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A J Scheen

Publications and source records attributed to A J Scheen.

At least 73 records · Page 4Linked to original sources
PubMed2003

[Clinical study of the month. The ALLHAT-LLT trial].

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.

Aged↗
PubMed2003

[Islet cell transplantation: a step toward curing diabetes?].

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.

Belgium↗
PubMed2003

[Clinical trial of the month. The STENO-2 study: a plea for global and intensive management of the type 2 diabetic patient].

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.

Albuminuria↗
PubMed2003

[How I treat...severe hypoglycemia in a diabetic patient].

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.

Blood Glucose↗
PubMed2003

[Optimizing the management of type 2 diabetics: results of the "DREAM" study in general practice].

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.

Algorithms↗
PubMed2003

[How I explore...glycemic kinetics by continuous glucose monitoring].

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.

Blood Glucose↗
PubMed2003

[Statins for cardiovascular prevention: is there still a place for cholesterol measurement?].

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).

Cardiovascular Diseases↗
PubMed2003

[Prevention of type 2 diabetes: lifestyle changes or pharmacological interventions?].

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 ("Malmö 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.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2003

[Prevention strategies of type 1 diabetes: the focus in 2003].

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.

Clinical Trials as Topic↗
PubMed2003

[Blood glucose control and prevention of microangiopathy and macroangiopathy in type 2 diabetes].

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.

Blood Glucose↗
PubMed2003

[Prevention of cardiovascular disease in type 2 diabetes].

It is estimated that 80% of individuals with type 2 diabetes die of cardiovascular diseases. Several factors account for the accelerated atherosclerosis present in diabetic patients. These include hyperglycaemia, dyslipidaemia, hypertension and prothrombotic state. Hypoglycaemic agents, statin or fibrates that improve dyslipidaemia, anti-hypertensive agents, aspirin and healthy lifestyle can modify these factors and have been shown to reduce morbidity and mortality caused by coronary heart disease in diabetic patients. It was recently demonstrated that a multifactorial intervention on modifiable risk factors of cardiovascular disease in type 2 diabetic patients dramatically reduces the incidence of cardiovascular events. Thus, an intensified intervention aimed at multiple risk factors should be recommended in patients with type 2 diabetes.

Cardiovascular Diseases↗
PubMed2003

[Prevention of diabetic nephropathy: from microalbuminuria to end-stage renal insufficiency].

Diabetic nephropathy is one of the leading causes of end-stage renal failure in western countries. This disease develops over several years. Early stages, if they are detected in time, can lead to preventive treatment at a moment when the disease is still reversible. This paper reviews the main primary and secondary preventive measures that have been proven efficacious. Those are essentially the optimal treatment of hyperglycaemia and hypertension, and probably the use of agents that specifically block the renin-angiotensin axis. We briefly discuss the results of the main studies that have led to those conclusions.

Diabetes Complications↗
PubMed2003

[Prevention of hypoglycemia in patients with type 1 diabetes].

Hypoglycaemia is the most common metabolic disorder in type 1 diabetic patients. It is rarely dangerous, but significantly alters the quality of life and hinders the achievement of "normoglycaemia". Even if hypoglycaemia is impossible to be avoided, both its frequency and severity may be reduced if patients follow several practical recommendations. After having defined hypoglycaemia, we shall briefly describe its pathophysiology and its main causes in type 1 diabetic patients. Afterwards, the different approaches of prevention of hypoglycaemia will be discussed. We will particularly stress the need to revise the glycaemic target in high-risk patients, the role of optimising insulin therapy, the valuable help of blood glucose monitoring, the critical support of diet adjustments, and the appropriate management in case of physical activity. There is no doubt that patient's education plays a crucial role in such a strategy that aims at preventing severe hypoglycaemia in type 1 diabetic individuals.

Diabetes Mellitus, Type 1↗
PubMed2003

[Medication of the month. Glucovance in type 2 diabetes, a fixed combination of metformin-glibenclamide for the treatment of a bipolar metabolic disease].

Glucovance, recently launched by Merck-Lipha (Glucovance 500 mg/2.5 mg and Glucovance 500 mg/5 mg), is a fixed combined therapy of a sulphonylurea (glibenclamide 2.5 or 5 mg) and a biguanide (metformin 500 mg), indicated for the treatment of type 2 diabetes in adult patients. The only current official indication in Belgium is the substitution of a dual therapy with metformin and glibenclamide in patients with a stable and adequate metabolic control. The fixed combination aims at simplifying patient's treatment in order to improve compliance despite polymedication. In addition, it allows targeting synergistically the two main abnormalities of type 2 diabetes, i.e. the insulin secretory defect and the insulin resistance.

Blood Glucose Self-Monitoring↗
PubMed2003

[Prevention of cardiovascular diseases using a combined pharmacological approach: is there any place for a "polypill"?].

In the June 28, 2003 issue of the British Medical Journal, an extensive literature survey based on various large meta-analyses of the efficacy and safety of the reduction of four cardiovascular risk factors (cholesterol, arterial blood pressure, platelet aggregation, homocysteine) leads to the conclusion that a combined pharmacological intervention should reduce ischaemic heart disease events by 88% and strokes by 80% in at risk individuals. Therefore, a new paradigm is proposed for the prevention of cardiovascular diseases. This new strategy would consist in the systematic prescription to people with a history of heart attack or stroke, those with any form of obliterative atherosclerotic vascular disease or diabetes, and everyone aged 55 and older of a fixed combination of 6 pharmacological agents independently of initial risk factor profile.... Such pharmacological formulation, called "polypill", should contain a statin, three blood pressure lowering drugs (each at half standard dose), aspirin (75 mg/day) and folic acid (0.8 mg/day). We discuss the pros and cons of this new paradigm. However, the efficacy of such "polypill" remains to be demonstrated in a large controlled clinical trial as well as its superiority as compared to a classical approach of cardiovascular prevention based upon the individual optimal correction of each risk factor thanks a dose titration of each pharmacological compound.

Antihypertensive Agents↗
PubMed2003

[Adiponectin: a new adipocytokine].

Adipose tissue is not simply a store of excess energy, but also secretes a variety of proteins into circulating blood that influence systemic metabolism. These include tumor necrosis factor (TNF-alpha), plasminogen activator inhibitor type 1 (PAI-1), leptin, resistine and adiponectin. These are collectively known as adipocytokines. Adiponectin (also referred to as AdipoQ, Acrp 30, apM1 or GBP28) is a novel adipose-specific protein. A recent genome study mapped a susceptibility locus for type 2 diabetes and the metabolic syndrome on chromosome 3q27, where the adiponectin gene is located. Adiponectin is a peculiar adipocytokine because in contrast to the markedly increased levels of many others, as leptin or TNF-alpha, its level is reduced in obesity and type 2 diabetes. The administration of thiazolidinediones, which are synthetic PPARs-gamma ligands, significantly increases the plasma adiponectin concentrations, an effect that could improve insulin sensitivity. Thus, the administration of adiponectin may provide a novel treatment modality for insulin resistance and type 2 diabetes.

Adiponectin↗
PubMed2003

[Medication of the month. Vardenafil (Levitra)].

Vardenafil (Levitra), recently launched in Belgium by Bayer and Glaxo-SmithKline, is a new drug that potently and selectively inhibits phosphodiesterase type 5 (PDE5) in the cavernosum tissue of the penis. Inhibition of PDE5 blocks the hydrolysis of cyclic guanosine monophosphate (GMPc) and results in increased arterial blood flow leading to enlargement of the corpus cavernosum and resulting in erection. In controlled clinical trials, vardenafil at least doubled the rate of successful erections as compared to placebo, whatever the evaluation parameter considered and the subgroup of patients studied. Vardenafil is thus indicated in the treatment of patients with erectile dysfunction. It is presented as 5, 10 and 20 mg tablets and the usual dose is 10 mg to be ingested 25 to 60 minutes before sexual activity. Vardenafil has a more potent inhibitory activity of PDE5 in vitro than sildenafil or tadalafil while its pharmacokinetics in vivo is somewhat more rapid than that of the two other compounds. The dosage of vardenafil may be reduced to 5 mg (especially in older individuals) to improve tolerance or be increased up to 20 mg (especially in the presence of organic diseases aggravating erectile dysfunction) to improve efficacy. Contra-indications (co-administration with drugs increasing nitric oxide) and side-effects (headache and flushing due to vasodilatation) of vardenafil are similar to those of other PDE5 inhibitors.

Erectile Dysfunction↗