Úvodní slovo prof. MUDr. Štěpána Svačiny, CSc., MBA, editora tohoto vydání časopisu Vnitřní lékařství

Vnitr Lek 2015, 61(4):285  

Do diabetologists choose a therapy rationally? Basic results of the PROROK project (A prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy)

Denisa Janíčková Žďárská, Pavlína Piťhová, Tomáš Pavlík, Milan Kvapil

Vnitr Lek 2015, 61(4):295-300  

Introduction:The PROROK project (A prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy) had a character of a non-interventional, prospective, multicentric observation project conducted for a period of 6 months, whose aim was to quantify the relevance of the difference between fasting and postprandial glycemia to the success of GLP1 receptor agonist treatment, or insulin therapy with basal or premixed insulin, or a combination of basal and bolus insulin. Physicians chose therapy for inadequately compensated patients...

Glycation of lens proteins in diabetes and its non-invasive assessment - first experience in the Czech Republic

Jan Škrha jr, Jan Šoupal, Martin Prázný, Jan Škrha

Vnitr Lek 2015, 61(4):346-350  

Advanced glycation end-products (AGEs) play a crucial role in the pathogenesis of diabetes and its complications. Their accumulation in the lens reflects total glycation rate in the human body. Recently, a new confocal biomicroscope ClearPath DS-120 quickly measuring lens autofluorescence (LAF) has been developed. Our pilot study included 69 patients with diabetes and 49 healthy controls, in all subject LAF was measured and compared with skin autofluorescence (SAF) assessed by AGE-Reader. Both LAF (T1DM: 0,27 ± 0,09; T2DM: 0,22 ± 0,06; controls: 0,17 ± 0,04 AU; p < 0,0001) and SAF (T1DM: 2,0 ± 0,4; T2DM: 2,3 ±...

miRNA-192, miRNA-21 and miRNA-200: new pancreatic cancer markers in diabetic patients?

Pavel Škrha, Aleš Hořínek, Michal Anděl, Jan Škrha

Vnitr Lek 2015, 61(4):351-354  

Introduction:Newly-onset diabetes mellitus (DM) in middle-aged and older people may be an early symptom of pancreatic cancer (PC). However, sensitive markers for PC are still missing. MicroRNAs (miRNAs) play an important role in a cell response regulation. Significant changes in miRNA expressions were observed in cancers. Our goal was to compare expressions of selected miRNAs in patients with PC, DM and controls. Methods:We enrolled 74 patients with PC (42/32, with/without DM), 29 type 2 diabetic patients and 17 controls. MicroRNA was determined in serum of all examined subjects. In 9 patients with PC the tumor was resected...

The position of new antidiabetics in clinical practice: SGLT2 vs DPP4 inhibitors

Jan Šoupal, Martin Prázný

Vnitr Lek 2015, 61(4):291-294  

SGLT2 and DPP4 inhibitors are new effective oral antidiabetic drugs with low risk of hypoglycemia and positive or neutral impact on body weight. These characteristics are substantially different from more widely used sulphonylureas. Current treatment of type 2 diabetes is rather complicated. Moreover, the position of new antidabetics in the guidelines has not yet been clearly defined. Personalised treatment on the basis of molecular markers is still not possible. Therefore, the position of new antidiabetics in the treatment of type 2 diabetes is often determined by clinical experience and subsequently modified by new clinical studies. Currently, doctors...

Biosimilar insulines - new possibilities of diabetes treatment

Jan Škrha

Vnitr Lek 2015, 61(4):301-303  

Biosimilar insulins are biological drugs with the effect similar to reference insulins. Documented safety and efficacy are the main demand for their clinical utility. The subsequent introduction into clinical practice will be followed by more frequent use which will need longterm evaluation of their effect on glycemia and eventual side effects as well.

The treatment of diabetes in patients with liver and renal impairment

Martin Haluzík

Vnitr Lek 2015, 61(4):304-311  

Diabetes mellitus is a progressive disease that may eventually lead to the development of chronic complications. In patients with type 2 diabetes, a simultaneous occurrence of liver or renal impairment is quite frequent. The presence of these diseases significantly increases the risk of hypoglycemia and in case of the renal impairment also the cardiovascular risk. At the same time, the options of antidiabetic treatment are markedly limited in particular in patients with more advanced impairment owing to the fact that numerous antidiabetic drugs are either metabolized or excreted by the liver or the kidney. In this paper, we focus on the treatment of...

Possibilities of therapy GLP1 RA for diabetics with nephropathy

Alena Adamíková

Vnitr Lek 2015, 61(4):312-315  

The incretin hormone GLP1 (glucagon-like peptide 1) has also systemic effects besides its effects on the pancreas. The renal expression for the receptors GLP1 and DPP4 has been described in a whole line of experimental studies. Activation of the receptors for GLP1 in the kidneys has diuretic and natriuretic effects apparently through the renal tubular cells and sodium transporters. Pre-clinical incretin therapy decreased albuminuria, affected glomerulosclerosis, oxidative stress and fibrosis in the kidneys. Diabetic nephropathy is the major cause of kidney failure. In the course of renal insufficiency the functional possibilities and simultaneous safe...

Treatment of GLP1 receptor agonists and body mass control

Petr Žák, Jindřich Olšovský

Vnitr Lek 2015, 61(4):316-319  

The prevalence of obesity continues to be increasing in all age groups in most countries of the European Union (EU). Many obese people have a history of several successful weight losses, but very few are able to maintain the weight loss over a longer period of time. Initiation of the GLP1 RA administration during weight loss maintenance would inhibit weight loss-induced increases in soluble leptin receptor plasma concentrations resulting in higher level of free leptin thereby preventing weight regain. In contrast initiation of insulin treatment in type 2 diabetes patients is frequently accompanied with weight gain. The GLP1 administration results in...

Treatment of an elderly patients with diabetes

Zdeněk Rušavý, Michal Žourek

Vnitr Lek 2015, 61(4):321-327  

Type 2 diabetes has become a pandemic disease over the past 50 years. Its incidence increases the most rapidly in the senior population, i.e. among people older than 65. In a number of countries 1/4 of the people with diabetes are now older than 65 years. Geriatrics now examines numerous differences regarding the senior patients, which often lead to somewhat different therapeutic procedures as compared to the treatment of other adult patients. This paper aims to show some different aspects of the treatment of an elderly patient with diabetes. The intensity of diabetes treatment in the elderly is mainly defined by the incidence of symptoms caused by...

Issues of infection related to diabetic foot syndrome

Milan Flekač

Vnitr Lek 2015, 61(4):328-334  

Foot wounds are common problem in people with diabetes and now constitute the most frequent diabetes-related cause of hospitalization. Diabetic foot infections cause substantial morbidity and at least one in five results in a lower extremity amputation. They are are now the predominant proximate trigger for lower extremity amputations worldwide. One in five diabetic wounds present clinical signs of infection at primomanifestation. About 80 % of limb non-threating wounds can be succesfully healed using appropriate and comprehensive approach, including antimicrobial therapy, revascularisation and off-loading.

Treatment of hypertension in diabetes mellitus

Jiří Widimský jr

Vnitr Lek 2015, 61(4):335-339  

Hypertension and diabetes mellitus (DM) are common diseases. Prevalence of hypertension in DM type II is 70-80 %. Goal blood pressure (BP) is around 130/80 mm Hg. RAS blockers (ACE inhibitors or AT₁ blockers) are considered as the drugs of choice because of the decrease of cardiovascular risk and prevention of nephropathy. Combination antihypertensive therapy is needed in 80-90 % of pts. Combination of RAS blocker and calcium channel blocker is clinically useful. Diuretics should be part of triple-combination. Low-dose spironolactone can be recommended in severe forms of hypertension. Pharmacological approach should involve also intervention...

Physical activity in patients with microvascular complications of diabetes

Martin Matoulek

Vnitr Lek 2015, 61(4):340-345  

Physical activity is often underestimated and little used in the treatment of diabetes. The fear of damage, especially in patients with diabetes complications is one of the reasons why it occurs. Physical activity plays an important role in prevention of the progression of peripheral neuropathy and its impact is primarily on the development of muscle strength and the ability to replace the function of nerve fibers damaged disabilities. Demonstrable effect on neuropathy is already recorded a few weeks of regular exercise, long-term programs then demonstrate the safety of occurrence of ulcers in compliance with basic foot care. Present autonomic neuropathy...

Progress in the development of insulin pumps and their advanced automatic functions

Martin Prázný

Vnitr Lek 2015, 61(4):355-360  

Patients with type 1 diabetes are exposed to permanent burden consisting of careful glucose self-monitoring and precise insulin dosage based on measured glucose values, carbohydrates content in the food and both planned and non-planned physical activity. Erroneous insulin dosing causes frequent both hypoglycemia and hyperglycemia. Hypoglycemia is, however, the most clinically significant complication limiting the optimal diabetes control. Automatic features for insulin dosage integrated in insulin pumps are thus very important. Low glucose suspend (LGS) and Predictive Low Glucose Management (PLGM) use glucose sensor values to prevent hypoglycemia,...

The microbial flora in the digestive tract and diabetes

Štěpán Svačina

Vnitr Lek 2015, 61(4):361-364  

The microbial flora in the digestive tract has been recently studied in relation to metabolic diseases. There are relations to both type 1 diabetes and type 2 diabetes. The intestinal flora is affected by diet, physical exercise and it significantly changes after bariatric surgeries. Giving birth by caesarean section affects the gut flora development and increases the risk of type 1 diabetes in further life of the child. Obese patients with type 2 diabetes may lack protective microbes which improve glucoregulation in the experiment or on the contrary their patogenous microbes may grow which have been proven to even be able to penetrate into abdominal...

Myokines - muscle tissue hormones

Zuzana Stránská, Štěpán Svačina

Vnitr Lek 2015, 61(4):365-368  

Physical inactivity is demonstrably related to the manifestation of chronic diseases which significantly modify the quality and prognosis of life in a negative way. The benefits of exercise are surely mediated by many pathophysiological mechanisms interrelated in varying degrees, which have not yet been fully examined in their complexity. In the late 20th century it was positively proven that a working striated muscle really regulates the metabolic and physiological response in the other organs. These involve several hundred substances with autocrine, paracrine and endocrine effects. These proteins and peptides, if released into the blood stream, substantially...

Errata et corrigenda

Vnitr Lek 2015, 61(4):294