[Modern technologies in diabetology. CSII (continuous subcutaneous insulin infusion) and CGM (continuous glucose monitoring) in clinical practice]. / Moderní technologie v diabetologii. CSII (kontinuální subkutánní infuze inzulinu) a CGM (kontinuální glykemicky monitoring) v klinické praxi.

Modern diabetology is closely associated with the use of modern technologies; glucometres are now widely clinically used and it is difficult to envisage diabetology without these devices. At present, CSII and CGM are less frequently used but they certainly are equally exciting. The author discusses both methods individually as well their interrelationship, mainly from the perspective of their optimal use.

[Autonomic neuropathy of the gastrointestinal tract]. / Autonomní neuropatie gastrointestinálního traktu.

The paper focuses on the issues of diabetic autonomic neuropathy in the gastrointestinal tract. It describes the aethiopathogenesis of diabetic polyneuropathy. More detailed discussion is then provided with respect to gastrointestinal tract. The clinical picture and options available for the diagnosis and treatment when various parts of the gastrointestinal tract are involvement are examined.

[Comprehensive care for diabetic patients with diabetic foot syndrome]. / Komplexní péce o diabetika se syndromem diabetické nohy.

The author presents a definition of diabetic foot syndrome and its various classifications. Presented are its epidemiology and the risk factors of its development. Management of this condition is demanding with respect to medical as well as economic resources and thus prevention is at the forefront. However, should this condition develop in a patient, specialised care becomes equally important. Care for a patient with diabetic foot syndrome is as complex as are the underlying causes of this condition. Management requires attention of a specialized team of experts, led and coordinated by a diabetologist-podiatrist. Therapy includes diabetes control, weight reduction, infection therapy, revascularisation and, alternatively, conservative treatment of lower limb ischemia, surgery, wound healing and local therapy as well as nutritional care. The author only discusses the areas of management that are not a subject to separate papers.

[Clinical studies that have influenced the treatment of diabetes]. / Klinické studie, které ovlivnily lécbu diabetu.

In the article, the author addresses the development of the targets of diabetes treatment. He provides an overview of the key clinical studies in diabetology from which we draw knowledge and therapeutical recommendations nowadays, i.e. in the times of evidence-based medicine. The author emphasizes the need for comprehensive treatment of diabetes, i.e. the treatment of obesity, hypertension, dyslipidemia and also the impact on blood coagulation, however, focuses, in particular, on clinical studies focusing on the influence of diabetes compensation (the impact on hyperglycemia) on the development of vascular complications.

[New and older pharmaceuticals influencing insulin secretion]. / Nová a starsí farmaka ovlivnující inzulinovou sekreci.

The author briefly recapitulates the physiology of insulin secretion and pathophysiology with type II diabetes mellitus. Besides sulfonylurea secretagogues and glinides practically used in the long term, the author points out new possibilities of influencing insulin secretion by way of incretin mimetics and gliptins.

[Visceral diabetic neuropathy of the urogenital tract]. / Visceralní diabetická neuropatie urogenitálního traktu.

The article deals with issues of diabetic autonomous neuropathy (DAN) in the urogenital tract (UGT), and brings attention to the ethiopathogenesis of diabetic polyneuropathy. It provides a synopsis of autonomous neuropathy and deals, in more detail, with its manifestations in the UGT. The different symptoms of the disorder are addressed, the need for timely diagnosis is pointed out as the prerequisite for a successful therapy, and the necessity for interdisciplinary cooperation in dealing with this health issue is exposed.

[Oral treatment of type 2 diabetes mellitus]. / Perorální lécba diabetes mellitus 2. typu.

The article informs about current views of the ethiopathogenesis of type 2 diabetes mellitus (DM). It presents diabetes as a disease which is chronic and progressive, therefore requiring a dynamic approach to treatment. Based on the above concept, the article lists the current armamentarium of oral antidiabetic drugs and the possibilities of their combining. In addition to the existing therapeutic options, it also brings information about innovative drugs from the above group to be made available in the near future.

[The influence of long-term therapy with the insulin pump (CSII) in patients with type 1 diabetes mellitus on metabolic compensation and on the incidence of hypoglycaemia. Comparison with intensified conventional insulin therapy (MDI)]. / Vliv dlouhodobé terapié inzulinovou pumpou (CSII) u pacientu s diabetes mellitus 1. typu na metabolickou kompenzaci a výskyt hypoglykemií. Porovnání s intenzifikovanou konvencní inzulinovou terapií (MDI).

The principal objective of this paper is to verify, in clinical practice, the long-term affect (7 to 8 year follow up) and safety of insulin pump treatment in type 1 diabetes mellitus patients and to compare the results for diabetes compensation in patients treated with the insulin pump with a control group of patients treated with intensified insulin therapy using the MDI (multiple daily injection) method. PATIENT SAMPLE AND METHOD: We followed up 35 patients treated with the insulin pump and 35 patients in the control group. We evaluated the monitored parameters for both patient groups at the beginning and at the end of the follow up period. With respect to glycated haemoglobin, we evaluated the results on a yearly basis, and also on year by year changes. We assessed the incidence of hypoglycaemia in both groups on a yearly basis. The following aspects were considered in order to determine the level of statistical significance of the different parameters: (1) we compared the initial state with that seen at the end of the follow up, (2) we analysed the year by year changes in glycated haemoglobin, (3) we compared the patients treated with the insulin pump with those in the control group. Diabetes compensation was evaluated on the basis of measurement of glycated haemoglobin and calculation of glycaemia. Comparison of the incidence of hypoglycaemia was done for all hypoglycemic events and then separately for severe hypoglycaemia. Also evaluated were changes in weight and in insulin dose in 24 hours. RESULTS: The group of patients treated with the insulin pump recorded a dramatic decrease in glycated haemoglobin in the course of the follow up, p < 0.001, and also in average glycaemia, p < 0.001. In the control group only a transitory significant decrease of HbA1c, p < 0.05, was recorded in the first and second year of follow up, later the result was insignificant, i.e. p > 0.05, as compared with the initial state. In this group of patients, no significant improvement in average glycaemia, p > 0.05, was recorded when compared with the initial state. Comparison ofthe two groups of patients showed that HbA(1c), p < 0.001, and average glycaemia, p < 0.001, were worse with statistical significance in patients treated with the insulin pump at the beginning of the follow up. At the end of the follow up period, there was no significant difference between the two groups in terms ofglycated haemoglobin, p > 0.05, but a statistically significant difference was recorded in average glycaemia, p < 0.001, in favour of the group of patients treated with the insulin pump. The use of the insulin pump resulted in a statistically significant decrease in the incidence of severe hypoglycaemic events as compared with the control group, p = 0.010. This decrease was reflected in the measured parameters from the third year of the study to the end of follow up. However, at the beginning of the study and in the first and second years of follow up there was no statistically significant difference between the two groups in terms of incidence of severe hypoglycaemic episodes, p > 0.05. No statistically significant difference between the two groups was recorded in the incidence of all hypoglycaemic episodes from the beginning of the follow up to its end, p > 0.05. In both groups of patients, a statistically significant gain in weight was seen from the beginning of the study to the end of the follow up period, however, its statistical significance was lower (p < 0.05) in the group of patients treated with insulin pump than in the control group (p < 0.001). We proved a statistically significant decrease in daily insulin dose (p < 0.001 )was required in the group of patients treated with insulin pump, whilst no statistically significant change in the dose was recorded in the control group (p > 0.05). CONCLUSION: In the course of the follow up, we proved that treatment with the insulin pump in type 1 diabetes is more beneficial to patients than MDI treatment. This was reflected by both better compensation of diabetes and a lower incidence of severe hypoglycaemic episodes.

[Therapeutic regimes accompanying physical exercise for diabetics]. / Upravy terapie pri pohybové aktivite diabetika.

The author explains the need for an individual approach to education on physical activity. The individual approach relates to suitable physical exercise and the intensity and length of exercise, but also therapeutic regimes. The author presents general recommendations for dietary regimes and regimes for insulin dosage as they are submitted, in the process of education, to patients with diabetes mellitus in his workplace.

[Skin complications of diabetes mellitus therapy]. / Kozní komplikace terapie diabetes mellitus.

Author summarizes potencial skin complications related to the therapy with insulin or peroral antidiabetics. These are mainly allergic reactions and lipodystrophic changes complicating or even precluding the therapy.

[A diabetic visceral neuropathy]. / Diabetická viscerální neuropatie.

The article concentrates on an issue of a diabetic autonomous neuropathy (DAN) in the gastrointestinal tract (GIT). It points out etiopathogenesis of diabetic polyneuropathy. It presents autonomous neuropathy in an overview where it also in more detail discusses this issue in the GIT. It highlights clinical picture and possible diagnostic and therapeutic ways of affecting individual parts of the gastrointestinal tract.

[The effect of walking exercise on aerobic capacity and serum lipids in type 2 diabetics]. / Vliv tréninku chuzí na aerobní kapacitu a krevní lipidy u diabetiku 2. typu.

Regular physical activity can have a favourable impact on other risk factors of ischaemic heart disease (IHD) and associated diabetes (DM), such as obesity, hypertension, dyslipidaemia, insulin resistance and others. This important part of treatment of diabetes is frequently difficult to implement because of the lack of willingness ("adherence") of type 2 diabetics to practice regular exercise, and unequivocal data are lacking on the intensity of exercise which will influence effectively these risk factors and be at the same time safe, readily available and psychologically acceptable. The objective of the work was to find out whether walking, i.e. locomotor activity with a low to medium intensity can effectively influence parameters of aerobic capacity and blood lipids. The authors submit the results of two groups of type 2 diabetics. The experimental group B (n = 10, age 57 +/- 7 years, BMI 31 +/- 3, duration of DM 8 +/- 5 years) participated in a 12-week training programme of walking; at the beginning and at the end of this period indicators of aerobic capacity at the level of the anaerobic threshold (VO2ANP) were evaluated as well as at the level of the symptom limited maximum (VO2SL, TepO2SL), and the blood lipid levels. In the control group A (n = 6, age 58 +/- 7 years, BMI 32 +/- 4) indicators of aerobic capacity and blood lipids were assessed after a 12-week period of the usual habitual physical activity. In group B the 12-week walking training led to significant improvement of parameters of aerobic capacity at the level of the anaerobic threshold (ANP), oxygen pulse at the level of the symptom limits maximum (SL) and a significant reduction of total and LDL cholesterol. In the control group no significant changes occurred in aerobic capacity nor blood lipid values. The training programme where walking was selected as physical activity with a low to medium intensity can be considered suitable for everyday life of motivated patients with type 2 diabetics, preferably in the form of a domestic training programme. The prerequisite of success is its regular and frequent evaluation by health professionals.

[Obesity and diabetes]. / Obezita a diabetes.

This paper discuses issues of obesity and type II diabetes mellitus. It tries to demonstrate a common cause of both these signs of metabolic syndrome. It notices the relationship of obesity and diabetes and summarises possibilities, successes, and goals in treatment of obesity in diabetics.

[Sexual problems in women with diabetes mellitus from the viewpoint of the diabetologist]. / Sexuální problémy u zen s diabetes mellitus z pohledu diabetologa.

Diabetes mellitus, as every chronic disease, leads to the development of a number of complications. The author pays attention to sexual aspects of this disease in women from the aspect of the diabetologist.

[The effect of antihypertensive therapy on insulin resistance]. / Vliv antihypertenzní terapie na inzulinovou rezistenci.

Insulin resistance is one of the main causes of diabetes mellitus type 2. This primary, genetically determined, by external environmental factors enhanced, reduced insulin effectiveness in target tissues (liver, muscle, adipose tissue) associated with compensatory hyperinsulinaemia is manifested by a prohypertensive effect. Secondary insulin resistance causes deterioration of diabetes compensation regardless of its type. It may have a number of causes and after their elimination it is fully reversible. Secondary insulin resistance can be influenced also by drugs. This fact must be born in mind when selecting antihypertensive treatment in diabetics.

[Indapamide in the treatment of hypertension in diabetes]. / Indapamid v lécbe hypertenze u diabetiku.

The authors treated 20 diabetics (14 men and 6 women) in an open clinical trial with indapamide (Arifon, Zorka Co.) for a period of three months, using a morning dose of 2.5 mg. In 10 patients with hypertension stage I in all normalization of the systolic pressure below 18.6 kPa and diastolic pressure below 12 kPa was achieved. Treatment of patients with hypertension stage II was not adequate in 6 patients. In the course of treatment metabolic compensation of diabetes (type 1 or type 2) did not deteriorate. No changes in the blood lipid spectrum and mineral metabolism were recorded. Indapamide is an antihypertensive drug suitable for treatment of mild hypertension in diabetics as monotherapy.