{"id":334277,"date":"2020-05-27T13:40:55","date_gmt":"2020-05-27T11:40:55","guid":{"rendered":"https:\/\/medizinonline.com\/traitement-du-diabete-en-cas-de-risque-accru-pour-le-coeur-et-les-reins\/"},"modified":"2020-05-27T13:40:55","modified_gmt":"2020-05-27T11:40:55","slug":"traitement-du-diabete-en-cas-de-risque-accru-pour-le-coeur-et-les-reins","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/fr\/traitement-du-diabete-en-cas-de-risque-accru-pour-le-coeur-et-les-reins\/","title":{"rendered":"Traitement du diab\u00e8te en cas de risque accru pour le c\u0153ur et les reins"},"content":{"rendered":"<p>Comment traiter un patient diab\u00e9tique typique, \u00e2g\u00e9 de 55 ans, ob\u00e8se, souffrant d&#8217;hypertension, de dyslipid\u00e9mie et d&#8217;une fonction r\u00e9nale r\u00e9duite ?<\/p>\n<p><!--more--><\/p>\n<p><iframe data-src=\"https:\/\/player.vimeo.com\/video\/422831249\" width=\"640\" height=\"480\" frameborder=\"0\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe><\/p>\n<h2 id=\"recommandation-therapeutique\"><strong>Recommandation th\u00e9rapeutique<\/strong><\/h2>\n<p>J&#8217;aimerais vous pr\u00e9senter ci-dessous mes recommandations pour le traitement optimal du patient de 55 ans r\u00e9cemment diagnostiqu\u00e9 avec un DT2, pr\u00e9sent\u00e9 dans la vid\u00e9o ci-dessus.<\/p>\n<p>Outre son DT2, le patient souffre notamment d&#8217;ob\u00e9sit\u00e9 visc\u00e9rale, d&#8217;hypertension art\u00e9rielle, d&#8217;une dyslipid\u00e9mie classique et d&#8217;une insuffisance r\u00e9nale chronique avec microalbuminurie. Son taux d&#8217;HbA1c \u00e9tait de 10,5% au moment de la pr\u00e9sentation.<\/p>\n<p>Dans l&#8217;ensemble, le patient pr\u00e9sente un risque cardiovasculaire \u00e9lev\u00e9 \u00e0 tr\u00e8s \u00e9lev\u00e9, ce qui signifie que sa valeur cible de PMA-C est de &gt;1,8 et &gt;1,4 mmol\/l, respectivement, selon les directives actuelles. En outre, une r\u00e9duction de la pression art\u00e9rielle systolique \u00e0 120 &#8211; 140 mmHg et de la pression art\u00e9rielle diastolique \u00e0 70 &#8211; 80 mmHg devrait \u00eatre obtenue.<\/p>\n<p>Comme traitement optimal pour ce patient, je recommanderais une triple combinaison de metformine, d&#8217;un GLP-1 RA et d&#8217;un inhibiteur du SGLT-2. Malheureusement, cette trith\u00e9rapie n&#8217;est pas encore rembours\u00e9e par les caisses d&#8217;assurance maladie, bien que ses avantages en termes de MACE en 3 points, d&#8217;hypoglyc\u00e9mie s\u00e9v\u00e8re et de mortalit\u00e9 totale aient \u00e9t\u00e9 clairement d\u00e9montr\u00e9s dans une \u00e9tude danoise men\u00e9e dans le monde r\u00e9el [1].<\/p>\n<p>En tenant compte de la situation de remboursement et des pr\u00e9f\u00e9rences du patient, je le traiterais par canagliflozine (Invokana\u00ae, 100mg, 1-0-0) et par sitagliptine\/metformine (Janumet\u00ae, 50mg \/1000mg, 1-0-1) pour mieux contr\u00f4ler son diab\u00e8te. \u00c9tant donn\u00e9 que le DT2 a \u00e9t\u00e9 d\u00e9couvert r\u00e9cemment et que le patient ne souhaite pas encore recevoir de traitement par injection, il est peu probable qu&#8217;un GLP1-1 RA soit envisag\u00e9 \u00e0 ce stade.<\/p>\n<p>Pour le traitement de l&#8217;hypertension et de la dyslipid\u00e9mie, je recommande l&#8217;atorvastatine\/p\u00e9rindopril\/amlodipine (Triveram\u00ae, 40mg\/10mg\/10mg, 1-0-0).<\/p>\n<p>En outre, le patient doit se pr\u00e9senter au bout d&#8217;un mois pour un contr\u00f4le de suivi.<\/p>\n<p><span style=\"font-size: 10px;\">R\u00e9f\u00e9rences<\/span><\/p>\n<p><span style=\"font-size: 11px;\">1. Jensen, M.H., et al, Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management : A Cohort Study of All Danish Users. Diabetes Care, 2020. 43(6) : p. 1209-1218.<\/span><\/p>\n<p><span style=\"font-size: 12px;\"><em>Commentaires : Roger Lehmann avec le soutien r\u00e9dactionnel de Dr. rer. nat. Jennifer Keim, IACULIS GmbH. Le copyright et la responsabilit\u00e9 du contenu du cas patient appartiennent exclusivement \u00e0 l&#8217;auteur.<\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Comment traiter un patient diab\u00e9tique typique, \u00e2g\u00e9 de 55 ans, ob\u00e8se, souffrant d&#8217;hypertension, de dyslipid\u00e9mie et d&#8217;une fonction r\u00e9nale r\u00e9duite ?<\/p>\n","protected":false},"author":12,"featured_media":97172,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Cas de diab\u00e8te","footnotes":""},"category":[11345,11549],"tags":[],"powerkit_post_featured":[],"class_list":["post-334277","post","type-post","status-publish","format-standard","has-post-thumbnail","category-contenu-des-partenaires","category-rx-fr","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-11 18:32:54","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"fr_FR","wpml_translations":{"it_IT":{"locale":"it_IT","id":334251,"slug":"trattamento-del-diabete-per-laumento-del-rischio-di-malattie-cardiache-e-renali","post_title":"Trattamento del diabete per l'aumento del rischio di malattie cardiache e renali","href":"https:\/\/medizinonline.com\/it\/trattamento-del-diabete-per-laumento-del-rischio-di-malattie-cardiache-e-renali\/"},"pt_PT":{"locale":"pt_PT","id":334261,"slug":"tratamento-da-diabetes-para-o-aumento-do-risco-de-doencas-cardiacas-e-renais","post_title":"Tratamento da diabetes para o aumento do risco de doen\u00e7as card\u00edacas e renais","href":"https:\/\/medizinonline.com\/pt-pt\/tratamento-da-diabetes-para-o-aumento-do-risco-de-doencas-cardiacas-e-renais\/"},"es_ES":{"locale":"es_ES","id":334267,"slug":"tratamiento-de-la-diabetes-para-aumentar-el-riesgo-de-enfermedades-cardiacas-y-renales","post_title":"Tratamiento de la diabetes para aumentar el riesgo de enfermedades cardiacas y renales","href":"https:\/\/medizinonline.com\/es\/tratamiento-de-la-diabetes-para-aumentar-el-riesgo-de-enfermedades-cardiacas-y-renales\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts\/334277","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/comments?post=334277"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts\/334277\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/media\/97172"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/media?parent=334277"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/category?post=334277"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/tags?post=334277"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/powerkit_post_featured?post=334277"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}