Jindřiška Perušičová. Perorální léčba diabetu 2013

Jana Pecová

Vnitr Lek 2014, 60(9):811  

Jan Chlumský. Plicní funkce pro klinickou praxi

Tomáš Tyll

Vnitr Lek 2014, 60(9):811  

Jiří Knor, Jiří Málek. Farmakoterapie urgentních stavů

Jiří Slíva

Vnitr Lek 2014, 60(9):812  

Profesor Jan Škrha šedesátiletý

Štěpán Svačina

Vnitr Lek 2014, 60(9):675  

Gratulace prof. MUDr. Richarda Češky, CSc., FACP, FEFIM, předsedy České internistické společnosti ČLS JEP

Richard Češka

Vnitr Lek 2014, 60(9):676  

Long-term acting insulin analogues and the risks of hypoglycemic incidence

Alena Adamíková, Jaroslav Rybka

Vnitr Lek 2014, 60(9):680-683  

As recommendation for treatment of type 2 diabetes mellitus, incorporating individualization of therapeutic targets for patients with co-morbidities, for whom hypoglycemia increases the risk of complications. The sufficient target value is 60 mmol/mol of HbA_1c under the guidelines of Czech Diabetesl Society. Insulin therapy becomes essential for a whole line of patients, including those of advanced age, in relation to duration of diabetes and progression of the disease. The Diabetes and Aging Study observed patients of ≥ 60 years age with diabetes, in which hypoglycemia ranked among the most frequent side effects of therapy and where...

Factors causing damage and destruction of beta-cells of the islets of Langerhans in the pancreas

Michal Anděl, Vlasta Němcová, Nela Pavlíková, Jana Urbanová, Marie Čecháková, Andrea Havlová, Radka Straková, Livia Večeřová, Václav Mandys, Jan Kovář, Petr Heneberg, Jan Trnka, Jan Polák

Vnitr Lek 2014, 60(9):684-690  

Insulin secretion in patients with manifested diabetes mellitus tends to disappear months to decades after the diagnosis, which is a clear sign of a gradual loss of pancreatic islet beta-cells. In our sample of 30 type 2 diabetic patients, whose disease manifested between 30 and 45 years of age, about a half have retained or even increased insulin secretion 30 years later, while the other half exhibit a much diminished or lost insulin secretion. Factors that can damage or destroy beta-cells can be divided into the following groups: Metabolic factors: hyperglycemia and glucotoxicity, lipotoxicity, hypoxia, reactive oxygen species; Pharmacological...

Calcium, vitamin D and health

Jaroslav Blahoš, Václav Vyskočil

Vnitr Lek 2014, 60(9):691-695  

The authors describe briefly recent views on physiological, pathological and practical aspects of calcium and vitamin D. The sources of calcium are the nutrients, mammal milk and milk products as well as pharmaceutical products. Their beneficial and potentially hazardous effects are discussed. The insufficiency of vitamin D [25(OH)D₃] is a global health problem and the necessity of monitoring of this hepatic metabolite (as a marker) is emphasized due to its role in physiological and pathological processes.

SOLOSTAR study demonstrated high levels of patient satisfaction with the use of the insulin pen SoloStar® in the Czech Republic

Tomáš Edelsberger, Michal Policar, Dita Pospíšilová, Jana Psottová, Jana Houdová, Denisa Janíčková Žďárská

Vnitr Lek 2014, 60(9):697-704  

Introduction:The aim of the observational, prospective and non-interventional survey SOLOSTAR was to obtain, in a clinical practice setting in the Czech Republic, information about patient satisfaction with the use of the pre-filled insulin pen SoloStar. Methodology:1 805 patients suffering from type 1 or 2 diabetes who began using the pen SoloStar were observed for 3 to 4 months. Satisfaction of patients with SoloStar and with its particular features was evaluated in the group of all patients and in subgroups defined by demographic parameters including the type of handicap. Patients also compared SoloStar with the pens used...

News and perspectives in insulin treatment

Martin Haluzík

Vnitr Lek 2014, 60(9):705-711  

Insulin therapy is a therapeutic cornerstone in patients with type 1 diabetes and also in numerous patients with type 2 diabetes especially with longer history of diabetes. The initiation of insulin therapy in type 2 diabetes patients is often delayed which is at least partially due to suboptimal pharmacokinetic characteristics of available insulins. The development of novel insulins with more favorable characteristics than those of current insulins is therefore still ongoing. The aim of this paper is to review current knowledge of novel insulins that have been recently introduced to the market or are getting close to routine clinical use. We will...

Basal insulin glargine using a basal-bolus regimen in a common clinical practice: observational, non-interventional, multicenter, national project LINDA (Lantus in daily practice - safety and efficacy in basal bolus regimen)

Denisa Janíčková Žďárská, Jan Brož, Bohumila Křivská, Zdeněk Rušavý, Milan Kvapil

Vnitr Lek 2014, 60(9):712-719  

Objective:To evaluate the safety and efficacy of basal insulin glargine using a basal-bolus regimen in a common clinical practice setting in the Czech Republic. Patients and methods:The LINDA project was a non-interventional, multicenter (n = 255), national, observational project. A total of 4,998 patients with Type 1 and 2 diabetes mellitus (T1DM, T2DM) with predominantly insulin therapy (99,7 %), after switch on insulin glargine at basal-bolus regimen, were enrolled in this project. The patients were followed up for 6 months after initiation of the therapy with insulin glargine. The primary objective of the project was to...

AGEs and RAGE - advanced glycation end-products and their receptor in questions and answers

Marta Kalousová, Tomáš Zima

Vnitr Lek 2014, 60(9):720-724  

Advanced glycation end products (AGEs) play an important role in the pathogenesis of chronic diseases and their complications, especially diabetic complications, atherosclerosis, complications of chronic kidney diseases and neurodegenerative diseases. These substances are formed via non-enzymatic glycation and their formation is potentiated in case of carbonyl stress. AGEs are represented by a heterogeneous group of compounds, e.g. carboxymethyllysine, pentosine, methylglyoxallysin dimer, vesperlysine, imidazolones etc. AGEs can modify proteins and so change their physical and chemical properties and can act also via specific receptors, among them...

Liver, kidneys and diabetes: three faces of HNF1B gene deficit

Jan Lebl, Stanislava Koloušková, Petra Dušátková, Ondřej Cinek, Lenka Dušátková, Tomáš Dědič, Radana Kotalová, Zdeněk Šumník, Tomáš Seeman, Štěpánka Průhová

Vnitr Lek 2014, 60(9):725-729  

The renal cysts and diabetes syndrome (RCAD), also known as HNF1B-MODYor MODY5, is caused by the deletion or point mutation of HNF1B gene which leads to the depletion of HNF1B transcription factor. The main clinical components of RCAD include cystic kidney disease or other developmental anomalies of the kidneys and diabetes mellitus which typically manifests in the second decade of life or later. Renal disorders may lead to the development of chronic renal insufficiency already in childhood or young adulthood. The other symptoms include hepatic impairment - cholestatic jaundice in middle-aged patients, sometimes even neonatal cholestasis, atrophy...

Problems of differential diagnosis of paraneoplastic hypoglycaemia

Marián Mokáň, Peter Galajda

Vnitr Lek 2014, 60(9):730-735  

Paraneoplastic hypoglycaemia is relatively rare. The most common cause is insulinoma, tumour from pancreatic beta cells with insulin production. Fasting glycaemia together with hyperinsulinaemia during 24 hours of fasting is characteristically present. Endoscopic ultrasonography is the most sensitive method for localization of insulinoma, scintigraphy with labelled GLP-1 analogs and modified positron emission tomography are new perspective methods. Non-beta-cells tumours are mesenchymal or epithelial tumours with huge size, slow growth and increased production of insulin like growth factor IGF-2 (IGF-2oma). Fasting hypoglycaemia in this case is associated...

Hypoglycemia as a limitation to the treatment of diabetes mellitus

Jindřich Olšovský

Vnitr Lek 2014, 60(9):737-740  

In his paper, the author deals with hypoglycemia-related problems as the most frequent complication of the therapy for diabetes mellitus (DM). He points to threats that patients with hypoglycemia are exposed to, but also gives attention to risk groups of patients with regard to hypoglycemia development as well as different levels of the risk related to different antidiabetics.

Changes of bone metabolism in diabetics

Vladimír Palička, Jana Lesná, Ladislava Pavlíková

Vnitr Lek 2014, 60(9):742-745  

The effect of impaired regulation of the glucose metabolism on the bone tissue metabolism is many-sided and very complicated. In most cases we observe an increased risk of fracture in people with diabetes. The reasons causing this condition are varied. Its main cause in diabetic patients is typically not the decrease in bone mineral density, it is rather deterioration of bone tissue and its structure. An important role of insulin and insulin resistance is beyond dispute, with numerous other factors at work, such as increased glycation of proteins, including increased glycation of collagen in bones, change in sclerostin production and levels, intervention...

Insulin resistance - its causes and therapy possibilities

Terezie Pelikánová

Vnitr Lek 2014, 60(9):746-755  

Insulin resistance (IR) is defined as a condition where normal plasma free insuconcentrations induce a reduced response of the body. In the narrower sense we understand IR as the impairment of insulin action in the target structure which may arise at any level of the insulin signalling cascade. In the clinical conditions we usually define it as the impairment of insulin action in glucose metabolism, although it is true that the impairment may concern different effects of insulin and different cell structures. The characteristic feature of IR linked to the metabolic syndrome or Type 2 diabetes is defective signalling which affects PI3-kinase branch...

Glycemic variability and continuous monitoring of glycemia

Martin Prázný, Jan Šoupal

Vnitr Lek 2014, 60(9):757-763  

Blood glucose levels are not constant in ther human body even in physiological status. It fluctuates depending on food intake, exercise, psychological and other factors. Normally it fluctuates between 3.9 to 7.5 mmol/l and in fasting in the standard conditions it does not exceed even more narrow range 3.9 to 5.5 mmol/l. Fluctuations are more pronounced in patient with diabetes. Hyperglycemia is a common and basic pathology in diabetes, however, antidiabetic drug often cause hypoglycemia, both increasing the range for glucose fluctuations. The level of glucose fluctuation is called glycemic variability (GV). Glycemic variability is now a favorite target...

Life expectancy of people with type 1 diabetes in the past and today

Zdeněk Rušavý, Silvie Lacigová

Vnitr Lek 2014, 60(9):765-771  

The life expectancy of Type 1 diabetes mellitus (T1DM) dramatically improved after the discovery of insulin in 1922, but was still 25 years shorter than that of non-diabetic population. Some people with T1DM, however, lived to the same age as a non-diabetic population and had no late complications of diabetes. They began to be awarded medals in appreciation of their long life with diabetes. They also became the subject of a research examining why they lived so long and what was the difference between them and those patients with T1DM, whose lives were much shorter. The paper deals with the differences observed in the 'medallists' and discusses various...

Gliptins: a safe and effective treatment of diabetes mellitus

Jiří Slíva, Martin Prázný

Vnitr Lek 2014, 60(9):772-775  

Gliptins are well recognized substances modulating incretin system via inhibition of dipeptidylpeptidase IV. Their efficacy was demonstrated both in monotherapy and in combination with metformin, where they act synergistically. Hence, a better control of diabetes might be assumed. This short article aims to show current trends in their prescription in the Czech Republic.

How we indicate oral antidiabetics today (from metformin to gliptins and gliflozins)

Štěpán Svačina

Vnitr Lek 2014, 60(9):777-781  

Today we treat Type 2 diabetes mellitus by gradually adding antidiabetics from monotherapy to double, triple and multi combinations of medicines. Metformin still remains the first-line medicine, if well tolerated and not contraindicated. In the next step, we have a wide choice of 5 groups of medicines at least. The new algorithms used in the U.S.A. introduce some degree of preference for the incretin therapy (gliptins and incretin analogues) and the new groups of gliflozins over the standard treatments. In the near future, the indication of antidiabetics is therefore about to undergo big changes or at least a discussion about the preferences of the...

Receptor for advanced glycation end-products (RAGE) - key player in the diabetic angiopathy?

Jan Škrha jr, Marta Kalousová, Tomáš Zima

Vnitr Lek 2014, 60(9):782-786  

Receptor for advanced glycation end-products plays a crucial role in chronic diabetes complications. It is supposed to be involved in the development of all kinds of diabetic angiopathy. Advanced glycation end-products (AGEs) excessively accumulated in diabetes belong to the most important ligands of RAGE, however there are more potent activators of this receptor - especially alarmins, often involved in inflammatory reactions. Activated RAGE triggers pathways leading to excessive accumulation of AGEs, reactive oxygen species and sustained inflammatory reactions via NF-κB. Central role of RAGE in the pathogenesis of vascular changes in diabetes...

Diabetes mellitus and pancreatic cancer - cause or result?

Pavel Škrha

Vnitr Lek 2014, 60(9):787-790  

Pancreatic cancer is a malignancy with a poor prognosis. Its increased incidence was observed in diabetic patients in the past. However, there is no evidence, whether diabetes is a risk factor for neoplastic transformation, or if it arises secondarily as a result of the tumor. The key is an early detection of cancer to perform pancreatectomy - the only possible curative therapy yet. This requires early diagnostic markers.

Diabetes mellitus and pancreatic cancer - cause or result?

Alena Šmahelová

Vnitr Lek 2014, 60(9):791-796  

Incretin glucagon like peptid-1 receptor agonists are also known as incretin mimetics. These are the new drugs for the treatment of type 2 diabetes, which have a significant antihyperglycemic effect. For the individual treatment can be used short-acting and long-acting drugs. In addition to glucose effect there are influenced another factors, especially weight and hypertension. The patophysiological mechanism of their action, pharmacological and clinical differences and their use in clinical practice are described.

Personalized therapy for diabetes in retrospect and prospect

Ivan Tkáč

Vnitr Lek 2014, 60(9):797-800  

In recent years, the term "personalized medicine" has been increasingly mentioned in relation to the endeavours to tailor the pharmaceutical as well as regimen therapy to the needs and requirements of individual patients. The personalization of antidiabetic treatment has undergone a dramatic advancement in relation to the expansion of knowledge about diabetes. From the empirical it moved forward to the phenotypic level which made it possible to differentiate between individual types of diabetes. The pathogenetic personalization which began to be used within Type 2 diabetes in the 1960s, was based on the assumption that while insulin resistance predominates...

First fixed dose combination perindopril arginine-indapamide-amlodipine: new approach in combination therapy in hypertension

Jiří Widimský jr

Vnitr Lek 2014, 60(9):801-807  

Use of fixed combination of antihypertensive drugs clearly improves compliance to the pharmacological therapy, control of hypertension and prognosis. Based on the current guidelines triple antihypertensive therapy with RAS-blocker, calcium channel blocker (CCB) and diuretic represents the standard and best option. The article introduces first and innovative fixed triple combination of perindopril arginine + indapamide + amlodipine (Triplixam®). This type of therapy is suitable for patients already treated with free combinations of three antihypertensive drugs or in those hypertensives with uncontrolled hypertension on two antihypertensive molecules...

Tisíce nalietaných hodín okolo celého sveta nemusia byť len vizitkou biznismena, ale aj úspešného lekára, výskumníka, pedagóga, manažéra a vysokého univerzitného hodnostára v jednej osobe

Vnitr Lek 2014, 60(9):808-810