References of "Médecine des Maladies Métaboliques"
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See detailInhibiteurs des SGLT2 et « perte de chance » : une interprétation diamétralement opposée de la Commission de Transparence de la Haute Autorité de santé (HAS) et de la Société Francophone du Diabète (SFD)
SCHEEN, André ULiege

in Médecine des Maladies Métaboliques (2019), 13(3), 309-312

The « loss of chance » is a legal term whose definition is a prejudice characterized by the deprivation of a probable gain or the occurrence of a loss that could have been avoided. This notion has been ... [more ▼]

The « loss of chance » is a legal term whose definition is a prejudice characterized by the deprivation of a probable gain or the occurrence of a loss that could have been avoided. This notion has been expanded to medical practice. As far the evaluation of sodium-glucose type 2 cotransporter inhibitors (SGLT2i, or gliflozins), the Société Francophone du Diabète (SFD) has a completely different view about the interpretation of the loss of chance given by the Commission de Transparence of the French Haute Autorité de santé (HAS). For the latter, the loss of chance associated with the prescription of a SGLT2i would correspond to a loss, i.e. the risk of severe adverse events, which may be avoided if another already available antidiabetic agent would have been prescribed instead of a SGLT2i. In contrast, for the SFD, the loss of chance results in the privation of a potential gain, i.e. a well demonstrated cardiovascular and renal protection, at least in patients with type 2 diabetes and at high risk. [less ▲]

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See detailPrise de position de la Société Francophone du Diabète (SFD) sur la prise en charge médicamenteuse de l'hyperglycémie du patient diabétique de type 2
Bauduceau, Bernard; Bordier, Lyse; Bringer, Jacques et al

in Médecine des Maladies Métaboliques (2019), 13(2), 577-593

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See detailÉtudes cardiovasculaires chez le patient diabétique de type 2 à risque : conclusions et impact des essais publiés en 2017-2018
SCHEEN, André ULiege

in Médecine des Maladies Métaboliques (2019), 13(supplément 1), 10-24

Les études à visée cardiovasculaire (CV) dans le diabète de type 2 (DT2) ont concerné les trois classes antidiabétiques les plus récentes, les inhibiteurs de la dipeptidyl peptidase-4 (DPP-4) (gliptines ... [more ▼]

Les études à visée cardiovasculaire (CV) dans le diabète de type 2 (DT2) ont concerné les trois classes antidiabétiques les plus récentes, les inhibiteurs de la dipeptidyl peptidase-4 (DPP-4) (gliptines), les agonistes des récepteurs du glucagon-like peptide-1 (GLP-1), et les inhibiteurs des cotransporteurs sodium-glucose de type 2 (SGLT2) (gliflozines). Les gliptines ont démontré leur sécurité cardiovasculaire, mais sans supériorité par rapport à un placebo. Les agonistes des récepteurs du GLP-1 ont montré une protection CV chez des patients à haut risque CV, mais avec certains résultats discordants selon les molécules testées. Les gliflozines ont montré une réduction des événements CV majeurs, tout en réduisant les hospitalisations pour insuffisance cardiaque et les événements rénaux. Les résultats des essais initiaux ont été généralement confirmés dans des études récentes, respectivement CARMELINA pour les gliptines, EXSCEL et HARMONY OUTCOMES pour les agonistes des récepteurs du GLP-1, et CANVAS et DECLARE-TIMI 58 pour les inhibiteurs des SGLT2. Les résultats de ces essais cliniques contrôlés ont considérablement impacté la nouvelle stratégie de prise en charge de l’hyperglycémie chez les patients DT2 dans le consensus ADA-EASD 2018. D’autres essais sont en cours, en particulier avec les inhibiteurs des SGLT2 chez des patients avec insuffisance cardiaque ou atteinte rénale. [less ▲]

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See detailPlace des inhibiteurs des SGLT2 dans le traitement du patient diabétique de type 2
Scheen, André ULiege

in Medecine des Maladies Metaboliques (2018), 12(1), 22-30

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors (SGLT2i; gliflozins) exert their glucose-lowering effect by enhancing glucosuria. Beyond improving glucose control, they are associated with other ... [more ▼]

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors (SGLT2i; gliflozins) exert their glucose-lowering effect by enhancing glucosuria. Beyond improving glucose control, they are associated with other metabolic and haemodynamic effects that are potentially beneficial. Empagliflozin (EMPA-REG OUTCOME) and canagliflozin (CANVAS) have shown significant reductions in major cardiovascular events, hospitalisation for heart failure and renal outcomes in patients with type 2 diabetes and high cardiovascular risk. Dapagliflozin (preliminary positive effects reported in the observational CVD-REAL registry) is currently evaluated in the DECLARE-TIMI 58 cardiovascular outcome trial. Gliflozins may be used in combination with metformin or a sulphonylurea, in triple oral therapy or in combination with basal insulin according to recent international guidelines. They should most probably be preferred in patients with established cardiovascular disease, at high risk of heart failure and/or with mild renal impairment. Their use is contra-indicated in case of more severe renal insufficiency and in patients with recurrent urinary or genital infections. As they as not commercialized in France yet, SGLT2i were not included in the position statement published by the French-speaking diabetes society (SFD) late 2017. This article analyses the different potential and preferential uses of SGLT2i according to recent data of evidence-based medicine and the clinical experience in French-speaking countries where they are already available. © 2018 Elsevier Masson SAS [less ▲]

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See detailHistorique des études cardiovasculaires: de l'UGDP… aux dernières études
Scheen, André ULiege

in Médecine des Maladies Métaboliques (2017), 11

An increasing number of cardiovascular outcome studies in type 2 diabetes are now available. Schematically, they aimed either at investigating the protective effect of intensifying glucose control on both ... [more ▼]

An increasing number of cardiovascular outcome studies in type 2 diabetes are now available. Schematically, they aimed either at investigating the protective effect of intensifying glucose control on both microangiopathic and macroangiopathic complications, or at proving the cardiovascular safety and if possible the efficacy of one specific antidiabetic agent. The UGDP study suggested an increased coronary risk of first-generation sulfonylureas, which was not confirmed by the UKPDS. The latter landmark study emphasized the cardiovascular protection provided by metformin. The PROactive trial reported favourable results, but which were controverted, with pioglitazone. ACCORD, ADVANCE, and VADT were unable to demonstrate a reduction in major cardiovascular events with the intensification of blood glucose control, and suggested that a too strong intensification leading to hypoglycemia could increase the cardiovascular mortality. Recent studies have proven the cardiovascular safety of insulin glargine, lixisenatide and gliptins (non-inferiority vs. placebo), whereas they showed a significant reduction in major cardiovascular events with liraglutide and semaglutide, and a remarkable reduction in cardiovascular and all-cause mortality as well as in the risk of heart failure with empagliflozin. Several ongoing large prospective trials should provide answers to remaining important questions in a near future. © 2017 Elsevier Masson SAS [less ▲]

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See detailPrise de position de la Société Francophone du Diabète (SFD) sur la prise en charge médicamenteuse de l'hyperglycémie du patient diabétique de type 2
Darmont, Fabrice; Bauduceau, Bernard; Bringer, jacques et al

in Médecine des Maladies Métaboliques (2017), 11(6), 577-593

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See detailQuelle est la stratégie idéale pour traiter l’hyperglycémie du diabète de type 2 ?
SCHEEN, André ULiege

in Médecine des Maladies Métaboliques (2016), 10(2), 91-93

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See detailInstauration d'une insulinothérapie chez le patient diabétique de type 2 en médecine générale: Comparaison de l’étude belge InsuStar avec quelques études françaises et internationales
Scheen, André ULiege

in Médecine des Maladies Métaboliques (2016), 10(4), 334-340

Initiating insulin therapy is often considered as a challenge in general practice, thus leading to a delay in the shift to insulin. We compare the results of the observational prospective Belgian study ... [more ▼]

Initiating insulin therapy is often considered as a challenge in general practice, thus leading to a delay in the shift to insulin. We compare the results of the observational prospective Belgian study InsuStar with those of several French and international studies. In most studies, initiating insulin therapy is proposed in patients with glycated hemoglobin (HbA1c) around 9% (75 mmol/mol). The initiation of insulin therapy, in most cases using basal insulin (NPH, or glargine), is associated with a mean HbA1c reduction of about 1.5%, but only around one third of the patients reach a target HbA1c level <7% (53 mmol/mol), which should promote further intensification of treatment. The risk of hypoglycemia is low, and patient's acceptance of insulin injection is usually good. These results should encourage general practitioners to initiate insulin therapy at an earlier stage in patients with insufficiently controlled type 2 diabetes on oral agents. © 2016 Elsevier Masson SAS [less ▲]

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See detailCibler la voie métabolique du cortisol comme action thérapeutique dans le diabète de type 2
Scheen, André ULiege

in Médecine des Maladies Métaboliques (2016), 10(8), 725-731

The 11ß-hydroxysteroid dehydrogenase type 1 (11βHSD1) enzyme promotes the local conversion from inactive cortisone to active cortisol. It may play a role in the pathophysiology of abdominal obesity and ... [more ▼]

The 11ß-hydroxysteroid dehydrogenase type 1 (11βHSD1) enzyme promotes the local conversion from inactive cortisone to active cortisol. It may play a role in the pathophysiology of abdominal obesity and the metabolic syndrome, both showing some similarities with the Cushing syndrome. Synthetic selective inhibitors of 11βHSD1 have been investigated in pilot studies in overweight/obese patients with type 2 diabetes or hypertension. Although some positive effects were observed, they were considered as too modest compared to what could be obtained with other available drugs. More recently, a reduction in liver steatosis was reported in overweight/obese non-diabetic patients. Whereas some early 11βHSD1 inhibitors have been abandoned, others are still in development, which demonstrates a persisting interest for this innovative therapeutic approach. © 2016 Elsevier Masson SAS [less ▲]

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See detailInsulinosensibilisateurs (metformine/glitazones) : niveau de preuve et controverse
SCHEEN, André ULiege

in Médecine des Maladies Métaboliques (2015), 9

Summary Because of the deleterious role attributed to insulin resistance, insulin sensitizing agents should theoretically reduce the incidence of cardiovascular complications in type 2 diabetes. In the ... [more ▼]

Summary Because of the deleterious role attributed to insulin resistance, insulin sensitizing agents should theoretically reduce the incidence of cardiovascular complications in type 2 diabetes. In the UKPDS, metformin reduced the risk of myocardial infarction and cardiovascular mortality in a rather small group of recently diagnosed patients at a low cardiovascular risk. These results deserve confirmation in a larger study with patients a high cardiovascular risk. Glitazones, as more specific insulin sensitizers, raised much hope. However, rosiglitazone fell from its pedestal after the suspicion of an increased risk of myocardial infarction. In PROactive among patients at high cardiovascular risk, pioglitazone gave positive but questionable results: statistical significance was not reached regarding the large composite primary endpoint, but well regarding the prespecified more focused principal secondary endpoint or in various post-hoc analyses. Thus, even if data with insulin sensitizers appear globally rather promising, evidence is rather weak, therefore leading to recurrent controversy. [less ▲]

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See detailLe mot de la... Société francophone du diabète: Société francophone du diabète et Afrique francophone: une relation enrichissante à double sens
Scheen, André ULiege; Hadjadj, S.

in Médecine des Maladies Métaboliques (2015), 9(2), 113-114

[No abstract available]

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See detailAntidiabétiques oraux dans le traitement du diabète de type 2 : perspectives historique et médico-économique
SCHEEN, André ULiege

in Médecine des Maladies Métaboliques (2015), 9(2), 186-197

Oral therapy of type 2 diabetes (T2D) is becoming increasingly complex during the last decade, with first the launch of glitazones, then that of gliptins and finally, very recently, that of gliflozins ... [more ▼]

Oral therapy of type 2 diabetes (T2D) is becoming increasingly complex during the last decade, with first the launch of glitazones, then that of gliptins and finally, very recently, that of gliflozins. However, the two oral glucose-lowering agents developed more than 50 years ago, metformin and sulfonylureas, still remain the leaders in the market. After failure of metformin monotherapy, the choice of antidiabetic medications is difficult and should be made taking into account the benefit-risk balance, with a special attention to cost of therapy and a focus on a patient-centered approach. This strategy is recommended in the recently updated joint ADA-EASD position statement, in January 2015. If the main principles of T2D therapy are universal, particularities should probably be discussed regarding regional situations, and the African continent obviously presents specificities in this respect. [less ▲]

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See detailDiabètes iatrogènes : importance d’une analyse critique du rapport bénéfices/risques des traitements en cause
SCHEEN, André ULiege

in Médecine des Maladies Métaboliques (2015), 9(3), 1-3

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See detailAvant-propos Journée thématique 2015 de la Société francophone du diabète (SFD)
Scheen, André ULiege

in Médecine des Maladies Métaboliques (2015), 9(8), 731

[No abstract available]

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See detailDe la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2
SCHEEN, André ULiege; DE FLINES, Jenny ULiege; DE ROOVER, Arnaud ULiege et al

in Médecine des Maladies Métaboliques (2011), 5(3),

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these ... [more ▼]

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures and to propose them to patients with type 2 diabetes but without severe obesity (body mass index <35 kg/m² or even <30 kg/m²). Therefore, we may progress in a near future from bariatric surgery to a so-called metabolic surgery, which may open a new paradigm for the management of type 2 diabetes. This innovative approach, promising but still insufficiently validated yet, deserves further careful evaluation in a multidisciplinary approach involving digestive surgeons, gastroenterologists, endocrinologists and diabetologists. [less ▲]

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See detailLe tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique
SCHEEN, André ULiege; DE FLINES, Jenny ULiege; DE ROOVER, Arnaud ULiege et al

in Médecine des Maladies Métaboliques (2011), 5(2), 155-161

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

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission of diabetes occurs very early, before any significant 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. These hormonal changes result from partial stomach amputation (leading to reduced ghrelin secretion), from bypass of duodenal-jejunal foregut (leading to reduced secretion of still unknown factors that may counteract insulin secretion and/or action) and from an earlier contact of food with hindgut (leading to enhanced secretion of incretin hormones such as glucagon-like peptide-1 [GLP-1] by the ileal L cells, neuropeptide YY and oxyntomodulin). 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. [less ▲]

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See detailAptitude physique versus adiposité : aspects physiopathologiques et impacts cardio-métaboliques chez le sujet adulte non diabétique
Esser, Nathalie ULiege; Paquot, Nicolas ULiege; Scheen, André ULiege

in Médecine des Maladies Métaboliques (2010), 4

L’excès de masse grasse (adiposité), surtout abdominale, induit des effets cardio-métaboliques néfastes, alors que l’exercice musculaire et une bonne aptitude physique exercent globalement une influence ... [more ▼]

L’excès de masse grasse (adiposité), surtout abdominale, induit des effets cardio-métaboliques néfastes, alors que l’exercice musculaire et une bonne aptitude physique exercent globalement une influence favorable. Les effets délétères d’un excès de masse grasse (fatness) pourraient donc être contrecarrés par la pratique régulière d’exercices aboutissant à une bonne forme physique (fitness). Cet article analyse d’abord les différents mécanismes physiopathologiques par lesquels l’exercice physique produit des effets bénéfiques chez la personne avec excès pondéral et fait le distinguo entre la pratique d’une activité physique (exercice musculaire) stricto sensu et aptitude physique (fitness). Ensuite, il décrit les études les plus importantes ayant analysé les relations entre le niveau d’aptitude physique et le degré d’adiposité chez le sujet adulte en surpoids ou obèse non diabétique et leurs influences respectives sur le risque de survenue de troubles métaboliques (syndrome métabolique) et sur la mortalité, en particulier cardiovasculaire. [less ▲]

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See detailL’hyperglycémie provoquée par voie orale (HGPO) revisitée 1re partie : Tolérance au glucose, diabète gestationnel et hypoglycémie réactive
Scheen, André ULiege; Luyckx, Françoise ULiege

in Médecine des Maladies Métaboliques (2010), 4(5), 569-574

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycemia. Since almost 10 years, however ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycemia. Since almost 10 years, however, it has been proposed to limit the use of this dynamic test, favoring instead the measurement of either fasting plasma glucose or glycated hemoglobin. Nevertheless, almost all recent important studies used OGTT as reference test. In this first article, we will consider the potential interest of OGTT as diagnostic or prognostic test able to evaluate glucose regulation. In a second article, we will describe how to use OGTT to derive indices that quantitatively evaluate insulin secretion and/or insulin sensitivity. [less ▲]

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See detailMaladie cardiovasculaire et diabète chez les personnes atteintes d'une maladie mentale sévère 2ème partie : Evaluation du risque et stratégie de prise en charge
Scheen, André ULiege; Gillain, Benoit; De Hert, Marc

in Médecine des Maladies Métaboliques (2010), 4(2), 223-230

Nous avons insisté, dans un premier article, sur le fait que les personnes souffrant de maladies mentales sévères telles que la schizophrénie, la dépression ou le trouble bipolaire sont en moins bonne ... [more ▼]

Nous avons insisté, dans un premier article, sur le fait que les personnes souffrant de maladies mentales sévères telles que la schizophrénie, la dépression ou le trouble bipolaire sont en moins bonne santé physique et ont une espérance de vie moindre que la population générale. Ils sont notamment exposés à de multiples facteurs de risque métabolique et cardiovasculaire conduisant à une surmortalité coronarienne et cérébrovasculaire. Ces patients peuvent avoir un accès restreint à la médecine générale, avec des opportunités de dépistage et de prévention du risque cardiovasculaire inférieures à celles que l'on est en droit d’attendre dans une population non-psychiatrique. L'European Psychiatric Association (EPA), soutenue par l'European Association for the Study of Diabetes (EASD) et l'European Society of Cardiology (ESC), a publié récemment une déclaration de position dans le but d'améliorer la prise en charge des patients atteints de maladies mentales sévères. L'intention est d'amorcer une coopération et une prise en charge partagée entre les différents professionnels de la santé et de sensibiliser les psychiatres et les médecins de première ligne qui s'occupent de patients souffrant de maladies mentales sévères au dépistage et au traitement des facteurs de risque cardiovasculaire et du diabète. Après avoir décrit l’épidémiologie des maladies cardiovasculaires et du diabète dans la population atteinte de maladies mentales sévères et analysé l’impact des médicaments psychotropes en termes de risques métabolique et cardiovasculaire dans une première publication, le présent article décrit comment évaluer le risque de maladies cardiovasculaires et donne des conseils quant à la prise en charge des facteurs de risque cardiovasculaire et du diabète dans cette population psychiatrique. [less ▲]

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