[Proceedings of the VIII Postgraduate Diabetology Seminar in Brno, 2003].

Vnitr Lek 2003, 49(12):893-975

[Pathogenesis of insulin resistance].

J Skrha

Vnitr Lek 2003, 49(12):894-899

Insulin resistance characterized by a decreased biological response to insulin is caused by genetic and exogenous factors influencing the target tissues for insulin, like the muscle, adipose tissue and the liver. A hyperbolic relationship was found between insulin secretion and insulin action. The insulin hypersecretion caused by short-time B-cell stimulation with free fatty acids is associated with hyperinsulinemia and worsening of insulin resistance. On the contrary, longtime exposure of B-cells by free fatty acids is followed by a decreased secretion and thus by hypoinsulinemia. Triglyceride infiltration of the muscle tissue and B-cells further...

[The metabolic syndrome].

T Pelikánová

Vnitr Lek 2003, 49(12):900-906

Metabolic syndrome represents a cluster of clinical, biochemical and humoral abnormalities associated with impaired insulin action in glucose metabolism. In the literature also the term syndrome of insulin resistance, dysmetabolic syndrome X, Reaven syndrome or Kaplans dead quartet can be found. Hyperinsulinaemia, central obesity, essential hypertension, dyslipidaemia, impaired glucose homeostasis or type 2 diabetes, hyperuricaemia, hypercoagulable state, endothelial dysfunction and increased markers of inflammation such as C-reactive protein, selectines, adhesion molecules, pro-inflammatory cytokines are the typical components of metabolic syndrome...

[Postprandial hyperglycemia].

J Perusicová

Vnitr Lek 2003, 49(12):907-910

Chronic hyperglycaemia, confirmed with HbA1c levels, is a leading cause of diabetic complications. Recent studies point to a significant effect of postprandial glycaemia which results from an impaired ability of early secretion of insulin in type II diabetes. Postprandial hyperglycaemia is a frequent phenomenon in people with diabetes with satisfactory control of diabetes based on checks of HbA1c levels. Many authors demonstrate statistically more significant correlations between postprandial hyperglycaemia and HbA1c levels, compared to correlation of fasting glycaemia. Monitoring of postprandial glycaemia is a significant means for improving co-operation...

[Diabetic peripheral arterial disease].

I Hofírek, B Vojtísek

Vnitr Lek 2003, 49(12):911-915

Macrovascular impairment of peripheral arteries in diabetes mellitus corresponds with such an impairment in atherosclerosis. Furthermore, peripheral angiopathy, microangiopathy, and polyneuropathy resulting from microangiopathy develop in diabetes. Impairment of microcirculation worsens peripheral blood flow. Infection and insufficient trophism worsen state. A wide range of factors participate in development of vascular disease in diabetes with adverse influence both on veins and reactions coming under rheology, haemocoagulation, and immune reactions. In type II diabetes an average interval of arterial impairment is 9-10 years, in type I diabetes approximately...

[Diabetes mellitus cerebrovascular disease].

M Soucek

Vnitr Lek 2003, 49(12):916-920

Cerebral vascular accident (CVA) is the second leading cause of deaths in developed countries. The mortality rate from CVA in the Czech Republic in people under 65 years is twice higher compared to countries in Western and Northern Europe. Every year it affects about 500/100,000 citizens with mortality within one year approximately in 45%. Incidence of this serious disease is three times more frequent in diabetics than in non-diabetics. After ictus, the prognosis is worse and repeated cerebral strokes more frequent. From the risk factors, diabetics usually suffer from hypertension which is part of a complex of metabolic syndrome X. There are more frequent...

[The heart in diabetics].

J Bělobrádková, B Filipenský

Vnitr Lek 2003, 49(12):921-926

Macrovascular complications in diabetics create a high risk for cardiovascular disease (CVD). Generally, the main risk factors for CVD include age, men's sex, elevated LDL-cholesterol and reduced HDL-cholesterol, elevated fibrinogen, hypertension, smoking, and diabetes mellitus. Clinical manifestation of coronary disease is determined by number, area, and severity of coronary stenoses, myocardial function, and presence of induced ischemia. Routine pharmacological treatment of ISHD concentrates on risk factors and hasn't been yet focused on changes in energy metabolism during ischemic situation which are important factors contributing to ischemic damage....

[Diabetes mellitus and chronic heart failure].

J Spinar, J Vítovec

Vnitr Lek 2003, 49(12):927-934

Diabetes mellitus is one of the significant risk factors for many cardiovascular diseases. Diabetes mellitus is 3-4 times more frequent in patients with heart failure compared to patients without heart failure. Prognosis of patients with heart failure and diabetes mellitus is worse than prognosis of non-diabetic patients with the same left ventricular dysfunction. The term diabetic cardiomyopathy refers to a relation between diabetes mellitus and heart disease, but it probably isn't a separate morphology unit. In treatment of patients with diabetes mellitus general rules apply to heart failure management. The effect of ACE inhibitors was in majority...

[Hypertension and diabetes--current views on specific questions].

M Kvapil

Vnitr Lek 2003, 49(12):935-937

Hypertension in patients with diabetes is proved to be connected with early development of macrovascular and atherosclerotic complications, increased incidence of heart failures, and development and progression of microangiopathic complications. We start interventions in diabetics when blood pressure values reach 140/90 mm Hg. Non-pharmacological treatment is often unsuccessful, so we apply pharmacological treatment. The target value of blood pressure does not exceed 130/80 mm Hg. Monotherapy is usually insufficient. Individual drugs we choose according to attendant complications, according to a potential benefit from affecting individual risks for...

[Ambulatory monitoring of blood pressure in the treatment of hypertension in diabetics].

H Nĕmcová

Vnitr Lek 2003, 49(12):938-942

Hypertension, the most significant cardiovascular risk factor, appears twice more often in persons with diabetes compared to nondiabetic population. A high percentage of complications (40-70%) in diabetic population is caused just by hypertension. That is why timely diagnosis and consistent treatment of hypertension is stressed in patients with diabetes. Blood pressure of young people with type I diabetes is proved to be higher compared to their healthy peers. Both in people with type I and type II diabetes are, compared to other populations, more frequent incidence of a phenomenon called "white coat", increased variability in blood pressure, and higher...

[Dyslipidemia and the metabolic syndrome].

V Soska

Vnitr Lek 2003, 49(12):943-947

Dyslipoproteinemia is the common part of metabolic syndrome, it appears probably due tu high level of free fatty acids. The typical lipid disorders are: high trigylcerides concentration, low HDL-cholesterol level, elevation of small dense LDLs particles and elevation of apolipoprotein B100 and non-HDL cholesterol. LDL-cholesterol concentration is usually normal. This type of dyslipoproteinemia is very aterogenic. Weight reduction, diet and regular physical activity is the most effective way how to treat this type of dyslipoproteinemia. When non-pharmacologic treatment is not successful, treatment with hypolipidemic drugs is necessary to prevent atherosclerotic...

[Angiotensin converting enzyme inhibitors in the treatment of diabetes].

A Smahelová

Vnitr Lek 2003, 49(12):948-951

[Low birth weight and delayed risk of type 2 diabetes and metabolic syndrome].

S Svacina

Vnitr Lek 2003, 49(12):952-955

Low birth weight is according to many studies associated with later incidence of type 2 diabetes, hypertension and in lower degree with obesity and hypertriacylglycerolemia. Detection of history of low birth weight could have some importance in detection of persons with metabolic syndrome and cardiovascular risk. In the pathogenesis can be involved fetal selection of thrifty genes which are later unable to overcome low physical activity and overfeeding in adult age. More probable is that low birth weight is primary of genetic origin. The same genetic origin can be involved in BMI rebound in childhood, development of insulin resistance, weight gain...

[Obesity and diabetes].

J Olsovský

Vnitr Lek 2003, 49(12):956-959

This paper discuses issues of obesity and type II diabetes mellitus. It tries to demonstrate a common cause of both these signs of metabolic syndrome. It notices the relationship of obesity and diabetes and summarises possibilities, successes, and goals in treatment of obesity in diabetics.

[Infectious and inflammatory factors in the etiology and pathogenesis of atherosclerosis].

M Anděl, A Tsevegjav, K Roubalová, D Hrubá, P Dlouhý, P Kraml

Vnitr Lek 2003, 49(12):960-966

Although the metabolic syndrome together with insulin resistance and their consequences are probably basic factors in pathogenesis of atherosclerosis, inflammatory and infectious aspects of this process are unquestionable only in some of the patients. Endothelial dysfunction was identified both in the experiment and in patients after herpes virus simplex 1 infection, cytomegaloviral infection, Chlamydia pneumoniae infection, or Helicobacter pylori infection. However, it is not clear whether it is always caused by direct specific activity of a given pathogen or whether it is a result of inflammatory cytokines activity, heat shock protein activity, or...

[The carotid drainage system--a "window" into the atherosclerosis process in diabetics?].

A Adamíková

Vnitr Lek 2003, 49(12):967-971

Macrovascular complications present from the viewpoint of morbidity and mortality the biggest risk in type 2 diabetics. An aim of this work is to show ways of detecting clinical and preclinical phases of atherosclerosis with special regard to carotid system. In our paper we have been presenting a sample of 239 patients with cardiovascular incidents and findings on their extracranial carotid systems detected by duplex sonography. 88 patients (36.8%) in the sample had type 2 diabetes, their average age was 68.2 +/- 8.5. 35 were on a diet, 34 were treated with peroral antidiabetics, and 19 with insulin. Findings on extracranial carotid systems were normal...

[Therapeutic use of acetylsalicylic acid in diabetics].

V Zácková

Vnitr Lek 2003, 49(12):972-975

Aterosclerosis is a leading cause of morbidity and mortality in diabetics. Macrovascular diseases--myocardial infarction, cerebral vascular accident, ischemic lower extremities--start in persons with diabetes earlier and in a bigger scope then in non-diabetics. Development of these changes is determined by diabetic vasculopathy which is connected with endothelial dysfunction, hypercoagulation state, and platelet abnormalities. Treatment of a patient with diabetes is based on compensation of diabetes and management of hypertension and dyslipidaemia. Drugs that inhibit platelets constitute an important part of prevention of cardiovascular disabilities...