Umělá inteligence a diabetologie: jde to dohromady?

Milan Kvapil

Vnitr Lek 2019, 65(4):231  

Management of diabetic patients with lower extremity peripheral arterial disease

Peter Gavorník, Andrej Dukát, Ľudovít Gašpar, Gabriela Gubo, Naďa Bežillová, Martina Kováčová, Eva Gavorníková, Anna Petrášová, Iveta Gašparová, Lujza Sabolová, Marek Kučera, Katarína Kusendová, Alena Uhrinová, Matej Bendžala, Dáša Mesárošová

Vnitr Lek 2019, 65(4):326-334 | DOI: 10.36290/vnl.2019.058  

Extremitovascular arterial ischemic disease (lower extremity peripheral arterial disease - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the ankle-brachial pressure index, the greater the risk of serious acute instable organovascular events (e. g. acute myocardial infarction, stroke). Complex prevention and treatment of extremitovascular arterial disease is discussed in this article. Angiology/vascular medicine is the fastest growing field of internal medicine.

Type 1 diabetes: etiology and epidemiology

Ondřej Cinek, Zdeněk Šumník

Vnitr Lek 2019, 65(4):235-247 | DOI: 10.36290/vnl.2019.041  

Type 1 diabetes is a consequence of islet autoimmunity destroying the pancreatic beta cells. Its dramatic rise in incidence, having apparently non-genetic causes, has made it very important to investigate environmental factors whose modification could prevent the disease. Here we review the disease incidence trends and periodicity, the genetic susceptibility, and selected non-genetic risk factors. There has been an enormous change over the past five decades in the exposure to microbial agents and their antigens: in particular, the use of antibiotics and improvements in hygiene and food safety have contributed to a decrease in the microbial load which...

Insulin pump therapy: education and its goals

Kateřina Štechová

Vnitr Lek 2019, 65(4):248-255 | DOI: 10.36290/vnl.2019.042  

Insulin pump therapy represents nowadays the way of insulin administration most similar to the physiological insulin secretion. This form of intensified insulin regime is used mostly (but not exclusively) in type 1 diabetes patients. Insulin pump therapy can be efficiently combined with continuous glucose monitoring. Even there are available insulin pumps which can serve as continuous glucose monitoring signal receiver themselves and are capable to stop automatically basal insulin infusion to prevent hypoglycemia. By this technological combination it is possible to reach near normoglycemia without increasing the risk of severe hypoglycemia. In the...

Diabetes in pregnancy: current ways of treatment

Dagmar Bartášková

Vnitr Lek 2019, 65(4):256-263 | DOI: 10.36290/vnl.2019.044  

It is well known, that number of diabetics pregnancies is raising. It is due to growing amount of women with type 1 and type 2 diabetes, which can easily reach the right age for pregnancy. It allows new ways of diabetes treatment, new technologies and in general better health state of this women. Displacement the pregnancy to later age, leads to gestational diabetes increasing. Especially women with pregestational diabetes are in higher risk of perinatal and diabetic complications. More than half of all pregnancies are not planned and so that often not well controlled or used inappropriate medication. Preterm deliveries, acute sectiones cesarea, eclampsia,...

Primary and secondary insulin resistance

Marián Mokáň, Peter Galajda

Vnitr Lek 2019, 65(4):264-272 | DOI: 10.36290/vnl.2019.045  

Insulin resistance (IR) is defined as insufficient insulin metabolic effect in target tissues, including glucose utilisation in skeletal muscle, suppression of hepatic glucose production and suppression of lipolysis in fat tissue. Primary IR originates as consequence of rare monogenetic defects of insulin receptor or molecules includes to post-receptor insulin signal cascade. Secondary IR originates mainly as a result of metabolic or hormonal changes, most commonly in visceral obesity by multifactorial postreceptor inhibition of insulin signal and it is associated with metabolic syndrome and type 2 diabetes mellitus. It is also present in endocrinopathies...

Strategy and tactics of treatment of type 2 diabetes mellitus

Milan Kvapil

Vnitr Lek 2019, 65(4):273-278 | DOI: 10.36290/vnl.2019.046  

The results of randomized double-blind studies provide scientifically accurate data on the efficacy of antidiabetic drugs. With the widening understanding of heterogeneity of the group of patients with type 2 diabetes mellitus and the broadening possibilities of interventions available, a differentiated approach to therapy is now accentuated. From the perspective of pathophysiology, 8-10 different disorders have been described which contribute to the occurrence of hyperglycemia, but they cannot be quantified in common practice. However, it is possible to evaluate the amount of insulin secretion (C-peptide), the presence or severity of insulin resistance...

How well we treat with insulin in the Czech Republic and in the Slovak Republic A summary of results and comments on the original Czech-Slovak DIAINFORM study

Jan Brož, Denisa Janíčková Žďárská, Jana Urbanová, Viera Doničová, Emil Martinka, Milan Kvapil

Vnitr Lek 2019, 65(4):279-283 | DOI: 10.36290/vnl.2019.048  

Despite the continuously improving treatment options, many patients with type 1 (T1DM) and type 2 diabetes (T2DM) still do not achieve the recommended treatment goals. The article provides summary and commentary of the results of DIAINFORM study focused on the level of metabolic control in T1DM and T2DM patients treated with insulin in the Czech and Slovak Republics. The overall percentage of patients with HbA_1c < 53 mmol/mol in the T1DM group was 29.9 % and in the T2DM group was 33.4 %.

The role of GLP-1 receptor agonists and their fixed combination with insulin in the treatment of type 2 diabetes mellitus

Zbynek Schroner, Vladimír Uličiansky

Vnitr Lek 2019, 65(4):284-288 | DOI: 10.36290/vnl.2019.049  

Therapy with GLP1 receptors agonists shows various multiorgans benefits. Possible reasons of preference of this treatment are: efficacy, decrease of weight, CV protectivity, slow down the progression of nephropathy, protection of function of B-cells, safety (low risk of hypoglycemia, small incidence of serious adverse events), decrease of blood pressure, lipids, biomarkers of CV risk, markers of chronic subclinical inflammation. In context of individual approach, therapy with GLP1 receptors agonists should be preferably used in early stages of type 2 diabetes mellitus, as second choice treatment after metformin, mainly in more obese patients with subclinical...

A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus

Jan Brož, Jana Urbanová

Vnitr Lek 2019, 65(4):289-294 | DOI: 10.36290/vnl.2019.050  

Hypoglycemia particularly severe one is important side effect of diabetes therapy with impact on patient's quality of life and mortality. The highest risk of hypoglycemia is connected with insulin therapy followed by derivates of sulfonylurea (SU) and glinides. The risk of hypoglycemia found in observational studies were 2-3 times higher in patients treated with SU and 3-4 higher when treated with insulin compared with other types of antidiabetics. The risk of hypoglycemia is increased in patients over 75 years of age, with longer period of treatment with insulin and in those treated with several types of antidiabetics.

Current view of treatment of hypoglycemia

Jan Brož, Jana Urbanová, Marisa Nunes, Martina Tuháčková, Ludmila Brunerová, Denisa Janíčková Žďárská

Vnitr Lek 2019, 65(4):295-299 | DOI: 10.36290/vnl.2019.051  

Hypoglycemia is a side effect of the therapy primarily with insulin, sulphonylurea derivates and glinides. Its therapy is based on the immediate ingestion of sacharides, preferably glucose. Amount of 15-20 g is recommended as its optimal dose, although several recent studies are suggesting amount related to the patient's weight. The therapy of severe hypoglycemia in the non-professional settings is based on glucagon injection, in the professional ones intravenous administration of glucose is preferable option.

Hypoglycemia as a symptom of adrenal dysfunction in patients with diabetes mellitus: rare but real situation

Ludmila Brunerová, Jana Urbanová, Jan Brož

Vnitr Lek 2019, 65(4):300-302 | DOI: 10.36290/vnl.2019.052  

Recurrent, unexplained, eventually severe hypoglycemias in patients with type 1 diabetes mellitus (T1DM) may be rarely but yet associated with the onset of adrenal insufficiency (AI), present in approximately 0.5 % of patients with T1DM, appearing usually several years after diabetes diagnosis, usually in middle age and more frequently in women. Screening for AI in patients who complained of recurrent hypoglycemias, difficult to explain by common causes, was ineffective and therefore it is not recommended. Nevertheless, the possibility of manifestation of AI in connection with above mentioned cases in patients with T1DM should be taken into consideration...

Ethanol and risk of hypoglycemia in patients with type 1 diabetes mellitus: a brief overview for clinical practice

Martina Tuháčková, Jana Urbanová, Ludmila Brunerová, Pavlína Piťhová, Milan Kvapil, Jan Brož

Vnitr Lek 2019, 65(4):303-306 | DOI: 10.36290/vnl.2019.053  

Alcoholic drinks are one of the risk factors for hypoglycemia. Ethanol inhibits gluconeogenesis, decreases a level of growth hormone and impairs hypoglycemia awareness. The risk of hypoglycemia while drinking alcohol can be reduced by parallel ingestion of food (saccharides). Some recommendations also mention the change of insulin doses.

Diabetes Mellitus and Chronic Heart Failure

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2019, 65(4):307-313 | DOI: 10.36290/vnl.2019.054  

Diabetes mellitus is one of the major risk factors for many cardiovascular diseases, primarily ischemic heart disease and heart failure. In patients with heart failure, the incidence of diabetes mellitus is 3-4 times greater than in non-cardiac patients and is reported to be about 40%. Diabetic cardiomyopathy is a term that expresses the relationship between diabetes mellitus and heart disease. Regarding the treatment of heart failure in patients with diabetes mellitus, the general principles of heart failure therapy apply. In most studies, the effect of ACE inhibitors was greater in diabetics than in non-diabetics, the effect of beta-blockers was...

Oral diseases in diabetic patients

Hana Poskerová, Petra Bořilová Linhartová, Lydie Izakovičová Hollá

Vnitr Lek 2019, 65(4):314-320 | DOI: 10.36290/vnl.2019.055  

In this paper, the authors summarize current findings on the relationship between diabetes mellitus (DM) and oral tissue diseases. They study the effect of diabetes on the condition of hard dental tissues, oral mucosa and salivary glands and explain how these undesirable changes occur. They focus primarily on the bilateral relationship between diabetes and periodontitis, common pathogenetic traits of both diseases and on the effect of periodontal treatment on basic metabolic diseases. They show that diabetes not only negatively affects the condition of periodontal tissues, but inflammatory disease of periodontium is also a risk factor for hyperglycemia....

Driver medical fitness and diabetes mellitus: legislative changes in 2018 and a summary of health aspects

Jan Brož, Katarína Halčiaková, Denisa Janíčková Žďárská, Ondřej Novák

Vnitr Lek 2019, 65(4):321-325 | DOI: 10.36290/vnl.2019.056  

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 in non professional drivers and 1 year in professional ones. Severe hypoglycemic events are an important criterion with the view of eligibility loss to drive a vehicle, among the others the vision impairment, diabetic peripheral neuropathy or extremity amputation should be evaluated. Also the ability of patient to follow recommendations particularly regarding glucose self-monitoring may influence the final decision.

Karel Pavelka, Jiří Vencovský, Pavel Horák et al. Revmatologie

Petr Němec

Vnitr Lek 2019, 65(4):255  

Karel Lukáš, Jiří Hoch (eds) et al. Nemoci střev

Jan Wechsler

Vnitr Lek 2019, 65(4):278  

Pavel Dostál et al. Základy umělé plicní ventilace

Pavel Ševčík

Vnitr Lek 2019, 65(4):325