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Biomedical subjects

A J Scheen

Publications and source records attributed to A J Scheen.

At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

[Drug-induced diabetes mellitus: the exemple of atypical antipsychotics].

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.

Antipsychotic Agents↗
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[Diabetic cardiac autonomic neuropathy].

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).

Autonomic Nervous System Diseases↗
PubMedDate not supplied

[Type 2 diabetes, in the heart of the metabolic syndrome: plea for a global approach].

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 Liège 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.

Diabetes Complications↗
PubMedDate not supplied

[The role of diabetes convention centres in Belgium].

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.

Belgium↗
PubMedDate not supplied

[Initiave to promote quality of care and epidemiology of diabetes mellitus].

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.

Belgium↗
PubMedDate not supplied

[Do statins have a place for cardiovascular prevention in elderly people?].

Cardiovascular prevention should only be considered if the treatment reduces the incidence of coronary and cerebrovascular events and death. In elderly people, such treatment should also, and most importantly, help maintain a good quality of life, without increasing the risk of iatrogenic side-effects. These key-elements should be kept in mind when prescription of a statin is envisaged in the old (> 70 years) and especially the very old (> 80 years) individual. Randomised controlled trials in people above 70 years are rather rare. In the field of cardiovascular prevention, two studies provide information, on post-hoc analysis of the Heart Protection Study (HPS) with simvastatin and the PROSPER trial with pravastatin. The protection observed in the general population of HPS was also present in the subgroup of subjects aged above 70, both for coronary and cardiovascular events. The difference was less impressive in PROSPER, without any significant difference as far as the incidence of stroke was concerned. None of these two prospective trials provide specific data on individuals above 80. Interestingly, some experimental and epidemiological observations suggested that statins may prevent Alzheimer disease. However, the data from HPS and PROSPER are not convincing in this respect. Thus, results from new ongoing trials should be awaited, especially in patients with mild to moderate Alzheimer disease. Finally, it is noteworthy that low serum cholesterol level can be used as a marker of poor nutrition in very old people. Such condition is rather common, especially among institutionalised subjects, and is usually associated with a higher risk of morbidity and mortality.

Aged↗
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[Angiotensin converting enzyme inhibitors or angiotensin II receptor blocker in cardiovascular and renal pathology in 2006: what does EBM teach us?].

Inhibitors of the renin-angiotensin system have proved their great value in secondary prevention trials for cardiovascular or renal complications. In favour of the preferred use of angiotensin receptor antagonists stand their excellent tolerance and the possible therapeutic escape seen with angiotensin converting enzyme inhibitors. For the preferential use of the latter, the arguments are the absence of a real proof of any superiority of the angiotensin receptor blockers and their higher cost. The wisdom is to initially use angiotensin converting enzyme inhibitors in secondary prevention excepted when they are not well tolerated. The large ONTARGET cardiovascular prevention trial should help solve this controversy.

Angiotensin II Type 2 Receptor Blockers↗
PubMedDate not supplied

[Effects of glimepiride (Amarylle) in type 2 diabetic patients: results of the Belgian study RECORD in general medicine].

Sulfonylureas still have a key place in the treatment of type 2 diabetes, especially those of the last generation. This article describes the results of a post-marketing study (RECORD, Routine Evaluation Conducted On Registered Drugs project) focusing on glimepiride (Amarylle). This study investigated the efficacy, safety and tolerance of glimepiride in primary care. It was performed in Belgium and concerned 1.012 patients with type 2 diabetes followed for 6 months by 204 general practitioners. Almost two thirds of recruited patients already received oral glucose-lowering agents whereas one third were naive patients. This open study showed a progressive decrease of fasting blood glucose and glycated haemoglobin (HbA1c) levels with glimepiride (titrated from 1 to 6 mg/day, as needed, with a mean daily dose of 2,6 mg), together with a simultaneous slight reduction in body weight and without any increase of the hypoglycaemic risk. Primary care physicians considered both the efficacy and tolerance of glimepiride as good or very good in more than 90% of cases. The value of such a study is to provide valuable information about glimepiride use in real life, a condition that may differ from strict follow-up imposed in randomised controlled clinical trials.

Belgium↗
PubMedDate not supplied

[Role of micronutrients in medicine].

Adequate micronutrient intake throughout life course is essential for the maintenance of health. Micronutrients are necessary for the maintenance of intermediary metabolism, play a crucial role as co-factors or co-enzymes in the activity of virtually all enzymes, and have important functions to neutralise the deleterious effects of oxidant species. Claims have been made for the benefits of micronutrient supplementation. Clinical benefit of a supplementation is obvious in those individuals who are severely depleted and at risk of complications. More recently, the concept of subclinical deficit has been developed, which essentially relies upon biochemical abnormalities the interpretation of which remains doubtful in most instances. Symptomatology related to such subclinical deficit is non specific and the potential advantages of micronutrient supplements remain marginal and largely not well-established. In contrast, provision of excess supplements to individuals who do not need them may be harmful. In the general population, a well-balanced diet supplies an adequate intake of micronutrient. Further research is needed to identify the best markers of micronutrient and antioxidant status, so that at risk patients can be identified and appropriate supplementation provided accordingly. New large-scale trials of different doses of micronutrients, based on precise outcome markers, are required to optimise intakes in different groups of patients as well as in the general population.

Dietary Supplements↗
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[Drug interactions: from theory to practice].

Pharmacotherapy becomes increasingly complex and therapeutic targets are more and more ambitious for both care and prevention. Therefore, polypharmacy is frequent, which exposes the patient to a high risk of drug-drug interactions. These are often underestimated although they are responsible for many adverse events that may be serious and even fatal. In the present paper, we will first briefly recall the main cautions in the use of medications as well as the most common conditions favouring the occurrence of harmful drug interactions. Then, we will analyze the various mechanisms leading to drug interactions, emphasizing especially those involving cytochrome P450 enzymatic system and P-glycoprotein. Finally, we will illustrate these theoretical considerations with some examples of drug interactions, among the most dangerous and the most frequent in clinical practice.

Cytochrome P-450 Enzyme System↗
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[Advices for a better drug prescription].

The prescription of a pharmacological agent concludes most medical visits. The rational basis of drug prescription by the physician relies on numerous pharmacodynamic, pharmacokinetic, pragmatic and economic considerations. However, it is a pity to notice that one patient out of two does not strictly follow the pharmacological treatment as it was prescribed. This article analyses some problems of the patient-doctor relationship, which may reduce medication compliance, and provides practical advice for improving such a situation in order to enhance both efficacy and safety of drug prescribing.

Drug Prescriptions↗
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[Arterial pulse pressure in relation to the duration of type 1 diabetes: a cross-sectional controlled study].

Diabetes mellitus and arterial pulse pressure (PP) are two independent cardiovascular risk factors. This cross-sectional study investigated the influence of diabetes duration on PP in type 1 diabetic patients without any cardiovascular disease. PP was measured continuously during 3 minutes (active orthostatic test: 1 min standing--1 min squatting--1 min standing) using a fingertip plethysmograph (Finapres) in 159 type 1 diabetic patients aged 20-60 yrs. They were divided into 4 groups according to diabetes duration: (1) G1 : <10 yrs (n=39); G2: 11-20 yrs (n=45); G3: 21-30 yrs (n=57); and G4: >30 yrs (n=18). In order to separate the effects of age from the effects of diabetes duration, diabetic patients were compared to age- and sex-matched non diabetic controls. PP (expressed in mmHg; mean +/- SD) was higher in men than in women in both diabetic (58 +/- 15 vs. 50 +/- 14; p = 0.001) and non diabetic subjects (55 +/- 14 vs. 47 +/- 12; p = 0.001). Overall PP was higher in diabetic than in non diabetic individuals (54 +/- 15 vs. 50 +/- 13; p = 0.025). PP progressively increased according to diabetes duration: 47 +/- 16 vs. 51 +/- 13 vs. 59 +/- 14 vs. 62 +/- 12, from G1 to G4 respectively; p < 0.0001. Such an increase was not observed in age-matched non diabetic subjects: 50 +/- 11 vs. 52 +/- 12 vs. 49 +/- 14 vs. 52 +/- 18, from G1 to G4, respectively; NS. PP was higher in squatting than in standing position in non diabetic subjects (52 +/- 16 vs. 47 +/- 13; p < 0.0001) and even more in diabetic patients (59 +/- 17 vs. 50 +/- 14; p < 0.0001). Overall, PP difference between diabetic and non diabetic individuals was not significant in standing position (50 +/- 14 vs. 47 +/- 13; NS) although it became highly significant in squatting position (59 +/- 17 vs. 52 +/- 16; p = 0.0005). The squatting-standing difference in PP markedly increased with diabetes duration: 69 +/- 14 during squatting vs. 50 +/- 18 during standing in G4 compared to respectively 50 +/- 17 vs. 44 +/- 15 in G1 diabetic patients. Finally, PP was similar (NS) in diabetic patients with HbA1c < 8% (54 +/- 14) or > or =8% (55 +/- 16), with (57 +/- 17) or without (54 +/- 14) microalbuminuria, treated (56 +/- 14) or not (54 +/- 15) by inhibitors of the renin-angiotensin system. In conclusion, PP progressively increased with the duration of type 1 diabetes, independently of age. Such increase was more marked in squatting than in standing position. The role of such PP rise in the increased cardiovascular risk of patients with type 1 diabetes, although suspected in the recent EURODIAB Prospective Complications Study, deserves further investigation.

Adult↗
PubMedDate not supplied

[Lack of benefit from the intermittent administration of insulin in treatment using subcutaneous perfusion pump in type 1 diabetes].

Our study is based on two constatations: 1) Hyperinsulinaemia, a possible atherogenic factor, is frequent under continuous subcutaneous insulin infusion. 2) Pulsatile intravenous insulin delivery improve the insulin's hypoglycaemic activity. To test if equivalent metabolic control can be obtained with a reduced intermittent subcutaneous infused insulin dose, we compared nocturnal metabolic control of 8 c-peptide negative type 1 diabetic patients under three experimental conditions: Continuous usual dose test (1.0 +/- 0.1 u/h); Intermittent half dose test (1.0 +/- 0.1 u/h, 30 min/h); Continuous half dose test (0.5 +/- 0.05 u/h) Five parameters were monitored: blood glucose, plasma free insulin and beta-hydroxy-butyrate, free fatty acid and glycerol plasma level. No significant differences were found between intermittent and continuous half-dose tests. We conclude that, in our experimental conditions, intermittent subcutaneous insulin infusion does not reduce the metabolic degradation induced by insulin dose reduction.

3-Hydroxybutyric Acid↗
PubMedDate not supplied

[Pharmacokinetics of insulin administered subcutaneously. Application to treatment by portable pump (1)].

Continuous subcutaneous insulin infusion is characterized by a basal insulin delivery rate to which insulin boluses are added. The basal delivery rate maintains a small insulin reserve in the local subcutaneous depot. This reserve averages 2 to 5 times the hourly basal rate at the steady-state which is reached after about 7 hours but depends on numerous factors: subcutaneous blood flow, skinfold thickness, insulin concentration, etc. It explains the pharmacokinetics time-lag of the system, more particularly the similar effects of a basal rate delivered in either a pulsatile/intermittent or a continuous manner, the lack of deleterious effect of a 1-h pump arrest, the 2-h delay before significant metabolic deterioration during a more prolonged interruption of the infusion, the delayed plasma insulin changes when the basal insulin delivery rate is doubled or reduced by half, etc. Insulin boluses pharmacokinetics is not fundamentally different from that of soluble insulin injection in conventional therapy. As an example, insulin boluses should ideally be given 30 min before the meals in order to better prevent post-prandial hyperglycaemia. However, the absence of intermediate zinc-insulin in the system may result in an earlier increase of plasma free insulin levels, which for instance allows a rapid correction of the metabolic alterations induced by a prolonged interruption of the basal infusion rate. This kinetics does not seem to be significantly altered by insulin concentration nor by the profile of the bolus but is affected by the insulin content of the subcutaneous depot at the time the bolus is delivered.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

The intra-nasal administration of insulin induces significant hypoglycaemia and classical counterregulatory hormonal responses in normal man.

The present study aimed at investigating the metabolic and hormonal consequences of intra-nasal administration of insulin in normal man. Lyophylisated regular porcine insulin (Insuline Ordinaire Organon) diluted with a non ionic detergent (Laureth-9 0,25%) was administered intra-nasally in 8 overnight fasted healthy volunteers using a calibrated aerosol delivery device (90 microliters = 9 U of insulin/spray) up to a total insulin dose close to 1 U/kg body weight. After intra-nasal insulin administration, plasma insulin levels rose from 5 +/- 1 to 38 +/- 10 mU/l (2p less than 0.01) at min 15, blood glucose concentrations decreased from 4.4 +/- 0.2 to 3.2 +/- 0.3 mmol/l (2p less than 0.01) at min 45, plasma C-peptide levels diminished from 327 +/- 31 to 174 +/- 28 mumol/l (2p less than 0.01) at min 60 and plasma free fatty acids concentrations fell from 336 +/- 109 to 130 +/- 31 mumol/l (2p less than 0.05) at min 30. The fall in blood glucose resulted in a prompt increase in plasma glucagon levels (from 78 +/- 28 to 150 +/- 24 ng/l at min 45; 2p less than 0.05) and in later rises in plasma growth hormone and cortisol concentrations. There was a close relationship between the individual maximal decreases in blood glucose levels and the individual maximal increases in plasma insulin (r = 0.81), glucagon (r = 0.88), cortisol (r = 0.87) and growth hormone (r = 0.76) concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗