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Biomedical subjects

A J Scheen

Publications and source records attributed to A J Scheen.

At least 235 records · Page 13Linked to original sources
PubMed1998

[How I treat a diabetes type 2 patient: the DREAM project for better general practitioner-specialist collaboration. Diabetes Reinforcement of Adequate Management].

Type 2 diabetes is an important public health problem because of its high prevalence and morbidity rate which both are associated with a considerable social and human cost. The general practitioner should play a central role in the management of patients with type 2 diabetes and try to meet the therapeutic objectives. Main goals include reinforcement of early diagnosis, by a better screening of individuals at risk for type 2 diabetes, achievement of a good glycaemic control, through an optimized antidiabetic treatment, correction of associated risk factors as well as detection and treatment of disease complications. DREAM ("Diabetes Reinforcement of Adequate Management") is a pilot project which started in Liege area end 1997 for at least 2 years. It aims at improving the management of type 2 diabetic patients through a better free collaboration between general practitioners and diabetologists and the adhesion to an optimized therapeutic strategy. This ambitious project benefits from the valuable support of three pharmaceutical companies.

Aged↗
PubMed1998

[How I study hypertriglyceridemia].

The strategy for the diagnosis of hypertriglyceridaemia comprises three successive steps. First, the physician should confirm the biological abnormality by at least one additional blood sample taken after an overnight fast; recent data, however, suggest that postprandial hypertriglyceridaemia may also represent a cardiovascular risk factor. Second, the phenotype of hypertriglyceridaemia should be considered as either isolated high triglyceride levels or hypertriglyceridaemia combined with hypercholesterolemia may be present; the combination of hypertriglyceridaemia with a low HDL cholesterol concentration or its association with the metabolic or insulin resistance syndrome should also be investigated. Third, all should be done in order to find the etiology of the hypertriglyceridaemia (by determining its genetic or nutritional origin, by excluding possible underlying pathologies, by looking for drugs able to increase serum triglyceride levels). These various steps should help the physician to take the final decision of treating one particular patient as well as to chose the most appropriate, nutritional or pharmacological, treatment.

Cholesterol, HDL↗
PubMed1998

Aggressive weight reduction treatment in the management of type 2 diabetes.

Most patients with Type 2 diabetes are significantly overweight, and diet-induced weight loss can provide marked improvement in their glycaemic control. As conventional therapy combining diet and exercise usually has a poor long-term success rate, more aggressive weight reduction programmes have been proposed for the treatment of severely obese diabetic patients, including very-low-calorie diets, anti-obesity drugs and bariatric surgery. Very-low-calorie diets usually have a remarkable short-term effect, and energy restriction and weight reduction are positive factors for the glycaemic control of obese diabetic subjects. However, the long-term efficacy of these methods remains doubtful since weight regain is a common phenomenon. Although anti-obesity (anorectic) drugs may help patients to follow a restricted diet and lose weight, their overall efficacy on body weight and glycaemia is generally modest, and their long-term safety still questionable. Interestingly, serotoninergic anorectic agents have been shown to improve both the insulin sensitivity and glycaemic control of obese diabetic patients independently of weight loss. Bariatric surgery may be helpful in well-selected patients. The correction of weight excess after successful gastroplasty fully reverses the abnormalities of insulin secretion, clearance and action on glucose metabolism present in markedly obese non-diabetic patients, and allows interruption or reduction of insulin therapy and antidiabetic oral agents in most obese diabetic patients. In conclusion, weight loss is a major goal in treating obese patients with Type 2 diabetes, and aggressive weight reduction programmes may be used in selected patients refractory to conventional diet and drug treatment. However, long-term prospective studies are needed for more precise determination of the role of such a strategy in the overall management of obese diabetic patients.

Appetite Depressants↗
PubMed1998

[Clinical case of the month. Galloping nephropathy in a patient with type 2 diabetes].

We report the case of a patient with insulin-requiring type 2 diabetes who exhibited a rapid deterioration of his renal function leading to haemodialysis in a few months. Various diagnosis were considered to explain this rapid deterioration, excluding diabetic nephropathy as major etiology. The exploration, especially renal biopsy, demonstrated the presence of a glomerulonephritis due to the deposition of immune complexes associated to active hepatitis C rather than diabetic glomerulosclerosis. A treatment with interferon-alpha allowed to partially restore renal function, this recovery permitting the interruption of hemodialysis, with a current follow-up of more than 6 months.

Adult↗
PubMed1998

[Drug clinics. The drug of the month. Alendronate (Fosamax)].

Alendronate (Fosamax, Merck Sharp & Dohme) is an aminobisphosphonate which inhibits bone turnover by suppressing the activity of osteoclasts without increasing the risk of osteomalacia. Alendronate is highly effective at preventing bone loss associated to absence of endogenous estrogen and induces a sustained increase in bone mass. Fosamax is indicated and reimbursed in the treatment of osteoporosis in postmenopausal women, with either an history of bone fracture confirmed by X-ray exam or obvious osteoporosis assessed by bone mineral density measurement. The recommended dosage is 10 mg once daily, continuously. The drug should be absorbed after an overnight fast to improve its bioavailability and with a big glass of plain water to reduce the risk of oesophageal ulcerations. Large randomized controlled trials for up to 3 years have demonstrated that alendronate is able to reduce the risk and rate of occurrence of vertebral and nonvertebral fractures in postmenopausal women.

Absorption↗
PubMed1998

[Pharmaco-economics of hypolipidemic agents: analysis of factors influencing the cost-effectiveness relation].

The demonstration that stains reduce the risk of cardiovascular diseases, in both secondary and primary prevention trials, led to the recent publication of sophisticated pharmaco-economical studies. A lot of factors may influence the cost-effectiveness ratio of the pharmacological intervention, especially the mode of calculation of various costs, the initial level of cardiovascular risk of the patients and the medico-economical particularities of each country. What so ever, available studies appear to justify the use of statins in secondary prevention, i.e. in coronary patients, even those with only a moderate hypercholesterolaemia, and, in primary prevention, i.e in hypercholesterolaemia individuals with obvious high risk of cardiovascular disease.

Adult↗
PubMed1998

[Pharmaco-economics of type 2 diabetes].

Type 2 diabetes has long been considered as a benign disease, whereas it is in fact associated with an enormous socio-economic cost. The major part of the burden of diabetes results from the management of complications (both direct and indirect costs), rather than from the various components of the antihyperglycaemic treatment itself. Solutions include a better prevention of the disease, an earlier diagnosis among individuals at risk, and an optimized management of diabetes, particularly in primary care settings, in order to avoid or retard the development of severe micro- or macroangiopathic complications which are particularly expensive.

Cost of Illness↗
PubMed1998

[Drug clinics. Drug of the month. Atorvastatin (Lipitor)].

Atorvastatin, commercialized by the pharmaceutical companies Parke-Davis and Pfizer under the trade name Lipitor, is a new statin acting as a potent hypolipidaemic drug. By inhibiting HMG-CoA reductase, the key-enzyme of cellular synthesis of cholesterol, it increases the expression of LDL receptors and promotes the hepatic extraction of circulating LDL. It has a more potent action than other available statins, both on LDL cholesterol and triglyceride levels. Atorvastatin is indicated, after diet failure, in the treatment of primary hypercholesterolaemia or combined hyperlipidaemia. Lipitor is available as tablets of 10 and 20 mg. The usual doses is 10 mg once a day, to be increased up to 20 mg/day if necessary. In rare severe cases, the doses may be increased up to 80 mg/day.

Anticholesteremic Agents↗
PubMed1998

Clinical efficacy of acarbose in diabetes mellitus: a critical review of controlled trials.

Acarbose, an alpha-glucosidase inhibitor, is a new antihyperglycaemic agent which has been proposed as add-on therapy in Type 2 diabetic patients not well-controlled with diet alone, sulphonylurea, metformin or insulin, and in Type 1 diabetic patients with large meal-related plasma glucose excursions. Numerous controlled studies investigating the clinical effects of acarbose in Type 2 diabetes versus either placebo or, more rarely, versus a reference drug (sulphonylurea or metformin) have been published during the last 10 years. All placebo-controlled studies have demonstrated the superiority of acarbose, at a dose of 150-600 mg/day, in decreasing fasting and postprandial glucose levels as well as HbA1c concentrations (mean decrease of 0.7%), whether acarbose was given as first-line therapy in diet-treated diabetic patients or in combination in individuals already receiving a sulphonylurea, metformin or insulin. Only a few controlled studies have compared the effects of acarbose with those of either sulphonylurea or metformin, yielding controversial results. In Type 1 diabetic patients, a small reduction of HbA1c levels was also reported after addition of acarbose to insulin therapy, which in some cases allowed a slight reduction of daily insulin needs. All these favourable biological effects occurred without exposing the patient to hypoglycaemia or weight gain. A few studies have also reported favourable effects on postprandial lipid profile and some other vascular risk factors. However, it is not clear whether the extra cost of acarbose, when compared to that of older oral antidiabetic agents, is justified since no study has yet demonstrated its potential benefit on the complications and long-term prognosis of diabetic patients.

Acarbose↗
PubMed1998

Effects of gastroplasty on body weight and related biological abnormalities in morbid obesity.

Obesity is a prevalent metabolic disorder associated with high morbidity and mortality rates. Medical treatment rarely succeeds, and bariatric surgery has been proposed as an alternative therapy. The purpose of this non-controlled retrospective study was to evaluate time-course changes in body weight in severely obese patients who underwent vertical ring gastroplasty or adjustable silicone gastric banding, and to assess the prevalence and potential reversibility of several of the biological abnormalities associated with morbid obesity. From an initial cohort comprising 658 patients, regular body weight measurements and biological data were obtained in 505 patients [419 females, 86 males; age 36 +/- 11 years; body mass index 42.7 +/- 6.9 kg/m2; (mean +/- SD)] with a mean follow-up of 26 +/- 14 months. Mean weight loss was 32 +/- 16 kg. Most weight reduction occurred within the first 6 months, followed by near-stabilisation or even slight weight regain. Most biological parameters were obtained before surgery and after at least 6 months of follow-up. The high prevalence and severity of metabolic disturbances associated with the insulin resistance syndrome (hyperglycaemia, hyperinsulinaemia, decreased HDL cholesterol, hypertriglyceridaemia, elevated fibrinogen levels and hyperuricaemia) before gastroplasty were significantly decreased after weight loss. No major biological deficiencies were observed following gastroplasty, except low iron serum levels. It is concluded that marked weight loss associated with gastroplasty involved a remarkable reduction in the prevalence and severity of several biological abnormalities classically considered as cardiovascular risk factors.

Adult↗
PubMed1998

[Therapeutic update 1997-1998 (1). First part].

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The originality of each molecule as well as its modalities of appropriate use in clinical practice will be stressed. This first part is devoted to drugs acting on cardiovascular, respiratory, digestive and neurologic diseases.

Belgium↗
PubMed1998

[How I evaluate...diabetic nephropathy. First part: micro- and macroalbuminuria].

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as an albumin excretion rate between 30 and 300 mg/24 h (on a 24-hour urine collection) or between 20 and 200 micrograms/min (on an overnight collection) in at least two out of three consecutive collections made within a 6-month period. Alternative screening techniques use either dipstick (Micral-Test II) or the albumin to creatinine ratio on an early morning urine sample (30-300 mg/g creatinine). Once persistent microalbuminuria is confirmed, 80% of type 1 diabetic patients and 20 to 50% of type 2 diabetic patients will progress to DN. In D2, microalbuminuria also represents a powerful predictor of early mortality from cardiovascular disease. Macroalbuminuria (AER > 300 mg/24 h, corresponding to a total protein excretion > 500 mg/24 h) will eventually lead to a end-stage renal insufficiency within 10 to 20 years. In D2, numerous patients will die from cardiovascular disease before reaching end-stage renal failure. Angiotensin-converting enzyme inhibitors can slow down the evolution toward DN when prescribed when microalbuminuria appears. Screening for microalbuminuria should therefore be a part of the annual clinical assessment in every diabetic patient.

Albuminuria↗
PubMed1998

[Pharma-clinics. Doping with erythropoietin or the misuse of therapeutic advances].

Sport performance depends on the capacity of oxygen transport to the exercising skeletal muscles. Performance may be increased thanks to an haematocrit augmentation, either by training in high altitude, using blood transfusions, or injecting erythropoietin (Epo). Since the synthesis of Epo by bioengineering, doping with recombinant human Epo has become popular in sports in general, and in cycling in particular. This new kind of doping might have been responsible for several sudden deaths in young athletes, essentially in racing cyclists. Until now, such a doping is hardly to be detected. However, it should deserve careful consideration from both public health authorities and sports communities in order to stop what could become a real plague.

Altitude↗
PubMed1998

[Therapeutic update 1997-1998].

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The originality of each molecule as well as its modalities of appropriate use in clinical practice will be stressed. This second part is devoted to drugs acting on infectious, rheumatoid, immunologic, oncologic and urogenital diseases.

Anti-Bacterial Agents↗
PubMed1998

[How I examine...diabetic nephropathy. Second part: assessment of glomerular filtration].

The natural history of diabetic renal disease can be divided into different stages according to the degree of albuminuria and the level of glomerular filtration rate (GFR). Assessment of the early hyperfiltration state, as well as determination of the rate of decline in kidney function at a later stage require precise and accurate methods to measure GFR. In this article, we briefly remind the reader of the physiological basis of GFR. We then review the different techniques for the monitoring of kidney function (inulin clearance, endogenous creatinine clearance, plasma disappearance of a radiolabelled tracer) and discuss the pro and cons of each of them in different clinical settings. Finally, we try to define a rational use of these techniques in everyday clinical practice.

Creatinine↗
PubMed1998

[Lessons from the "United Kingdom Prospective Diabetes Study"].

The United Kingdom Prospective Diabetes Study (UKPDS) is the largest study ever performed in the field of diabetes. It has been carried on in more than 5000 patients with newly diagnosed type 2 diabetes and followed during almost 15 years. The main goals of the study were to investigate the effects of improving blood glucose and/or blood pressure control on diabetic complications, and to compare the advantages and inconvenients of the most important pharmacological approaches. The results of the UKPDS have been presented at the last Congress of the European Association for the Study of Diabetes (EASD) in Barcelona, September 10-11, 1998. They essentially showed that improving blood glucose or arterial blood pressure control allows to significantly reduce the incidence of complications associated to diabetes. Best results were observed in individuals in whom treatments of both hyperglycemia and hypertension were intensified. For each risk factor, no threshold has been found so that every reduction in blood glucose or arterial pressure is accompanied by a nearly linear diminution in the incidence of diabetic complications. The type of pharmacological treatment appears to have a less prominent influence, even if metformin appears to exert the most favourable effects in the group of obese patients with type 2 diabetes.

Diabetes Mellitus, Type 2↗