Úvodní slovo

Alena Šmahelová

Vnitr Lek 2009, 55(4):329  

10. celostátní diabetologické sympozium Diabetes a klinická farmakologie

Vnitr Lek 2009, 55(4):330  

Pharmacoeconomy of diabetes mellitus - trends in the Czech Republic

P. Horák

Vnitr Lek 2009, 55(4):331-340  

Since 2002, we found relatively stable number of diabetes mellitus cases among clients of General Health Insurance Company of the Czech Republic. This means, after calculating incidence rate with respect to decline in total numbers of insured during the same period, a 6% increase in real incidence rate. On the doctors side, outpatient, mostly private diabetologists have about the same capacity of their offices, 2.9 physicians (WTE)/100 000 citizens over the last years. Analysis of costs and volume of services provided, clearly demonstrate, that diabetology is medical specialization of a great importance not only from the point of view of number of...

Costs of Type II Diabetes in the Conditions of the Czech Republic's Medical Care System

T. Doležal, Z. Písaříková, P. Zemanová, D. Bartášková

Vnitr Lek 2009, 55(4):342-344  

The analysis of direct medical care costs in the conditions of the Czech Republic has demonstrated that the average annual costs per type II diabetic patient amounts to 25,858 CZK. Thanks to its high prevalence and incidence, it represents 10% of total medical care costs. The hospital treatment of diabetic complications takes up the major share in these costs, similarly as in other advanced European countries. It is therefore evident that type II diabetes has not only health but also economic and social impacts and from this point of view, preventative and therapeutical strategies need to be evaluated.

Drug Clinical Trials and Their Importance for Diabetology

K. Macek, J. Kopecký, D. Svoboda

Vnitr Lek 2009, 55(4):345-348  

The system of drug clinical trials has gradually become the basic pillar of pharmacotherapy principles denoted as evidence-based medicine. It serves, in particular, to ensure the efficacy and safety of newly introduced drugs. The first institute dealing with drugs in the territory of the current Czech Republic was founded as early as in 1918. The then drug research institute became one of the predecessors of the modern State Institute for Drug Control. The definition of drug clinical trials covers several basic factors, such as pharmacodynamics, pharmacokinetics, adverse effects, drug safety and efficacy and, in particular, testing systematicness....

Clinical Studies That Have Influenced the Treatment of Diabetes

J. Olšovský

Vnitr Lek 2009, 55(4):349-353  

In the article, the author addresses the development of the targets of diabetes treatment. He provides an overview of the key clinical studies in diabetology from which we draw knowledge and therapeutical recommendations nowadays, i.e. in the times of evidence-based medicine. The author emphasizes the need for comprehensive treatment of diabetes, i.e. the treatment of obesity, hypertension, dyslipidemia and also the impact on blood coagulation, however, focuses, in particular, on clinical studies focusing on the influence of diabetes compensation (the impact on hyperglycemia) on the development of vascular complications.

Enteral and Parenteral Nutrition with Diabetes

L. Sobotka

Vnitr Lek 2009, 55(4):354-356  

In type I diabetes insulin must be administered during nutritional support. The method of insulin administration is dependent on the clinical situation, presence of inflammation, method of nutrition delivery (enteral or parenteral) and other conditions. In type II diabetic patients oral drug treatment should be stopped in stress conditions. Obese type II diabetic patients often profit from hypocaloric nutrition but only when they are stable and any acute inflammatory illness has passed. This may improve their condition before elective procedures. However, strict monitoring of these patients is necessary in both types of diabetes mellitus.

Hypolipidemic drugs and diabetes mellitus

V. Bláha, E. Mistrík

Vnitr Lek 2009, 55(4):357-362  

Diabetes mellitus associates with high cardiovascular risk. The absolute values of cardiovascular risk tend to be even higher than as calculated from the SCORE tables. Recent randomized clinical trials have shown evidence of benefit and safety of more intensive LDL-cholesterol lowering in patients with diabetes and established cardiovascular disease supporting guidelines for a more intensive LDL goal of therapy. A recent meta-analysis has confirmed benefit on major coronary events and ischaemic stroke in many diabetic patient subgroups, including those with type 1 disease. The pathological combination of several lipoprotein metabolism abnormalities...

Target Values of Blood Pressure in Patients with Diabetes Mellitus

M. Souček

Vnitr Lek 2009, 55(4):363-367  

Diabetes mellitus considerably worsens the prognosis of hypertension both in the occurrence of microvascular and macrovascular complications. The guidelines of the European Society of Hypertension and the European Society of Cardiology suggest a significantly more invasive treatment of hypertension achieving blood pressure target values below 130/80 mm Hg. The control of hypertension in diabetic patients treated with antihypertensives in the consulting rooms of our physicians is poor. Target values < 130/80 mm Hg are achieved in less than 5% of cases. More extensive application of combined treatment, in particular 3 or more antihypertensives, and...

Drugs Influencing Bone Metabolism in Diabetic Patients

V. Palička

Vnitr Lek 2009, 55(4):368-370  

A significant improvement in the knowledge of physiology, pathophysiology and pathobiochemistry of bone metabolism has enhanced the understanding not only of regulatory mechanisms of bone remodelation in adulthood but also of the dysfunction of such regulatory processes with other diseases. In the pathophysiology of metabolic bone disease in diabetic patients, attention is currently being focused on the method in which the differentiation of mesenchymal stem cells in osteoblasts, or adipocytes is regulated. The key role of PPAR-γ, its activation or activity inhibition and thus also the directing of the differentiation in fat cells or osteoblasts...

Hypothyroidism Substitution and Adrenal Insufficiency in Diabetic Patients

J. Čáp

Vnitr Lek 2009, 55(4):371-374  

As diabetes mellitus type 1 is part of the polyglandular autoimmune syndrome it is no wonder that autoimmune disorders of the thyroid are in diabetics about five times more common and adrenal insufficiency four times more common than in general population. Manifest hypothyroidism leads to the decrease in insulin sensitivity and increase of glucose stimulated insulin secretion. These changes are reversible by substitution. Even subclinical hypothyroidism increases demand on pancreatic β cell. The glucocorticoid insufficiency causes marked increase of insulin sensitivity, decrease of endogenous glucose production and increase of glucose oxidation....

Options of Hormonal Contraceptives and Substitution in Female Diabetic Patients

J. Sadloňová

Vnitr Lek 2009, 55(4):375-383  

The pregnancy planning is extremely important for women with diabetes mellitus and therefore, reliable contraceptives are indispensable for such women. Generally, female diabetic patients can use the same forms of contraceptives as healthy women, however, in their case many specific circumstances must be considered, which are addressed in the first part of the overview. In particular, the selection of hormonal contraceptives for type I female diabetic patients with late complications and type II female diabetic patients is problematic as in this area very few studies are available. The other part of the overview is dedicated to hormonal substitution...

Pharmaceutical Care of Patients with Diabetes Mellitus and Its Relationship to Clinical Pharmacy

J. Vlček, J. Malý, M. Doseděl

Vnitr Lek 2009, 55(4):384-388  

Introduction:Pharmaceutical care develops both at universities in the Czech Republic and in daily practice, and is focused on drug-related issues as a pharmacist has the broadest knowledge of the drug and offers such knowledge to other persons involved in patient care. Pharmaceutical care is part of health care and although the pharmacist is considered to be a health service officer by legislation, health insurance companies - probably due to the fact the pharmacist is paid based on the margin obtained in business activities from the purchase and sale of prescribed drugs - do not see the pharmacist as such and they need to be convinced that...

Improving Blood Pressure Control with Physician/Pharmacist Collaboration

B. L. Carter

Vnitr Lek 2009, 55(4):389-394  

Studies have shown that it is very important to control blood pressure in patients with diabetes. Unfortunately, blood pressure control throughout the world is poor. Numerous studies have used interdisciplinary team-based care to improve the control of many chronic conditions including hypertension and diabetes. This discussion will focus on the results of a study we recently conducted involving clinical pharmacists located in physician offices. The study was a randomized, cluster trial in five clinics. The pharmacists assessed patients with poorly controlled blood pressure and made recommendations to the physicians to change therapy. The patients...

Drug Interactions of Selected Drugs Used by Patients with Diabetes Mellitus

M. Prokeš, J. Suchopár

Vnitr Lek 2009, 55(4):395-402  

Many patients with diabetes mellitus are treated by various medicinal products, which can in some cases lead to drug interaction. In this paper drug interactions of antidiabetics are summarised and most important drug interactions of other drugs frequently prescribed to diabetics are mentioned: drugs acting on the renin-angiotensin system and statins.

Drug-drug interactions in diabetic patients at the department of clinical pharmacology

L. Magulová, T. Foltánová

Vnitr Lek 2009, 55(4):403-407  

Drug-drug interactions in diabetic patients could be serious, even life threatening. Possible manifestation of hypo/hyperglycemia as a consequence of drug-drug interactions are often wrong interpreted as a nonadherence to the diabetic diet or polymorbidity of the patient. Drug-drug interactions are not taken into account. The risk of drug-drug interactions is exponentially increasing with the number of taken drugs. In the group of diabetic patients is good to prevent the combinations of drugs, which can lead to drug-drug interactions and use alternative therapy with lower potential of drug-drug interactions. In this paper we present the possibilities...

Importance of the Structure of Insulin Preparations for Clinical Practice

Š. Svačina

Vnitr Lek 2009, 55(4):409-411  

Since the first application of insulin in the 1920s, many clinically necessary changes in the insulin action, effect reduction and extension, hypoglycemia risk reduction and positive weight development have been achieved by way of technological changes of insulin preparations. Such results have been achieved, in particular, by replacing insulin with insulin analogues. The impact on diabetes compensation and on the prevention of complications is not achieved by individual preparations but, in particular, by the quality of treatment and cooperation from the patient. The doctor should know, in particular, the clinical impacts of changes in the structure...

Functional Foodstuffs and Diabetes - Evidence and Myths

Z. Zadák, R. Hromádka, M. Hronek, A. Tichá, R. Hyšpler

Vnitr Lek 2009, 55(4):412-415  

Functional food and nutritional supplements balance the difference between the natural nutritional requirement of man, as a slowly changing genotype, and the nutrition of today's man. This type of specifically treated food enables the nutrition of both the healthy population, where functional food eliminates certain risks and have a preventative effect (fibre, microelements), and the nutrition of the ill, which is based on the therapeutical and regulatory effect of nutrients (organ-specific nutrition).

Natural substances affecting type 2 diabetes

L. Jahodář

Vnitr Lek 2009, 55(4):416-420  

More than 1,000 species of seed plants and fungi are active in hypoglycemic tests. The potential of their effective molecules is considerable; it could be also expected, that the mechanism of their activity will be very varied. Even though the majority of information is only screening of hypoglycemic effect, there occur the results of valid essays, which report on the possible mechanisms of the activity. This paper represents the attempt at the categorisation of plant drugs, their fractions and isolated substances according to their pharmacological activity and mechanism of the effect.

New and Older Pharmaceuticals Influencing Insulin Secretion

J. Olšovský

Vnitr Lek 2009, 55(4):421-424  

The author briefly recapitulates the physiology of insulin secretion and pathophysiology with type II diabetes mellitus. Besides sulfonylurea secretagogues and glinides practically used in the long term, the author points out new possibilities of influencing insulin secretion by way of incretin mimetics and gliptins.

Insulin Sensitizing Drugs

A. Šmahelová

Vnitr Lek 2009, 55(4):425-428  

Currently, insulin sensitizing drugs in the form of metformin as the basic drug are part of the treatment of practically any type II diabetic patient. At the beginning of the therapy, metformin is used; later, insulin sensitizers (PPAR-γ stimulators) such as rosiglitazone and pioglitazone are often applied. Nowadays, extensive research into new pharmaceuticals is being conducted in the group of insulin sensitizers. So-called double sensitizers, panPPAR sensitizers or PPAR-δ sensitizers, are being developed. The most promising group is of the PPAR-γ selective modulators.

Potential New Antidiabetics for the Next Decade

Š. Svačina

Vnitr Lek 2009, 55(4):429-433  

In the next 10 years, major changes in the pharmacotherapy of diabetes can be expected. Both the currently used groups of drugs classified as dipeptidyl-peptidase IV blockers (gliptins) and so-called incretin mimetics (including both natural substances and incretin analogues) will be significantly expanded by up to ten new drugs. In addition, other completely new groups of drugs that act, for instance, via the hepatal mechanism or by influencing the metabolism of steroids will appear. Blocking the absorption of glucose in renal tubules by gliflozines seems to be very promising. In the treatment of diabetes complications, the inhibition of protein kinase...

Pozvánka

Vnitr Lek 2009, 55(4):434  

Z odborné literatury

Vnitr Lek 2009, 55(4):438  

XXXIV. angiologické dny 2009 s mezinárodní účastí

J. Spáčil

Vnitr Lek 2009, 55(4):435-437