Changes in weight and diabetes compensation (HbA_1c) in patients with diabetes mellitus type 2 after adding exenatide (Byetta) to the current treatment in 28 diabetology departments in the Czech Republic - BIBY-I study (observations lasting 3 to 12 months)

J. Perušičová, I. Haladová, P. Piťhová, D. Ácsová, J. Bělobrádková, A. Belzová, K. Berková, B. Doležalová, H. Dvořáková, K. Hejnicová, M. Hudcová, D. Kallmünzerová, Z. Krejsová, G. Markofová, H. Müllerová, K. Owen, M. Pelikánová, L. Raclavská, E. Račická, O. Škarpová, A. Váchová, A. Veselá, J. Vyoralos, J. Brož, T. Edelsberger, M. Honka, T. Hrdina, P. Chmura, J. Tošovský

Vnitr Lek 2013, 59(3):165-171  

BIBY study objective:To obtain experience with exenatide treatment (Byetta) in patients with diabetes mellitus type 2 in a common clinical practice of diabetology departments. Type of observation:Observational study conducted by a randomly selected group of outpatient medical practitioners from 28 diabetology departments in the Czech Republic. Observed and assessed population:465 patients underwent at least three months of Byetta treatment; 347 persons (74.6% of the research population) stayed for the extended observation of 6-12 months. Apart from the basic identification data (year of birth, sex, age when...

What has the largest study in the history of diabetology brought us?

Z. Rušavý, S. Lacigová, M. Kvapil

Vnitr Lek 2013, 59(3):160-164  

The main objective of the ORIGIN study was an observation of the effects of treatment with insulin analogue, insulin glargine on cardiovascular complications in patients with severe atherosclerosis and early stages of well-compensated diabetes and prediabetes. The authors expected that a long-term reduction of glycaemia on an empty stomach will reduce the number of occurrences of cardiovascular complications. The study, which was conducted over a period of more than six years, showed neither a positive nor a negative effect of insulin treatment on cardiovascular complications. The second main objective of the study was the following: to compare the...

Problematic issues related to screening for diabetic retinopathy

P. Skalická, B. Kalvodová

Vnitr Lek 2013, 59(3):218-223  

The aim of this paper is to highlight the importance of screening for diabetic retinopathy and the education of diabetic patients. The key prerequisite of an effective screening is close collaboration between health care professionals. Successful screening detects DR at early stages and helps to prevent severe visual loss. Two cases of proliferative DR exhibiting the most serious complications (vitreous haemorrhage, traction retinal detachment and combined traction and rhegmatogenous retinal detachment, neovascular glaucoma) are reported. The first comorbid patient lost her vision despite the adequate treatment. The second patient was successfully...

Progression of diabetic retinopathy in pregnancy

J. Studnička, L. Hejsek

Vnitr Lek 2013, 59(3):224-226  

Pregnancy is a risk factor for the development of diabetic retinopathy and diabetic macular edema. Ideally, it is appropriate to perform laser treatment of advanced forms diabetic retinopathy before pregnancy, but in case of progression of diabetic retinopathy during pregnancy is laser treatment also indicated. The authors present a case of a young diabetic, who unexpectedly became pregnant. During pregnancy were accelerated changes of diabetic retinopathy. The visual acuity improved in both eye after repeated retinal laser treatment and pars plana vitrectomy in the left eye. The course of disease was documented with digital color fundus pictures,...

Diabetic macular oedema in the third trimester of pregnancy

J. Šimičák

Vnitr Lek 2013, 59(3):227-230  

The authors describe a case of a female patient with diabetes mellitus (DM) type 1 who faced a progress of diabetic retinopathy (DR) during her pregnancy with a development of diabetic macular oedema (DMO) and a deterioration of visual acuity (VA) in the right eye. The patient had been under observation for DM for 18 years, the last six years for the onset of the non-proliferative form of DR. During the 28th week of pregnancy, a significant reduction of visual acuity in the patient's right eye occurred as a result of a fast developing DMO. The patient was generally given corticosteroids for a gynaecological indication to accelerate the maturing of...

Treatment of diabetic macular oedema in a type 1 diabetes patient - mistakes in interdisciplinary collaboration

M. Veith

Vnitr Lek 2013, 59(3):231-233  

Diabetic retinopathy (DR) is a significant microvascular complication of diabetes. High quality interdisciplinary collaboration is an important aspect of a successful DR therapy. A case of a 41-year-old diabetic is presented below, who has been in our care for almost four years. His Diabetes ID card only contains his current glycaemia values. Although the patient had been regularly given a report for his diabetologist with a request for additional information, we have only obtained one value of glycated haemoglobin through the course of the patient's dispensarisation. For this reason, and the non-stabilisation of DR, we have recommended that the patient...

Patophysiology of diabetic retinopathy

P. Kolář

Vnitr Lek 2013, 59(3):173-176  

Diabetic retinopathy (DR) is the affection of the retina in patients with diabetes mellitus (DM). The basic causative factor is prolonged hyperglycaemia. DR is microangiopathy, ie impairment of retinal capillaries. Pathophysiology of DR is very complex and there are involved in many factors. The first and most fundamental factor is the failure blood-retinal barrier (BRB). The major mechanism causing malfunction of BRB are advanced glycation end-products (AGE). In the failure of the inner BRB are involved losses of endothelial cells in capillaries, together with the losses of pericytes. A very important role in the failure of BRB plays too increased...

Risk factors for diabetic retinopathy

T. Sosna, R. Švancarová, M. Netuková

Vnitr Lek 2013, 59(3):177-181  

Risk factors for diabetic retinopathy can be divided into modifiable and non modifiable. Non modifiable include the type of diabetes, age of the patient at the time of onset, duration, and genetic factors. Primarily it can be influenced by glycemic control, as well as systemic factors such as blood pressure, serum lipids. Concomitant diseases also affect diabetic retinopathy. The article also mentions the risk of rapid compensation and iatrogenic influences.

Present state of diagnostic and screening of the diabetic retinopathy and diabetic macular oedema

B. Kalvodová

Vnitr Lek 2013, 59(3):182-186  

Diabetic retinopathy (DR) and its complications are worldwide one of the main causes of the visual impairment and blindness. An incidence of DR is substantially raised due to increasing amount of diabetic patients in population. Systematic screening of diabetic eye complications makes possible a timely incorporation of patients with diabetes mellitus to a lifelong preventive ophthalmological treatment. According to an extent of progress of the DR, these patients are treated by retinal laser coagulation or inhibitors of growth factors and/or surgical treatment of retinal complications by the pars plana vitrectomy. Essential aspects of the effective...

Treatment of diabetic macular oedema

J. Ernest

Vnitr Lek 2013, 59(3):194-200  

Diabetic macular oedema (DMO) is currently the main complication associated with diabetes. The percentage of patients with DMO grows alongside the increasing number of diabetes occurrences. The DMO treatment has seen major developments in the past few years. A number of new treatment technologies have emerged, which enable not only a stabilisation of macular oedema but in the case of an early detection also a decrease of retina oedema accompanied by a visual functions improvement. Laser coagulation has remained the standard DMO treatment for many years; when applying modern diagnostic testing technologies (FAG and OCT), the newest trend in DMO treatment...

Diabetic nephropathy/diabetic kidney disease

P. Bouček

Vnitr Lek 2013, 59(3):201-203  

Diabetic kidney disease (DKD), which belongs to the triad of diabetic microvascular complications, is currently the main cause of end-stage renal disease in developed countries. DKD usually simultaneously leads to a deteriorated long-term control of glucose metabolism and blood pressure, and to the development of diabetic retinopathy, neuropathy and atherosclerotic complications, which are the main causes of patients' mortality. Screening of the initial stages of DKD is to be based on the detection of increased albumin leak into the urine, microalbuminuria, and the reduction of renal function by means of estimates of glomerular filtration rate based...

Incretin therapy and diabetic retinopathy

M. Kvapil

Vnitr Lek 2013, 59(3):204-207  

Therapy based on incretins presents a new group of medicinal substances designated for an intervention in patients with type 2 diabetes. It includes a therapy that is efficient, safe and effective. Its advantage is a low risk of hypoglycaemia and a positive effect on body weight. The analyses that have been published so far consistently indicate a positive impact on cardiovascular risk factors. The first studies conducted on animal models prove a favourable influence of incretin therapy on the pathophysiology of diabetic retinopathy.

Present and future of insulin treatment

J. Škrha

Vnitr Lek 2013, 59(3):209-213  

The main goal of modern insulin treatment is to bring diabetes control to physiological regulation as close as possible. We move from human insulin to insulin analogues which may due to their properties reduce glucose excursions (glucose variability) with hypoglycemic and hyperglycemic episodes. Besides short acting insulin analogues diminishing extension of hyperinsulinemia and postprandial hypoglycemia observed by human insulin treatment, the long-acting analogues are used to create stabilized insulin level and to prevent nocturnal hypoglycemia. Individualized insulin treatment is the basement for modern trends in diabetology.

Diabetic retinopathy in the Czech National Diabetes Programme 2012-2022

T. Pelikánová

Vnitr Lek 2013, 59(3):214-217  

Diabetic retinopathy (DR) develops in patients with both type 1 and type 2 diabetes and is the major cause of vision loss and blindness in people of working age. In the Czech Republic, the number of patients with diabetic retinopathy is still increasing as well as the number of diabetic patients. It is known, that the comprehensive preventive and therapeutic procedures reduce the risk of visual loss by more than 90%. These procedures include intervention of modifiable risk factors (especially hypertension and hyperglycaemia), active screening of DR and specialized ophthalmologic treatment. The Czech National Diabetes Programme 2012-2022, which is built...

The benefit of pars plana vitrectomy for the resolution of complications of proliferative diabetic retinopathy

O. Chrapek, B. Jirková, J. Šimičák, M. Šín, J. Řehák

Vnitr Lek 2013, 59(3):187-192  

Between 1997 and 2007, we have conducted eye surgery on 72 patients (i.e. 72 eyes) as a consequence of proliferative diabetic retinopathy complications. The patients' average age was 61; the follow-up observations were carried out over a period of one year after the surgery. When we compare the initial vision with the visual acuity measured during the last follow-up examination in the late post-operative period, i.e. one year after the surgery, we can conclude that the vision of 46 eyes (63%) had improved, 17 eyes (24%) did not show any change in vision, and the vision of nine eyes (13%) had deteriorated. Visual acuity of 1/60 (metric system) or better...

Zpráva ze Zimní školy interní medicíny 2013 (Zprávy z odborných akcí)

MUDr. Ludmila Pohludková

Vnitr Lek 2013, 59(3)

Diabetes mellitus a bolest. Průvodce pro každodenní praxi (Z odborné literatury)

MUDr. Petr Žák

Vnitr Lek 2013, 59(3)

Diabetes mellitus v kostce. Průvodce pro každodenní praxi (Z odborné literatury)

MUDr. Petr Žák

Vnitr Lek 2013, 59(3)

Diabetes mellitus a reprodukční funkce (Z odborné literatury)

MUDr. Petr Žák

Vnitr Lek 2013, 59(3)

Miniinvazivní přístupy v cévní chirurgii (Z odborné literatury)

Prof. MUDr. Robert Staffa, Ph.D.

Vnitr Lek 2013, 59(3)