Aktuality v diabetologii Poděbrady 2015

Jindřiška Perušičová

Vnitr Lek 2016, 62(3):177  

Vyvažujeme: Poděbrady 2016

Milan Kvapil

Vnitr Lek 2016, 62(3):177  

Obesity paradoxes

Hana Rosolová

Vnitr Lek 2016, 62(3):181-182  

Obesity (esp. abdominal type) was still considered as a risk factor for cardiovascular disease. During the last decade has a new phenomenon appeared: "obesity paradox", i.e. patients with high BMI die less frequently than patients with low BMI. Obesity paradox was described first in patients with chronic renal failure, heart failure or in oncological patients, later on in patients with cardiovascular disease and now also in patients with type 2 diabetes. In comparison with population studies, BMI associated with low cardiovascular mortality in patients with Type 2 diabetes is shifted to the higher level than in subjects from general population. Mechanisms...

Clinical aspects of pharmacological treatment of diabetic neuropathy - cooperation with neurologists and diabetologists

Denisa Janíčková Žďárská, Milan Kvapil

Vnitr Lek 2016, 62(3):183-185  

The development and progression of symptomatic diabetic neuropathy (SDN) is linked to hyperglycemia. The effort to improve compensation of diabetes mellitus during therapy is therefore very important. This is where the cooperation between the diabetologist and neurologist within therapy plays an important role. The pharmacological therapy of symptomatic sensitive peripheral diabetic neuropathy is difficult and with a less than satisfactory effect. A variety of active substances is used in symptomatic therapy, primarily designed for intervention in other pathological conditions. The recommended guidelines include antidepressants, anticonvulsants, opiates...

Pharmacogenetics of oral antidiabetic treatment

Ivan Tkáč

Vnitr Lek 2016, 62(3):186-188  

Pharmacogenetics is the study of how genes (individual genotypes) affect a person's response to drugs. At present, recommendations made about the treatment of some monogenic forms of diabetes are based on genetic diagnostics. The first studies in the field of pharmacogenetics of oral antidiabetics have now been published which have identified associations of individual genetic variants with response to treatment. The response to sulfonylurea derivatives was significantly associated with the variants KCNJ11/ABCC8, TCF7L2 and CYP2C9. The response to metformin treatment was associated with the genetic variants ATM and SLC47A1....

Cholesterol metabolism in patients with type 2 diabetes

Michal Vrablík, Eva Tůmová

Vnitr Lek 2016, 62(3):189-194  

Diabetic dyslipidemia is a complex disorder associated with changes in lipid metabolism, which must be considered during care of the diabetic patient. Type 2 diabetes mellitus is a disease associated with a number of macrovascular and microvascular complications and it is necessary to treat the patient with regard to the possibility of developing these disorders. Prevention of cardiovascular complications is one of the most important factors of diabetes care, because cardiovascular diseases are among the leading causes of morbidity and mortality in patients with diabetes mellitus. The risk of developing atherosclerotic changes is significantly higher...

Victoza changes diabetes and lives of patients 5 years already

Jana Jiráčková, Alena Šmahelová

Vnitr Lek 2016, 62(3):195-197  

Victoza (liraglutide) is a modern antidiabetic drug of GLP1 (glucagone like peptide) analogue group; since 2009 registered in Czech republic. VICTOZA is used in therapy of type 2 diabetic patients with preserved endougenous insulin secretion, usually in combination with other peroral antidiabetic drugs or with basal insulin. VICTOZA is applied once a day subcutaneously. The characteristical antidiabetic effect with β cell protection is enhanced with supportive weigth reduction effect. Positive cardiovascular influence is expected, however data from recent studies are not available at this time. In clinical practice, the mild upper dyspepsia after...

XIGDUO - fixed combination of the active ingredients dapagliflozin and metformin

Tomáš Edelsberger

Vnitr Lek 2016, 62(3):199-201  

Fixed dose combination of two different drugs in the same or related indications are successfully used in various medical fields including diabetology. This article deals with the combination therapy comprising metformin and dapagliflozin in a single preparation, molecules affecting different pathophysiological mechanisms of type 2 diabetes, particularly insulin resistance and increased glucose reabsorption in the kidney. Most patients with type 2 diabetes does not achieve target glycemic control when treated with single antidiabetics and need for proper control of diabetes combination of several different drugs. Using the fixed combination leads to...

Diabetes mellitus and pancreas cancer

Jan Škrha, Pavel Škrha, Přemysl Frič

Vnitr Lek 2016, 62(3):202-209  

Diabetes mellitus and pancreatic cancer establish both-side relationship, one disease may have influence a development of the other. Pathogenic mechanisms sharing their relationship are overviewed. Early diagnosis may contribute to better prognosis of the patients with malign tumor. The treatment by antidiabetic drugs offer to diabetic patients different risks of pancreatic cancer but lots of data are still lacking.

Early detection of ISHD in diabetic patients and determining the type of treatment

Tomáš Kovárník, Kristýna Bayerová, Karel Kopřiva

Vnitr Lek 2016, 62(3):210-214  

Diabetes mellitus is a major risk factor for the development of ischemic heart disease. Its prevalence in diabetic patients is reported to range broadly between 10-55 %. It is necessary to actively search for the presence of myocardial ischemia in patients with diabetes, since waiting for the development of symptoms is associated with the finding of already advanced coronary atherosclerosis in these patients, with less satisfactory outcomes of coronary interventions and surgery. Results of the BARDOT study seem to indicate that the appropriate tool for stratification of the risk of cardiac events in diabetics could be stress myocardial scintigraphy....

What is the significance of the phenomenon of hypertension in disguise in patients with type 2 diabetes mellitus treated for long-lasting hypertension?

Jiří Charvát

Vnitr Lek 2016, 62(3):215-217  

"Hypertension in disguise" is quite frequent in the patients with diabetes mellitus. It leads to organ damage similarly as persistent hypertension and it is associated with an increased cardiovascular risk which can be reduced through effective treatment. Persistent hypertension is present in 70% of the patients with type 2 diabetes mellitus. During its treatment, the picture of "masked hypertension" may be imitated (normalized blood pressure taken at a day clinic, as opposed to the increased values outside of it). This finding occurs in 35-60 % of the patients with type 2 diabetes mellitus and it is associated with the significance of changes to internal...

Management of type 2 diabetes mellitus therapy in a mature age

Jiří Hradec, Eva Račická

Vnitr Lek 2016, 62(3):218-222  

Type 2 diabetes mellitus represents a serious medical, social and economic problem, since it has become a pandemic in recent years, affecting up to 1/3 of the Czech population in old age. It is the clinically most significant metabolic disease in older age. A pharmacotherapeutic approach needs to be adjusted to the presence of multiple comorbidities in the elderly and to the patient's ability to cooperate with treatment, and owing to the feared hypoglycemia which may contribute to increased morbidity, it detracts from the quality of life and limits the possibilities of treatment in many cases. When taking decisions about the treatment, the recommendations...

Motor vehicle driving and diabetes mellitus - medical aspects

Jan Brož, Lenka Syčová Kriváňová, Zuzana Fedáková, Lilit Petrosyan, Milan Kvapil, Jan Polák

Vnitr Lek 2016, 62(3):223-225  

Diabetes mellitus is a disease which may affect the eligibility to hold a driving license and increase the risk of a road accident. Hypoglycemia while driving is considered to be the most risky situation, with diabetes increasing the mentioned risk for instance due to impaired vision in the case of possible retinopathy. The group of drivers with diabetes being at the greatest risk as to accidents are those with a case history of severe hypoglycemia or hypoglycemia occurred while driving, or possibly of a road accident. Measuring glycaemia before driving and their knowledge how to prevent and treat hypoglycemia - those are the two crucial preventive...

Motor vehicle driving and not only diabetes mellitus - certain aspects of the legislations in the Czech Republic

Jan Brož, Lenka Syčová Kriváňová, Denisa Janíčková Žďárská, Ondřej Novák

Vnitr Lek 2016, 62(3):226-228  

A review of medical fitness to hold a driver's license in diabetes mellitus patients occurs when applying for the license and then at least every three years. Severe hypoglycemic events are an important criterion with the view of eligibility loss to drive a vehicle. All physicians regardless of their speciality who suspect the loss of eligibility in a patient they come into professional contact with are under the obligation to report this fact to the local authority in the patient's place of residence.

"Healthy behaviour" and mental resilience in youth within the Diateens project

Viera Cviková, Adriana Ilavská

Vnitr Lek 2016, 62(3):229-232  

Approximately every fifth Slovak is obese and every other is overweight. These findings gave birth to a project called Diateens - the youth-oriented project aimed at the prevention of diabetes mellitus. The patronage over the project as one of the educational programme within the National Diabetes Programme, was assumed by the Slovak Diabetes Society and the Slovak WHO Office. The purpose of the project was to improve the awareness of young people about diabetes mellitus, ascertain the general state of their health and support a healthy lifestyle (healthy behaviour) as an important component in the prevention of the disease.