Comparison of Control-IQ and open-source AndroidAPS automated insulin delivery systems in adults with type 1 diabetes: The CODIAC study.

AIM: To compare open-source AndroidAPS (AAPS) and commercially available Control-IQ (CIQ) automated insulin delivery (AID) systems in a prospective, open-label, single-arm clinical trial. METHODS: Adults with type 1 diabetes who had been using AAPS by their own decision entered the first 3-month AAPS phase then were switched to CIQ for 3 months. The results of this treatment were compared with those after the 3-month AAPS phase. The primary endpoint was the change in time in range (% TIR; 70-80 mg/dL). RESULTS: Twenty-five people with diabetes (mean age 34.32 ± 11.07 years; HbA1c 6.4% ± 3%) participated in this study. CIQ was comparable with AAPS in achieving TIR (85.72% ± 7.64% vs. 84.24% ± 8.46%; P = .12). Similarly, there were no differences in percentage time above range (> 180 and > 250 mg/dL), mean sensor glucose (130.3 ± 13.9 vs. 128.3 ± 16.9 mg/dL; P = .21) or HbA1c (6.3% ± 2.1% vs. 6.4% ± 3.1%; P = .59). Percentage time below range (< 70 and < 54 mg/dL) was significantly lower using CIQ than AAPS. Even although participants were mostly satisfied with CIQ (63.6% mostly agreed, 9.1% strongly agreed), they did not plan to switch to CIQ. CONCLUSIONS: The CODIAC study is the first prospective study investigating the switch between open-source and commercially available AID systems. CIQ and AAPS were comparable in achieving TIR. However, hypoglycaemia was significantly lower with CIQ.

Real-world characteristics, modern antidiabetic treatment patterns, and comorbidities of patients with type 2 diabetes in central and Eastern Europe: retrospective cross-sectional and longitudinal evaluations in the CORDIALLY® study.

BACKGROUND: Guidelines from 2016 onwards recommend early use of SGLT2i or GLP-1 RA for patients with type 2 diabetes (T2D) and cardiovascular disease (CVD), to reduce CV events and mortality. Many eligible patients are not treated accordingly, although data are lacking for Central and Eastern Europe (CEE). METHODS: The CORDIALLY non-interventional study evaluated the real-world characteristics, modern antidiabetic treatment patterns, and the prevalence of CVD and chronic kidney disease (CKD) in adults with T2D at nonhospital-based practices in CEE. Data were retrospectively collated by medical chart review for patients initiating empagliflozin, another SGLT2i, DPP4i, or GLP-1 RA in autumn 2018. All data were analysed cross-sectionally, except for discontinuations assessed 1 year ± 2 months after initiation. RESULTS: Patients (N = 4055) were enrolled by diabetologists (56.7%), endocrinologists (40.7%), or cardiologists (2.5%). Empagliflozin (48.5%) was the most prescribed medication among SGLT2i, DPP4i, and GLP-1 RA; > 3 times more patients were prescribed empagliflozin than other SGLT2i (10 times more by cardiologists). Overall, 36.6% of patients had diagnosed CVD. Despite guidelines recommending SGLT2i or GLP-1 RA, 26.8% of patients with CVD received DPP4i. Patients initiating DPP4i were older (mean 66.4 years) than with SGLT2i (62.4 years) or GLP-1 RA (58.3 years). CKD prevalence differed by physician assessment (14.5%) or based on eGFR and UACR (27.9%). Many patients with CKD (≥ 41%) received DPP4i, despite guidelines recommending SGLT2is owing to their renal benefits. 1 year ± 2-months after initiation, 10.0% (7.9-12.3%) of patients had discontinued study medication: 23.7-45.0% due to 'financial burden of co-payment', 0-1.9% due to adverse events (no patients discontinued DPP4i due to adverse events). Treatment guidelines were 'highly relevant' for a greater proportion of cardiologists (79.4%) and endocrinologists (72.9%) than diabetologists (56.9%), and ≤ 20% of physicians consulted other physicians when choosing and discontinuing treatments. CONCLUSIONS: In CORDIALLY, significant proportions of patients with T2D and CVD/CKD who initiated modern antidiabetic medication in CEE in autumn 2018 were not treated with cardioprotective T2D medications. Use of DPP4i instead of SGLT2i or GLP-1 RA may be related to lack of affordable access, the perceived safety of these medications, lack of adherence to the latest treatment guidelines, and lack of collaboration between physicians. Thus, many patients with T2D and comorbidities may develop preventable complications or die prematurely. Trial registration NCT03807440.

The position of SGLT2 inhibitors in current medical practice - update 2022.

Cardiovascular diseases are still the most common cause of mortality in patients with type 2 diabetes. Studies on the cardiovascular safety of new antidiabetic treatments, that have significantly expanded the treatment options for type 2 diabetes over the last 20 years, have provided evidence not only for the cardiovascular safety of SGLT-2 inhibitors (SGLT-2i, gliflozins), but also unexpectedly showed a significant effect on the reduction of cardiovascular risk, incidence and progress of heart failure and nephroprotectivity. For the first time, a reduction in cardiovascular and overall mortality was demonstrated for empagliflozin in 2015 in patients at very high cardiovascular risk. Further studies with gliflozins in patients with diabetes, but also in non-diabetic individuals, show that gliflozins have more pharmacological similarities than differences, especially in terms of protection against the development and progression of heart failure and maintenance of glomerular filtration rate. The revolutionary contribution of SGLT-2i is therefore perceived today not only by diabetologists, but also by cardiologists and nephrologists. In ESC guidelines, SGLT-2i are recommended as a first-line antidiabetic treatment for patients with diabetes at high cardiovascular risk, attacking the hitherto unshakable position of metformin at this pole position, and their indications should be considered in patients with type 2 diabetes with atherosclerosis, heart and renal failure regardless of the level of diabetes control (values of HbA1c). In the treatment of heart failure with reduced ejection fraction (with or without diabetes), dapagliflozin and empagliflozin have been recommended by cardiologists since 2021 to prevent hospitalizations for heart failure and to reduce mortality with the strongest class and level of evidence.

Expert opinion on the cooperation of diabetologists and internists with nephrologists in the care of patients with chronic kidney diseases.

Chronic kidney disease (CKD) affects 10% of the population of developed countries and significantly affects the population health. In addition to the well-known renoprotection tools slowing down the progression of CKD, SGLT2 inhibitors have been newly introduced into clinical practice based on the results of extensive studies, both in diabetics and non-diabetics. This expert opinion discusses the classification of CKD, current renoprotection options, and the recent role of SGLT2 inhibitors in the care of patients with CKD.

The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence?

Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available-but currently limited-evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care.

Expert consensus on the practical aspects of the cooperation of cardiologist and diabetologist in the management of the patients with chronic heart failure and reduced ejection fraction.

Diabetes mellitus is an important risk factor for the development of heart failure and presence of diabetes significantly worsens heart failure outcome. Introduction of gliflozins to the therapy of heart failure is one of the most important novelty. Gliflozins reduce glucose level by the sodium-glucose contransporter 2 inhibition in proximal tubulus in the kidney. Gliflozins are used as effective antidiabetic drugs with improvement of glycemic control without risk of hypoglycemia, gliflozins decrease blood pressure and patients weight. Recent studies have shown that gliflozins significantly reduce risk of cardiovascular complications and heart failure hospitalizations in diabetic patients. Clinical trials with dapagliflozin and empagliflozin have shown reduction of the risk of cardiovascular death and heart failure hospitalization in the patients with heart failure and reduced ejection fraction both in the patients with diabetes and in the patients without diabetes. The aim of the expert consenzus is to summarize practical aspects in the cooperation of cardiologist and diabetologist in the management of the patients with heart failure and reduced ejection fraction in the context of the current guidelines and other treatment options.

The position of SGLT2 inhibitors in current medicine.

Cardiovascular disease is still the most common cause of mortality in patients with type 2 diabetes. Some prospective studies have produced unexpected results in connection with the requirements for the demonstration of cardiovascular safety of new antidiabetics, which have significantly expanded the treatment options for diabetes over the past 20 years. Although these studies were statistically designed to exclude excessive cardiovascular risk in patients with type 2 diabetes, some drugs have shown not only cardiovascular safety but also significant cardioprotective and nephroprotective effects in these studies. For the first time, a reduction in cardiovascular and overall mortality was demonstrated for the SGLT2 inhibitor empagliflozin in EMPA-REG OUTCOME trial in patients at very high cardiovascular risk. We already know that a beneficial effect on the risk of heart failure, but also renal failure, is a class effect in gliflozins. The revolutionary benefits of SGLT2 inhibitors are now perceived not only by diabetologists, but also by cardiologists and nephrologists. In European Society of Cardiology clinical guidelines, gliflozins even endanger the still unshakable position of metformin as the first line of antidiabetic therapy in patients with very high cardiovascular risk. Their indication should be today considered in all patients with type 2 diabetes and atherosclerosis, cardiac and renal failure regardless of diabetes control because they can reduce cardiovascular risk, risk of hospitalizations for heart failure and preserve glomerular filtration rate.

Evidence from routine clinical practice: EMPRISE provides a new perspective on CVOTs.

EMPA-REG OUTCOME is recognised by international guidelines as a landmark study that showed a significant cardioprotective benefit with empagliflozin in patients with type 2 diabetes (T2D) and cardiovascular disease. To assess the impact of empagliflozin in routine clinical practice, the ongoing EMPRISE study is collecting real-world evidence to compare effectiveness, safety and health economic outcomes between empagliflozin and DPP-4 inhibitors. A planned interim analysis of EMPRISE was recently published, confirming a substantial reduction in hospitalisation for heart failure with empagliflozin across a diverse patient population. In this commentary article, we discuss the new data in the context of current evidence and clinical guidelines, as clinicians experienced in managing cardiovascular risk in patients with T2D. We also look forward to what future insights EMPRISE may offer, as evidence is accumulated over the next years to complement the important findings of EMPA-REG OUTCOME.

SGLT2 inhibitors in T2D and associated comorbidities - differentiating within the class.

BACKGROUND: For patients with type 2 diabetes (T2D), cardiovascular disease (CVD) is the single most common cause of mortality. In 2008 and 2012, the Federal Drug Administration (FDA) and the European Medicines Agency (EMA) respectively mandated cardiovascular outcomes trials (CVOTs) on all new anti-diabetic agents, as prospective trials statistically powered to rule out excess cardiovascular risk in patients with T2D. Unexpectedly, some of these CVOTs have demonstrated not only cardiovascular safety, but also cardioprotective effects, as was first shown for the SGLT2 inhibitor empagliflozin in EMPA-REG OUTCOME. EXPERT OPINION: To debate newly available CVOT data and to put them into context, we convened as a group of medical experts from the Central and Eastern European Region. Here we describe our discussions, focusing on the conclusions we can draw from EMPA-REG OUTCOME and other SGLT2 inhibitor CVOTs, including when considered alongside real-world evidence. CONCLUSION: CVOTs investigating SGLT2 inhibitors have suggested benefits beyond glucose lowering that have been confirmed in real-world evidence studies.

Translating recent results from the Cardiovascular Outcomes Trials into clinical practice: recommendations from the Central and Eastern European Diabetes Expert Group (CEEDEG).

AIMS: These recommendations aim to improve care for patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk in Central and Eastern Europe. Cardiovascular disease (CVD) and/or chronic kidney disease (CKD) are major interdependent comorbidities in patients with T2D, accounting for 50% of mortality. Following recent CV outcomes trial (CVOT) results, including those from EMPA-REG OUTCOME®, LEADER®, SUSTAIN™-6 and, most recently, the CANVAS study, it is essential to develop regional expert consensus recommendations to aid physicians in interpreting these newest data to clinical practice. METHODS: The Central and Eastern European Diabetes Expert Group (CEEDEG) followed a Delphi method to develop treatment algorithms to aid physicians in the clinical management of patients with T2D at high CV risk. RESULTS: In light of the latest CVOT results, and in particular the EMPA-REG OUTCOME® and LEADER® trials, the diagnosis, assessment, treatment choice and monitoring of patients with T2D and established CVD and/or CKD have been considered together with existing guidelines and presented in two reference algorithms. In addition, adherence, special prescribing considerations and a proposed multidisciplinary management approach have been discussed and are presented with the proposed algorithms. CONCLUSIONS: The latest available high-level evidence on glucose-lowering drugs has enabled CEEDEG to develop practical consensus recommendations for patients with established CVD and/or CKD. These recommendations represent an update to international and country-level guidelines used for these patients, with the aim of providing a resource not only to endocrinologists, but to cardiologists, nephrologists and primary care physicians in the region.

[Glycemic variability and microvascular complications of diabetes]. / Glykemická variabilita a mikrovaskulární komplikace diabetu.

Vascular complications of diabetes result from long lasting unsatisfactory glycemic control. We usually assess glycemic control based on the value of glycated hemoglobin HbA1c. 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. Together with the research of short-term glycemic variability, also the study of long-term fluctuations in glycemic control based on HbA1c variability has now intensified. Glycemic variability may be related to oxidation stress, endothelial dysfunction and inflammation, the factors traditionally associated with vascular damage. This overview summarizes the recent findings in the field of glycemic variability and its possible association with microvascular complications in patients with type 1 and type 2 diabetes.Key words: glycemic variability, HbA1c variability, microvascular complications, type 1 and type 2 diabetes mellitus.

Glucose variability, HbA1c and microvascular complications.

Microvascular complications in diabetes are associated with poor long-term diabetes control as measured by HbA1c levels. Glucose fluctuations are related to oxidative stress, endothelial dysfunction, and inflammation, factors traditionally associated with the pathogenesis of vascular damage. Glucose variability has been associated with macrovascular disease in some studies but any association with microvascular disease remains controversial. This overview summarizes recent findings in the field of glucose variability and its possible relationship with retinopathy, nephropathy and neuropathy. It is concluded that randomized prospective follow-up trials could possibly help estimate whether short-term glucose variability should be considered as an independent risk factor for microvascular complications in diabetes.

[Insulin application techniques in adult patients with diabetes]. / Aplikacní technika inzulinu u dospelých pacientu s diabetem.

UNLABELLED: Treatment of diabetes mellitus with insulin is associated with a large number of subcutaneous injections. Incorrect insulin application technique can lead to complications both local (lipohypertrophy, scars) and systemic (high variability of insulin absorption and action, unexpected hypoglycemia or hyperglycemia, suboptimal overall glucose control). Regarding insulin application, we need to pay particular attention to the risk of intramuscular application and consequent less expectable insulin effect. The risk of accidental intramuscular administration of insulin is reduced when shorter 4 mm insulin pen needles are used. Repeated application of insulin in the same locations may cause changes in the subcutaneous tissue (lipohypertrophy, inflammation). Application sites should be examined during routine checks at diabetes clinics. Patients should also be repeatedly advised to rotate the injection sites as a prevention of lipohypertrophy formation and not to inject any more injections into pathologically changed subcutaneous tissue. At the same time, patients should be advised that their total insulin dose may be decreased, and that they are temporarily at higher risk of hypoglycemia, if they switch injecting from lipohypertrophy changed tissue into healthy tissue. KEY WORDS: glucose variability - insulin application - lipohypertrophy - needles.

[Short-term and long-term glycemic variability and its relationship to microvascular complications of diabetes]. / Krátkodobá a dlouhodobá glykemická variabilita a její vztah k mikrovaskulárním komplikacím diabetu.

Vascular complications of diabetes result from long lasting unsatisfactory glycemic control. We usually assess glycemic control based on the value of glycated hemoglobin HbA1c. 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 HbA1c variability has now intensified. Glycemic variability may be related to oxidation stress, endothelial dysfunction and inflammation, the factors traditionally associated with vascular damage. Several studies have described the relation of glycemic variability to macrovascular complications of diabetes, still its relation to microvascular complications remains unclear. This overview summarizes the recent findings in the field of glycemic variability and its possible association with retinopathy, nephropathy and neuropathy.Key words: type 1 and 2 diabetes mellitus - glycemic variability - microvascular complications - HbA1c - variability.

[Mild hypoglycaemia is common in type 2 diabetic patients treated with insulin analogues in the Czech Republic and the patients are concerned about it: results of a GAPP2TM survey (Global Attitudes of Physicians and Patient)]. / Lehké hypoglykemie jsou v Ceské republice u pacientu s diabetem 2. typu lécených inzulinovými analogy bezné a jejich výskyt pacienty znepokojuje Výsledky pruzkumu GAPP2TM (Global Attitudes of Patient and Physicians).

OBJECTIVE: Mild hypoglycaemia affects diabetes management, productivity and quality of life of patients. Data are scarce about the incidence of mild hypoglycaemia in daily life of type 2 diabetic patients treated with insulin analogues. The aim was to focus on the incidence of mild hypoglycaemia and its consequences in the international GAPP2 survey (Global Attitudes of Patient and Physicians) conducted also in the Czech Republic. METHODS: The GAPP2 project - Global Attitudes of Patients and Physicians is an international cross-sectional study conducted online via Internet in a questionnaire form dedicated to type 2 diabetic patients treated with insulin analogues and physicians who treat these patients. The survey was realized in two steps including 17 countries. The first step was completed by six countries in 2012. The second step was terminated by additional eleven countries including the Czech Republic in 2014. The survey was designed to obtain data on some aspects of insulin therapy and persistent issues in daily practice from the views of patients and physicians. One part of survey was dedicated to mild hypoglycaemia occurring in treatment with insulin analogues. The incidence of mild hypoglycaemia and the reaction of patients and physicians on hypoglycaemia (including modification of therapy, self-monitoring) were investigated. Moreover, there was investigated the impact of mild hypoglycaemia on quality of life from the view of patients and physicians. RESULTS: The results of the survey have shown that mild hypoglycaemia is common in patients with insulin analogues in the Czech Republic. In addition, patients in the Czech Republic are more afraid from hypoglycaemia and feel more limited in daily life in comparison to other countries in GAPP2 survey. Patients try to avoid nocturnal hypoglycaemia through reduction or omission of prescribed dose of insulin. Furthermore, research has observed that physicians are poorly informed by patients about incidence and severity of hypoglycaemia. CONCLUSION: The incidence of mild hypoglycaemia is in the Czech Republic as common as in other countries involved in the GAPP2 survey. However, the Czech patients are more afraid and this fact is often hidden before physicians. Increased fear of hypoglycaemia suggests inadequate education in terms of how to avoid and manage hypoglycaemia. Particular emphasis should be placed on nocturnal hypoglycaemia. Physicians should discuss more with patients about issue of hypoglycaemia. It is important to motivate patients to share the information with physicians about incidence and severity of hypoglycaemia.

[Progress in the development of insulin pumps and their advanced automatic functions]. / Pokroky ve vývoji inzulinových pump a jejich pokrocilých automatických funkcí.

Patients with type 1 diabetes are exposed to permanent burden consisting of careful glucose self-monitoring and precise insulin dosage based on measured glucose values, carbohydrates content in the food and both planned and non-planned physical activity. Erroneous insulin dosing causes frequent both hypoglycemia and hyperglycemia. Hypoglycemia is, however, the most clinically significant complication limiting the optimal diabetes control. Automatic features for insulin dosage integrated in insulin pumps are thus very important. Low glucose suspend (LGS) and Predictive Low Glucose Management (PLGM) use glucose sensor values to prevent hypoglycemia, shorten the time spent in hypoglycemic range and present further step forward to fully closed-loop system of insulin treatment.

[The position of new antidiabetics in clinical practice: SGLT2 vs DPP4 inhibitors]. / Postavení nových antidiabetik v klinické praxi: SGLT2 vs DPP4 inhibitory.

SGLT2 and DPP4 inhibitors are new effective oral antidiabetic drugs with low risk of hypoglycemia and positive or neutral impact on body weight. These characteristics are substantially different from more widely used sulphonyl-ureas. Current treatment of type 2 diabetes is rather complicated. Moreover, the position of new antidabetics in the guidelines has not yet been clearly defined. Personalised treatment on the basis of molecular markers is still not possible. Therefore, the position of new antidiabetics in the treatment of type 2 diabetes is often determined by clinical experience and subsequently modified by new clinical studies. Currently, doctors are asking which of these modern antidabetics to choose. The following text might help in this decision.

[Empagliflozin - the new representative of SGLT2 transporter inhibitors for the treatment of patients with diabetes 2 type]. / Empagliflozin - nový zástupce inhibitoru transportéru SGLT2 pro lécbu pacientu s diabetem 2. typu.

Empagliflozin is a new medicine used to reduce hyperglycemia in patients with type 2 diabetes. It belongs to the most advanced class of antidiabetic drugs, known as gliflozins, which prevent reabsorption of glucose through inhibiting SGLT2 sodium-glucose cotransporter. Thereby they cause therapeutic glycosuria, thanks to which a loss of approximately 70 g of glucose per day occurs. This not only effects the decrease in glycemia, but also the loss of body mass, since this excreted glucose cannot be used as an energetic substrate. The studies within phase 3 have proven the therapeutic efficacy of empagliflozin in monotherapy, in combination with the other oral antidiabec drugs and insulin. Another favourable effect of empagliflozin is a slight decrease in blood pressure. In May 2014, empagliflozin was approved for the treatment of patients with type 2 diabetes within the European Union 2014, since October 2014 it has been available in the Czech Republic and since 1 February 2015 empagliflozin (under the trade name Jardiance®) has been partially covered by the health insurance for the treatment of patients with type 2 diabetes either in combination with metformin or in combination with insulin (with or without metformin).

[Glycation of lens proteins in diabetes and its non-invasive assessment - first experience in the Czech Republic]. / Glykace proteinu ocní cocky u diabetiku a její neinvazivní merení - první zkusenosti v Ceské republice.

Advanced glycation end-products (AGEs) play a crucial role in the pathogenesis of diabetes and its complications. Their accumulation in the lens reflects total glycation rate in the human body. Recently, a new confocal biomicroscope ClearPath DS-120 quickly measuring lens autofluorescence (LAF) has been developed. Our pilot study included 69 patients with diabetes and 49 healthy controls, in all subject LAF was measured and compared with skin autofluorescence (SAF) assessed by AGE-Reader. Both LAF (T1DM: 0,27 ± 0,09; T2DM: 0,22 ± 0,06; controls: 0,17 ± 0,04 AU; p < 0,0001) and SAF (T1DM: 2,0 ± 0,4; T2DM: 2,3 ± 0,6; controls: 1,8 ± 0,3 AU; p < 0,0001) was significantly higher in patients with diabetes. In all groups significant relationship between LAF and SAF was observed (T1DM: r = 0,53, p < 0,005, T2DM: r = 0,37, p < 0.05; controls: r = 0,30, p < 0,05). On the contrary, LAF and SAF relationship with glycated hemoglobin (HbA1c) was rather poor, since HbA1c cannot wholly reflect long-term glycation process. Lens autofluorescence could be a robust marker of long-term diabetes control predicting future complication risks. However, confirmation of such hypothesis will need other and long-term clinical studies.

[Adherence of type 2 diabetes patients on insulin analogues application: missed dose, time imprecision and dose reduction. The results of GAPP2TM(Global Attitudes of Physicians and Patient) survey in the Czech Republic]. / Adherence pacientu s diabetem 2. typu k aplikaci inzulinových analog: vynechávání, casový posun a snizování dávek. Výsledky pruzkumu GAPP2TM (Global Attitudes of Patient and Physicians) v Ceské republice.

OBJECTIVE: Irregular insulin dose is one of the main problems associated with insulin therapy in patients with type 2 diabetes; its extent is not known precisely. The aim of survey conducted in the Czech Republic in the international project GAPP2 - Global Attitudes of Patients and Physicians was to determine the incidence and the impact of irregular use of basal insulin analogues in patients with type 2 diabetes, to point out the reasons for these irregularities and to focus on how physicians discuss irregular application of insulin with patients. METHODS: The project GAPP2 is an international cross-sectional study performed on-line via the Internet using a questionnaire filled by diabetic patients treated with insulin analogues and physicians who treat these patients. The survey was conducted in two steps in 17 countries; the first step included 6 countries and was completed in the beginning of 2012, the second step involved 11 other countries including the Czech Republic with termination in 2014. The survey was designed to obtain the views of patients and physicians on certain aspects of insulin treatment and persistent issues in this field in the real daily practice. Special focus was on the incidence and management of hypoglycaemia as well as on irregularities of insulin application. In the part dedicated to adherence to basal insulin application were observed three types of irregular insulin therapy: missed dose, time imprecision of dose (± 2 hours vs. the prescribed time) and dose reduction in all cases in the past 30 days before completing the questionnaire. In addition, it was investigated the attitude and relation of patients to these issues. RESULTS: The results have shown that irregular insulin dose in the Czech Republic is less frequent than in other countries involved in the GAPP2 research. Nevertheless, approximately one fifth of diabetic patients using insulin analogues in basal-bolus or only basal therapy regimen is related to this problem. The last irregular insulin application was due to missed dose in 13% of cases, time imprecision in 23% and reduction of dose in 61% of cases. The most commonly reported reason was risk reduction of hypoglycaemia and the recommendations of health professionals. Fear of missed dose is present in 40% Czech patients and 35% would feel guilty if their insulin dose is missed (up to 47% in patients with intensified insulin regimen). Only 60% patients are aware of negative impact on their long-term health after missed dose of basal insulin. Questioned doctors have suspected that the patients report lower number of missed doses during regular medical check because one third of patients doesn´t admit missed dose. However, this fact conceded only 11% of patients on basal insulin and 15% of patients on intensified insulin therapy. Quarter of prescribing doctors admit that they usually don´t discuss with patients irregularities in basal insulin treatment. CONCLUSION: Although, type 2 diabetes patients in the Czech Republic follow prescribed basal insulin therapy scheme more often than patients in other countries participating in the survey GAPP2 , missed dose, time imprecision and reduction of dose is quite common and it deserves more attention from medical side during regular medical check together with appropriate education of patients.