Effectiveness of treatment of arterial hypertension in Central Europe from 1972 to 2022.

BACKGROUND: Hypertension is a leading cause of cardiovascular disease. This review examines the literature on hypertension control in the Czech Republic from 1972 to 2022 addressing limited data on its effectiveness. METHODS: A literature review was conducted covering the period from 1972 to 2022, utilizing MEDLINE (PubMed), Web of Science, and Scopus databases. Articles were selected based on title and abstract evaluations, with full-text reviews performed as needed. Thirteen studies involving 44,990 participants were included in this review. RESULTS: Control rates increased from 2.8% (men) and 5.2% (women) in 1985 to 32.3% (men) and 37.4% (women) from 2015 to 2018. Women showed better blood pressure control. Specialised centres achieved higher success (48%) than general practitioners (18.4%). Diabetic patients had a lower percentage (29.1%) of patients meeting their target values (<130/80 mmHg) compared to non-diabetic patients, who had a higher percentage (60.6%) meeting their target values (<140/90 mmHg). CONCLUSION: Hypertension treatment success rate in the Czech Republic improved significantly over the last 50 years and is currently comparable to that of other European countries with similar healthcare resources. However, it still remains suboptimal and lags behind the countries with the most successful treatment outcomes (Tab. 3, Fig. 1, Ref. 37). Text in PDF www.elis.sk Keywords: hypertension, treatment, effectiveness, Czech Republic, blood pressure.

Smoking cessation and risk of type 2 diabetes.

Risk of type 2 diabetes mellitus (T2DM) is higher in tobacco smokers compared to non-smokers. The risk declines after smoking cessation. However, ex-smokers are also more prone to the metabolic syndrome. The question thus is, whether ex-smokers could temporarily have a higher risk of T2DM than current smokers. The available studies on this topic are not in agreement in their conclusions, as most of them also primarily do not compare ex-smokers to current smokers, but to non-smokers. However, based on the available studies, it rather seems the risk of T2DM is temporarily higher after smoking cessation. The higher risk of T2DM seems to be enhanced by weight gain that typically occurs first years after smoking cessation without intervention. Therefore, smoking cessation in patients who are in an increased risk of T2DM should be accompanied by T2DM preventative measures (lifestyle modification, weight monitoring and recommendation of pharmacotherapy of tobacco addiction to lower the risk of weight gain) and more frequent checks of blood glucose level to ensure early T2DM detection.

Colorectal cancer in patients with diabetes - epidemiology, pathophysiology and applications for clinical practice.

Diabetes mellitus (type 2 diabetes in particular) and colorectal carcinoma are relatively frequent diseases in our population. At the same time, these units share some common risk factors, for example obesity, lack of physical activity and hyperinsulinemia. Available data show patients with diabetes have increased risk of colorectal adenoma and carcinoma, increased risk of colorectal carcinoma at a lower age, as well as increased risk of relapse and increased mortality with colorectal cancer. The aim of this article is to point out the relationship between diabetes and colorectal carcinoma, with emphasis on the information important for clinical practice, particularly the screening of colorectal carcinoma and lifestyle recommendations for patients with diabetes. Therefore, we offer an overview of the important available publications which consider this topic.

How to convince a patient refusing colonoscopy - a qualitative study.

The available literature suggests that the most significant barriers to undergoing colonoscopy in general include “fear of pain and discomfort”, “fear of bowel preparation”, as well as directly unrelated influences such as “lack of support from family and friends”, “busy family and work schedules”, “other health problems” and the current “fear of getting COVID-19 in hospital”. A marital union may play a positive role, previous cancer a negative one. Another important factor is that patients are not used to talking about their barriers spontaneously; a guided conversation is a useful tool. Respondents in this qualitative study addressed these barriers as significant in their answers.

Continuous glucose monitoring - a new and expanding element in the care of patients with diabetes mellitus during pregnancy.

A new parameter of metabolic control derived from the results of continuous blood glucose monitoring is time in range (TIR). According to current recommendations, in pregnant women with diabetes, this glycemic range is defined by values of 3.5 to 7.8 mmol/L, with the aim of keeping glycemia in this range as much time as possible, and at the same time reducing the time spent below its lower limit (< 3.5 mmol/L)). In pre-gestational type 1 diabetes, it is recommended to reach this TIR above 70% of the total measurement time including up to 4% of simultaneous time spent in hypoglycemia. In gestational (and pre-gestational type 2) diabetes, the recommended % of in-range times are not yet specified.

Differential dignosis: „primary“ or secondary diabetes - should Cushing´s syndrome be routinely screened in the patients with type 2 diabetes mellitus?

Cushing´s syndrome is a rare disease with the population prevalence about 40 patients per 1 million inhabitants, the number among patients with diabetes mellitus (DM) is probably higher. The screening of CS among the DM patients showed the prevalence between 0-2.9% in the groups of outpatients and 2-2.9% among the patients admitted to the hospital at the time of randomization. The routine screening of CS among patients with type 2 DM is not recommended at the moment. Nevertheless, the possibility of CS should be taken into the account mainly in patients with hypertension, obesity, microvascular complications, bad level of metabolic control or high insulin doses, especially, if more of these features are present. A hormonal profile of patients with adrenal incidentaloma should be evaluated.

Glucagon in treatment of hypoglycemia - novelties.

Glucagon is actually used in the treatment of severe hypoglycemia. Due to technological difficulties with stability in solution, glucagon in currently available preparations was contained in a form of powder, which needs to be first dissolved in the water before application. This particular administration of glucagon was associated with a certain delay and several mistakes that decreased real amount of glucagon injected in the body. Currently two new formulas of glucagon appeared on the market - first as a stable liquid solution, second as a powder for nasal administration. This article summarizes currently available information about these preparations.

Metabolic and endocrine diseases - is our approach always rational?

Choosing wisely in metabolic and endocrine diseases shows the inutility of some, in clinical practice often used, ways of management. In diabetology, the routine recommendation for selfmonitoring of type 2 diabetic patients not treated with insulin represents a contraversial issue. On the contrary, there is a consensus on rational targets of glycemic control in elderly frailty patients with limited life expectancy. In endocrinology (thyroid diseases), the iniciative fights against the overuse of some laboratory examinations and ultrasonography. The recommendations on the rational indications of densitometry are discussed. In conclusion, these recommendations within Choosing wisely initiative of different professional associations usualy arise from expert views, supported by relevant clinical studies. They represent a challange to think over rational management of care.

High-rank technology in the medicine - the impact of continuous glucose monitoring system alarm settings values on glycemic control in type 1 diabetes patients: a systematic review.

Alarms in continuous glucose monitoring systems (CGM) represent a very important feature enabling to patients with diabetes who use these systems to keep their blood glucose level in the target range and to avoid excursion to hypoglycemia or hyperglycemia. The possibility to warn the patient that the target range has been crossed means one of the main advantages of CGM over the selfmonitoring of blood glucose with personal glucometers, but also (so far) flash glucose monitoring systems. However, there is surprisingly few studies concerning specifically the relationship between the alarms settings and glucose control. Therefore, there are currently no recommendations nor guidelines for optimal settings of alarms in CGM. Limited number of studies suggest that the setting of the hypoglycemia alarm to a level higher than 4 mmol/L is associated with lower frequency and shorter duration of hypoglycemia, and may be temporarily increased to 6 mmol/L in patients with impaired hypoglycemia awareness.

Screening for risk alcohol use in clinical settings.

Alcohol is an important risk factor for development of numerous chronic diseases and it is a cause of 3 million deaths worldwide every year. The Czech Republic is one of the countries with highest alcohol consumption per capita in the world. AUDIT and CAGE are examples of fast and easy screening tools for early diagnostics of patients at risk that help in estimating a level of risk related to patients drinking. The screening is followed by simple advice for risk drinking and brief intervention for harmful drinking, based on the estimated level of risk. This approach is an easy and effective prevention measure to reduce risk and harmful alcohol drinking and prevent further progression of drinking. Implementation of this approach into routine clinical practice can be a significant step in reducing alcohol consumption in the Czech population.

Current view of diagnosis and treatment of latent autoimmune diabetes in adults.

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune disease arising at adulthood. LADA is characterized by a less intensive autoimmune process, slower progression and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus. The onset of LADA is usually in non-obese patients over 30, without prominent features of metabolic syndrome and insulin resistance. Nevertheless it may be falsely classified as type 2 diabetes, especially, when diagnosed in older age and for the possibility of non-insulin treatment for at least 6 months after diagnosis. LADA is treated early with insulin and combined with metformin in patients with a higher level of insulin resistance. Clinical studies suggested also effectivity of other oral antidiabetics enabling preservation of residual β-cell function, such as particularly incretines.

Importance and efficiency of blood pressure control not only in type 2 diabetes patients.

Arterial hypertension is one of the most frequent comorbidities of patients with type 2 diabetes, the rates are approximately three times higher among diabetics than in general population. The presence of both diseases increases the cardiovascular risk of the patients two to three times. Therefore, it is essential to control the blood pressure values vigorously down to 130/80 mmHg as recommended in guidelines of the Czech Hypertension Society. According to EHES Study data, the blood pressure control is not sufficient in Czech diabetic population. The target values are reached in only 29 % of diabetics. A well organized system of care, intensive antihypertensive treatment, self-monitoring of patients or appointment reminder system can be used to improve blood pressure control.

Long terminal repeats power evolution of genes and gene expression programs in mammalian oocytes and zygotes.

Retrotransposons are "copy-and-paste" insertional mutagens that substantially contribute to mammalian genome content. Retrotransposons often carry long terminal repeats (LTRs) for retrovirus-like reverse transcription and integration into the genome. We report an extraordinary impact of a group of LTRs from the mammalian endogenous retrovirus-related ERVL retrotransposon class on gene expression in the germline and beyond. In mouse, we identified more than 800 LTRs from ORR1, MT, MT2, and MLT families, which resemble mobile gene-remodeling platforms that supply promoters and first exons. The LTR-mediated gene remodeling also extends to hamster, human, and bovine oocytes. The LTRs function in a stage-specific manner during the oocyte-to-embryo transition by activating transcription, altering protein-coding sequences, producing noncoding RNAs, and even supporting evolution of new protein-coding genes. These functions result, for example, in recycling processed pseudogenes into mRNAs or lncRNAs with regulatory roles. The functional potential of the studied LTRs is even higher, because we show that dormant LTR promoter activity can rescue loss of an essential upstream promoter. We also report a novel protein-coding gene evolution-D6Ertd527e-in which an MT LTR provided a promoter and the 5' exon with a functional start codon while the bulk of the protein-coding sequence evolved through a CAG repeat expansion. Altogether, ERVL LTRs provide molecular mechanisms for stochastically scanning, rewiring, and recycling genetic information on an extraordinary scale. ERVL LTRs thus offer means for a comprehensive survey of the genome's expression potential, tightly intertwining with gene expression and evolution in the germline.

Identification of MODY among patients screened for gestational diabetes: a clinician's guide.

PURPOSE: Screening of gestational diabetes/GDM (although different in different countries) represents a standard procedure allowing to identify women with pregnancy-associated diabetes. Some of the women with GDM (up to 5%) may, however, suffer from previously undiagnosed MODY (Maturity-Onset Diabetes of the Young). Currently, no international or local guidelines focused on the identification of MODY among GDM exist. Thus, the aim of this manuscript is to propose a clear guide for clinicians on how to detect MODY among pregnant women with gestational diabetes. METHODS: Based on the available literature about diagnosis (in general population) of MODY and management of MODY (both, in general population and in pregnant women), we propose a clear clinical guide on how to diagnose and manage MODY in pregnancy. RESULTS: The manuscript suggests a feasible clinical approach how to recognize MODY among patients with GDM and how to manage pregnancy of women with three most common MODY subtypes. CONCLUSION: A correct classification of diabetes is, nonetheless, essential, particularly in case of MODY, as the management of pregnant women with MODY is different and the correct diagnosis of MODY enables individualized treatment with regard to optimal pregnancy outcomes.

Diabetes mellitus and illicit drugs.

Lifetime prevalence of illicit drug use is high in the Czech Republic (CR) - it reached 31.2 % of the population in the age group 15-64 years in 2017. Diabetes mellitus (DM) applies to 8.8 % of the Czech population. Risks of illicit drug use in diabetic patients are related both to their effect on glucose metabolism and to the lifestyle associated with illicit drug use, which might lead to worsened glycemic control and increased morbidity and mortality of the patients. Cannabis use, being the most common illicit drug use in the CR, presumably does not have a direct effect on glucose metabolism. However, it increases appetite and decreases self-control. Opioids/opiates disrupt insulin secretion, which consequently leads to hyperglycaemia. On the other hand, hypoglycaemia might be an adverse effect of opioid treatment in diabetic patients. Cocaine and other stimulants such as MDMA increase a blood glucose level and increase the risk of diabetic ketoacidosis in Type 1 DM. Patients with DM who use illicit drugs should therefore be sufficiently informed about health risks related to illicit drug use in combination with DM.

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).

A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus.

Hypoglycemia particularly severe one is important side effect of diabetes therapy with impact on patient´s quality of life and mortality. The highest risk of hypoglycemia is connected with insulin therapy followed by derivates of sulfonylurea (SU) and glinides. The risk of hypoglycemia found in observational studies were 2-3 times higher in patients treated with SU and 3-4 higher when treated with insulin compared with other types of antidiabetics. The risk of hypoglycemia is increased in patients over 75 years of age, with longer period of treatment with insulin and in those treated with several types of antidiabetics.

Hypoglycemia as a symptom of adrenal dysfunction in patients with diabetes mellitus: rare but real situation.

Recurrent, unexplained, eventually severe hypoglycemias in patients with type 1 diabetes mellitus (T1DM) may be rarely but yet associated with the onset of adrenal insufficiency (AI), present in approximately 0.5 % of patients with T1DM, appearing usually several years after diabetes diagnosis, usually in middle age and more frequently in women. Screening for AI in patients who complained of recurrent hypoglycemias, difficult to explain by common causes, was ineffective and therefore it is not recommended. Nevertheless, the possibility of manifestation of AI in connection with above mentioned cases in patients with T1DM should be taken into consideration and usual symptoms of AI such as weakness, lack of appetite, weight loss, orthostatic hypotension, hyperpigmentation or ions disorders should be examined.

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 %.

Current view of treatment of hypoglycemia.

Hypoglycemia is a side effect of the therapy primarily with insulin, sulphonylurea derivates and glinides. Its therapy is based on the immediate ingestion of sacharides, preferably glucose. Amount of 15-20 g is recommended as its optimal dose, although several recent studies are suggesting amount related to the patient´s weight. The therapy of severe hypoglycemia in the non-professional settings is based on glucagon injection, in the professional ones intravenous administration of glucose is preferable option.