A J Scheen

..Because of these favourable properties, linagliptin may be used without dose adjustment (5 mg once a day) in patients with renal impairment, as well as in elderly people...

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..Weight loss, especially reduction of abdominal adiposity, and increased physical activity may contribute to improve insulin sensitivity and glucose tolerance, and prevent the development of type 2 diabetes in elderly people...

..Appropriate drug selection and dosing in patients with CKD is imperative to avoid drug adverse events and to ensure optimal patient outcomes...

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..New trials are supposed to confirm the potential role of rimonabant in patients with abdominal adiposity, atherogenic dyslipidaemia and/or type-2 diabetes, i.e. at high cardiometabolic risk...

..A multi-risk intervention is mandatory to improve the cardiovascular prognosis. The prevention of diabetes and its complications is a major public health objective...

..These intriguing results argue for a long-term memory of previous therapeutic interventions in cardiovascular prevention...

..When prescribing an atypical antipsychotic, a commitment to careful baseline screening and follow-up monitoring is essential in order to mitigate the risk of developing diabetes and associated complications...

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..Although no studies have been performed in patients with type 2 diabetes, the latter combination should be avoided in clinical practice...

..Insulin secretion should ideally be measured according to the corresponding insulin sensitivity. Dynamic tests are generally more informative than static measurements in the fasting state...

..Although some food components have also been shown to potentially interfere with drugs metabolised with the CYP system, no published study deals specifically with these possible CYP-mediated food-drug interactions with glitazones...

..The aim of the RIO-Diabetes trial was to assess the efficacy and safety of rimonabant in overweight or obese patients with type 2 diabetes that was inadequately controlled by metformin or sulphonylureas...

..Almost half of the metabolic effects, including adiponectin increase, occur beyond weight loss, suggesting a direct peripheral effect of rimonabant...

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..Finally, we will illustrate these theoretical considerations with some examples of drug interactions, among the most dangerous and the most frequent in clinical practice...

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..New trials are supposed to confirm the potential role of rimonabant (and other CB1 neutral antagonists or inverse agonists) in overweight/obese patients with type 2 diabetes and high risk cardiovascular disease...

..EXPERT OPINION: The combination saxaglitpin plus metformin may be used as first-line or second-line therapy in the management of type 2 diabetes, especially as a valuable alternative to the classical metformin-sulfonylurea combination...

..Future critical issues may include the durability of glucose control, resulting from better ?-cell protection, positive effects on cardiovascular outcomes and long-term safety issues...

..Tolerance and safety profile is rather good even if muscular and hepatic adverse events may occur. The prescription of statins should target high-risk individuals and both therapeutic inertia and drug non-compliance should be avoided...

..EXPERT OPINION: Head-to-head comparative studies and/or increased clinical experience with DPP-4 inhibitors will determine the clinical advantage, if any, of one agent over another...

..Dapagliflozin should be the first medication of this new pharmacological class to be commercialized for the management of type 2 diabetes...

..Indeed, the shift from squatting to standing imposes a major orthostatic stress leading to rapid and large changes in arterial blood pressure (BP) and heart rate (HR) allowing precise baroreflex assessment...

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..We will provide the pro-contra arguments concerning each therapeutic alternative and describe the practical modalities of an appropriate management according to the patient's characteristics...

..Functional imaging is of interest for exploring diabetes-associated cerebral abnormalities. Thus, the intimate relationship between the brain and diabetes is increasingly acknowledged in both research and clinical practice...

..In conclusion, concern still persists about the safety profile of sibutramine regarding cardiovascular outcomes, and the drug should not be prescribed for overweight/obese patients with a high cardiovascular risk profile...

..These rather disappointing results should be interpreted to provide practical guidelines...

..Adequate blood glucose control is necessary to minimize complications. DPP IV inhibitors (sitagliptin, vildagliptin, saxagliptin) offer new options for combined pharmacological therapy...

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..Thus, bariatric surgery may be said to be progressing towards so-called 'metabolic surgery', which merits further evaluation in patients with T2DM within a multidisciplinary approach that involves both surgeons and endocrinologists...

..placebo in patients with Type 2 diabetes treated with combined metformin-sulphonylurea therapy in the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROactive)...

..Ongoing studies should demonstrate whether improved metabolic disorders with CB1 receptor antagonists (rimonabant, taranabant, etc.) would translate into fewer cardiovascular complications among high-risk individuals...

..New prospective studies are mandatory before accepting such new potential indications of statins...

..However, the best dosage of acarbose for this specific indication remains to be specified, especially when all three important parameters, efficacy, tolerance and cost, are taken into consideration...

..What might be the main mechanism in the overall protection effect of ACEIs or ARBs remains an open question...

..Considering the pandemic of T2DM, such pharmacological approach deserves further attention among the strategies aiming at preventing T2DM...

..From a practical point of view, they may offer a new strategy to reduce the ongoing epidemic and burden of type 2 diabetes...

..The better understanding of the pathophysiology of the disease should lead to the development of new strategies to preserve beta-cell function in both type 1 and type 2 diabetes mellitus...

..The growing prevalence and high-risk nature of MetS highlights the need to identify individuals with this condition and to treat them with an aggressive multitargeted approach...

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..These two paradigms constitute the framework for the study of the interplay between insulin resistance and beta-cell dysfunction in type 2 diabetes as well as between our obesogenic environment and diabetes risk in the next decade...

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..This objective justifies more aggressive weight reduction programmes, including very-low-calorie diets and bariatric surgery, but only within a multidisciplinary approach and long-term strategy...

..In addition, some case reports have evidenced potential drug-drug interactions with various antihyperglycaemic agents that are usually associated with a higher risk of hypoglycaemia...

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..However, until now, results regarding efficacy and/or safety have been disappointing or preliminary in humans...

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..The evolution from obesity to diabetes represents a continuum that progresses through different phases in which defects in both insulin action and insulin secretion play a critical interaction and must be looked at in concert...

..Once neuropathy is diagnosed, the physician should provide specific advice to diabetic patients in order to prevent possible dramatic complications...

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..Recent clinical trials have shown both the efficacy and safety of this triple oral therapy. However, its precise place remains to be better specified in the overall management of type 2 diabetes...

..Whenever possible, we will focus our attention on the results obtained in the diabetic population...

..placebo in diabetic patients receiving metformin or sulphonylurea monotherapy at baseline in the PROspective pioglitAzone Clinical Trial in macroVascular Events (PROactive)...

..Whenever possible, we will focus our attention on the results obtained in the diabetic population...

..In contrast, valsartan reduced the incidence of type 2 diabetes by 14%, confirming the potential interest of the blockade of the renin-angiotensin system in this high-risk population...

..After 3-6 months of follow up, more than 95% of patients still received sitagliptin, arguing for both the efficacy and the good tolerance of this new oral antidiabetic agent in clinical practice...

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..XENDOS is the first study demonstrating that an antiobesity agent, like orlistat, is able to reduce the progression to diabetes in obese subjects as compared with lifestyle changes alone...

..Rimonabant is indicated in Europe as an adjunct to diet and exercise for the treatment of obese patients, or overweight patients with associated risk factor(s), such as type 2 diabetes or dyslipidaemia...

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..There was no evidence that the effects of the study treatment differed by initial blood pressure level or concomitant use of other treatments at baseline...

..The potential risks and benefits, the profile of adverse events, and the costs of the three drugs should all be considered to help inform the choice of pharmacotherapy for patients with type 2 diabetes...

..As all glitazones, rosiglitazone moderately promotes weight gain. It can also induce some fluid retention which may reveal or aggravate heart failure in at risk patients...

..To evaluate changes in pulse pressure (PP) and markers of cardiovascular autonomic neuropathy (CAN) according to duration of type 1 diabetes mellitus (T1DM)...

..The present paper aims at better understanding the etiopathogenesis and pathophysiology of this particular phenotype, at evaluating its potential clinical consequences and at describing the main principles of its therapeutic management...

..002). These results are, however, less marked than those obtained with lifestyle modifications including better dietary habits and increased physical exercise (-58% versus control group, p < 0.001)...

..The impact of sibutramine on cardiovascular morbidity and mortality of obese nondiabetic and diabetic patients will be studied soon in a large international prospective clinical trial...

..No comparison is made between this "new" association and the more frequently used biotherapy (i.e. ACE-I plus thiazidic diuretic) and therefore its usefulness in regular practice is still to be determined...

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..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...

..We summarize the most useful indices based on anamnesis, clinical examination and biological assays that can help to detect subjects at high risk of progression towards type 2 diabetes...

..The main results and conclusions of these trials are briefly presented as they open new perspectives in the management of patients with type 1 or type 2 diabetes mellitus...

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..In Belgium, sitagliptin is currently reimbursed in patients with type 2 diabetes not adequately controlled with diet and metformin monotherapy...

..We will conclude, referring to the recent position statement of the Advisory Committee of the Food and Drug Administration, by providing some practical recommendations...

..Ongoing trials aim at proving the efficacy of such a fixed combination in reducing cardiovascular morbidity and mortality...

..These agents should occupy a key place in the overall pharmacological strategy of type 2 diabetes in a near future, especially if the additional favourable effects on B cells are confirmed in clinical practice...

..These observations should motivate any practitioner to promote endurance physical exercise in every subject, especially in individuals at high cardiovascular risk...

..More particularly, it points out the importance of a correct differential diagnosis between C-peptide positive insulin-requiring type 2 diabetes and C-peptide negative (insulin-dependent) type 1 diabetes...

..In conclusion, in patients with type 2 diabetes who are at high cardiovascular risk, pioglitazone improves cardiovascular outcome, and reduces the need to add insulin to glucose-lowering regimens compared to placebo...

..We will discuss the advantages and limitations of this new definition as well as the consequences of its use on the prevalence of the metabolic syndrome in the Belgian population...

..Besides a better understanding of the natural history of the disease, these clinical trials open new perspectives for prevention of type 1 diabetes mellitus, currently assessed by the Belgian Diabetes Registry...

..Two large prospective, controlled, randomized, double-blind trials are ongoing to specifically confirm this interesting hypothesis, one with ramipril and the other with valsartan...

..The most important factors leading to adequate metabolic control are a global educational approach together with a intensified follow up, independently of the insulin regimen...

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..More surprisingly, fenofibrate exerted a favourable effect on microangiopathy complications, with less albuminuria progression and less retinopathy needing laser treatment (tertiary endpoints)...

..Such condition is rather common, especially among institutionalised subjects, and is usually associated with a higher risk of morbidity and mortality...

..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...

..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...