Publications of Michel LETIEXHE
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See detailObesite et diabete de type 2.
Rorive, Marcelle ULiege; Letiexhe, Michel ULiege; Scheen, André ULiege 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. Chirurgie bariatrique: les resultats a 10 ans de la Swedish Obese Subjects Study"."
Scheen, André ULiege; Letiexhe, Michel ULiege; Rorive, Marcelle ULiege 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 detailIntact cross-talk between insulin secretion and insulin action after postgastroplasty recovery of ideal body weight in severely obese patients.
Letiexhe, Michel ULiege; Desaive, Claude ULiege; Lefebvre, Pierre ULiege et al

in International Journal of Obesity (2004), 28(6), 821-3

Most reports investigating the hormonal and metabolic effects of bariatric surgery studied obese subjects after partial weight loss only. Nevertheless, all studies showed significant improvements of ... [more ▼]

Most reports investigating the hormonal and metabolic effects of bariatric surgery studied obese subjects after partial weight loss only. Nevertheless, all studies showed significant improvements of insulin secretion, action, clearance and inhibition of its own secretion, although the parallel kinetics of all these changes remained questionable. Using the intravenous glucose tolerance test, we demonstrated a full normalization of insulin secretion, action on glucose metabolism and clearance in eight obese women who recovered and maintained ideal body weight following gastroplasty. Reciprocal changes were observed between postglucose acute insulin secretion and insulin-mediated glucose disposal so that the so-called disposition index (product of these two variables) remained unchanged after vs before gastroplasty in those individuals with normal glucose tolerance. These favourable results should encourage obtaining a drastic and sustained weight loss in patients with severe obesity at risk of developing type II diabetes. [less ▲]

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

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 detailRelation between disease phenotype and HLA-DQ genotype in diabetic patients diagnosed in early adulthood
Weets, Ilse; Siraux, Valérie; Daubresse, Jean-Claude ULiege et al

in Journal of Clinical Endocrinology and Metabolism (2002), 87(6), 2597-2605

We investigated inaugural disease phenotype in relation to the presence or absence of diabetes-associated autoantibodies and human leukocyte antigen (HLA) DQ risk genotypes in adult-onset diabetic ... [more ▼]

We investigated inaugural disease phenotype in relation to the presence or absence of diabetes-associated autoantibodies and human leukocyte antigen (HLA) DQ risk genotypes in adult-onset diabetic patients. Blood samples and questionnaires were obtained from 1584 recent-onset Belgian Caucasian patients (age 15-39 yr at diagnosis of primary diabetes) who were recruited by the Belgian Diabetes Registry over an 11-yr period. At clinical diagnosis, antibody-positive patients (n = 1198) were on average younger and had more symptoms, a more acute disease onset, lower body mass index, and random C-peptide levels, but higher insulin needs, glycemia, and prevalence of ketonuria, HLA-DQ, and 5' insulin gene susceptibility genotypes (P < 0.001 vs. antibody-negative patients; n = 386). In antibody-positive patients, these characteristics did not differ according to HLA-DQ genotype. However, in antibody-negative subjects, we found that patients were younger (P = 0.001); had a lower body mass index (P < 0.001), higher insulin needs (P = 0.014), and amylasemia (P = 0.001); and tended to have a higher glycemia and lower C-peptide in the presence of susceptible HLA-DQ genotypes. Differences according to HLA-DQ genotype subsisted after careful age-matching. In conclusion, we found no relation between initial disease phenotype and HLA-DQ genotype in antibody-positive diabetic young adults. In contrast, antibody-negative patients displayed more type I-like features when carrying susceptible HLA-DQ genotypes known to promote the development of antibody-positive diabetes. The overrepresentation of these susceptibility genotypes in antibody-negative patients suggests the existence of an immune-mediated disease process with as yet unidentified immune markers in a subgroup of seronegative patients. [less ▲]

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See detailApproches pharmacologiques de prévention du diabète de type 2.
SCHEEN, André ULiege; PAQUOT, Nicolas ULiege; LETIEXHE, Michel ULiege et al

in Médecine et Hygiène (2002), 60

L’augmentation rapide de la prévalence du diabète de type 2 impose la mise en place de stratégies de prévention. Outre les mesures hygiéno-diététiques, essentielles, diverses approches pharmacologiques ... [more ▼]

L’augmentation rapide de la prévalence du diabète de type 2 impose la mise en place de stratégies de prévention. Outre les mesures hygiéno-diététiques, essentielles, diverses approches pharmacologiques ont apporté récemment la preuve d’une certaine efficacité chez les sujets à risque de par la présence d’un excès pondéral et/ou d’une diminution de la tolérance au glucose. C’est le cas de plusieurs antidiabétiques oraux comme la metformine, l’acarbose ou encore la troglitazone. C’est également le cas de médicaments anti-obésité comme l’orlistat et, peut-être aussi, la sibutramine. L’inhibition du système rénine-angiotensine par un inhibiteur de l’enzyme de conversion ou par un antagoniste sélectif des récepteurs AT1 peut aussi, outre protéger contre les complications cardiovasculaires, prévenir l’apparition d’un diabète de type 2. Enfin, le rôle des médicaments hypolipidémiants reste controversé. De nouvelles études prospectives sont en cours pour confirmer ces résultats. [less ▲]

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See detailL'hyperglycemie post-prandiale. II. Approches therapeutiques medicamenteuses.
Scheen, André ULiege; Letiexhe, Michel ULiege; Geronooz, I. et al

in Revue Médicale de Liège (2002), 57(4), 196-201

Besides dietary approaches, various pharmacological means have been recently developed in order to better control postprandial hyperglycaemia. This objective may be obtained: 1) by slowing down the ... [more ▼]

Besides dietary approaches, various pharmacological means have been recently developed in order to better control postprandial hyperglycaemia. This objective may be obtained: 1) by slowing down the intestinal absorption of carbohydrates; 2) by insuring a better insulin priming soon after the meal; and 3) by inhibiting post-prandial glucagon secretion or action. Some hormones (amylin, glucagon-like peptide-1) can slow gastric emptying while alpha-glucosidase inhibitors (acarbose, miglitol) retard intestinal digestion and resorption of complex carbohydrates. A more physiological post-meal profile of insulin may be obtained in type 2 diabetes by using new insulin secretagogues of the glinide family (repaglinide, nateglinide) with an earlier and shorter insulinotropic action or, mainly in type 1 diabetes but also in type 2 diabetes, by using short-acting insulin analogues (lispro. Asp B28) or inhated insulin the action of which is faster than that of subcutaneous insulin. Post-prandial glucagon secretion can be inhibited by amylin. GLP-1 or insulin while other glucagon antagonists are currently in development. [less ▲]

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