Management of Type 2 diabetes in 2019: the same cost/efficiency ratio? The nephrologist’s perspective

Jean-François Cambier Published in the journal : March 2019 Category : Session de Diabétologie

Diabetic nephropathy is currently the leading cause of chronic end-stage renal disease. Its prevention is essential and implies a multidisciplinary management of the diabetic patient, as based on a strict control of blood glucose levels from the onset of diabetes, control of blood pressure, with a privileged place for either ACE inhibitors or sartans whose anti-proteinuric effect has been well demonstrated, and control of other cardiovascular risk factors. In addition, chronic kidney disease significantly increases the cardiovascular risk of diabetic patients. Recent randomized clinical trials involving the new classes of anti-diabetic agents (DPP4-inhibitors, GLP-1 receptor agonists, and SGLT2-inhibitors) have demonstrated the cardiovascular protection ensured by several molecules (empaglifozin, canaglifozin, dapaglifozin, liraglutide, semaglutide, albiglutide, and dulaglutide), along with an additional nephroprotective effect shown for gliflozins, liraglutide, and semaglutide.

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Type 2 diabetes management in 2019: the same cost-efficiency? The cardiologist’s perspectives

Christophe Beauloye Published in the journal : March 2019 Category : Session de Diabétologie

Diabetes is a major cardiovascular risk factor, as it significantly increases the risk of cardiovascular events, such as myocardial infarction or stroke. In addition, once these last complications have occurred, the patient prognosis is poorer. Recently, as well documented in the scientific literature, diabetes has been demonstrated to be a significant risk factor for heart failure. New anti-hyperglycemic treatments for Type 2 diabetes and, particularly, sodium-glucose-2 co-transporter inhibitors have reduced cardiovascular events both in primary and secondary prevention. This pharmacological class has been proven to protect Type II diabetes patients from heart failure and to reduce their mortality. These medications’ impact on the occurrence of acute coronary syndromes appears to be more marginal.

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Type 2 diabetes management in 2019: the same cost-efficiency ratio? The diabetologist’s perspective

Michel P. Hermans Published in the journal : March 2019 Category : Session de Diabétologie

The results of 14 prospective randomized clinical trials designed to verify the macrovascular safety of various classes of anti-hyperglycemic agents in T2DM, such as DPP4-inhibitors, SGLT2-inhibitors, and GLP-1 receptor agonists, have confirmed their safety for use in all studies; for some molecules, such as empagliflozine, canagliflozine, dapagliflozine, liraglutide, semaglutide, albiglutide and dulaglutide, the data revealed a beneficial pleiotropic effect on the primary endpoint, usually consisting of a composite of CV death, non-fatal infarction, and non-fatal stroke.

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Diabetic Charcot foot: crossed looks on the scientific literature and our 5-year clinical expertise at the University clinics of Saint-Luc

Laura Orioli (1), Dan Putineanu (2), Frank Hammer (3), Bruno Vande Berg (3), Dominique Maiter (1), Bernard Vandeleene (1) Published in the journal : March 2019 Category : Session de Diabétologie

The Charcot foot, a rare medical condition, defines a particular form of the diabetic foot, representing both a diagnostic and therapeutic challenge.

In 2017, we reviewed the medical records of patients with a Charcot foot, who were hospitalized in our diabetic foot unit between 2010 and 2014. In this article, we have combined some of our results with those retrieved from the literature in order to deliver several key messages dedicated to the everyday practice.

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Diagnostic and therapeutic innovations in rheumatology in 2018

Bernard R. Lauwerys Published in the journal : February 2019 Category : Rheumatology

Novel therapeutic developments are increasing in the field of rheumatology, particularly with respect to inflammatory and systemic rheumatisms.

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Innovations in 2018 in the psychiatry field ?

Published in the journal : February 2019 Category : Psychiatrie

Psychiatry occupies a very specific position within the field of medicine, given that it integrates the biological, psychological, and sociological dimensions that all contribute to the expression of mental health disorders. The essential innovations that have taken place within the fields of biology and more particularly, neuroscience, experimental psychology, and social sciences, may all be instrumental in advancing the field of psychiatry. On the other hand, psychiatry appears to be quite preoccupied with the mental health treatment reform that will profoundly modify treatment attitudes, involving an increase in community mental healthcare services, as well as more efficient first-line care facilities for mental health problems. On account of this treatment reform, special attention will be given to limiting desocialization of patients, developing mobile care units that are able to visit isolated patients at home, while promoting care intensification within hospital care units, in addition to creating long-term housing facilities for the most fragile patients. The Department of Adult Psychiatry of the academic Saint-Luc Hospital is heavily involved in this reform, but also in the project of building a new psychiatric hospital in Woluwé, in direct collaboration with the Sanatia Hospital and with our colleagues from the infanto-juvenile psychiatry department. One major challenge inherent to this new project is to not abandon our role and place in the main academic hospital, where specific innovative initiatives are presently being implemented, and this in close collaboration with our colleagues from the somatic medical fields. To end with, we think it essential that all these changes do not make us forget psychiatry’s anthropological roots that must remain its major strengths.

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Cystic fibrosis: The era of CFTR modulators

Olivier Lebecque (1), Teresinha Leal (2), Patrick Lebecque (3) Published in the journal : February 2019 Category : Pneumology

Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are small molecules aimed at improving CFTR function by specifically targeting the different classes of CFTR mutations. Recent Phase II studies of triple therapy, including new generation correctors, have demonstrated spectacular improvements in forced expiratory volume in 1s (FEV1), likely to translate into improved quality of life and increased life expectancy. Within the next 5 years, a highly effective CFTR modulator therapy will probably be approved for most cystic fibrosis patients, including those carrying at least one copy of the F508del mutation (88% of Belgian patients). Patients with well-preserved lungs will benefit most from these treatments.

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Improved patients’ prognosis by using innovative treatments at earlier stages

Jean-Francois Baurain, Jean-Pascal Machiels, François Duhoux Published in the journal : February 2019 Category : Oncologie

There has been no revolution in the oncology field in 2018. We have, however, been able to further confirm the major benefits of immunotherapy for patients with metastatic cancers. Anti-PD1 antibodies have now become the standard of treatment for head and neck cancers, bladder cancers, melanoma, lung carcinomas, kidney cancers, and cutaneous spinocellular carcinomas. Based on mature survival data, we’ll likely be able to cure numerous metastatic cancer patients. Amongst targeted therapies, PARP inhibitors will possibly be more effective in terms of increased progression-free survival. These inhibitors block one of the two DNA repair mechanisms and are active in ovarian cancer patients responding to platinum salt-based chemotherapy. At present, we are witnessing another prognosis improvement in our patients, as a consequence of using these agents at earlier stages and preventing relapse after curative surgery in patients at high-risk of relapse. At the King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Brussels, these treatments are now available, as are other new treatments still being investigated, which may become the standard of care in the future.

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Innovations in onco-hematology in 2018

Violaine Havelange (1), Xavier Poire (1), Jean-Philippe Defour (2), Stefan N Constantinescu (3), Pascale Saussoy (2), Eric Van Den Neste (1), Sarah Bailly (1) Published in the journal : February 2019 Category : Onco-Hématologie

In 2018, major developments have been achieved in the diagnostic and therapeutic fields of CAR-T cell immunotherapy, next-generation sequencing (NGS), and targeted therapies. Several studies have demonstrated the benefits of CAR-T cells in refractory or relapsing diffuse large B-cell lymphomas. NGS is a major breakthrough in the diagnosis and management of patients with myeloid neoplasia and represents an important prognostic tool that will probably replace many other conventional factors in the future. Finally, several targeted therapies reviewed in this article are about to revolutionize the management of acute myeloblastic leukemia.

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Innovations in Nephrolgy in 2018

Eric Goffin (1), Arnaud Devresse (1), Jean-François Baurain (2), Isabelle Tromme (3), Michel Mourad (4), Nada Kanaan (1) Published in the journal : February 2019 Category : Nephrology

This article reviews innovations in kidney transplantation, particularly in terms of cutaneous carcinomas and ABO incompatibility. Kidney transplant recipients are at risk of developing basal cell or squamous cell carcinomas due to immunosuppression induced by anti-rejection therapy. A multidisciplinary approach to these skin lesions is required to optimize the therapeutic management, thereby improving patient prognosis. Kidney transplantation from ABO-incompatible living donor patients was introduced in 1982 and successfully taken up in our institution last year. It is rendered possible due to a strategy combining desensitization of the recipient and reinforced immunosuppression. Survival of patients and grafts appears to be equivalent to that observed in ABO compatible transplant patients.

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