Metabolic syndrome in patients with diabetes mellitus type 1, prevalence, impact on morbidity and mortality

Jitka Brožová, Daniela Čechurová, Silvie Lacigová

Vnitr Lek 2016, 62(Suppl 4):8-14  

Aim of this retrospective observational study was to determine the prevalence of metabolic syndrome (MS) in patients with diabetes mellitus type 1 (DM1Z) at baseline (in 2003) and find the parameters that determine the difference between group with (MS+) and without MS (MS-). Did the presence of MS affect morbidity and mortality in the subsequent 10 years? Methods:278 patients were enrolled to the study with age average 39 ± 13 years with medical history of diabetes 15.9 ± 9 years. The IDF criteria were used for MS diagnosis. Anthropometric and biochemical parameters, prevalence and incidence of microangiopathic...

Frequency and timing of meals and changes in body mass index: Analysis of the data from the Adventist Health Study-2

Hana Kahleová, Jan Irene Lloren, Andrew Mashchak, Martin Hill, Gary Fraser

Vnitr Lek 2016, 62(Suppl 4):15-20  

Goal:Our study focuses on examining the relationship between the frequency and timing of meals and changes in BMI in the Adventist Health Study-2 (AHS-2) which represents a relatively healthy population in North America. Methodology:A longitudinal analysis was undertaken using data from 48 673 individuals monitored over an average period of 7.43 ± 1.24 years. The number of meals per day, length of nighttime fasting, eating breakfast and timing of the largest meal of the day (breakfast 5-11 a.m., lunch noon-4 p.m. or supper/dinner 5-11 p.m.) were used as independent variables. The primary output was the change in body...

Education of a patient with diabetes - an integral part of complex therapy

Alena Adamíková

Vnitr Lek 2016, 62(Suppl 4):21-25  

Determination of the diagnosis of diabetes mellitus means a radical life change for a patient. Education of a patient with diabetes means the provision of essential information and practical guidance for linkage of the disease with the life style of the patient for the purpose of providing the required control of the disease, to gain the necessary knowledge for self-care management of the disease in collaboration with the education team. Education is a permanent integral part of the complex therapy of diabetes, adaptation to the phases of the disease, targeting not only the patient but immediate family. The fundamental aim is improvement of the state...

Pregestional diabetes mellitus and pregnancy

Jana Bělobrádková

Vnitr Lek 2016, 62(Suppl 4):26-29  

There is a groving number of women with pregestational diabetes mellitus. Additionaly, nowadays therapy of diabetes mellitus type I allows gravidity even in patients in whom diabetes manifested itself during their early childhood. Presence of chronic complications of diabetes increases risk of complications during pregnancy. There is incerasing number of patients with DM type II and appearence of it shifts into younger age group. Perinatal mortality and morbidity of children of mothers with pregestional diabets is higher than in comparison with common population and pregnancy planning is important measure to their decrease.

Bariatric surgeries at diabetic patients

Martin Haluzík

Vnitr Lek 2016, 62(Suppl 4):30-35  

A worldwide increase in the prevalence of obesity and type 2 diabetes mellitus along with accompanying chronic, in particular cardiovascular, complications represents one of the leading challenges of current medicine. Despite major advances in diabetes pharmacotherapy, bariatric surgery remains the most effective treatment of diabetes. It not only markedly decreases body weight and improves glucose control but also induces diabetes remission in a significant percentage of patients. According to current recommendations, bariatric surgery is indicated in patients with 3^rd degree obesity (even without any complications) or with 2^nd...

Mind as an immunomodulator

Cyril Höschl, Jiří Horáček

Vnitr Lek 2016, 62(Suppl 4):36-41  

Review paper highlights the connection between psyche and the body's immune defense mechanisms and summarizes new findings on the relations between nervous and immune systems. The article also briefly describes the outcome of authors' own original works on the relationship between infections and schizophrenia, and their notice about possible immunomodulatory effects of antipsychotics

Diabetic foot syndrome from the perspective of internist educated in podiatry

Alexandra Jirkovská

Vnitr Lek 2016, 62(Suppl 4):42-47  

Podiatry is the science dealing with the diagnostics and treatment of the foot and ankle and associated tissues and structures by all appropriate methods and also with the local manifestation of the overall processes in this area. Diabetic foot disease is defined as infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of people with diabetes according to the latest edition of the International Consensus. Successful treatment and prevention of diabetic foot syndrome depends on a holistic approach, in which it is seen as part of the multiple organ involvement. Teamwork...

OxLDL/β2-glycoprotein I complex as a pro-atherogenic autoantigen. Is atherosclerosis an autoimmune disease?

Pavel Kraml

Vnitr Lek 2016, 62(Suppl 4):48-51  

Oxidation of atherogenic low-density lipoproteins (LDL) plays a key role in the pathogenesis of atherosclerosis. Oxidation stress and inflammation are closely interrelated and they can potentiate one another. In the subendothelial space of the arterial intima, monocytes/macrophages become activated and phagocyte oxidized LDL (oxLDL) via scavenger receptors. It has been demonstrated that oxLDL forms complex with plasma β2-glycoprotein I (β2GPI) and becomes autoantigenic triggering synthesis of specific antiphosholipid antibodies. It has been documented that oxLDL/β2GPI in immune complex with IgG autoantibody is internalized by macrophages...

Gestational Diabetes Mellitus

Hana Krejčí

Vnitr Lek 2016, 62(Suppl 4):52-61  

The present generation of women of childbearing age more frequently suffer from overweight, obesity, initial as well as fully established metabolic syndrome, which together with postponing motherhood until the third decade in life plays an important role in the increasing incidence of gestational diabetes (GDM) that currently affects about 1/5 of pregnant women. However the causal link between diabetes during pregnancy and metabolic diseases in the whole population is mutual. By way of epigenetic changes, maternal diabetes unfavourably programmes metabolism of the offspring, who tend to transfer the disorder to the next generations. Gestational diabetes...

Growth hormone, axis GH-IGF1 and glucose metabolism

Michal Kršek

Vnitr Lek 2016, 62(Suppl 4):62-66  

Growth hormone is a hormone of anterior lobe of pituitary gland which possesses besides its growth promoting effects also many other various physiological effects including its regulatory influences on metabolism with glucose metabolism belonging to most important ones. The present article summarizes basic information about metabolic consequences of disturbed growth hormone secretion and their importance for clinical presentation and management.

Promising molecules for treatment of hyperglycemia in patients with type 2 diabetes

Milan Kvapil

Vnitr Lek 2016, 62(Suppl 4):67-71  

New antidiabetic drugs are being developed today that expand the range of pharmacological intervention, in particular for patients with type 2 diabetes (imeglimin, semaglutide, dulaglutide, FGF 21 analogue). At the same time innovations take place that "better" the well-proven molecules, they offer new application forms we have no experience of diabetology (osmotic pump for exenatide, faster acting insulin aspart). New properties are brought by just the change of concentration (insulin glargine in a concentration of 300 U/ml), unexpected positive results are also brought by new fixed-ratio combinations of antidiabetics (fixed-ratio combination of insulin...

Congenital hyperinsulinism: Loss of B-cell self-control

Jan Lebl, Klára Roženková, Štěpánka Průhová

Vnitr Lek 2016, 62(Suppl 4):72-76  

Congenital hyperinsulinism is a serious blood glucose regulation defect that interferes with brain development, leading to mental retardation, neurological sequelae and secondary epilepsy and ultimately may be life-threatening. Congenital hyperinsulinism (CHI) is caused by genetic defects of regulation of insulin secretion that induce insulin oversecretion in intrauterine life and postnatally. The clinical consequence is fetal macrosomia and subsequently neonatal and infantile hypoglycaemia. The most severe form is caused by biallelic mutations of KCNJ11 and ABCC8 genes that encode both potassium channel subunits, whereas their heterozygous...

Obstructive sleep apnoea and type 2 diabetes mellitus

Andrea Plíhalová, Kateřina Westlake, Jan Polák

Vnitr Lek 2016, 62(Suppl 4):79-84  

Obstructive sleep apnoea syndrome (OSA) is a disease very frequently occurring in people with type 2 diabetes, that significantly increases cardiovascular morbidity and mortality. In a number of studies, OSA has been identified as an independent risk factor for the development of insulin resistance, glucose intolerance and type 2 diabetes mellitus. Disorders of glucose homeostasis in patients with OSA are probably mediated by chronic intermittent hypoxia and/or sleep fragmentation through activation of the sympathetic nervous system, the hypothalamic-pituitary-adrenal stress axis, pro-inflammatory paths or oxidative stress. Despite the high prevalence...

Short-term and long-term glycemic variability and its relationship to microvascular complications of diabetes

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

Vnitr Lek 2016, 62(Suppl 4):85-93  

Vascular complications of diabetes result from long lasting unsatisfactory glycemic control. We usually assess glycemic control based on the value of glycated hemoglobin HbA_1c. The glycated hemoglobin test, however, says nothing about short-term glycemic fluctuations. Recently, continuous monitoring of glycemia has enabled us an in-depth assessment of changes in glucose concentrations, called glycemic variability. In connection with the research into short-term glycemic variability, also the study of long-term fluctuations in glycemic control based on HbA_1c variability has now intensified. Glycemic variability may be related to...

Composition of macronutrients in the diabetic diet

Zdeněk Rušavý, Michal Žourek

Vnitr Lek 2016, 62(Suppl 4):94-99  

The diabetic diet is one of the pillars of diabetes treatment. The rapid development of knowledge relating to the treatment of diabetes also includes diet. The paper focuses on the importance of a diet in the treatment of type 2 diabetes and prevention of atherosclerosis. Its main goal is to assess the impact of a composition of macronutrients on individuals with type 2 diabetes. The paper is divided into several parts, each of which ends with a conclusion. The first part examines weight reduction. The diet aimed at a weight loss is effective, it can effectively prevent diabetes, it leads to improvements in glucose control and reduction of the risk...

Is glucosis only basic energy substrate?

Luboš Sobotka

Vnitr Lek 2016, 62(Suppl 4):100-102  

At present time glucose is primarily considered as basic energy substrate. Therefore, it is recommended to give amount of glucose which is necessary for oxidation and energy production. As critical illness is connected with so-called insulin resistance, it is recommended to reduce the glucose dose and maintain normal blood glucose. Glucose, however, may not only be the principal energy substrate but also the substrate necessary for many metabolic reactions, which are essential for normal reactivity and survival.

Actual trends in diagnostics and treatment of congenital hyperinsulinism

Juraj Staník, Martina Škopková, Monika Rosoľanková, Iwar Klimeš, Daniela Gašperíková

Vnitr Lek 2016, 62(Suppl 4):103-112  

Congenital hyperinsulinism (CHI) is the most common cause of severe persistent hypoglycemia in neonates and infants. Early diagnosis and effective treatment (based on the principles of pharmacogenetics) play the key role for the prognosis. The DNA anlysis, which can identify mutation in one of the 11 genes causing MODY, is crutial in the diagnostics. Moreover, The genotype determines also the optimal therapy approach (medicaments, diet or rarely surgery). There was a large progress of novel medicaments treating particularly most severe (diazoxide-resistant) forms of CHI.

Should we consider a new classification of diabetes influenced by therapeutic decisions?

Jan Škrha

Vnitr Lek 2016, 62(Suppl 4):113-118  

The growing number of diabetic patients in the whole world causes the problems to allocate some patients into the respective type of diabetes related to the present classification. B cell is considered as the central cause of diabetes and its intracellular impairment is practically the same in both types of diabetes. Diabetic patients will be recognized according to the state of impaired B cell. The antidiabetic drugs will be selected according to their effect protecting the B cells. Some antidiabetic drugs will be used more frequently in type 1 diabetes as well.

Diabetes mellitus in older adults from the point of view of the clinical diabetologist

Alena Šmahelová

Vnitr Lek 2016, 62(Suppl 4):119-122  

Disorders of glucose homeostasis affect quite a large part of the older population and their incidence including manifest diabetes is growing. Diabetes in older adults is associated with an increased risk of geriatric syndrome expressed in various ways (decrease in muscle size, functional disability, frailty) and early mortality. Diabetes care for the elderly requires, also in view of heterogeneity of diabetes itself, an individual specific approach. This involves not only diagnostics and a clinical picture, but also the treatment goals and the therapy of diabetes and complications in itself. Diabetes treatment includes both regimen adjustments and...

Adaptation of adipose tissue to weight-reduction energy-restricted diet in obese individuals

Vladimír Štich

Vnitr Lek 2016, 62(Suppl 4):123-128  

Obesity is associated with a number of metabolic disorders that lead to the development of type 2 diabetes, hyperlipidemia and ultimately cardiovascular diseases. An important role in the pathogenesis of metabolic disorders accompanying obesity is probably played by the alterations of adipose tissue characteristics: metabolic, endocrine and immune functions. The key component of obesity treatment, the weight-reduction energy-restricted diet, leads not only to the reduction of weight (specifically fat mass), but also to correction of obesity accompanying metabolic disorders. The mechanisms which mediate the metabolic effect of the weight-reduction energy-restricted...

Heterogeneity of childhood diabetes and its therapeutic implications

Zdeněk Šumník, Štěpánka Průhová, Ondřej Cinek

Vnitr Lek 2016, 62(Suppl 4):129-135  

The prevalence of diabetes in Czech children is 1 : 500-1 000. Its incidence rose about threefold over the past 25 years. Type 1 diabetes is the prevailing form of diabetes in childhood, but also monogenic forms are frequently diagnosed. The occurrence of type 2 diabetes is still marginal in Czech children, with a relative proportion of less than 1 % of all diabetic children. Etiological diagnosis is the basic prerequisite of an effective diabetes treatment. In this review we present novel aspects on etiology and therapy of diabetes diagnosed in childhood and adolescence.

History of diagnosis and therapy of diabetic retinopathy

Tomáš Sosna

Vnitr Lek 2016, 62(Suppl 4):136-141  

The article surveys the fascinating historical milestones of the diagnosis of diabetic retinopathy. In the context of the discovery then it represents some of the famous characters of ophthalmology and documents the evolution of diagnostics, conservative treatment, as well as laser and surgical therapy for this serious disease

Michal Anděl slaví sedmdesátku!

Terezie Pelikánová

Vnitr Lek 2016, 62(Suppl 4):3-4