[Changes in weight and diabetes compensation (HbA(1c)) in patients with diabetes mellitus type 2 after adding exenatide (Byetta) to the current treatment in 28 diabetology departments in the Czech Republic - BIBY-I study (observations lasting 3 to 12 months)]. / Zmeny hmotnosti a kompenzace diabetu (HbA(1c)) u nemocných s diabetes mellitus 2. tpu po pridání exenatidu (Byetta) ke stávající lécbe ve 28 diabetologických ambulancích v CR--studie BIBY-I (sledováni 3-12 mesícu).

UNLABELLED: BIBY STUDY OBJECTIVE: To obtain experience with exenatide treatment (Byetta) in patients with diabetes mellitus type 2 in a common clinical practice ofdiabetology departments. TYPE OF OBSERVATION: Observational study conducted by a randomly selected group of outpatient medical practitioners from 28 diabetology departments in the Czech Republic. OBSERVED AND ASSESSED POPULATION: 465 patients underwent at least three months of Byetta treatment; 347 persons (74.6% ofthe research population) stayed forthe extended observation of 6-12 months. Apart from the basic identification data (year of birth, sex, age when diabetes mellitus manifested, height, maximum patient weight before diabetes and when diabetes mellitus manifested), the following information was recorded in three-month intervals: weight, waistline, glycated haemoglobin (HbA(1c)), and diabetes mellitus treatment The population included 50.3% women and 49.7% men, and the average age at the time of diabetes manifestation was 48 (20-73 years). The period between the diabetes manifestation and the start of exenatide treatment was 8.3 years on average. RESULTS: The average maximum BMI value before the detection of diabetes was 39.05 (+/- 6.73); at the time of the diabetes manifestation 37.88 (+/- 6.40); and at the start of Byetta treatment 39.01 (+/- 6.22). The BMI after three, six, and 12 months of treatment was as follows: 37.86 (+/- 6.12), 37.18 (+/- 6.0), and 36.60 (+/- 6.21); it decreased by > or = 0.5 in 83.3% patients who were under observation for 12 months. HbA(1c) value decreased in the first three months from 7.39% (+/- 1.57) to 6.41% (+/- 1.34), p < 0.0001. In the period of three-six months, the value decreased to 6.22% (+/- 1.34), and after 12 months, HbA(1c) was at 6.04 (+/- 1.20). An improvement in HbA(1c) value of 0.5-2.0% occurred after the first year in 49% of our research population. The waistline was measured on a regular basis in only 267 patients (58.9%). The average initial value of 120.7 cm was reduced within three months of the treatment to 118.3 cm, and within six and 12 months to 117.3 and 112.6 cm respectively. CONCLUSION: Adding Byetta to the currently applied treatment of obese patients with diabetes mellitus type 2 led, in 66.8% of the population, to a statistically significant reduction in HbA(1c) levels in the first three-six months of the treatment; after 12 months of treatment, 25% of the population was still showing an improvement in HbA(1c) of > 2.0%. Of observed patients, 74.4% significantly reduced their BMI (by > 0.5) during the first three months; 39.6% of patients reduced their BMI in the period of three-six months.

[Changes in weight and diabetes compensation (HbA1c) in patients with diabetes mellitus type 2 after adding exenatide (Byetta) to the current treatment in 28 diabetology departments in the Czech Republic -  BIBYII study (observations lasting 24 months)]. / Zmeny hmotnosti a kompenzace diabetu (HbA1c) u nemocných s diabetes mellitus 2. typu po pridání exenatidu (Byetta) ke stávající lécbe ve 28 diabetologických ambulancích v CR -  studie BIBYII (sledování 24 mesícu).

UNLABELLED: BIBYII STUDY OBJECTIVE: To obtain experience with longterm (24 months) exenatide treatment (Byetta) in patients with diabetes mellitus type 2 from a common clinical practice of diabetology departments in the Czech Republic. TYPE OF OBSERVATION: Observational study conducted by a randomly selected group of outpatient medical practitioners from 28 diabetology departments in the Czech Republic. OBSERVED AND ASSESSED POPULATION: From the original population of 465 patients, who underwent a minimum of three months Byetta treatment, 169 patients (36.6%) remained during the second prolonged observation after 18 months, and 76 patients completed 24 months of uninterrupted Byetta treatment. The following basic information about the patients was collected: year of birth, sex, age when diabetes mellitus (DM) manifested, height, maximum weight before diabetes and when DM manifested. The study recorded the following values in three- month intervals: weight, waistline, glycated haemoglobin (HbA1c), and DM treatment. The population of the prolonged observation comprised 50.3% women and 49.7 % men, and the average age at the time of DM2 manifestation was 48.0 (20- 73 years). RESULTS: At the beginning of Byetta treatment, the average maximum BMI in the subpopulation observed for 24 months was 38.44; after 3, 6, 9, 12 and 24 months the following levels were measured, respectively: 36.79, 36.22, 35.91, 35.57 and 35.58. The original HbA1c level of 7.44% at the beginning of Byetta treatment decreased after 3, 6, 9, 12 and 24 months to 6.33, 5.98, 5.83, 5.86 and 5.93%. CONCLUSION: Adding Byetta to the currently applied treatment of obese patients with diabetes mellitus type 2 over a period of 24 months has led to an improvement in HbA1c level by 1.51%, and BMI level was reduced by 2.37 after two years of Byetta treatment.

[Exenatid and its position as antidiabetic drug in the treatment of type 2 diabetes mellitus]. / Exenatid a jeho místo v lécbe diabetes mellitus 2. typu.

'Incretin effect' refers to increased insulin response to oral glucose as compared to i.v. glucose response. Incretin mimetics are a new class of antidiabetic drugs lowering hyperglycaemia. Incretin mimetics mimic the natural human hormones called 'incretins' with blood glucose regulating action. Exenatide is a synthetic analogue GLP-1 which is resistant to enzymatic degradation by DPP IV. Subcutaneously administered exenatide stimulates insulin secretion, suppresses glucagon secretion, slows down stomach evacuation and reduces the weight. Its administration is safe and the most frequent side effect is mild nausea.

The efficacy of self-monitoring of blood glucose in the management of patients with type 2 diabetes treated with a gliclazide modified release-based regimen. A multicentre, randomized, parallel-group, 6-month evaluation (DINAMIC 1 study).

AIM: To determine if therapeutic management programmes for type 2 diabetes that include self-monitoring of blood glucose (SMBG) result in greater reductions in glycated haemoglobin (HbA1c) compared with programmes without SMBG in non-insulin requiring patients. METHODS: Multicentre, randomized, parallel-group trial. A total of 610 patients were randomized to SMBG or non-SMBG groups. Patients in both groups received the same oral antidiabetic therapy using a gliclazide modified release (MR)-based regimen for 27 weeks. The primary efficacy end-point was the difference between groups in HbA1c at the end of observation. RESULTS: A total of 610 patients were randomized: 311 to the SMBG group and 299 to the non-SMBG group. HbA1c decreased from 8.12 to 6.95% in the SMBG group and from 8.12 to 7.20% in the non-SMBG group; between-group difference was 0.25% (95% CI: 0.06, 1.03; p = 0.0097). Symptoms suggestive of mild to moderate hypoglycaemia was the most commonly reported adverse event, reported by 27 (8.7%) and 21 (7.0%) patients in the SMBG and non-SMBG groups, respectively; the incidence of symptomatic hypoglycaemia was lower in the SMBG group. CONCLUSION: In patients with type 2 diabetes, the application of SMBG as an adjunct to oral antidiabetic agent therapy results in further reductions in HbA1c.

[Incretin strategy in the treatment of type 2 diabetes mellitus--the DPP-IV inhibitor sitagliptin]. / Inkretinová strategie lécby diabetes mellitus 2. typu--inhibitor DPP-IV sitagliptin.

Sitagliptin, distributed under the brand name of Januvia, has been the first and so far the only dipeptidyl peptidase IV (DPP-IV) inhibitor introduced in clinical practice. The results of published clinical studies clearly demonstrate its effectiveness and safety as an oral antidiabetic. Apart from increasing the insulin level, Sitagliptin reduces the level ofglucagon. The principal advantages of Sitagliptin from the clinical point of view are: a) the ability to reduce both fasting and non-fasting glycaemia and improve the HbA(1c) values, b) the fact that it does not provoke weight increase, c) the fact that the risk of hypoglycaemia is significantly lower as compared with sulfonylurea derivatives, d) good tolerability.

[Incretin strategy in the treatment of type 2 diabetes mellitus--DPPIV]. / Inkretinová strategie lécby diabetes mellitus 2. typu--DPP-IV.

Administration ofGLP-1 analogue resistant to DPPIV or therapeutic inhibition ofthe enzymes, allowing for an increase in the levels of GLP-1, are the very new approaches to the treatment of type 2 diabetes mellitus. Incretin therapy has an immense potential of improving unsatisfactory compensation in diabetic patients thus reducing the risk of manifestation of all arterial complications. Low fasting circulating levels of GLP-1 (and also GIP) grow rapidly after eating and are subsequently degraded to inactive forms by dipeptidyl peptidases IV (DPPIV). DPPIV are enzymes widely present in the body which proteolytically degrade GLP-1 and GIP (as well as other active substances). The preventing of their inactivation effect by administering DPPIV inhibitors allows for increasing the GLP-1 levels, which are reduced in type 2 diabetic patients, and subsequently improves glucose homeostasis in such patients. DPPIV inhibitors represent the principal new class of PAD, and their metabolic profile offers a number of unique clinical advantages for the treatment of patients with type 2 diabetes mellitus.

[Gastrointestinal complications in diabetes mellitus]. / Gastrointestinální komplikace pri diabetes mellitus.

Impaired function of the gastrointestinal tract related to diabetes mellitus (DM) results from diabetic autonomous neuropathy, impaired sensory innervation and a direct effect of chronic hyperglycaemia. Another possible connection between DM and the gastrointestinal tract can be infrequent autoimmune diseases associated with type I DM (celiac disease, autoimmune gastropathy, autoimmune chronic pancreatitis). Functional or organic changes resulting from diabetes can be seen in every organ of the gastrointestinal tract. Some of the diabetic gastrointestinal tract difficulties affect almost 60% of patients with long lasting diabetes. On one side, impaired function of individual organs in diabetics can significantly influence level of diabetes compensation and vice versa. On the other side, unsatisfactory diabetes compensation can result in manifestation of digestive problems. The most frequent and the most serious clinical complication is diabetic gastroparesis (DG). The highest incidence of impaired evacuation and motility of the stomach (and the small intestine) is described in diabetics with long lasting unsatisfactory diabetes compensation, microangiopathic complications, and diabetic neuropathy (55-75% in type I diabetes and 15-20% in type II diabetes). Symptoms accompanying impaired motility and emptying of the stomach (feeling of early fullness, eructation, nausea, vomiting and abdominal pains) can be only temporary or can be missing in some patients. Hyperglycaemia accompanied by slowing down evacuation of the stomach is different in patients with an empty stomach--glycaemia over 7.8 mmol/l, and postprandially--antral motility decreases after blood glucose levels get over 9.7 mmol/l. Treatment options for symptomatic diabetic gastroparesis are limited. Achieving normoglycaemia usually improves diabetic gastroparesis but in up to 80% of cases simultaneous administration of prokinetics is necessary.

[Diabetes mellitus in chronic pancreatitis]. / Diabetes mellitus pri chronické pankreatitide.

Diabetes mellitus (DM) in chronic pancreatitis (ChP) is considered a unique clinical and metabolic unit. Compared to type I DM it has many different properties: glycemic lability, more frequent hypoglycaemic episodes, and minimum incidence of ketoacidosis. The need of insulin administration to achieve satisfying diabetes mellitus compensation is significantly lower and response of peripheral tissues to endogenous and exogenous insulin significantly higher compared to type I diabetics. These clinical differences result from decreased but always preserved insulin secretion, decreased glucagon production, impaired external pancreatic secretion, and also excessive alcohol use or insufficient or irregular food intake of the patients. Secondary DM in ChP is accompanied by chronic, microangiopathic and neuropathic complications analogous to other DM types. Nonpharmacological treatment measurements of the first choice are elimination of alcohol, sufficient and adequate nutrition, and simultaneous treatment of impaired exocrinal secretion. A pharmacology treatment is insulin therapy! It is a substitution treatment for insulin deficiency. Insulin doses must be chosen very carefully because of the risk of hypoglycaemia. The most frequent cause of secondary diabetes mellitus in patients with pancreatic diseases in Europe is chronic alcoholic pancreatitis and in tropical countries and India non-alcoholic tropical calcific pancreatitis (TCP).

Anti-GAD-positive patients with type 1 diabetes mellitus have higher prevalence of autoimmune thyroiditis than anti-GAD-negative patients with type 1 and type 2 diabetes mellitus.

The aim of our study was to evaluate antibodies against thyroglobulin (anti-TG) and thyroid peroxidase (anti-TPO) - markers of autoimmune thyroiditis - in several groups of adult patients with type 1 and type 2 diabetes mellitus (DM). We were particularly interested whether the presence of thyroid antibodies is related to the positivity of glutamic acid decarboxylase antibodies (anti-GAD). We found elevated anti-GAD in 46 % (97/210) patients with type 1 DM. All patients with type 2 diabetes were anti-GAD-negative. At least one thyroid antibody (anti-TG and/or anti-TPO) was found in 30 % (62/210) patients with type 1 DM and 27 % (22/83) type 2 diabetes patients. The patients with type 1 DM were further grouped according to their anti-GAD status. The anti-GAD-positive patients had a higher prevalence of anti-TG antibodies than the anti-GAD-negative patients (25 % vs. 12 %, p=0.03) as well as anti-TPO antibodies (32 % vs. 12 %, p<0.001). At least one thyroid antibody was detected in 39 % (38/97) of anti-GAD-positive but only in 21 % (24/113) of anti-GAD-negative patients with type 1 DM (p=0.006). No significant difference in the frequency of thyroid antibodies was found between anti-GAD-negative patients with type 1 and type 2 DM (21 % vs. 27 %, p=0.4). The groups with or without thyroid antibodies in both type 1 and type 2 diabetic patients did not differ in actual age, the age at diabetes onset, duration of diabetes, body mass index or HbA1c level. Patients with elevated thyroid antibodies had significantly higher levels of TSH than those without thyroid antibodies (1.86 vs. 3.22 mIU/l, p=0.04 in type 1 DM; 2.06 vs. 4.89 mIU/l, p=0.003 in type 2 DM). We conclude that there is a higher frequency of thyroid-specific antibodies in anti-GAD-positive adult patients with type 1 DM than in anti-GAD-negative patients or in patients with type 2 DM. Patients with or without thyroid antibodies do not differ in age, DM onset and duration, BMI or HbA1c. Thyroid antibodies-positive patients have higher levels of thyroid stimulating hormone (TSH).

[Rosiglitazon in treatment of Type II diabetes mellitus--experience of diabetologists in the Czech Republic. Part I: compensation of diabetes, sugar metabolism]. / Rosiglitazon v lécbe diabetes mellitus 2. typu--zkusenosti diabetologu v Ceské republice. 1. cást: kompenzace diabetu, glukózový metabolismus.

UNLABELLED: Thiazolidindione derivates (glitazones) make a very promising group of peroral antidiabetic drugs. They are represented by rosiglitazon which is available on our market to type II diabetics. As far as sugar metabolism is concerned, rosiglitazon can reduce glycaemia and insulin level both when fasting and postprandially. GOAL: The goal of the authors' work was to gain their own experience with rosiglitazon treatment in type II diabetics in the Czech Republic. SAMPLE: The monitored sample consisted of 388 patients with insufficiently compensated type II diabetes when treated by sulphonylurea compounds or metformine. METHODS: 95 diabetologists from diabetology medical offices started a 6-month-long treatment with rosiglitazon (Avandia) dose of 4 mg a day as stated in European recommendations. In order to assess changes in sugar metabolism (compensation of diabetes) glycaemia and C peptide were monitored when fasting and postpradially and HbA1c was monitored in 2-month-long intervals. RESULTS: Weight, waist-hip ratio (WHR) and C-peptide levels remained unchanged. Statistically significant (p < 0.0001) was a HbA1c decrease over 6 month from 9.61% to 8.48%. Fasting glycaemia decreased by 2.49 and postprandial glycaemia by 2.71 mmol/l. No significant side effects were identified. CONCLUSION: Rosiglitazon administration combined with administration of sulphonylurea compounds or metformine significantly improved compensation of diabetes compared to initial therapy.

[Postprandial hyperglycemia]. / Postprandiální hyperglykémie.

Chronic hyperglycaemia, confirmed with HbA1c levels, is a leading cause of diabetic complications. Recent studies point to a significant effect of postprandial glycaemia which results from an impaired ability of early secretion of insulin in type II diabetes. Postprandial hyperglycaemia is a frequent phenomenon in people with diabetes with satisfactory control of diabetes based on checks of HbA1c levels. Many authors demonstrate statistically more significant correlations between postprandial hyperglycaemia and HbA1c levels, compared to correlation of fasting glycaemia. Monitoring of postprandial glycaemia is a significant means for improving co-operation with a patient and provides a physician with a possibility of choice between an appropriate type of peroral antidiabetic or insulin.

[C-peptide as the decisive factor for classification of type 1 diabetes mellitus and type 2 diabetes mellitus]. / C-peptid jako rozhodující faktor pro klasifikaci diabetu mellitu 1. typu a diabetu mellitu 2. typu.

OBJECTIVE: The main objective was to seek, based on defined groups of diabetics, C-peptide levels on fasting and after stimulation which would help to differentiate diabetes mellitus type 1 from diabetes mellitus type 2 in patients with manifestation of diabetes in adult age. GROUPS: Group A comprised 65 non-obese diabetics type 2 with failure of PAD treatment. Group B included 304 newly manifested diabetics type 1 and 2 aged 31-65 years. Group C was formed by 424 patients with diabetes mellitus type 1 and type 2 with different duration of diabetes. RESULTS: Group A: mean C-peptide levels on fasting 0.32 and after stimulation with a standard breakfast 0.59 pmol/ml suggest absolute insulin deficiency in type 2 diabetics with failure of PAD treatment. Group B: 29.2% diabetics type 1 had already during manifestation of diabetes C-peptide levels on fasting < 0.43 pmol/ml and 47.9% C-peptide of < 0.6 after a meal. There were 1.9 and 4.9% subjects among type 2 diabetics with such low C-peptide levels. After a six-year follow up the mean C-peptide levels on fasting declined in type 1 diabetics from 0.49 to 0.16 pmol/ml and in patients originally with type 2 diabetes reclassified to type 1 the levels dropped from 0.56 to 0.26 pmol/ml. Group C served as the basic group for statistically (linear regression method) detected discrimination values of C-peptide differentiating diabetes mellitus type 1 and diabetes mellitus type 2--the liminal value being 0.59 pmol/ml on fasting and 1.0 pmol/ml after a meal. CONCLUSION: In clinical practice it is not possible to assess reliably slowly manifesting diabetes type 1 (LADA by age, BMI and compensation of diabetes. Positivity of antiGAD antibodies does not rule out diabetes mellitus type 1. In unequivocal cases the decisive factor is therefore the C-peptide level on fasting and after a meal.

[Diabetes mellitus associated with chronic pancreatitis]. / Diabetes mellitus pri onemocnení chronickou pankreatitidou.

Diabetes mellitus (DM) as part of chronic pancreatitis (ChP) belongs into the group of secondary DM with typical insulin deficiency. The prevalence and incidence of DM in ChP depends on the selected diagnostic criteria, geographical conditions and duration and grade of pancreatitis. Based on our findings during a 15-year investigation of impaired glucose tolerance and insulin secretion in patients with ChP the authors submit some partial (published and unpublished) results. The largest investigated group were 122 patients with ChP diagnosed according to the morphological appearance during ERCP. The authors detected a mutual close relationship between the extent of morphological damage of the efferent system of the pancreas on one hand and impaired glucose metabolism and endogenous insulin secretion on the other hand. It was revealed that values of C-peptide are in patients with ChP and normal glucose tolerance significantly lower as compared with the healthy population, and in patients with ChP and DM they are significantly lower as compared with non-obese type 2 diabetics. With the persistence of ChP the C-peptide levels decline gradually and the incidence of diabetes increases but even when DM persists in ChP C-peptide does not reach zero values as in type 1 DM. For detection of diabetes in ChP assessment of the fasting blood sugar level does not suffice and an oral glucose tolerance test must be made.

[Women and diabetes]. / Zena a diabetes mellitus.

The objective of the work was to assess, based on the results of studies conducted abroad and the author's own results from the Prague register of diabetic patients, whether there exist differences in the epidemiology, clinical course of diabetes mellitus (DM) and its complications between female and male diabetics. As far as type 1 DM is concerned there are significant differences in the clinical course of diabetes, i.e. deteriorated compensation of DM in girls and women in conjunction with menstruation and the menopause. As compared with men, young women have a higher mortality on account of diabetic nephropathy, and at any age they have as higher incidence of hypertension. In DM2 they have also a high incidence of hypertension and risk of compensation of DM during menstruation and later during the menopause. A significantly less frequent complication in women is ischaemia of the lower extremities. From the epidemiological aspect a higher prevalence of DM2 was proved in women after the age of 65 years.

[Detection programme for diabetes mellitus type 2 in the Czech Republic--initial results]. / Detekcní program diabetes mellitus 2. typu v Ceské republice--první výsledky.

Detection programmes and screening activities with the objective to reveal risk groups with asymptomatic diabetes mellitus or impaired glucose tolerance are an important tool for reducing the morbidity and mortality of type 2 diabetics from cardiovascular diseases. The detection programme in the Czech Republic was focused on the risk group of the population above 45 years of age. During the screening in which 120 general practitioners and 20 diabetolgists participated a total of 30672 subjects were examined and the results were evaluated statistically in 26577 subjects (86.52%). Diabetes mellitus was detected in 2.43% of the examined subjects and impaired glucose tolerance in 1.28 % of the investigated group. The most frequently present risk factor in newly detected diabetics was hypertension and obesity. As compared with non-diabetics, whose ratio in the group above 60 years was 47.9%, 56.7% were newly detected diabetics in this age group.

[Prevalence of dyslipidaemia, hypertension and vascular complications in newly diagnosed diabetics (prospective study: part 2)]. / Prevalence dyslipidémie, hypertenze a cévních komplikací u nove manifestovaných diabetiku (prospektivní sledování: 2. cást).

UNLABELLED: In a 10-year prospective study of a group of 314 newly manifested diabetics (1988-1991) aged 20-65 years the authors follow up the development of diabetic complications and therapeutic methods used in diabetes. 85 patients were classified on detection of diabetes as diabetes mellitus (DM) type 1, 228 as DM type 2. At the age under 30 years there were 10 subjects (group M), the remainder (304) formed group A. In this second part of the initial results the authors provide information on biochemical changes, prevalence of hypertension and vascular complications already during manifestation of DM. Hypercholesterolaemia was detected in 29% of the group,triacylglycerylaemia was recorded in 31%. The mean cholesterol levels were in the subgroup of patients above 50 years of age significantly higher in women (6.51 mmol/l) as compared with men of similar age (5.66 mmol/l), while mean triacylglycerol levels did not differ in men and women above 50 years of age. Pathologically elevated levels of microalbuminuria were recorded in 13.7%. Hypertension was found in 42.7% diabetics type 2 in group A. 8.4% of this group were examined for ischaemic heart disease. 4.8% of the patients had an acute myocardial infarction in the case-history and 1.3% a cerebrovascular attack. Ophthalmological examination revealed in 8 type 2 diabetics (3.5%) diabetic retinopathy. CONCLUSION: In the investigated group of newly manifested diabetics aged under 65 years the authors detected a high prevalence of hypertension, hyperlipoproteinaemia and macroangiopathic complications, in particular in obese type 2 diabetics.

[Plasma leptin levels in patients with kidney diseases of various etiologies]. / Plazmatické hladiny leptinu u pacientu s ledvinovým onemocnením ruzné etiologie.

BACKGROUND: Leptin is a new hormone influencing food intake, energy expenditure and body weight. This protein is produced by adipocytes, exerts its effects on brain, endocrine pancreas and other organs by activating transmembrane receptors and is cleared from plasma mainly by the kidneys. The aim of our study was to compare plasma concentrations of leptin in our nephrological out-patients and controls. METHODS AND RESULTS: We examined 36 diabetic patients with various stages of nephropathy, 12 males with nephrotic syndrome due to membranous nephropathy, 15 dialysis patients and 11 controls. Leptin was assessed in plasma by ELISA. There was a significant difference between plasma levels of leptin in males and females (7.7 +/- 11.4 vs 17.6 +/- 17.3, p < 0.001) and in dialysis and non-dialysis patients (19.6 +/- 16.5 vs 10.7 +/- 14.5, p < 0.05). There was also a difference between dialysed and non-dialysed men (15.1 +/- 16.2 vs 5.9 +/- 9.2, p < 0.05). We found no difference between men with and without nephrotic syndrome and between BMI or age. There was a positive correlation of leptin with diabetic and non-diabetic women. There was positive correlation of P-leptin with serum creatinine in non-dialysed women (r = 0.68, p < 0.001) and a negative correlation with S-albumin in nephrotic men (r = -0.65, p < 0.05). CONCLUSIONS: Women have higher plasma leptin concentrations than men and dialysis patients have higher concentrations than non-dialysed patients. Apart from the positive correlation with S-creatinine in non-dialysed women. There was positive correlation with S-albumin in nephrotic men there were no correlations with renal function, BMI, age, S-cholesterol, S-triglycerides and S-albumin.

[Relation between plasma levels of IGF-I, leptin and TNF-alpha in diabetics]. / Vztah plazmatických hladin IGF-I, leptinu a TNF-alfa u diabetiku.

BACKGROUND: TNF-alpha, IGF-I and leptin are agents which influence insulin resistance, they play probably a part in the pathogenesis of diabetic nephropathy and influence mutually their production. The objective of the submitted investigation was to assess whether there exist relations between their concentrations in the plasma of diabetic patients. METHODS AND RESULTS: The authors examined 37 patients aged 18-67 years from a diabetic clinic, 10 with normal albuminuria and normal renal function, 12 with microalbuminuria and 15 with macroalbuminuria and/or reduced renal function. TNF alpha, IGF-I and leptin were assessed in plasma, using commercial kits, by the ELISA method. IgF-I in plasma correlated inversely with glycated haemoglobin (r = -0.20, p < 0.05). In women a correlation was found between IGF-I and TNF-alpha concentrations (r = 0.65, p < 0.01). No other mutual correlations were found between concentrations of the investigated substances and between cytokine concentrations and serum creatinine, glycated haemoglobin, the blood glucose level and body mass index. CONCLUSIONS: IGF-I plasma levels correlate inversely with glycated haemoglobin and in women with the TNF-alpha level. No other correlations were found between IGF-I. TNF-alpha and leptin plasma levels. The levels do not correlate with age, renal function and compensation of diabetes.

[The level of diabetic compensation and endogenous secretion of insulin in newly diagnosed diabetics. Prospective study: Part 1]. / Uroven kompenzace cukrovky a endogenní sekrece inzulinu u nove zachycených diabetiku. Prospektivní sledování: 1. cást.

In a prospective study of newly detected diabetic patients in 1989-1991 the authors focused their attention on the evaluation of blood sugar levels and HbA1c during manifestation of DM and the amount of insulin secretion in relation to diabetes type 1 and 2 in adult patients. Part 1 of the paper reveals great differences in the fasting blood sugar level during manifestation of DM (26% of the group had a blood sugar level lower than 8.5 mmol/l and 14% above 15 mmol/l) even after 1-4 months treatment (3.8-17.2 mmol/l). Similar differences were found in HbA1c values (4.5-12.9%). High C-peptide levels revealed an incorrectly assessed diagnosis of type 1 diabetes in 16.7% diabetics and low C-peptide values on fasting and postporandial values were at variance with the diagnosis of type 2 diabetes in 6% of the group.

[Type 1 diabetes mellitus in the aged]. / Diabetes mellitus I. typu ve vyssím veku.

Diabetes mellitus type I was till recently considered a disease affecting children and young adults. Research in the past several years provided evidence that this type of diabetes is found in all age groups and that the majority develops after the age of 35 years. Diagnostic possibilities of type I diabetes were markedly extended due to the introduction of radioimmunoassay of antibodies against glutamate decarboxylase. This examination has a 82% sensitivity and 100% specificity in diabetes. Diabetes mellitus in advanced age is manifested much less dramatically than in child age. It is found in non-obese subjects and usually its clinical manifestation is gradual. At first the patients are as a rule treated by diet. After several months usually sulphonylurea derivatives are started and only later insulin. If the diagnosis of diabetes mellitus type I is beyond doubt due to autoimmune disease, assessed preferably by antiGAD antibodies, immediate substitution therúpy with insulin is fully indicated. The latter can protect the residual function of B cells of the islets of Langerhans of the pancreas and contribute thus to the prevention of microvascular complications of diabetes mellitus.