The fat mass, estimated glomerular filtration rate, and chronic inflammation in type 2 diabetic patients.

BACKGROUND: The aim of the study was to analyze the degree of obesity and its associations with age, gender, inflammation, an estimated glomerular filtration rate (eGFR), and liver function in type 2 diabetes mellitus (T2DM) patients. METHODS: A total of 874 consecutive adult Caucasian T2DM patients from outpatient diabetic clinic were included in the study. The relative fat mass (RFM) and body mass index (BMI) were used as obesity markers. Serum creatinine and cystatin C were used for the GFR estimation. Serum high-sensitive C-reactive protein (hsCRP) was used as the indicator of inflammation. RESULTS: The median, interquartile range (IQR) of RFM in females was higher than that in males (44.8 (42.3-47.2) % vs 31.3 (28.8-34.1) %, respectively; P < .0001). The median (IQR) of BMI in females was no higher than that in males (30 (27-34) kg/m2 vs 30 (27-34), respectively; P = .5152). The obesity prevalence was 99% in males and 98% in females according to RFM. BMI recognized obesity in 51% males and 53% females. RFM was positively associated with hsCRP in both males (rs  = .296, P < .0001) and females (rs  = .445, P < .0001). ALT was positively correlated with eGFRcys in both males (rs  = .379, P < .0001) and females (rs  = .308, P < .0001). CONCLUSION: The RFM equation leads to higher obesity prevalence compared to BMI. Women have higher RFM compared to men. The kidney function was positively correlated with ALT serum concentrations.

Cystatin C measurement leads to lower metformin dosage in elderly type 2 diabetic patients.

The aim of this study was to provide evidence for the hypothesis that estimated glomerular filtration rate from serum Cystatin C (eGFRcys) is better to be determined for all elderly type 2 diabetes mellitus (T2DM) patients based on eGFRcys upward and downward reclassification rate for hypothetical metformin dose reduction by eGFRcys at the GFR decision point of 45 mL/min/1.73 m2 . A total of 265 consecutive T2DM elderly patients (age range 65-91 years) from outpatient diabetic clinic were included in the study. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines for metformin dosing were strictly followed. Estimated glomerular filtration rate from serum creatinine (eGFRcrea) led to results of metformin eligibility. Each of the results of eGFRcrea-based eligibility was further compared to eGFRcys-based eligibility. Creatinine was measured by enzymatic method standardized against international reference material SRM 967. Cystatin C was determined by method traceable to DA ERM 471 international standard. eGFRcrea and eGFRcys were calculated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. A downward reclassification rate was higher than upward reclassification rate (31 vs 3, respectively; P < 0.0001). The median (IQR) eGFRcrea was higher than eGFRcys (73 (58-85) vs 63 (50-75) mL/min/1.73 m2 , respectively; P < 0.0001). eGFRcys reclassified significant proportion of patients with T2DM from metformin eligible CKD stages to less or non-eligible stages. The downward reclassification was more frequent in patients older than 80 years (P < 0.01). Cystatin C-based eGFR selects more complicated patients, where lower doses of metformin are possibly advisable. We recommend calculating both eGFRcrea and eGFRcys for metformin dosing in elderly patients with T2DM.

Effectiveness and safety of lixisenatide for treatment of diabetes in the real world: data from the Monitoring Registry in a Real-Life Cohort in the Czech and Slovak Republic.

INTRODUCTION: GLP1 receptor agonist lixisenatide has demonstrated its efficacy in numerous clinical trials, nevertheless its real-life effectiveness data is limited. AIM: To describe effectiveness and safety of lixisenatide in routine clinical practice in the Czech Republic and the Slovak Republic, as recorded by the Registry-Based Observational Study. METHODS: Multinational, multicenter, observational, non-interventional, 6-month prospective product registry of patients with type 2 diabetes mellitus aged > 18 years who were initiating therapy with lixisenatide. Patients were enrolled into this registry, provided written informed consent, between 1 May 2013 and 31 December 2015. Evaluations were performed at baseline and after 3 and 6 months of lixisenatide treatment. The primary objective of the study was the absolute change in glycated hemoglobin (HbA1c) from baseline to month 6 after lixisenatide initiation. The study was approved by responsible ethics committees and performed in accordance with the Helsinki Declaration. Informed consent was obtained from all patients before enrolment in the study. RESULTS: Overall 772 eligible patients (51.4 % males), mean age 56.7 (± 9.3) years, with mean diabetes duration 7.7 (± 5.5) years, mean duration of treatment with oral antidiabetic drugs 6.8 (± 4.9) years, and body mass index 37.6 (± 5.9) kg/m2 were enrolled in the study. Overall, 93.6 % were obese, 86.3 % subject were treated for hypertension, and 76.0 % for dyslipidemia. In total 96.1 % of patients completed the 6 months therapy. Lixisenatide significantly reduced HbA1c (decrease by 9.7 ± 14.4 mmol/mol [3.1 ± 0.2 % DCCT] after 6 months in per protocol population), and body weight (decrease by 3.5 ± 5.4 kg). The best responders to the treatment were younger patients with higher BMI, who had a shorter duration of diabetes. Overall safety profile of lixisenatide was satisfactory in the study. The most frequent adverse events were functional disorders affecting the gastrointestinal system. There was no episode of severe hypoglycemia reported throughout the study. CONCLUSION: In a real-life practice cohort of patients with type 2 diabetes mellitus 6 months treatment with once-daily GLP1 receptor agonist lixisenatide significantly improved glucose control and decreased body weight without increasing the risk of symptomatic and/or severe hypoglycemia risk. FUNDING: Sanofi Czech Republic.Key words: GLP1 receptor agonist - glycated hemoglobin - HbA1c - lixisenatide - oral antidiabetic drugs (OAD) - observational study - hypoglycemia - type 2 diabetes mellitus.

[Education of a patient with diabetes - an integral part of complex therapy]. / Edukace pacienta s diabetem - soucást komplexní terapie.

Determination of the diagnosis of diabetes mellitus means a radical life change for a patient. Education of a patient with diabetes means the provision of essential information and practical guidance for linkage of the disease with the life style of the patient for the purpose of providing the required control of the disease, to gain the necessary knowledge for self-care management of the disease in collaboration with the education team. Education is a permanent integral part of the complex therapy of diabetes, adaptation to the phases of the disease, targeting not only the patient but immediate family. The fundamental aim is improvement of the state of health and the ensuring of life quality.Key words: content of education - diabetes mellitus - education - educational phases - education team.

[Clinical contribution of new basal analogue insulin]. / Klinický prínos nových bazálních analog inzulinu.

UNLABELLED: Chronic long term hyperglycemia plays a key role in the pathogenesis of micro and macrovascular complications. The UKPDS study and its further analysis has proved that reduction of the value of glycated hemoglobin by 1 % leads to a 14 % reduction of the risk of myocardial infarction and a 37 % reduction of the risk of microvascular complications. Effective control of glycaemia, optimal value of pre-prandial, postprandial glycaemia, and low variability from the start of the disease has a long term beneficial impact. The therapy of basal insulin analogues ranks among the recommended procedures for achieving control. The new insulin analogues (insulin glargin 300 U/ml, insulin degludec) have a longer effect, practically a peakless course, lower variability, lower risk of hypoglycemia events and better application technique with greater flexibility of administration. The pharmacokinetic and pharmacodynamics properties provide new quality in the chronic therapy of people with type 1 and 2 diabetes. KEY WORDS: diabetes mellitus - glycemia control - hypoglycemia - new basal insulin analogues.

[Clinical importance of basal insulin analogues and insulin Toujeo® 300 units/ml]. / Klinický význam nových bazálních inzulinu a inzulin Toujeo® 300 U/ml.

Type 2 diabetes mellitus is a heterogeneous disease that requires a personalized approach to treatment with goals tailored to capabilities and abilities of the patient, his other diseases so as to ensure good diabetes control without the risk of hypoglycemic events and the development or progression of late diabetic complications. Recommendations for treatment of diabetes is classified in second-line as a one of the possibilities of treatment of basal insulin immediately after the failure of therapy with metformin and diet. The new generation of basal insulin analogues provides its effect profile and features a completely new quality to the treatment of diabetes. Toujeo® 300 units/ml is a new long-acting basal insulin glargine concentration of 300 units/ ml with a low glycemic variability, which in studies has demonstrated consistent control of diabetes in a significant reduction in the risk of hypoglycemia especially at night compared with insulin glargin of concentration 100 units/ml.

[Possibilities of therapy GLP1 RA for diabetics with nephropathy]. / Moznosti terapie agonisty receptoru pro GLP1 u diabetiku s nefropatií.

The incretin hormone GLP1 (glucagon-like peptide 1) has also systemic effects besides its effects on the pancreas. The renal expression for the receptors GLP1 and DPP4 has been described in a whole line of experimental stu-dies. Activation of the receptors for GLP1 in the kidneys has diuretic and natriuretic effects apparently through the renal tubular cells and sodium transporters. Pre-clinical incretin therapy decreased albuminuria, affected glomerulosclerosis, oxidative stress and fibrosis in the kidneys. Diabetic nephropathy is the major cause of kidney failure. In the course of renal insufficiency the functional possibilities and simultaneous safe compensation of diabetes are limited. The treatment GLP1 RA of patients with type 2 diabetes and nephropathy appear to be effective from the aspect of effectiveness and safety.

[Insulin analogues of patients with diabetes and renal impairment]. / Inzulinová analoga u pacientu s diabetem a renální dysfunkcí.

The main cause of renal failure is diabetic nephropathy which affects 20-40 % of diabetic patients. Diabetics with altered renal function have restricted therapeutic options due to the risk of accumulation of oral antidiabetic drugs and of their metabolites at a reduced glomerular filtration rate. Good metabolic control is very important during the early phases of nephropathy for reducing the risk of progression and in the stage of renal failure reduces the risk of progression of atherosclerosis and improves life prognosis. Metabolism of insulin is changed during renal failure, clearance of insulin is prolonged, the risk of hypoglycemia increases. Short-acting insulin analogues have faster absorption and long-acting analogues have a lower risk of hypoglycemia. Thus they can positively affect glycemic control of patients with diabetes and impaired renal function.

[Long-term acting insulin analogues and the risks of hypoglycemic incidence]. / Dlouhodobe pusobící inzulinová analoga a riziko hypoglykemických príhod.

As recommendation for treatment of type 2 diabetes mellitus, incorporating individualization of therapeutic targets for patients with co-morbidities, for whom hypoglycemia increases the risk of complications. The sufficient target value is 60 mmol/mol of HbA1c under the guidelines of Czech Diabetesl Society. Insulin therapy becomes essential for a whole line of patients, including those of advanced age, in relation to duration of diabetes and progression of the disease. The Diabetes and Aging Study observed patients of 60 years age with diabetes, in which hypoglycemia ranked among the most frequent side effects of therapy and where incidence increased with age. It is necessary to select simple insulin regimens which are in accordance with the associated diseases and the age of the person. A therapy of basal insulin analogues, linked to a low risk rate of hypoglycemic incidence, enables combination with oral antidiabetic drugs and GLP-1 receptor agonists.Key words: basal insulin analogues - hypoglycemia - type 2 diabetes mellitus.

Transient ischemic dilation ratio (TID) correlates with HbA(1c) in patients with diabetes type 2 with proven myocardial ischemia according to exercise myocardial SPECT.

OBJECTIVE: Abnormal values of the transient ischemic dilation ratio (TID) according to an exercise myocardial SPECT are linked to severe coronary artery disease. The authors investigated the relationship between TID and the levels of VCAM, ICAM, E-selectin, microalbuminuria, intima-media thickness and HbA(1c) of diabetic subjects. METHODS: We observed 38 subjects with diabetes type 2 (10 women, 28 men), of average age 56.08 +/- 8.24 years, with no past history of cardiovascular disease. All subjects were examined using an exercise myocardial SPECT. Transient ischemic dilation, summed stress score (SSS), summed rest score (SRS) and stress total severity score (STSS) were determined to quantify myocardial ischemia. RESULTS: The average IMT value was 1.05 +/- 0.31 mm. The TID value was 1.02 +/- 0.154, VCAM 795.24 +/- 163.25 mg/l, ICAM 516.55 +/- 164.07, E-selectin 63.82 +/- 38.89, HbA(1c) 7.09 +/- 1.68%, microalbuminuria 68.01 +/- 55.21 mg/l. When ascertaining the relation of TID to the other factors we used Pearson's correlation at the level of significance p < 0.05. We proved a statistically significant correlation between the value of TID and glycosylated hemoglobin HbA(1c) (p = 0.035); the other factors did not show any significant correlation. CONCLUSION: Diabetes and its long- term unsatisfactory compensation can be one of the factors which affect left ventricular transient ischemic dilation.