Hlavní téma – diabetologie

prof. MUDr. David Karásek, Ph.D.

Vnitr Lek 2025, 71(8):479  

Endocrine disruptors and diabetes mellitus

Michaela Svojtková, Lucie Kolátorová, Jana Vítků

Vnitr Lek 2025, 71(8):484-488  

The incidence of diabetes mellitus of all types has been increasing in recent years. At the same time, the number of anthropogenic chemicals in the environment that can influence the endocrine system is increasing. These substances are called endocrine disruptors (EDs) and their effects on endocrine-active organs are intensively studied. The relationship between ED and diabetes mellitus is a current topic of research. This review presents the current state of knowledge about the role of ED in all types of diabetes and the possible late consequences of their exposure during development. It also briefly discusses a basic overview of endocrine disruptors,...

Pancreatic cancer and diabetes mellitus

Jan Křivinka, Petr Dítě, Beatrice Mohelníková Duchoňová, Ondřej Urban, Lumír Kunovský

Vnitr Lek 2025, 71(8):490-496  

Pancreatic cancer (PC) is one of the most lethal malignancies with increasing incidence. Diabetes mellitus (DM) is a common condition that shares multiple pathophysiological links with pancreatic cancer. New-onset diabetes may represent an early manifestation of pancreatic cancer, whereas long-standing diabetes slightly increases its risk. Recognizing features of paraneoplastic diabetes is essential in clinical practice. This article reviews current knowledge on the PC-DM relationship, emphasizing diagnostic and therapeutic implications.

Immune-mediated diabetes mellitus induced by checkpoint inhibitors: case reports and clinical overview for internists

Martina Tuháčková, Jan Brož

Vnitr Lek 2025, 71(8):498-501  

Immune checkpoint inhibitors (ICIs) represent a major advancement in the treatment of solid tumors, but their use carries the risk of immune-related adverse events (irAEs). Among the rare but clinically significant irAEs is insulin-dependent diabetes mellitus (ICI-DM), which shares features with type 1 diabetes. This article presents two case reports of patients who developed ICI-DM during anti-PD-1 therapy (nivolumab, pembrolizumab). The first case involved acute onset of ICI-DM with diabetic ketoacidosis, positive autoantibodies, and concurrent autoimmune hepatitis. The second patient, with pre-existing type 2 diabetes, initially presented with hyperglycemia;...

Cardio-renal-metabolic syndrome and its management in clinical practice

Martin Šatný

Vnitr Lek 2025, 71(8):502-507  

Cardio-reno-metabolic syndrome (CRM syndrome) is an umbrella term linking metabolic, kidney, and cardiovascular diseases, resulting from the complex interaction of insulin resistance, chronic inflammation, activation of neurohumoral systems, and maladaptive organ responses. Epidemiological data clearly show its high prevalence and significant contribution to global morbidity and mortality. The following text summarizes the current evidence on CRM syndrome, with an emphasis on pharmacotherapy with simultaneous cardiovascular and kidney benefits, particularly SGLT2 inhibitors, GLP-1 receptor agonists, renin-angiotensin-aldosterone inhibitors, mineralocorticoid...

Unrealized potential of innovative therapies for type 2 diabetes - the economic burden of preventable cardiorenal complications

Tomáš Doležal, Klára Lamblová, Kateřina Chadimová, Barbora Decker, Bohdana Kubešová, Iva Piljarová, Klára Koubková, Michal Kostern, Anastasie Halas

Vnitr Lek 2025, 71(8):509-515  

In the Czech Republic, the prevalence of type 2 diabetes is significantly increasing. For the future sustainability of treatment costs related to complications, timely treatment based on evidence-based medicine and in accordance with clinical guidelines is essential. The current consensus on type 2 diabetes treatment focuses not only on glycemic and weight control but primarily on reducing cardiorenal risk using modern drug classes with sufficient evidence - GLP-1 receptor agonists and SGLT2 inhibitors. An analysis of administrative patient data from 81,204 insured individuals of the health insurance companies OZP, RBP, and ZPS, who had the E11 (type...

Angioedema as an adverse effect of treatment with various drugs

Jan Baroš, Roman Hakl, Sáva Pešák, Zita Chovancová

Vnitr Lek 2025, 71(8):517-523  

Angioedema is an intermittent and localized swelling of the deeper layers of the skin or mucous membranes. The most important mediators involved in its development are bradykinin and histamine. The latest classification (known as DANCE) distinguishes five types of angioedema. Drug-induced angioedema forms a separate group. The most significant drug classes causing angioedema include angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor-neprilysin inhibitors (ARNIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and tissue plasminogen activators (tPAs). Although the exact mechanism responsible for the development of angioedema in these...

Current trends in pharmacotherapy of overweight and obesity

Anna Ürgeová, Miriam Kozárová

Vnitr Lek 2025, 71(8):E14-E21  

Obesity is a chronic, progressive, often relapsing disease with numerous metabolic, physical, and psychological complications. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a pivotal therapeutic class in the management of type 2 diabetes mellitus (T2DM), demonstrating remarkable efficacy not only in glycemic control, but also in weight reduction. GLP-1RAs act as incretin mimetics, i.e. enhancers of the incretin effect. GLP-1, an incretin hormone secreted from the gut after food intake, stimulates insulin release from pancreatic islet β-cells in a glucose-dependent manner. The incretin effect is often impaired in patients...

Atrial Fibrillation at the Internal Medicine Department of the Regional Hospital in Frýdek-Místek in 2023

Iveta Ožanová, Tomáš Svoboda, Kamil Zeman

Vnitr Lek 2025, 71(8):E1-E6  

Introduction: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, with a prevalence that increases significantly with age and is associated with reduced quality of life, higher morbidity, and mortality. On internal medicine wards, patients with AF represent a substantial proportion of hospitalizations, and it is essential not only to manage the acute condition but also to establish an optimal long-term treatment strategy. Aim: To evaluate the demographic characteristics of the patient cohort, the chosen treatment strategy, and its outcomes. Methods and patient cohort: A retrospective analysis of patients with AF hospitalized at...

Potential of Glucagon-like peptide-1 receptor agonists (GLP1a) and Sodium-Glucose Co-transporter-2 inhibitors (SGLT2i) in the treatment of MASLD

Anna Török Zapletalová, Boris Focko, Martin Jozef Péč, Daniel Ján Havaj, Ľubomír Skladaný, Emil Martinka, Peter Galajda

Vnitr Lek 2025, 71(8):E7-E13  

Objectives: In type 2 diabetics, MASLD has a prevalence of 65.33%. DM2 itself is a risk factor for disease progression. GLP-1 receptor agonists (GLP1a) and SGLT2 inhibitors (SGLT2i) have shown significant cardioprotective and hypoglycemic effects. Their potential in the treatment of MASLD is currently being investigated. The aim of our pilot prospective observational study was to determine the prevalence of MASLD in a sample of hospitalized patients with DM2 and to evaluate the impact of GLP1a and SGLT2i on hepatic steatosis and fibrosis. Material and method: 112 hospitalized patients with DM2 and MASLD were included in the study. The presence of steatosis...

Acute liver failure after unprofessional indication for albendazole

Helena Laurinová

Vnitr Lek 2025, 71(8):525-527  

Albendazole is a used medication for parasitic diseases and is generally accepted as a safe drug. It may cause asymptomatic transient liver enzyme abnormalities but manifestation of toxic damage is very rare. This case study presents the case of a middle-aged female patient evaluated for suddenly developed acute liver failure caused by several days of administration of higher doses of albendazole. The aim of the case report is to highlight that even potentially safe drugs can lead to serious adverse effects such as drug-induced liver injury (Drug induced liver injury, DILI).

Suspected pellagra in a patient treated with azathioprine for Crohn's disease

Pavel Polák, Michal Řiháček, Andrea Wagnerová, Alexandr Trunečka, Petra Adamczyk, Dalibor Váhala

Vnitr Lek 2025, 71(8):E22-E27  

Pellagra is a disease due to nutritional deficiency of niacin (vitamin B3). The main causes include nutritionally poor diet or impaired intestinal absorbtion. Other risk factors represent alcohol abuse, idiopathic bowel disease and immunosuppressive and antituberculotic treatment. Dermatitis, diarrhoea and dementia (3D) are characteristical clinical signs, untreated disease may lead to the death. The diagnosis is based on typical clinical signs which subside quickly after niacin supplementation. The authors present a clinical case of a patient with Crohn´s disease treated with azathioprine, who was acutely hospitalized for community-onset pneumonia,...

Why might it be appropriate to replace rosuvastatin with atorvastatin in patients with chronic kidney disease?

Kryštof Rückl

Vnitr Lek 2025, 71(8):535-541  

Despite excellent mortality data, rosuvastatin does not appear to be a suitable hypolipidemic agent in patients with chronic kidney disease due to the risk of rhabdomyolysis and direct tubulotoxicity. As part of nephroprotection, it seems appropriate to replace rosuvastatin with atorvastatin in patients at risk because atorvastatin has a similar hypolipidemic action and it has been documented as nephroprotective agent. When using rosuvastatin, the need for dose reduction adjusted to glomerular filtration rate is often not respected, which is documented in a small review of cases of acute kidney injury in rhabdomyolysis recorded from a district hospital...

Mirikizumab in the therapeutic portfolio for inflammatory bowel diseases

Jan Šťovíček

Vnitr Lek 2025, 71(8):530-534  

Mirikizumab is a newly available biologic that expands the range of targeted therapies for inflammatory bowel disease. As a selective inhibitor of interleukin 23, it demonstrates beneficial effects in patients with ulcerative colitis and Crohn's disease, particularly in those who have not responded to previous treatment. Clinical studies indicate a favorable efficacy and safety profile, supporting its inclusion in current therapeutic strategies. This review summarizes existing knowledge on the mechanism of action, key clinical trial findings, and practical considerations related to the use of mirikizumab in the management of intestinal inflammation.