Editorial

A. Šmahelová

Vnitr Lek 2010, 56(4):267  

Diabetes and predictive medicine - parallax of the present time

J. Rybka

Vnitr Lek 2010, 56(4):269-279  

Predictive genetics uses genetic testing to estimate the risk in asymptomatic persons. Since in the case of multifactorial diseases predictive genetic analysis deals with findings which allow wider interpretation, it has a higher predictive value in expressly qualified diseases (monogenous) with high penetration compared to multifactorial (polygenous) diseases with high participation of environmental factors. In most "civilisation" (multifactorial) diseases including diabetes, heredity and environmental factors do not play two separate, independent roles. Instead, their interactions play a principal role. The new classification of diabetes is based...

Endocrine abnormities and vessels in patients with diabetes

J. Čáp

Vnitr Lek 2010, 56(4):280-283  

Endocrine impairment is more common in patients with diabetes than in general population. Both hyper- and hypothyroidism increases cardiovascular morbidity and mortality. Subclinical hypothyroidism is a risk factor for coronary hearth disease in patients younger than 65 years. In elderly is its influence questionable or even preventive and the benefit of substitution should be weighted against the risks. Treatment with glucocorticoids in a dose of 7.5 mg methylprednisolone and higher considerably increases risk of vascular impairment. Patients cured from endogenous Cushing's syndrome maintain increased cardiovascular risk factors and structural changes...

Diabetes mellitus and prothrombotic activity

J. Malý

Vnitr Lek 2010, 56(4):284-288  

Diabetes mellitus (DM) is defined by significant hyperglycaemia representing a high risk of thrombosis in coronary as well as central and peripheral arteries. The risk of myocardial infarction in patients with type 2 diabetes is 3-5 times higher than in non-diabetics. This is consequent to changes in haemostasis in obese patients with type 2 diabetes, including changes to fibrinolysis, decreased fibrinolytic activity and increased thrombogenic risk, as part of the pluri-metabolic insulin resistance syndrome [1,2]. The REACH study evaluated more than 67 thousands of patients with a risk of arterial thrombosis or with arterial thrombosis. The patients...

Obesity and atherosclerosis - what's the link?

P. Sucharda

Vnitr Lek 2010, 56(4):289-291  

Obesity, primarily abdominal obesity, is a significant risk factor for symptomatic atherosclerosis. Atherosclerotic vascular changes and the pandemic of obesity are connected with the civilization process, in particular with diet modification and shortage of exercise and physical effort. The clinically defined metabolic syndrome is the most prominent atherosclerotic risk factor based on adipose tissue dysfunction producing low grade inflammation and endothelial dysfunction.

Locomotive activity in prevention blood-vessel complication and diabetes

K. Barták, J. Radvanský

Vnitr Lek 2010, 56(4):292-294  

Adequate, gradual, regular and locomotive diversified physical activities and training is at present a substantial part of treatment virtually in all patients with both type 1 and type 2 diabetes mellitus (T1DM and T2DM). In postgraduate conceived lecture authors explained meaning and indications of physical activities in primary and secondary prevention of metabolic syndrome and its complications. The lecture is focused also on relative contraindications of physical activities and sports in patients with T1DM and T2DM.

Acute hyperglycemia and reperfusion therapy in stroke patients

D. Krajíčková

Vnitr Lek 2010, 56(4):295-300  

Current acute therapies for ischemic stroke are limited. Only a small proportion of stroke patients are eligible to receive reperfusion therapy. Acute hyperglycemia has a deleterious effect in stroke patients by accelerating ischemic brain damage. The complex relationship between hyperglycemia and stroke is discussed. In tPA-treated patients, the acute but not chronic hyperglycemic state may hamper fibrinolytic process, delaying reperfusion of ischemic penumbra. Early measures to reduce hyperglycemia may favor early recanalization.

Diabetes mellitus and ischemic heart disease

I. Dresslerová, J. Vojáček

Vnitr Lek 2010, 56(4):301-306  

Diabetes mellitus (DM) is closely associated with cardiovascular (CV) diseases. These are the main cause of death in patients not only with type 2 but also type 1 diabetes. Apart from the traditional risk factors such as arterial hypertension, dyslipidemia and obesity, hyperglycaemia is an independent risk factor for the development of ischemic heart disease (IHD). Long-term hyperglycaemia leads to vascular damage through several mechanisms. These include oxidative stress, formation of advanced glycation end products, activation of the nuclear factor κ B and decreased production of nitrogen monoxide (NO). Insulin resistance is believed to have...

Treatment of hypertension in patients with diabetes mellitus and lower limb ischemia

M. Souček

Vnitr Lek 2010, 56(4):309-312  

The impact of some types of antihypertensives on carbohydrate metabolism and their association with type 2 diabetes is well-known. In this respect, ACE inhibitors, AT₁ blockers or I1 imidazoline agonists, known to improve insulin sensitivity, are the first line therapeutic choice. Metabolism-neutral calcium channel blockers, particularly the dihydropyridines, are the second in line of therapeutic options. On the other hand, beta-blockers and diuretics, thiazide in particular, exert negative effect on carbohydrate metabolism. Should their use be still desirable, e. g. due to co-morbidities, it is advisable to select cardio-selective beta-blockers...

Antihyperglycaemic treatment and vascular diseases

Š. Svačina

Vnitr Lek 2010, 56(4):313-316  

Hyperglycaemia is being linked to the development of vascular complications of diabetes - diabetic micro- as well as macro-angiopathies. It is, therefore, logical to assume that a reduction of glycaemia will result in a reduction of diabetic complications. However, recent clinical studies in type 2 diabetes described a range of observations that make this general statement less unambiguous: possibly increased incidence of coronary events following rosiglitazone use, discontinuation of some studies due to significantly decreased HbA_1c in long-term diabetes, metabolic memory phenomenon, where early diabetes treatment exerts it effect for more...

Surgical treatment of ischemic heart disease and diabetes mellitus

J. Harrer, A. Drašnar, J. Vojáček

Vnitr Lek 2010, 56(4):317-319  

At present, treatment of IHD is relatively frequently surgical. Approximately every fourth patient undergoing surgery for IHD is a diabetic. The surgery itself does not differ from non-diabetic patients except for the specific preparation of a diabetic patient with respect to glycaemia control and with respect to metabolic demands associated with the surgical intervention. Frequent involvement of more extensive as well as more peripheral regions of the coronary arteries makes the surgical intervention more difficult. The differences with respect to mortality have been diminished mainly due to the continuously improving cardiac surgery and expanding...

Percutaneous coronary interventions in diabetic patients

J. Šťásek

Vnitr Lek 2010, 56(4):320-323  

Diabetes mellitus (DM) is a serious medical problem. The patients with diabetes have higher risk of coronary artery diseases. Diabetes mellitus also increases the risk of complication resulting from revascularization treatment in compare with non-diabetic patients. The first studies, which compare the surgical and percutaneous revascularization proved, that the major difference between these two revascularization techniques is in patients with diabetes. The difference is inflected by necessity of repeated revascularization after PCI, which is caused by higher incidence of a restenosis in patients with DM. Mortality, myocardial infarction and stroke...

Care for diabetic patients with vascular disease

A. Šmahelová

Vnitr Lek 2010, 56(4):324-328  

There is an association between vascular complications and diabetes compensation in ambulatory as well as inpatient care. Diagnostics of vascular complications in diabetic patients are linked to increased risk of contrast-induced nephropathy. Treatment of severe vascular complications usually requires hospitalization. Achieving and maintaining target glycaemia is essential. Compensation of hyperglycaemia must be sufficient and timely; the risk of hypoglycaemia must not be ignored. Target glycaemia values must be adjusted individually, insulin administration is usually preferred.

Veins and diabetes

S. Kašpar

Vnitr Lek 2010, 56(4):329-332  

Patients with trophic ulcers of lower extremities are relatively frequently diagnosed with diabetes mellitus with venous aetiology being the cause of these defects in up to 70% of patients. Chronic venous insufficiency most frequently results from primary venous insufficiency (mostly lower limb varices) or occurs secondarily as a result of deep vein thrombosis. Lower limb varices are common in human population; they affect 20-25% of women and 10-15% of men, and the incidence increases with age. With respect to radicality of treatment approaches, surgical management is unequivocally considered as the most effective. Apart from the traditional open surgery,...

Angiopathy and the eye

E. Rencová

Vnitr Lek 2010, 56(4):333-339  

Introduction:Diabetic retinopathy is an important microvascular complication of diabetes as it threatens the vision. Diabetic maculopathy is the main cause of legal blindness in the adult population in western countries. Methods:The examination method involves digital fundus photography that enables comparison of the incidence, number as well as the size and the shape of pathological foci on the retina during patient visits. It, however, does not depict one important change - chronic retinal ischemia. This is identified using contrast imaging - fluorescein angiography (FAG). Administration of a contrast medium - fluorescein...

Peripheral arterial disease and diabetes

R. Malý, V. Chovanec

Vnitr Lek 2010, 56(4):341-346  

Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes mePADtus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors...

Comprehensive care for diabetic patients with diabetic foot syndrome

J. Olšovský

Vnitr Lek 2010, 56(4):347-350  

The author presents a definition of diabetic foot syndrome and its various classifications. Presented are its epidemiology and the risk factors of its development. Management of this condition is demanding with respect to medical as well as economic resources and thus prevention is at the forefront. However, should this condition develop in a patient, specialised care becomes equally important. Care for a patient with diabetic foot syndrome is as complex as are the underlying causes of this condition. Management requires attention of a specialized team of experts, led and coordinated by a diabetologist-podiatrist. Therapy includes diabetes control,...

Clinical significance of vascular damage in patients with diabetes and renal impairment - a nephrologist's view

S. Dusilová Sulková

Vnitr Lek 2010, 56(4):351-355  

Care for diabetic patients with renal impairment and vascular damage is a typical example of care requiring inter-professional approach. Vascular damage in patients with diabetes may lead to renal disease (ischemic nephropathy, high incidence but frequently unrecognised in diabetic patients). Renal ischemia resulting from hypoperfusion due to vascular changes contributes to progression of nephropathy and accelerates destruction of functional renal parenchyma. Vascular damage is the leading cause of morbidity and mortality in patients on dialysis. Amputations are reported in 6% of patients and increase the risk of death by at least 50%. All these issues...

Local treatment of wounds and vascular perfusion

L. Sobotka

Vnitr Lek 2010, 56(4):356-358  

Skin defects and wounds are rather frequent in diabetic population. They most frequently occur on lower limbs and their origins are often multifaceted. If vascular perfusion is not damaged, it is important to secure perfect drainage with sufficient incision and to use local treatment modalities such as hyaluronan-iodine complex, now well-established at our clinic. It is always essential to save the vascular system if this is damaged. Careful examination by an angiologist is normally followed by angioplasty or vascular bypass. Amputation is an extreme solution that, nevertheless, may save the limb functionality if done in a patient with ischemic damage...