Prevalence and management of arterial hypertension in the population aged 25-64 in the Czech Republic with a focus on diabetic patients.

OBJECTIVE: The aim of the study was to determine the prevalence of arterial hypertension and its awareness rate and control rate among diabetes mellitus (DM) patients in the Czech Republic between 25-64 years of age and to compare the results with those in age-matched non-diabetic patients. MATERIALS AND METHODS: Blood pressure measurement data of 1 170 respondents (467 men and 703 women) obtained during the EHES study in 2014 were analysed. DM was diagnosed in 95 (8.2%) respondents (44 men and 51 women). RESULTS: Mean systolic blood pressure in DM patients was 130.7 ± 18.3 vs. 123.2 ± 16.8 mmHg in non-DM subjects (p < 0.001). The difference in diastolic blood pressure was on the borderline of statistical significance (82.2 ± 9.4 mmHg in DM vs. 80.0 ± 10.6 mmHg in non-DM subjects, p = 0.051). Among the study population, 69.5% of DM and 34.2% of non-DM subjects suffered from arterial hypertension (p < 0.001). The hypertension awareness rates were 87.9% in the DM group and 66.8 % in the non-DM group. (p = 0.001). The percentage of treated arterial hypertension was 94.8% in DM patients vs. 80.5% in the non-DM group (p = 0.010). The blood pressure target of < 140/90 mmHg was achieved in 47.3% of DM patients vs. 60.6% in non-DM subjects (p = 0.077). Using a blood pressure target of < 130/80 mmHg, adequate arterial hypertension control was achieved in only 29.1% of DM patients. When comparing the achievement of the blood pressure targets recommended for diabetic patients (< 130/80 mmHg) and non-DM patients (< 140/90 mmHg), the difference between these groups was statistically significant (p < 0.001) in favour of the non-diabetic group. CONCLUSION: The study has shown the prevalence of arterial hypertension to be twice as high in DM patients aged 25-64 compared to the age-matched non-DM subjects in the Czech Republic. The adequate blood pressure control rate is significantly lower in DM patients than in the non-diabetic population. The study results indicate that the blood pressure targets recommended for diabetic patients (< 130/80 mmHg) are not always reached in clinical practice.

MODY diabetes and screening of gestational diabetes.

OBJECTIVE: The aim of this article is to present a summary of the actual diagnostic possibilities and differentiation of MODY (Maturity-Onset Diabetes of the Young) from gestational diabetes (GDM) found during routine screening, and specific aspects of care and treatment of MODY during pregnancy and early postpartum period. DESIGN: Rewiev. SETTINGS: Centre for Research of Diabetes, Metabolism and Nutrition; Second Department of Internal Medicine University Hospital Královské Vinohrady and Third Faculty of Medicine, Prague. Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague. METHODS: Recent publications selected in PubMed with the key words MODY, gestational diabetes. RESULTS: Many patients with MODY, especially the glucokinase MODY, can be first diagnosed during pregnancy. It is estimated that MODY patients account for up to 5% of GDM cases found in routine screening of GDM. MODY should be considered in lean women around 25 years of age, with a positive family history of diabetes in one of the parents. The differentiation of MODY from GDM is of particular importance not only for the different management and goals of antidiabetic therapy and planning ultrasound controls of fetal growth during pregnancy, but also because of the risk of hyperinsulinemic hypoglycemia in newborns. CONCLUSION: Recognition of MODY during pregnancy and adherence to existing recommendations concerning specific care of these patients is essential for the optimal course of their pregnancy and proper care of the newborn in the early postpartum period.

[Food intake regulation -  1st part]. / Regulace príjmu potravy -  I. cást.

The review article summarizes a very complex process of appetite regulation: the part focused on homeostatic regulation of food intake. The aim of homeostatic regulation is to achieve energy balance, stabile weight and optimal nutrient intake, in contrast to hedonic regulation of food intake, in which emotional and motivational factors are involved. Homeostatic regulation could be divided into shortterm and longterm regulation and comprises mainly gastrointestinal peptides, fat tissue hormones and central mechanisms localized in hypothalamus. It is a resultant of the action of orexigenic factors (increasing appetite and food intake) and anorexigenic factors (decreasing appetite and thus food intake), respectively. The anorexigenic factors include gastrointestinal peptides (e.g. cholecystokinin, glucagonlike peptide 1, bombesin, peptide YY and others), hormone of fat tissue leptin and centrally acting melanocortin system. On the contrary, orexigenic factors comprise of gastric ghrelin and centrally acting system of neuropeptide Y/ Agoutirelated peptide. Understanding the principles of the regulation of food intake is essential for comprehension of pathogenesis of eating disorders and obesity, whose prevalence has been recently increasing, and it provides potential targets for pharmacological interventions.

[Cardiac symptoms in a patient with Addison's disease and hypothyreosis on the basis of autoimmune polyglandular syndrome type II]. / Kardiální projevy u pacienta s Addisonovou chorobou a hypotyreózou pri autoimunitním polyglandulárním syndromu II. typu.

In many endocrine diseases we can find a heart disorder. We present a case of a young patient aged 34 years, who was examined for non-specific ST-T abnormalities on ECG and a new-diagnosed left ventricle dysfunction with suspicion to the acute coronary syndroma. However, this diagnosis wasn't verified. Endocrinological examination detected the Addison's disease and a severe hypothyreosis. After the hormonal substitution therapy was given, the patient became asymptomatic and the ECG- and echocardiographic changes disappeared.

Three novel mutations in MODY and its phenotype in three different Czech families.

AIMS/HYPOTHESIS: MODY (Maturity Onset Diabetes of the Young) is an autosomal dominant inherited type of diabetes with significant genetic heterogeneity. New mutations causing MODY are still being found. A genetically confirmed diagnosis of MODY allows application of individualized treatment based on the underlying concrete genetic dysfunction. Detection of novel MODY mutations helps provide a more complete picture of the possible MODY genotypes. MATERIALS AND METHODS: We tested 43 adult Czech patients with clinical characteristics of MODY, using direct sequencing of HNF1A (hepatocyte nuclear factor 1-alpha), HNF4A (hepatocyte nuclear factor 4-alpha) and GCK (glucokinase) genes. RESULTS: In three Czech families we identified three novel mutations we believe causing MODY-two missense mutations in HNF1A [F268L (c.802T>C) and P291S (c.871C>T)] and one frame shift mutation in GCK V244fsdelG (c.729delG). Some of the novel HNF1A mutation carriers were successfully transferred from insulin to gliclazide, while some of the novel GCK mutation carriers had a good clinical response when switched from insulin or oral antidiabetic drugs to diet. CONCLUSION: We describe three novel MODY mutations in three Czech families. The identification of MODY mutations had a meaningful impact on therapy on the mutation carriers.

A comparison of the influence of a high-fat diet enriched in monounsaturated fatty acids and conventional diet on weight loss and metabolic parameters in obese non-diabetic and Type 2 diabetic patients.

AIMS: The aim of our study was to compare the influence of a hypocaloric, high-fat diet enriched with MUFA (M) and conventional diet (C) on weight loss and metabolic parameters in obese non-diabetic and obese Type 2 diabetic subjects over a 3-month period. It was our hypothesis that the enriched diet would be more effective in decreasing blood glucose and glycated haemoglobin (HbA(1c)) than the control diet. METHODS: Twenty-seven Type 2 diabetic patients (54.5 +/- 3.5 years; DM), treated with diet or oral glucose-lowering agents, and 31 obese non-diabetic subjects (53.6 +/- 3.5 years; OB) were randomized to M or C. Individual calculations of energy requirements were based on the formula: [resting energy expenditure (REE) x 1.5] - 600 kcal. Subjects were assessed by a dietitian every 2 weeks and by a physician every month. Statistical analyses were carried out between the four groups--DM/M, DM/C, OB/M and OB/C--using pair Student's test and anova. RESULTS: After 3 months, body weight, waist-hip ratio, total body fat, levels of C-peptide, triglycerides and homeostasis model assessment (HOMA) decreased in all four groups (P < 0.01). However, fasting blood glucose and HbA(1c) decreased (P < 0.01) and high-density lipoprotein cholesterol increased significantly only in the DM/M group (P < 0.05). In general, M was well tolerated. CONCLUSIONS: Individualized M and C diets were successful in improving metabolic and anthropometric parameters in both the obese non-diabetic and the Type 2 diabetic subjects. Although the superiority of the higher fat diet did not reach statistical significance, the decline in blood glucose and HbA(1c) in the Type 2 diabetic group on M was encouraging.

An unusual cause of renal amyloidosis secondary to gout: the first description of familial occurrence.

BACKGROUND: AA amyloidosis caused by the chronic inflammation accompanying gouty arthritis is extremely rare and familial occurrence has not been described so far. CASE REPORT: We present the case of two brothers (47 and 44 years old) with 7- and 10-year history of hyperuricaemia and chronic tophaceous gout with polyarticular involvement. The enzymatic assay performed in their erythrocytes proved the partial hypoxanthine-guanine phosphoribosyl transferase deficiency (Kelley-Seegmiller syndrome), the genetic defect of purine metabolism. Later on they developed proteinuria and chronic renal insufficiency /CRI/. Renal biopsy disclosed the combination of AA amyloidosis and gouty nephropathy in both the cases. Despite the standard treatment the older brother progressed to chronic renal failure. On the contrary, the younger one being longterm treated with oral colchicin have stabilized CRI. CONCLUSIONS: Only several cases of AA renal amyloidosis until recently, secondary to gout have been reported. Our case represents the first report of familial occurrence of this extremely rare disease.

[Glibenclamide instead of insulin: a new chance for MODY 3 type diabetes patients: case report]. / Glibenklamid místo inzulinu: nová sance pro pacienty s diabetem MODY 3: kazuistika.

MODY 3 belongs to monogenic forms of diabetes mellitus and is caused by monoallelic mutation in gene for transcription factor HNF-1alpha, essential for regulation of beta-cell function. Clinical presentation of MODY 3 is similar to that of type 1 diabetes. Although MODY 3 patients are not threatened by ketoacidosis, tight metabolic control is important for prevention of chronic diabetic complications. In the sibbling pair diabetes was manifested by osmotic symptoms resulting from hyperglycaemia at the age of 18 years (brother) resp. 15 years (sister) and both of them started being treated with intensified insulin treatment. Metabolic control of the brother was very tight with HbA1c 3.3 % but frequent hypoglycaemias occured. On the contrary metabolic control of the sister was very poor due to her non-compliance (HbA1c 10.9 %, IFCC). Molecular-genetic testing proved HNF-1alpha gene mutation (Arg200Gly). In accordance with the references treatment with sulphonylurea derivate glibenclamide was initiated [at the doses 1.25 (brother) resp. 7.5 (sister) mg/day] and insulin treatment was discontinued. The treatment change led to better quality of life and metabolic control in both the patients and suprisingly to the lower frequency of the hypoglycaemias in the brother (HbA1c decreased from 3.3 % to 2.8 % in three months in the brother resp. from 10.9 % to 10.0 % in two months in the sister). Molecular-genetic testing enables the change of treatment leading to better quality of life and metabolic control, although its longterm safety and efficacy will have to be confirmed.

[Diabetic diet and reduction diet are worthy of a basic discussion of their paradigms]. / Diabetická i redukcní dieta zasluhují základní diskusi o svých paradigmatech.

Present knowledge of etiopathogenesis of various types of diabetes postulate substantial differences between type I and type II diabetes. Whereas type I diabetes results from autoimmune destruction of pancreatic B-cells and subsequent absolute lack of insulin, type II diabetes is connected with insulin resistance and frequently with rather relative lack of sometimes absolutely elevated plasmatic insulin. From the viewpoint of the diet therapy an access to both types of diabetes fairly differs. Whilst in type I diabetes it is necessary to find out relationship among preprandial insulin dose, received carbohydrates, and expected physical activity soon after meal, treatment of type II diabetes is based in an effort to influence insulin resistance and the whole metabolic syndrome. Therefore, on one side carbohydrates with low glycemic index and plenty of fibers are administered in a diet and on the other side monoenic and polyenic fatty acids are preferred to saturated fatty acids and trans fatty acids are continuously reduced in a diet. Of course, diets for patients with overweight and for obese patients are low energy. From the viewpoint of the current structure of the diabetic diets it is suitable to differentiate diets for patients with type I and type II diabetes. Instead of the use of a fix proportion of nutrients we have to discuss diets with regard to a qualitative composition of fatty acids in fats, glycemic index of saccharides, and an amount of fibers in the diet.

[The Budd-Chiari syndrome in a patient with primary thrombocythemia treated with interferon alfa and transjugular portosystemic shunt]. / Budduv-Chiariho syndrom u pacientky s primární trombocytémií lécené interferonem alfa resený transjugulární portosystémovou spojkou.

The case report of a young female patient with personal history of primary thrombocythaemia, treated with interferon alpha, admitted to our medical department for severe abdominal pain, hepatomegaly, ascites and alteration of hepatic function is presented. Magnetic resonance imaging showed the picture typical for Budd-Chiari syndrome caused by external obstruction of the intrahepatal portion of inferior vena cava. The cause of the syndrome remains uncertain, possibility of the haematogenic infiltration of the liver or venal thrombosis within primary or secondary (interferon-induced) antiphospholipid syndrome is discussed. Liver biopsy could elucidate the exact cause, but it was not performed for technical problems.

[Calculation of the costs of drugs, medical materials, certain medical procedures and social services for patients with diabetic foot syndrome]. / Kalkulace nákladu na léky, zdravotní materiál, nekteré vybrané lécebné výkony a sluzby sociální oblasti u pacientu se syndromem diabetická noha.

The aim of this study was to analyse the direct costs of some components of primary, secondary and tertiary prevention of the diabetic foot syndrome (cost of illness study). Information considering the costs of prevention and therapy of the diabetic foot and costs following after amputation in diabetic patients is available from international economical trials but is almost missing in the Czech Republic. The economical assessment of the most important mean of primary prevention/which is regular dispensarisation and preventive care for diabetic patients in risk of diabetic foot syndrome/is very problematic. The costs of primary prevention were calculated as the intervention costs of risk factors of diabetic foot syndrome according to the recommended daily doses and prices of the medicaments in AISLP database. Costs of hospitalisation in secondary and tertiary prevention were calculated by using bills for health insurance company in the programme Steiner-UNIS, costs for out-patient care according to ordinations (medication, aids, codes for heath insurance companies and means of diagnostic process). Costs of tertiary prevention were based on information gained from the Regional Social Authority. There were 20 patients (12 men, 8 women, age 65 +/- 12 years, 3 patients with 1. type diabetes, 17 with 2. type diabetes), involved in secondary in-patient care, 30 (20 men, 10 women, age 69 +/- 12.4 years, 2 patients with type 1. diabetes, 28 with type 2 diabetes) in out-patient care and 20 (12 men, 8 women, age 70 +/- 9.4 years, 1 patient with type 1 diabetes, 19 with type 2 diabetes) in tertiary prevention. This study proved high costs of the intervention of hyperglycaemia in type 1. diabetics, hypertension with ACE inhibitors, critical ischaemia, neuropathy. Costs of out-patient care for ulcers for eight months were 7,500.- +/- 4,400.-CK, antimicrobial treatment 1,900.-CK, in-patient care for ulcers 22,500.- +/- 6,400.-CK and amputation 22,000.- +/- 9,900.-CK. The highest costs were calculated for tertiary prevention--the first year after amputation 400,000.- CK. The study shows very high costs of tertiary prevention and suggests discussion on this topic.