rosiglitazone and pioglitazone in such an indication, two insulinsensitizers of the thiazolidinedione family. We will briefly described the main results of intervention studies to prevent type 2 diabetes in at risk subjects, because of the presence of obesity, impaired glucose tolerance and/or arterial hypertension. [less ▲]

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See detailPrevention cardio-vasculaire par les statines: faut-il encore doser le cholesterol?
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2003), 58(4), 191-7

Statins, the most popular lipid-lowering agents, have proven their efficacy in preventing cardiovascular events in subjects with lower and lower initial plasma cholesterol levels. Besides, the protective ... [more ▼]

Statins, the most popular lipid-lowering agents, have proven their efficacy in preventing cardiovascular events in subjects with lower and lower initial plasma cholesterol levels. Besides, the protective effect does not seem to be directly related neither to the degree of the cholesterol reduction nor to the final level of plasma cholesterol level reached under treatment. Such observations suggest that statins may exert vascular protective effects, at least in part, independently of their specific cholesterol-lowering effect (so-called pleiotropic effects). The present paper will discuss the arguments pro and contra the dosage of cholesterolaemia before initiating a therapy with statin and during treatment follow up, both in subjects with previous cardiovascular events (secondary prevention) and in subjects with a high cardiovascular absolute risk but without previous clinical expression of atherosclerosis (primary prevention). [less ▲]

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See detailLa medecine preventive dans tous ses etats.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(4), 173-4

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See detailComment j'explore ... la cinetique glycemique des patients diabetiques par monitoring continu du glucose interstitiel.
Radermecker, Régis ULg; Magis, Delphine ULg; Selam, J. L. et al

in Revue Médicale de Liège (2003), 58(3), 164-7

The improvement of diabetic patients' glycaemic status requires an increase of fingerstick blood glucose measurements. Among the possibilities available to assess diabetes' control, we will consider new ... [more ▼]

The improvement of diabetic patients' glycaemic status requires an increase of fingerstick blood glucose measurements. Among the possibilities available to assess diabetes' control, we will consider new systems of continuous interstitial glucose monitoring. After a brief description of the devices presently commercialized, we will discuss their indications and their limitations, as well as their future prospects in a possible "closed loop" insulin delivery according to blood glucose level. [less ▲]

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See detailOptimalisation de la prise en charge du patient diabetique de type 2: resultats de l'etude DREAM" en medecine generale."
Scheen, André ULg; Bruwier, Geneviève ULg; Schmitt, H.

in Revue Médicale de Liège (2003), 58(3), 139-46

This paper reports the results of the "DREAM" ("Diabetes REinforcement of Adequate Management") study performed among 42 general practitioners. A treatment algorithm was proposed to intensify the ... [more ▼]

This paper reports the results of the "DREAM" ("Diabetes REinforcement of Adequate Management") study performed among 42 general practitioners. A treatment algorithm was proposed to intensify the management of type 2 diabetic patients in case of poor control (HbA1C > 7.5% and fasting blood glucose > 140 mg/dl) before asking for an advice from a diabetologist. A total of 163 patients participated in the study: 84 men and 79 women, 59 +/- 10 years old; 5.2 +/- 6.1 years of known duration of diabetes; BMI: 30.7 +/- 5.8 kg/m2. Almost two thirds of patients received an antihypertensive agent, one third a lipid-lowering drug, and three quarters at least one antidiabetic agent: 22% a sulfonylurea, 18% metformin, 25% a combined oral therapy, 10% insulin (alone or in combination). At baseline, mean HbA1C averaged 7.1 +/- 2.2% (N: 4-6%), and 34% of patients had HbA1C > 7.5%. From these 163 patients, 100 were evaluated after 12 months, 57% being well controlled vs 36% at baseline. Among the 32 patients whose hypoglycaemic treatment was intensified, HbA1C level significantly decreased by almost 0.8% (p < 0.05). Despite precise guidelines, 55% of patients with HbA1C > 7.5% had no treatment adjustment, essentially in the group already on oral bitherapy or on insulin. Among the 65 patients evaluated after 24 months, the percentage of well controlled patients decreased to 44% (vs 51% after 12 months). The decision of switching to insulin was often delayed (no patient after 1 year and 2 patients only after 2 years). In conclusion, the "DREAM" study demonstrates the feasibility, but also the difficulty, of optimising the management of type 2 diabetic patients in general practice. [less ▲]

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See detailComment je traite ... une hypoglycemie grave chez un patient diabetique.
Radermecker, Régis ULg; Philips, Jean-Christophe ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(3), 119-22

Severe hypoglycaemic episodes are defined as need of assistance and may progress to profound coma. They can occur in patients treated with insulin, generally for type 1 diabetes, or in patients receiving ... [more ▼]

Severe hypoglycaemic episodes are defined as need of assistance and may progress to profound coma. They can occur in patients treated with insulin, generally for type 1 diabetes, or in patients receiving sulphonylureas, for type 2 diabetes. Diagnosis is usually obvious, at least in insulin-treated patients, and requires an urgent intervention from the entourage. Such an intervention should comprise the oral administration of carbohydrates with high-glycaemic index if consciousness allows it or, if not, the injection of glucagon. When necessary, people should ask the help of a physician who will inject hypertonic glucose intravenously. Hypoglycaemic coma related to an absolute or relative excess of insulin should, in most cases, be treated at home. In contrast, a hypoglycaemic coma due to a too high dosage of sulphonylurea always requests a hospitalisation in order to carefully supervise the patient and to provide a prolonged intravenous infusion of glucose. It is mandatory that family or entourage members of any diabetic patient at risk to develop severe hypoglycaemia receive a specific education in order to promptly apply the best treatment capable of a rapid and safe recovery from hypoglycaemic coma. [less ▲]

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See detailL'etude clinique du mois. L'etude Steno-2: plaidoyer pour une prise en charge globale et intensive du patient diabetique de type 2.
Scheen, André ULg; Estrella, F.

in Revue Médicale de Liège (2003), 58(2), 109-11

Cardiovascular morbidity is a major burden in patients with type 2 diabetes. The Steno-2 Study compared the effect of a targeted, intensified, multifactorial intervention (n = 80) with that of a ... [more ▼]

Cardiovascular morbidity is a major burden in patients with type 2 diabetes. The Steno-2 Study compared the effect of a targeted, intensified, multifactorial intervention (n = 80) with that of a conventional treatment (n = 80) on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. After a mean follow-up of 7.8 years, the risk of cardiovascular events was reduced by 53% in the intensive group, and the risk of microvascular events (nephropathy, retinopathy, autonomic neuropathy) by 58-63%. Thus, a target-driven, long-term, intensified intervention aimed at multiple risk factors should be recommended in patients with type 2 diabetes and microalbuminuria. [less ▲]

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See detailLa transplantation d'ilots de Langerhans ou de cellules B: un pas vers la guerison du diabete?
Philips, Jean-Christophe ULg; Radermecker, Régis ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(2), 83-7

Diabetes mellitus places an enormous burden on patients, their relatives and the society. Current therapies do not provide sufficiently tight control of blood glucose to avoid diabetic complications. Some ... [more ▼]

Diabetes mellitus places an enormous burden on patients, their relatives and the society. Current therapies do not provide sufficiently tight control of blood glucose to avoid diabetic complications. Some recent developments try to restore normal glucose homeostasis. Research is islet and stem cell transplantation is developing rapidly and this article summarizes the new approaches that could cure and not simply treat diabetes in the future. [less ▲]

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See detailL'etude clinique du mois. L'etude ALLHAT-LLT.
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(1), 53-8

ALLHAT-LLT was part of the ALLHAT study. The purpose was to determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolaemic, hypertensive ... [more ▼]

ALLHAT-LLT was part of the ALLHAT study. The purpose was to determine whether pravastatin compared with usual care reduces all-cause mortality in older, moderately hypercholesterolaemic, hypertensive patients with at least one additional coronary heart disease (CHD) risk factor. 10,355 ambulatory patients, aged 55 years or more, with LDL cholesterol of 120-189 mg/dl (or, 100-129 mg/dl if known CHD) and triglycerides < 350 mg/dl, were randomised to pravastatin (40 mg/d; n = 5,170), or usual care (n = 5,185). Mean age was 66 years; 49% were women; 38% were black and 23% hispanic; 14% had a history of CHD and 35%, type 2 diabetes. Baseline mean total cholesterol was 224 mg/dl; LDL-C, 146 mg/dl; HDL-C, 48 mg/dl, and triglycerides, 152 mg/dl. Mean follow-up was 4.8 years. Among usual care patients, 32% of those with known CHD and 29% of those without CHD started taking lipid-lowering drugs. At year 4, total cholesterol was reduced by 17.2% with pravastatin and by 7.6% with usual care. A random sample had their LDL-C levels assessed: there was a reduction of 28% with pravastatin and of 11% with usual care. All-cause mortality was similar in the two groups (RR, 0.99; 95% CI, 0.89-1.11; p = 0.88), with 6-year mortality rates of 14.9% (pravastatin) and 15.3% (usual care). CHD event-rates were not different between the two groups (RR, 0.91; 95% CI, 0.79-1.04; p = 0.16); 6-year CHD event rates were 9.3% (pravastatin) and 10.4% (usual care), respectively. These results are likely due to the small differential in total cholesterol (9.6%) and LDL-C (16.7%) between pravastatin and usual care, compared with prior statin trials. Such an unusual differential essentially results from the open table of the study and from the possibility of prescribing a statin in the usual care group. [less ▲]

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See detailL'etude clinique du mois Quel antihypertenseur en premiere intention? Resultats de l'etude ALLHAT.
Scheen, André ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2003), 58(1), 47-52

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is still controversial. The "Antihypertensive and Lipid-Lowering ... [more ▼]

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is still controversial. The "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial" (ALLHAT) should give such an answer. It is a randomised, double-blind, trial designed to determine whether treatment with either a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. A total of 33,357 participants aged 55 years or older with mild to moderate hypertension and at least 1 other CHD risk factor were randomly assigned to receive chlorthalidone (12.5 to 25 mg/day; n = 15,255), amlodipine (2.5 to 10 mg/day; n = 9,048) or lisinopril (10 to 40 mg; n = 9,054). The primary outcome combined both fatal CHD and non-fatal myocardial infarction, analyzed by intent-to-treat. Secondary outcomes were all-causes mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure and peripheral arterial disease). Chlorthalidone was slightly more effective in reducing systolic pressure while amlodipine reduced slightly more effectively diastolic blood pressure. After a mean follow up of 4.9 years, no differences were observed between the three treatments regarding both the primary outcome and the total mortality. Secondary outcomes were similar when comparing amlodipine vs chlorthalidone. A moderately higher 6-year incidence rate of clinically detected heart failure was observed with amlodipine, but without significant influence on mortality. For lisinopril vs chlorthalidone, lisinopril had slightly higher 6-year rates of combined CVD, stroke and heart failure. In conclusion, thiazide-type diuretics are superior in preventing one or more major forms of CVD and offer the advantage to be cheaper. They should be preferred for first-step antihypertensive therapy. However, to reach the recommended blood pressure target, most patients should receive a combination of antihypertensive compounds. Such a combination should always comprise a diuretic agent, in absence of contra-indications. [less ▲]

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See detailComment j'explore ... les secrets d'une meta-analyse.
Scheen, André ULg

in Revue Médicale de Liège (2003), 58(1), 41-6

Meta-analysis is becoming a key partner of Evidence-Based Medicine. This statistical tool is currently used in most systematic reviews and allows to quantitatively synthesize the results of several ... [more ▼]

Meta-analysis is becoming a key partner of Evidence-Based Medicine. This statistical tool is currently used in most systematic reviews and allows to quantitatively synthesize the results of several studies by a single weighted average whose precision is indicated by the confidence interval. A standardized graphical representation allows, at first glance, to derive a lot of useful information, especially the number of studies taken into account for the analysis, the mean effect observed in each study with its confidence interval, the relative size (number of subjects) of each study, the homogeneity/heterogeneity of between-study results, finally the overall mean effects with its confidence interval. The meta-analysis plays a key-role in epidemiology, for the evaluation of a risk or a protective factor, and in therapeutics, for summarizing the results of numerous clinical trials with a specific drug or a pharmacological class in a given disease. [less ▲]

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See detailChoice of an adjuvant for vaccination trials
Vermout, Sandy; Denis, M.; Losson, Bertrand ULg et al

in Annales de Médecine Vétérinaire (2003), 147(6), 393-401

The development of new vaccines, containing protective antigens that are more and more well characterized, is hindered by the lack of adjuvants able both to amplify immune response and to control it ... [more ▼]

The development of new vaccines, containing protective antigens that are more and more well characterized, is hindered by the lack of adjuvants able both to amplify immune response and to control it qualitatively. A number of tumors and infectious diseases could be treated with adjuvant preparations that would adequately intensify and modulate specific immune response; in particular, the possibility to specifically induce a Th1 response seems to be of paramount importance for the prevention and for the cure of these diseases. Furthermore, these adjuvants must be as safe as possible, not only for commercial applications, but also in the respect of laboratory animals' welfare. This review describes the different adjuvants presently used in vaccinology, classifying them following their chemical nature and presenting for each category the knowledge concerning their activity and toxicity. [less ▲]

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See detailGénération non-intentionnelle de polluants: Le cas des dioxines
Focant, Jean-François ULg

Article for general public (2003)

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See detailConceptual issues in 3D Urban GIS
Billen, Roland ULg; Zlatanova, Siyka

in GIM International (2003), 17(1), 33-35

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See detailL'Observatoire de la consommation alimentaire
Claustriaux, Jean-Jacques ULg; Cordier, L.; Duquesne, Brigitte ULg et al

in Vers une politique de qualité, à quel prix ? (2003)

Description de l'utilisation d'une base de données relative aux achats de produits alimentaires effectués par des ménages.

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See detail3D spatial relationships model: a useful concept for 3D cadastre?
Billen, Roland ULg; Zlatanova, Siyka

in Computers, Environment & Urban Systems (2003), 27(4), 411-425

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See detailAn Integrated Software for Scantling Optimization and Least Production Cost
Rigo, Philippe ULg

in Ship Technology Research = Schiffstechnik (2003)

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See detailTomographie à émission de positons : vers une approche plus spécifique des pathologies oncologiques
Hustinx, Roland ULg

Thèse d’agrégation de l’enseignement supérieur (2003)

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