Trends in the representation of specialties caring for patients with diabetes in the Czech Republic.

The increasing prevalence of diabetes mellitus (DM) leads to the differentiation of the registration of diabetics in individual specialties. Objective of this paper was the evaluation of changes in the representation of expertise providing care for patients with DM (pDM) in the Czech Republic, based on data analysis from the National Register of Paid Health Services (NRHZS) 2010-2021. In the entire pDM group, the number of patients treated by a diabetologist (DIA) increased from 491,490 (57.0 %) to 537,430 (50.4 %), with a general practitioner (GP) from 27,719 (3.2 %) to 181,330 (17.0 %) and by internist (INT) from 172,918 (20.0 %) to 161,291 (15.1 %). In 2021, 57.9 % DIA, 17 % GP, 12.2 % INT were treated from the group treated with antidiabetics (813,873). In 2021, 84,345 were treated with insulin alone (87.2 % DIA), 129,127 were treated with a combination of insulin and non-insulin antidiabetics; 115,604 (91.6 %) in DIA, 322 (0.3 %) in GP and 7,983 (6.3 %) in INT. 603,331 treated only with non-insulin antidiabetic drugs, of which 281,929 (46.7 %) DIA, 137,744 (22.8 %) GP and 85,273 (14.1 %) INT. For other specialties, 98,385 (16.3 %) persons. 185,838 patients without reported DIA/GP/INT control, of which 80,144 without therapy. The increasing prevalence of DM and changes in reimbursement conditions are reflected in the dynamic development of the distribution of diabetes care by individual specialties.

The impact of type 1 diabetes mellitus on male sexual functions and sex hormone levels.

Little is known about type 1 diabetes mellitus (T1DM) impact on the male sexual and reproductive functions. We aim to evaluate the influence of T1DM on male sexual function, quality of sexual life, and sex hormone levels. A total of 57 male patients aged 18 to 50 years (mean = 33) with T1DM (duration mean = 15 years) had a medical examination and completed a set of questionnaires - International Index of Erectile Function-5 (IIEF-5), Beck Depression Inventory (BDI) and Sexual quality of life questionnaire male (SQoL-M). The prevalence of erectile dysfunction was 28.1% (IIEF-5 ≤21). Patients without diabetic nephropathy had better erectile function (p = 0.008). Subjects with better glycemic control (HbA1c <65 mmol/mol) had also better erectile function (p = 0.041). At least 8.8% patients had retrograde ejaculation. Blood serum levels of sex hormones were determined and compared to laboratory reference values of healthy men. Total testosterone level was not significantly changed, sex hormone binding globulin was higher (p < 0.001) and its level correlated with daily insulin dose adjusted to body weight (p = 0.008). Free androgen index and calculated free testosterone were lower (p = 0.013; p < 0.001), estradiol was not significantly changed, LH was higher (p < 0.001), FSH was unchanged, and prolactin was higher (p < 0.001). Prostate-specific antigen (PSA) negatively correlated with HbA1c (p < 0.001). To conclude, we found significant changes in sexual functions and sex hormone blood concentrations that indicate impairment of sexual and reproductive functions in T1DM males.

Long term use of the telemonitoring system Diani in the therapy of a patient with type 1 diabetes.

Mobile and wearable technologies offer patients with diabetes mellitus new possibilities for data collection and their more effective analysis. The Diabesdagboga smartphone application and the Diani web portal enable to collect and analyze glycaemia values, carbohydrates intake, insulin doses and the level of physical activity. The data are not only accessible in the corresponding smartphone but also automatically transferred to an Internet portal, where they may be completed by the records from an electronic pedometer and continuous glucose monitor. All these data may then be displayed in various types of graphical outputs and are available to both the patient and the physician. The case report of a patient who has used the system for almost two years shows a significant improvement in metabolic compensation (a decrease in the mean HbA1c value by 18.6 mmol/mol as compared with the previous period).

Strategy and tactics of treatment of type 2 diabetes mellitus.

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 (triacylglycerols), glomerular filtration and, of course, patient compliance. The strategic goal of treatment of diabetes mellitus is to reduce the risk of late complications, both specific and non-specific (atherosclerotic), and if they arise, then slowing-down of their progression. All of this as a means of reducing mortality and improving quality of life. The tactics of therapy for type 2 diabetes mellitus must first of all be chosen individually. We bear in mind the general circumstances (life expectancy, comorbidities, age, compliance, social background, type of work) and specific characteristics of the current development of diabetes (the dominant nature of metabolic disorder, the level of preservation of insulin secretion or response to prandial stimulation, presence and progression of complications). A timely combination of 2 or more antidiabetic drugs targeting individual pathophysiological mechanisms can be considered useful.

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.

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 HbA1c 3 mmol/mol in the T1DM group was 29.9 % and in the T2DM group was 33.4 %.

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

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.

Early urinary biomarkers of diabetic nephropathy in type 1 diabetes mellitus show involvement of kallikrein-kinin system.

BACKGROUND: Additional urinary biomarkers for diabetic nephropathy (DN) are needed, providing early and reliable diagnosis and new insights into its mechanisms. Rigorous selection criteria and homogeneous study population may improve reproducibility of the proteomic approach. METHODS: Long-term type 1 diabetes patients without metabolic comorbidities were included, 11 with sustained microalbuminuria (MA) and 14 without MA (nMA). Morning urine proteins were precipitated and resolved by 2D electrophoresis. Principal component analysis (PCA) and Projection to latent structures discriminatory analysis (PLS-DA) were adopted to assess general data validity, to pick protein fractions for identification with mass spectrometry (MS), and to test predictive value of the resulting model. RESULTS: Proteins (n = 113) detected in more than 90% patients were considered representative. Unsupervised PCA showed excellent natural data clustering without outliers. Protein spots reaching Variable Importance in Projection score above 1 in PLS (n = 42) were subjected to MS, yielding 33 positive identifications. The PLS model rebuilt with these proteins achieved accurate classification of all patients (R2X = 0.553, R2Y = 0.953, Q2 = 0.947). Thus, multiple earlier recognized biomarkers of DN were confirmed and several putative new biomarkers suggested. Among them, the highest significance was met in kininogen-1. Its activation products detected in nMA patients exceeded by an order of magnitude the amount found in MA patients. CONCLUSIONS: Reducing metabolic complexity of the diseased and control groups by meticulous patients' selection allows to focus the biomarker search in DN. Suggested new biomarkers, particularly kininogen fragments, exhibit the highest degree of correlation with MA and substantiate validation in larger and more varied cohorts.

[The SPACE project (Stav Pacientu Akceptovaných diabetologem Cestou Exportu/The Health Records of Patients Accepted by a Diabetologist by way of Export)]. / Projekt SPACE (Stav Pacientu Akceptovaných diabetologem Cestou Exportu).

INTRODUCTION: A structured care of patients with diabetes is in place in the Czech Republic and the majority of patients are followed up by a diabetologist in outpatient diabetes units. The SPACE project (The Health Records of Patients Accepted by a Diabetologist by way of Export) was initiated to address the lack of the data which would allow for objective evaluation of how the cooperation in the care of patients with diabetes works in the real-life health care practice in the Czech Republic. GOAL: Gaining the description of anthropometric parameters, presence of complications, the chosen therapy and metabolic state of patients registered for diabetes specialist care. Secondary goals involved identification of the average duration of diabetes at the first patient visit to the outpatient diabetes clinic, prevalence of diabetes-related complications on the registration for diabetes care, the structure of pharmacological therapy for diabetes, hypertension, hyperlipoproteinemia. METHODOLOGY: Retrospective collection of data for the first 20-25 patients, who were consecutively registered in diabetes outpatient clinics from 1 January 2015 onwards. RESULTS: 778 complete questionnaires were included in the analysis. The greatest number of patients were referred by the general practitioner (64.5 %). Over 55 % of the patients were aged 50-69, less than 10 % were up to 40 years of age. 95.6 % of all cases involved type 2 diabetes mellitus. In almost 65 % of the cases duration of diabetes before registration for diabetes care is up to 2 years. There were 433 late complications recorded in 272 patients of the total number of 778 patients. 506 patients (65 %) had no late complications. Three most frequently occurring complications were ischemic heart disease (18.6 %), diabetic neuropathy (7.8 %) and stroke (5.5 %). The analysis of pharmacotherapy shows a significant increase in the use of the followed drugs after visiting a diabetologist (74.9 % before the diabetes visit and 96.7 % after the visit). Antidiabetic drugs or insulin were taken by 48.3 % of patients before the diabetologist visit, and they were taken by 92.5 % of patients after the first diabetologist visit.Key words: diabetes mellitus - epidemiology of diabetes mellitus complications - glycated hemoglobin - diabetes mellitus therapy.

[Promising molecules for treatment of hyperglycemia in patients with type 2 diabetes]. / Perspektivní molekuly pro lécbu hyperglykemie u pacientu s diabetem 2. typu.

New antidiabetic drugs are being developed today that expand the range of pharmacological intervention, in particular for patients with type 2 diabetes (imeglimin, semaglutide, dulaglutide, FGF 21 analogue). At the same time innovations take place that "better" the well-proven molecules, they offer new application forms we have no experience of diabetology (osmotic pump for exenatide, faster acting insulin aspart). New properties are brought by just the change of concentration (insulin glargine in a concentration of 300 U/ml), unexpected positive results are also brought by new fixed-ratio combinations of antidiabetics (fixed-ratio combination of insulin degludec and liraglutide, fixed-ratio combination of insulin glargine and lixisenatide). Also results of clinical studies appear that concern molecules already in use which facilitate the formulation of new recommendations regarding treatment type 2 diabetes.Key words: type 2 diabetes mellitus - dulaglutide - FGF 21 - imeglimin - insulin aspart - insulin degludek - insulin glargine - ITCA 650 - liraglutide - national information diabetes system - semaglutide.

[Toxic epidermal necrolysis]. / Toxická epidermální nekrolýza.

Toxic epidermal necrolysis is a rare, acute and life-threatening disorder manifested by extensive separation of the epidermis and mucosal surfaces. It is a serious adverse response to administered drugs, mostly antibiotics, anticonvulsants or NSAIDs. First described by Scottish dermatologist Alan Lyell in 1956, it is also known as Lyells syndrome. Mortality of the disease is high, therefore its early diagnosis is crucial and immediate initiation of appropriate patient care necessary. It is a rare disease with a very low incidence and serious prognosis, which is a considerable hindrance to undertaking large randomized clinical studies. It is therefore difficult to evaluate the effectiveness of various therapeutic options. As the most promising so far appears the administration of intravenous immunoglobulins, apparently reaching improvement in the clinical condition of the patient, with a good tolerances and minimal side adverse effects. New experimental techniques endeavour to seek a way to the therapy through targeted influencing of granulysin as the major cytotoxic mediator.

[Prevalence of microalbuminuria in patients with diabetes mellitus in the Czech Republic: Project IDN-Micro]. / Prevalence mikroalbuminurie u pacientu s diabetes mellitus v Ceské republice: Projekt IDN-Micro.

INTRODUCTION: Prevalence of a positive testing for microalbuminuria (MA) in patients with diabetes mellitus in the Czech Republic is not described in the available literature. The data is important with regard to monitoring effectiveness of the comprehensive therapy for diabetes mellitus, from the prognostic and pharmacoeconomic perspective.The aim of the study was to assess the prevalence of presence of microalbuminuria or proteinuria (PU) in randomly chosen patients with diabetes mellitus aged up to 65 years in a cross-cutting study. The secondary aim was to assess the distribution of eGFR (estimated glomerular filtration) in the same population. METHODOLOGY: 2 024 patients with diabetes aged up to 65 years were examined within the project. The median of diabetes duration was 6.0 years, the BMI median was 30.7 kg/m2, the creatinine median 74.9 µmol/l, the median of HbA1c 5.45 %, the blood pressure median 132/80 mm Hg. 1 888 patients had type 2 diabetes (DM2T). RESULTS: 19.96 % of the examined patients tested positive for MA (24.24 % of them with type 1 diabetes - DM1T, 19.16 % DM2T). 11.36 % tested positive for PU (17.78 % DM1T, 10.21 % DM2T). Glomerular filtration was established through calculation (MDRD), with a normal value identified in 44.7 %, a mild decrease (eGFR 1.0-1.49 ml/s) in 46.7 %, medium (eGFR 0,5-0,99 ml/s) in 7.7 %, and a severe decrease (eGFR < 0.5 ml/s) identified in 0.7 %, hemodialysis in 0.2 %. The median of diabetes duration in MA-negative patients was 5 years, in MA-positive patients 7 years and in patients with proteinuria 11 years. Regarding patients with eGFR between 0.5-0.99 ml/s/1.73 m2, 63.23 % of them tested negative for MA and 71.62 % for PU, regarding those with eGFR in the range of 0.25-0.49 ml/s/1,73 m2, 15.38 % tested negative for MA and 7.69 % were PU-negative. CONCLUSION: The IDN-Micro project shows high prevalence of positive MA and PU findings in individuals with diabetes mellitus younger than 65. For a significant proportion of individuals, the most likely cause of the decrease in eGFR is other than hyperglycemia. It is apparent that examination of serum concentrations of creatinine and evaluation of eGFR is also necessary for relatively younger patients with diabetes.Key words: diabetes mellitus - eGFR - microalbuminuria.

[Clinical aspects of pharmacological treatment of diabetic neuropathy - cooperation with neurologists and diabetologists]. / Klinické aspekty farmakologické lécby diabetické neuropatie - spolupráce neurologa a diabetologa.

The development and progression of symptomatic diabetic neuropathy (SDN) is linked to hyperglycemia. The effort to improve compensation of diabetes mellitus during therapy is therefore very important. This is where the cooperation between the diabetologist and neurologist within therapy plays an important role. The pharmaco-logical therapy of symptomatic sensitive peripheral diabetic neuropathy is difficult and with a less than satisfactory effect. A variety of active substances is used in symptomatic therapy, primarily designed for intervention in other pathological conditions. The recommended guidelines include antidepressants, anticonvulsants, opiates and their derivatives. However this therapy brings with it a relatively high incidence of adverse effects which detract from patients adherence to treatment. Very good results are reached by the therapy with thioctacid.

[Motor vehicle driving and diabetes mellitus - medical aspects]. / Rízení motorových vozidel a diabetes mellitus - lékarské aspekty.

Diabetes mellitus is a disease which may affect the eligibility to hold a driving license and increase the risk of a road accident. Hypoglycemia while driving is considered to be the most risky situation, with diabetes increasing the mentioned risk for instance due to impaired vision in the case of possible retinopathy. The group of drivers with diabetes being at the greatest risk as to accidents are those with a case history of severe hypoglycemia or hypoglycemia occurred while driving, or possibly of a road accident. Measuring glycaemia before driving and their knowledge how to prevent and treat hypoglycemia - those are the two crucial preventive elements indispensable for insulin treated diabetes patients in order to secure safe road traffic.

[Realistic possibilities of using data sources in quality assessment of care of patients with diabetes in the Czech Republic: National Diabetes Information System]. / Reálné moznosti vyuzití datových zdroju pro hodnocení kvality péce o pacienty s diabetem v Ceské republice: Národní diabetologický informacní systém.

UNLABELLED: Diabetes mellitus is a serious health and economic problem of our time. Therapy is primarily perceived as prevention of the late complications of diabetes. Most pharmacoeconomic analyses state that the cost associated with the therapy of diabetes mellitus is largely spent on the therapy of its complications. The project of the National Diabetes Information System is based on the essential principle of automated collection of data which is available in digital form in the Czech Republic and which describes the quality and quantity of the care provided for patients with diabetes mellitus and its results. Benefits of the posited National Diabetes Information System embrace minimizing of selective loss of data, a comprehensive view of epidemiology, therapy and its results, possibility of following trends, inclusion of costs related to hospitalization and social benefits. Risks involve correct interpretation and a possible system error. If we succeeded in implementing such system in the Czech Republic, it would be the first fully automatic information system on such a comprehensive scale worldwide. CONCLUSION: The data describing the incidence and prevalence of diabetes mellitus, therapy structure, direct healthcare costs and induced costs of social payments is in the largest part available in digital form. This creates a basis for the foundation of the National Diabetes Information System which will allow for continuous quality assessment of care for patients with diabetes mellitus, including the related pharmacoeconomic and social impacts.

[Does "LDL hypothesis" also apply to patients with diabetes?]. / Platí "LDL-hypotéza" i pro pacienty s diabetem?

The basic symptom of diabetes mellitus is hyperglycemia. However the increased cardiovascular risk in patients with both type 1 and type 2 diabetes mellitus has a multifactorial etiology. Concurrent negative effects of hyperglycemia, hypertension and hyperlipidemia on the vascular system reinforce one another. Consistent prevention of cardiovascular risk parameters in patients with type 2 diabetes mellitus (DM2T) has brought significant decline in mortality and morbidity due to cardiovascular diseases. Still there is "residual risk" remaining. The full use of the potential of statins and their combination with ezetimibe may lower the CV risk even more and extend the life of patients with DM2. The importance of an intervention by means of PCSK9 inhibitors for the cardiovascular risk reduction in patients with diabetes mellitus is the subject of study.

[Distribution of values of glycated haemoglobin in a population with type 2 diabetes: a project Valetudo]. / Distribuce hodnot glykovaného hemoglobinu v populaci diabetiku 2. typu: projekt Valetudo.

Currently, there are no available data on distribution of the values of glycated haemoglobin in patients with type 2 diabetes in the Czech Republic. More frequent, efficacy and early application of new antidiabetic agents is limited by indication criterion which restricts the payment of this therapy for patients with poorly compensated diabetes defined by threshold value of 60 mmol/mol (6% IFCC). The study Valetudo analyzed distribution of glycated haemoglobin values in the random population of patients with type 2 diabetes and showed that within the critical range from 43 mmol/mol to 80 mmol/mol is the average frequency of patients from the whole population of 1.88%/1 mmol/mol glycated haemoglobin. Interpretation of data from cross-sectional studies is very difficult as they involve patients before treatment (possibly before the intensification of therapy) and also patients successfully treated.Key words: diabetes mellitus type 2 - distribution of HbA1c - glycated haemoglobin - HbA1c - Valetudo project.

[The mortality of patients with diabetes mellitus using oral antidiabetic drugs in the Czech Republic decreased over the decade of 2003-2013 and came closer to the population average]. / Mortalita pacientu s diabetes mellitus lécených perorálními antidiabetiky v Ceské republice poklesla behem let 2003-2013 a priblízila se populacnímu prumeru.

INTRODUCTION: Every year official data is published which describes the care of patients with diabetes mellitus in the Czech Republic. An overall number of individuals with diabetes, the number of newly reported cases and the number of patient deaths is always specified. However this data does not allow us to identify the differences in mortality between the individual cohorts of diabetic patients in relation to therapy. GOAL: Comparison of the mortality development in the periods of 2002-2006 and 2010-2013 in a representative sample of the patient population with type 2 diabetes mellitus using oral antidiabetic drugs, kept in the database of the General Health Insurance Company of the Czech Republic (VZP) which provided health care coverage for 63% of Czech population in 2013. METHODOLOGY: A retrospective epidemiologic analysis. We identified all individuals in the VZP database who had a record of DM diagnosis (E10-E16 based on ICD 10) or who had any antidiabetic therapy prescribed (ATC group A10) in the periods of 2002-2008 and 2009-2013. We only selected those patients for the analysis who were treated with oral antidiabetic medicines (in the given year or the preceding years they had a record of treatment with at least one medicine from A10B group, while having no record of treatment with medicines from A10A group within both years). 237,665 individuals met the selected criteria in 2003 and 315,418 individuals in 2013. RESULTS: Mortality rates dropped for all age groups (from 2003-2013): for 50-59 year olds by 1.2%-0.7%; in 60-69 year olds by 2.6%-1.6%; for 70-79 year olds by 5.8%-3.5%. In 2013 mortality rates came close to the general population where for the same age groups they reached 0.6%, 1.5% and 3.4% respectively. When expressed in relative terms, the mortality among 50-59 year olds declined by 42% (Czechia by 25%), among 60-69 year olds by 39% (Czechia by 17%) and among 70-79 year olds by 40% (Czechia by 28%) from the year 2003. The decline in mortality among the patients with DM treated with oral antidiabetic medicines was greater in both absolute and relative terms in the period of 2003-2013 than among the general population in the Czech Republic. CONCLUSION: The analysis of mortality among the patients treated with oral antidiabetic medicines, registered in the VZP database, has shown a clearly favourable trend of mortality decline which is faster than among the general population. The fact that mortality among this cohort is getting closer to that among the general population of the corresponding age is a finding of critical importance. There is a justified expectation that mortality, with increasingly extensive utilization of the present therapeutic procedures, will continue to decrease.

[Incidence of amputations among patients with diabetes mellitus in the Czech Republic from 2010 to 2014]. / Incidence amputací u pacientu s diabetes mellitus v Ceské republice v letech 2010-2014.

INTRODUCTION: Information about the incidence of organ-affecting complications of diabetes, including the diabetic foot syndrome, can be obtained from the documents of the Institute of Health Information in the Czech Republic. GOAL: Assessment of the development of high amputations and minor surgical procedures on the lower limb from 2010 to 2014 in a representative sample of the population of patients with DM kept in the General Health Insurance Company of the Czech Republic database. METHODOLOGY: We identified all individuals in the VZP database who had a record of DM diagnosis (E10-E16 based on ICD 10) or any antidiabetic therapy prescribed (ATC group A10) in the period of 2010-2014. A set of patients who had an agent from A10 group prescribed at least once in the given year was extracted for analysis. In the next step we identified individuals, who in the period of 2010-2014 also underwent a surgical procedure on the lower limb due to diabetic foot. RESULTS: An absolute number of lower limb amputations remains at a stationary level. CONCLUSION: The submitted analysis presents the first assessment of the development of surgical treatment of diabetic foot in the Czech Republic. The amount of surgical procedures on the diabetic foot remains stable, regarding both high amputations and lower limb minor surgical procedures. In the context of an absolute increase of patients treated for diabetes mellitus, the stationary state is an indication of a relative decrease, which is favourable in particular with regard to the amputation of long bones.

[The PROROK project results after 6 months of intervention (Prospective observation project focusing on the relevance of the difference between fasting blood glucose levels and postprandial blood glucose for estimation of success of type 2 diabetes therapy)]. / Výsledky projektu PROROK po 6 mesících intervence (Prospektivní observacní projekt významu diference glykemie nalacno a postprandiální glykemie pro odhad úspesnosti terapie diabetu 2. typu).

INTRODUCTION: The PROROK project (Prospective observation project focusing on the relevance of the difference between fasting and postprandial blood glucose levels for the estimation of success of type 2 diabetes therapy) had a character of non-interventional, prospective, multicentric observation study lasting 6 months, whose goal was to quantify the relevance of the difference between fasting and postprandial blood glucose levels to the success of the treatment with GLP1 receptor agonists, resp. the treatment with basal, premixed insulin, or a combination of basal-bolus insulin. Physicians chose a therapy for patients with insufficiently compensated problems as they considered appropriate; 4,972 patients were included. GOAL: Evaluation of the intervention results for the patients included in the PROROK observation project with a focus on the choice of therapy by the treating diabetologist after 6 months of observation. RESULTS: An average improvement of the glycated hemoglobin values in the whole cohort reached 1.6%, the median of the resulting glycated hemoglobin reached 5.9% and 5.8% resp. (basal insulin). Statistically significant was the change in the median weight in the cohort treated with GLP-1 receptor agonists, from 105 kg to 100 kg; this did not significantly change in the other cohorts. The change of waist circumference over time in all patients and in the individual cohorts was consistent with the change of weight. The median change of fasting blood glucose levels in the whole cohort was -1.7 mmol/l after 3 months and -2.4 mmol/l (p<0.001) after 6 months. The greatest absolute decrease was recorded in the cohort treated with basal insulin (-2.8 mmol/l). The median change of postprandial blood glucose levels was -2.4 mmol/l after 3 months and -3.3 mmol/l (p<0.001) after 6 months. The greatest absolute decrease was recorded in the branch treated with a combination of prandial and basal insulin (-3.9 mmol/l). All differences p<0.001. CONCLUSION: The choice of therapy in the PROROK project is in agreement with the basic findings in pathophysiology of type 2 diabetes and with the options of an individually chosen targeted intervention involving antidiabetic therapy. The results of the six-month observation have proven the individual choice of therapy correct. In the cohort of diabetic patients differing at the beginning in weight, waist circumference, fasting blood glucose and the difference between fasting and postprandial glucose levels, an individually chosen therapy led to the same final result, while an absolute change in the followed parameters differed in the individual groups.

[Do diabetologists choose a therapy rationally? Basic results of the PROROK project (a prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy)]. / Volí diabetologové terapii racionálne? Základní výsledky projektu PROROK (Prospektivní observacní projekt významu diference glykemie nalacno a postprandiální glykemie pro odhad úspesnosti terapie diabetu 2. typu).

INTRODUCTION: The PROROK project (A prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy) had a character of a non-interventional, prospective, multicentric observation project conducted for a period of 6 months, whose aim was to quantify the relevance of the difference between fasting and postprandial glycemia to the success of GLP1 receptor agonist treatment, or insulin therapy with basal or premixed insulin, or a combination of basal and bolus insulin. Physicians chose therapy for inadequately compensated patients at their own discretion, with 4 972 patients included. AIM: The study aimed at the assessment of the differences in basic anthropometric and biochemical parameters between the patient cohorts included in the PROROK project with regard to the therapy selected by the treating diabetologist. METHODOLOGY AND RESULTS: The patients treated with GLP1 receptor agonists were quite young, they have suffered from diabetes for a shorter period of time and at the same time were more obese and had the highest concentration of triacylglycerols. The patients who underwent basal insulin therapy, had the highest fasting glycemia. The patients for whom premixed insulin therapy or basal/bolus insulin regimen were chosen, manifested the highest postprandial glycemia, those with basal/bolus insulin regimen had the highest initial glycated haemoglobin. The difference between fasting and postprandial glycemia was the smallest in the cohort for which basal insulin therapy was chosen and the greatest in the cohort chosen for the therapy with premixed insulin, or with the basal/bolus insulin combination. Average improvement in glycated haemoglobin values reached 1.6 % within the whole cohort, a median of the resulting glycated haemoglobin reached 5.9 % or 5.8 % (GLP1 receptor agonist treatment). All the differences amounted to p < 0.001. CONCLUSION: Bearing in mind that the differences established in the parameters describing the cohorts, although statistically relevant, are of smaller clinical relevance, we regard as an important finding that the choice of therapy is in accordance with the basic knowledge about the pathophysiology of type 2 diabetes and possibilities of an individually chosen targeted intervention with antidiabetic therapy. We may conclude that most of the physicians participating in the PROROK project choose their therapy in a rational manner.