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See detailBelgium stranding network
Jauniaux, Thierry ULg; Das, Krishna ULg; Brenez, C. et al

in annual proceeding (2005)

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See detailL'insulinotherapie dans le diabete de type 2.
Philips, Jean-Christophe ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 419-23

As compared to type 1 diabetes, type 2 diabetes usually requires insulin at a late stage, after secondary failure to oral antidiabetic drugs. However, it should be pointed out that insulin therapy should ... [more ▼]

As compared to type 1 diabetes, type 2 diabetes usually requires insulin at a late stage, after secondary failure to oral antidiabetic drugs. However, it should be pointed out that insulin therapy should not be delayed in patients not well controlled on oral agents. Type 2 diabetic patients failing to oral antidiabetic medications need insulin. Nevertheless, insulin therapy in type 2 diabetic patients is less standardized than in those with type 1 diabetes. Several clinical trials tried to investigate what is the most appropriate initial insulin therapy in type 2 diabetic patients, with the main objectives of reaching almost normoglycaemia without increased risk of frequent or severe hypoglycaemic episodes. However, there is no agreement upon optimal mode of initiating insulin. The most important factors leading to adequate metabolic control are a global educational approach together with a intensified follow up, independently of the insulin regimen. [less ▲]

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See detailObesite et diabete de type 2.
Rorive, Marcelle ULg; Letiexhe, Michel ULg; Scheen, André ULg et al

in Revue Médicale de Liège (2005), 60(5-6), 374-82

Obesity is an epidemic disease associated with numerous cardiovascular risk factors as diabetes mellitus, dyslipidemia, hypertension. Insulin resistance seems to be an important promoter for the ... [more ▼]

Obesity is an epidemic disease associated with numerous cardiovascular risk factors as diabetes mellitus, dyslipidemia, hypertension. Insulin resistance seems to be an important promoter for the development of most of these abnormalities. Besides genetic background, obesity, especially abdominal adiposity, is by far the most important factor for the development of type 2 diabetes. The treatment of a diabetic obese subject begins with diet and regular physical activity, eventually with a psychological support. In case of failure of such lifestyle approach alone, addition of drug therapy should be considered. It may include pharmacological agents able to promote weight loss (orlistat, sibutramine, possibly rimonabant) and/or antihyperglycaemic compounds capable of reducing insulin resistance (metformin, glitazones, acarbose). In case of severe/morbid obesity complicated with type 2 diabetes not well controlled with medical means, bariatric surgery is the only treatment that can induce an important and sustained weight loss, associated with marked improvement of metabolic control and amelioration of overall prognosis. [less ▲]

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See detailL'etude clinique du mois. L'etude FIELD de protection cardio-vasculaire avec le fenofibrate chez le patient diabetique de type 2.
Radermecker, Régis ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(12), 957-61

FIELD ("Fenofibrate Intervention and Events Lowering in Diabetes") study compared the incidence of coronary and cardiovascular events in 4895 patients with type 2 diabetes treated with fenofibrate ... [more ▼]

FIELD ("Fenofibrate Intervention and Events Lowering in Diabetes") study compared the incidence of coronary and cardiovascular events in 4895 patients with type 2 diabetes treated with fenofibrate (micronized fomulation, 200 mg/day) and in 4900 patients treated with placebo. After a mean 5-year follow-up, the fenofibrate group did not have less coronary events (primary endpoint), neither present a significant reduction in cardiovascular or total mortality as compared to the placebo group. However, it had significantly less non-fatal myocardial infarctions and cardiovascular events in general as well as less coronary and total revascularization procedures (secondary endpoints). The higher rate of starting statin therapy in patients allocated placebo might have masked a larger treatment benefit of fenofibrate on macrovascular complications. The tolerance of fenofibrate was good, even in combination with statins. More surprisingly, fenofibrate exerted a favourable effect on microangiopathy complications, with less albuminuria progression and less retinopathy needing laser treatment (tertiary endpoints). [less ▲]

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See detailL'etude Proactive: prevention secondaire des accidents cardio-vasculaires par la pioglitazone chez le patient diabetique de type 2.
Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (2005), 60(11), 896-901

PROactive is a prospective, randomised controlled trial in 5238 patients with type 2 diabetes who had evidence of macrovascular disease. Patients were assigned to oral pioglitazone titrated from 15 mg to ... [more ▼]

PROactive is a prospective, randomised controlled trial in 5238 patients with type 2 diabetes who had evidence of macrovascular disease. Patients were assigned to oral pioglitazone titrated from 15 mg to 45 mg or matching placebo, to be taken in addition to their glucose-lowering drugs and other medications. After a mean follow up of 34.5 months, pioglitazone reduced the composite of all-cause mortality, non-fatal myocardial infarction, and stroke (intention to treat analysis: hazard ratio = 0.84; 95% CI: 0.72-0.98; p = 0.027). Various favourable metabolic effects could contribute to this cardiovascular protection, i.e. an absolute 0.5 % reduction in HbA1c, a 9% increase in HDL cholesterol, a 13% decline of triglycerides, and a 3 mm Hg reduction in systolic blood pressure in the pioglitazone group compared to placebo. The requirement of insulin was reduced by almost 50% in the pioglitazone group as compared to the placebo group. The incidence of cases of oedema and congestive heart failure was higher in the pioglitazone group. In conclusion, in patients with type 2 diabetes who are at high cardiovascular risk, pioglitazone improves cardiovascular outcome, and reduces the need to add insulin to glucose-lowering regimens compared to placebo. [less ▲]

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See detailLe medicament du mois. L'insuline detemir (Levemir)
Scheen, André ULg; Radermecker, Régis ULg; Philips, Jean-Christophe ULg et al

in Revue Médicale de Liège (2005), 60(10), 814-9

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby ... [more ▼]

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged metabolic effect (up to 24 hours) with low variability. Indeed, in patients with type 1 or type 2 diabetes mellitus, insulin detemir has a more predictable, protracted and consistent effect, with less intrapatient variability in glycaemic control (particularly fasting plasma glucose levels), compared with NPH (Neutral Protamine Hagedorn) insulin. Insulin detemir, is at least as effective as NPH insulin in maintaining overall glycaemic control, with a lower risk of nocturnal hypoglycaemia. It also provides the additional benefit of less body weight gain as compared to other basal insulins. Levemir, presented in cartridges for the pen device NovoPen 3 and administered preferably at bedtime (if necessary morning and evening), is a promising new option for basal insulin therapy in diabetic patients, especially those on a basal-bolus scheme. [less ▲]

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See detailLe diabete sucre: epilogue.
Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (2005), 60(5-6), 628-31

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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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