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1.
Rev Med Liege ; 75(9): 626-632, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32909416

RESUMO

Ertugliflozin is a new sodium-glucose cotransporter type 2 inhibitor (SGLT2i) that is indicated in the treatment of type 2 diabetes. It has been investigated in the large phase 3 development programme VERTIS, in monotherapy and in association with different antidiabetic medications, including insulin. The add-on of ertugliflozin to metformin (VERTIS MET) and the association ertugliflozin-sitagliptin (VERTIS-SITA, VERTIS FACTORIAL, VERTIS SITA2) showed a significant reduction in glycated haemoglobin, without hypoglycaemia, together with a diminution of body weight and arterial blood pressure. As expected, more genital mycotic infections were observed, the only adverse event consistently reported. The cardiovascular safety of ertugliflozin has been demonstrated in VERTIS CV. Ertugliflozin is commercialized with two doses 5 mg and 15 mg. This SGLT2i is also available in fixed-dose combinations, ertugliflozin-metformin and ertugliflozin-sitagliptin. The three presentations offer a greater flexibility to the practitioner to optimize therapeutic choices for a complex disease where the treatment should be individualized according to the patient profile.


Assuntos
Diabetes Mellitus Tipo 2 , Metformina , Compostos Bicíclicos Heterocíclicos com Pontes , Humanos , Hipoglicemiantes
2.
Diabetes Metab ; 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32750451

RESUMO

Type 2 diabetes mellitus (T2DM) is associated with both poorer clinical outcomes during the COVID-19 pandemic and an increased risk of death in such hospitalized patients. While the role of glucose control has been emphasized to improve the prognosis, the impact of different glucose-lowering agents remains largely unknown. Metformin remains the first-line pharmacological choice for the management of hyperglycaemia in T2DM. Because metformin exerts various effects beyond its glucose-lowering action, among which are anti-inflammatory effects, it may be speculated that this biguanide might positively influence the prognosis of patients with T2DM hospitalized for COVID-19. The present concise review summarizes the available data from observational retrospective studies that have shown a reduction in mortality in metformin users compared with non-users, and briefly discusses the potential underlying mechanisms that might perhaps explain this favourable impact. However, given the potential confounders inherently found in observational studies, caution is required before drawing any firm conclusions in the absence of randomized controlled trials.

3.
Diabetes Metab ; 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: covidwho-600994
6.
Rev Med Liege ; 75(5-6): 392-398, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32496686

RESUMO

Type 2 diabetes is a complex disease with an increasing prevalence and a huge morbidity and premature mortality, essentially due to cardiovascular and renal complications. Classical glucose-lowering agents (metformin, sulphonylureas) exert little protective effects on these complications so that emphasis has been put on a multifactorial management targeting all risk factors. Gliptins offer the advantage of an excellent tolerance profile, with no hypoglycaemia or weight gain, but have not shown any specific cardiovascular or renal protection. Over the last decade, new antidiabetic medications (glucagon-like peptide-1 receptor agonists and gliflozins) have demonstrated a cardiovascular and renal protection, independently of glucose control. These data of evidence-based medicine have revolutionized the therapeutic approach of patients with type 2 diabetes who are at high risk of atherosclerotic cardiovascular disease, heart failure and progressive renal disease. Unexpectedly, the protective effect of gliflozins is currently investigated in patients with heart failure or renal disease, in the absence of diabetes.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Inibidores da Dipeptidil Peptidase IV , Inibidores do Transportador 2 de Sódio-Glicose , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Humanos , Hipoglicemiantes , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
7.
Diabetes Metab ; 2020 May 21.
Artigo em Inglês | MEDLINE | ID: covidwho-347515

RESUMO

Diabetes mellitus is challenging in the context of the COVID-19 pandemic. The prevalence of diabetes patients hospitalized in intensive care units for COVID-19 is two- to threefold higher, and the mortality rate at least double, than that of non-diabetes patients. As the population with diabetes is highly heterogeneous, it is of major interest to determine the risk factors of progression to a more serious life-threatening COVID-19 infection. This brief review discusses the main findings of CORONADO, a prospective observational study in France that specifically addressed this issue as well as related observations from other countries, mainly China and the US. Some prognostic factors beyond old age have been identified: for example, an increased body mass index is a major risk factor for requiring respiratory assistance. Indeed, obesity combines several risk factors, including impaired respiratory mechanics, the presence of other comorbidities and inappropriate inflammatory responses, partly due to ectopic fat deposits. While previous diabetic microvascular (renal) and macrovascular complications also increase risk of death, the quality of past glucose control had no independent influence on hospitalized diabetes patient outcomes, but whether the quality of glucose control might modulate risk of COVID-19 in non-hospitalized diabetes patients is still unknown. In addition, no negative signs regarding the use of RAAS blockers and DPP-4 inhibitors and outcomes of COVID-19 could be identified. Hyperglycaemia at the time of hospital admission is associated with poor outcomes, but it may simply be considered a marker of severity of the infection. Thus, the impact of glucose control during hospitalization on outcomes related to COVID-19, which was not investigated in the CORONADO study, is certainly deserving of specific investigation.

8.
Diabetes Metab ; 46(4): 265-271, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32447101

RESUMO

Diabetes mellitus is challenging in the context of the COVID-19 pandemic. The prevalence of diabetes patients hospitalized in intensive care units for COVID-19 is two- to threefold higher, and the mortality rate at least double, than that of non-diabetes patients. As the population with diabetes is highly heterogeneous, it is of major interest to determine the risk factors of progression to a more serious life-threatening COVID-19 infection. This brief review discusses the main findings of CORONADO, a prospective observational study in France that specifically addressed this issue as well as related observations from other countries, mainly China and the US. Some prognostic factors beyond old age have been identified: for example, an increased body mass index is a major risk factor for requiring respiratory assistance. Indeed, obesity combines several risk factors, including impaired respiratory mechanics, the presence of other comorbidities and inappropriate inflammatory responses, partly due to ectopic fat deposits. While previous diabetic microvascular (renal) and macrovascular complications also increase risk of death, the quality of past glucose control had no independent influence on hospitalized diabetes patient outcomes, but whether the quality of glucose control might modulate risk of COVID-19 in non-hospitalized diabetes patients is still unknown. In addition, no negative signs regarding the use of RAAS blockers and DPP-4 inhibitors and outcomes of COVID-19 could be identified. Hyperglycaemia at the time of hospital admission is associated with poor outcomes, but it may simply be considered a marker of severity of the infection. Thus, the impact of glucose control during hospitalization on outcomes related to COVID-19, which was not investigated in the CORONADO study, is certainly deserving of specific investigation.


Assuntos
Infecções por Coronavirus , Complicações do Diabetes , Pandemias , Pneumonia Viral , Idoso , Betacoronavirus , Glicemia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Complicações do Diabetes/complicações , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Prognóstico , Respiração Artificial , Fatores de Risco
9.
Rev Med Liege ; 75(4): 233-239, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32267111

RESUMO

The strategy for the management of type 2 diabetes (T2D) has been updated late 2019-2020 by a group of experts of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). The indications of two pharmacological classes that have demonstrated a cardiovascular and renal protection, i.e. sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1AR), are now extended because of the favourable results of recent clinical trials. In patients with T2D at high cardiovascular risk (even without previous event, but with indicators of atherosclerotic disease), the addition of these antidiabetic agents to metformin background therapy is now recommended independently of the glycated haemo¬globin (HbA1c) level. For SGLT2i, the prescription may be extended to patients with an estimated glomerular filtration rate down to 30 (instead of 60) ml/min/1.73 m², in particular in patients with progressive renal disease and albuminuria and in patients at risk of heart failure, especially if left ventricular ejection fraction is reduced. However, these new proposals could not be applied stricto sensu because of strict reimbursement criteria based upon HbA1c currently applied in our country.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemiantes , Disfunção Ventricular Esquerda/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico , Rim , Nefropatias/complicações , Volume Sistólico , Função Ventricular Esquerda
10.
Rev Med Liege ; 75(4): 260-264, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32267116

RESUMO

LDL cholesterol targets are increasingly strict in recent international guidelines, especially in patients at very high or high cardiovascular risk. To reach these targets, it is recommended to use a potent statin, with a titration up to the maximal tolerated dose and, if not sufficient, to combine ezetimibe, a medication that blocks the intestinal absorption of cholesterol. This association allows reduce the dose of statin, while keeping an excellent cholesterol-lowering efficacy and favouring a good tolerance profile. This article describes the characteristics of a fixed-dose combination of rosuvastatin, the most potent statin, and ezetimibe, commercialized in Belgium under the trade name Myrosor®.


Assuntos
Anticolesterolemiantes , Ezetimiba , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , Rosuvastatina Cálcica , Anticolesterolemiantes/administração & dosagem , Bélgica , LDL-Colesterol , Quimioterapia Combinada , Ezetimiba/administração & dosagem , Humanos , Hipercolesterolemia/tratamento farmacológico , Rosuvastatina Cálcica/administração & dosagem , Resultado do Tratamento
11.
Rev Med Liege ; 75(3): 154-158, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32157839

RESUMO

Syncope is a frequent reason for admission to emergency department or consultations. The common pathophysiological mechanism is a drop in systemic blood pressure leading to cerebral hypoperfusion, and ultimately to total loss of consciousness. The causes are multiple, with varying degrees of severity, classified into three main types : reflex syncope, syncope due to orthostatic hypotension and cardiac syncope. Among these, orthostatic hypotension can be easily detected, particularly by performing an orthostatic challenge with active standing, which is recommended in the presence of any syncope. Simple measures can reduce the recurrence of this type of syncope, even if sometimes drug treatments are necessary. In this article, we will detail the characteristics, diagnostic methods and therapies recommended by the latest guidelines of the European Society of Cardiology.


Assuntos
Hipotensão Ortostática , Síncope , Serviço Hospitalar de Emergência , Humanos , Hipotensão Ortostática/complicações , Recidiva , Síncope/diagnóstico , Síncope/etiologia , Síncope/terapia
12.
Diabetes Metab ; 46(3): 186-196, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32007623

RESUMO

AIMS: This study compared the reduction of glycated haemoglobin (HbA1c) with sodium-glucose cotransporter type-2 inhibitors (SGLT2is) vs. dipeptidyl peptidase-4 inhibitors (DPP-4is) as add-ons to metformin in patients with type 2 diabetes mellitus (T2DM), with a specific focus on HbA1c changes according to baseline HbA1c. MATERIALS AND METHODS: Electronic databases were scrutinized for randomized controlled trials (RCTs) evaluating the reduction of HbA1c from baseline (Δ HbA1c) with an SGLT2i or DPP-4i in patients with T2DM not well controlled by metformin monotherapy. The endpoint was Δ HbA1c using both indirect and direct comparisons. RESULTS: Overall, Δ HbA1c was slightly greater with SGLT2is (-0.80±0.20% from 8.03±0.35%; 44 analyses, 29 RCTs, 15 with two doses, n=9321) than with DPP-4is (-0.71±0.23% from 8.05±0.43%; 61 analyses, 59 RCTs, n=17,914; P=0.0354). When the mean baseline HbA1c was<8% ([64mmol/mol] 7.79±0.15% vs. 7.71±0.23%), Δ HbA1c averaged -0.735±0.17% vs. -0.62±0.16% (P=0.0117) with SGLT2is vs. DPP-4is, respectively. However, this difference vanished when the mean baseline HbA1c was≥8% (-0.87±0.22% from 8.27±0.32% with SGLT2is vs. -0.80±0.24% from 8.35±0.33% with DPP-4is; P=0.2756). The relationship between Δ HbA1c and baseline HbA1c was only slightly stronger with SGLT2is (slope: -0.39, r2=-0.43; P<0.0001) than with DPP-4is (slope: -0.26, r2=-0.25; P<0.0001). CONCLUSION: Because of the small difference in Δ HbA1c whatever the baseline HbA1c level with SGLT2is vs. DPP-4is as add-ons to metformin, choosing between these glucose-lowering agents in clinical practice should be based on other efficacy criteria (such as weight and blood pressure changes, cardiovascular and renal protection) or on safety profiles rather than on HbA1c levels.

13.
Rev Med Liege ; 75(1): 60-66, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920046

RESUMO

The shift to injection therapy, after failure of oral antidiabetic agents, is often considered as a difficult step by both the patient with type 2 diabetes and the physician, a situation that may lead to clinical inertia. Schematically, two options may be considered, either starting insulin therapy with a preference for basal insulin analogues, or adding a glucagon-like peptide-1 receptor agonist (GLP-1 RA). Each option has its advantages and disadvantages, which opens the road to personalized medicine. Nevertheless, the preference is increasingly given to GLP-1 AR, yet this solution is more limited by reimbursement conditions. A combination of the two approaches is also possible, with the recent commercialisation of fixed-ratio specialities combining a basal insulin analogue and a GLP-1 RA. This clinical case offers the opportunity to discuss all these different therapeutic options in a patient with poorly controlled type 2 diabetes despite a combination of oral antidiabetic agents, taking also into account the current conditions for reimbursement in Belgium.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemiantes , Administração Oral , Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon , Receptor do Peptídeo Semelhante ao Glucagon 1 , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem
14.
15.
Rev Med Liege ; 74(10): 508-513, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31609553

RESUMO

Canagliflozin, a sodium-glucose cotransporter type 2 inhibitor, has been evaluated in two large clinical trials, CANVAS that focused on cardiovascular (CV) risk and CREDENCE that focused on renal risk. CANVAS recruited type 2 diabetic patients (T2D) at high CV risk (65 % in secondary prevention) and demonstrated that canagliflozin significantly reduces major CV events, hospitalisations for heart failure and renal outcomes when compared to placebo. CREDENCE specifically enrolled T2D patients with albuminuric renal disease (50 % in secondary CV prevention). This trial confirmed the cardiovascular protection reported in CANVAS with canagliflozin and more specifically demonstrated a renal protection, including a reduced progression towards end-stage renal disease, in this particular population. Finally, CREDENCE did not observe the increased risk for bone fractures and lower-limb amputations previously reported in CANVAS. Globally, these two studies emphasize a favourable benefit/risk balance of canagliflozin in a T2D population at CV or renal risk, including in patients with a glomerular filtration rate comprised between 30 et 60 ml/min/1.73 m².


Assuntos
Canagliflozina , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Inibidores do Transportador 2 de Sódio-Glicose , Canagliflozina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Taxa de Filtração Glomerular , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
16.
Rev Med Liege ; 74(9): 443-450, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31486312

RESUMO

Type 2 diabetes (T2D) is an evolving disease that requires therapeutic adjustments to maintain adequate glucose control in the long run. An increasing number of patients with T2D are treated with a metformin plus gliptin (DPP-4 Inhibitor) combination, especially those for whom a sulfonylurea is avoided because of a risk of hypoglycaemia. When this dual metformin-gliptin therapy becomes insufficient to reach or maintain adequate glucose control, three solutions may be considered : the addition of a gliflozin (SGLT2 inhibitor), the replacement of the gliptin by a glucagon-like peptide-1 receptor agonist or the addition of a basal insulin whose posology should be progressively up-titrated according to fasting glycaemia. This article describes the pro and contra arguments of these three therapeutic regimens. According to the recent data of the literature, the triple oral therapy combining metformin, a gliptin and a gliflozin appears to offer a favourable alternative in terms of efficacy, tolerance, ease of use, patient adherence and cost.


Assuntos
Diabetes Mellitus Tipo 2 , Inibidores da Dipeptidil Peptidase IV , Metformina , Inibidores do Transportador 2 de Sódio-Glicose , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Quimioterapia Combinada , Humanos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
17.
Rev Med Liege ; 74(9): 488-494, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31486321

RESUMO

Semaglutide (Ozempic®) is a new once-weekly agonist of glucagon-like peptide-1 receptors (GLP-1 AR) indicated in the treatment of type 2 diabetes (T2D). Phase III clinical trials of the SUSTAIN programme demonstrated both the efficacy and safety of semaglutide in patients with T2D treated by diet and exercise, oral antidiabetic agents or even insulin. Direct and indirect comparative clinical trials showed that semaglutide (subcutaneous 0.5 or 1.0 mg once weekly) exerts a better glucose-lowering activity and a greater weight loss than other GLP-1 AR. Presented as prefilled pens for subcutaneous injection, semaglutide is currently reimbursed in Belgium after failure of antidiabetic therapy including metformin (HbA1c superior to 7,5 % or 58 mmol/mol) in T2D patients with body mass index ? 30 kg/m².


Assuntos
Diabetes Mellitus Tipo 2 , Peptídeos Semelhantes ao Glucagon , Hipoglicemiantes , Bélgica , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1 , Peptídeos Semelhantes ao Glucagon/uso terapêutico , Humanos , Hipoglicemiantes/uso terapêutico
19.
Rev Med Liege ; 74(5-6): 258-264, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-31206263

RESUMO

Alcohol intoxication during car driving represents a well-recognized danger and is responsible for numerous accidents leading to premature death or infirmities. The objectives of this article are to describe some epidemiological data about driving under alcohol influence and associated car accidents, to remind which alcohol blood concentrations are acceptable from a legal point of view, to analyse the acute effects of alcohol on cortical function that could alter driving capacities and, finally, to consider some conditions that may reduce or increase the effects of alcohol on the performances during car driving. Keywords : Alcohol - Car accident - Driving - Brain.


Assuntos
Consumo de Bebidas Alcoólicas , Intoxicação Alcoólica , Condução de Veículo , Etanol , Humanos
20.
Rev Med Liege ; 74(5-6): 304-309, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-31206271

RESUMO

Metabolic disturbances associated with chronic alcohol consumption, among which those affecting glucose regulation, lipid profile, uric acid and nutritional status, are described. In fact, alcohol abuse can lead to overweight and obesity, but also to protein-caloric malnutrition. Finally, we will discuss concerns about vitamin and mineral deficiencies that may be observed in alcoholic people and can contribute to aggravate somatic complications.


Assuntos
Consumo de Bebidas Alcoólicas , Desnutrição , Obesidade , Consumo de Bebidas Alcoólicas/efeitos adversos , Humanos , Estado Nutricional , Ácido Úrico
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