Jedním z největších objevů v diabetologii posledních desetiletí je možnost dosažení remise DM 2. typu. DM 2. typu bylo podobně jako ostatní typy diabetu dlouho považováno za chronické, progredující a nevyléčitelné onemocnění. Jako první prokázaly možnosti remise DM 2. typu metody bariatrické chirurgie. V posledních letech ale přibývají studie, které dokládají možnosti dosažení remise také pomocí dietních intervencí jako je nízkoenergetická, středomořská, ketogenní dieta nebo přerušované lačnění. Klíčovým mechanismem dosažení remise DM 2. typu je redukce hmotnosti. Článek se zabývá jednotlivými metodami dosažení remise DM 2. typu a v závěru shrnuje praktická doporučení pro jejich aplikaci v klinické praxi.
One of the biggest breakthroughs in diabetes of the last decades is the possibility of achieving remission of type 2 DM. Type 2 DM, like other types of diabetes, has long been considered a chronic, progressive, and incurable disease. Bariatric surgery was the first to demonstrate the possibility of remission of type 2 DM. In recent years, however, an increasing number of studies have demonstrated that remission can also be achieved with dietary interventions such as low-calorie, Mediterranean, ketogenic diets or intermittent fasting. Weight reduction is a key mechanism for achieving remission of type 2 DM. The article reviews the different methods of achieving remission of type 2 DM and concludes with practical recommendations for their application in clinical practice.
- Klíčová slova
- studie DIRECT, studie DIADEM-I, studie LOOK AHEAD,
- MeSH
- bariatrická chirurgie metody MeSH
- časové faktory MeSH
- diabetes mellitus 2. typu * diagnóza metabolismus patofyziologie MeSH
- dietoterapie klasifikace metody MeSH
- hmotnostní úbytek * MeSH
- indukce remise * metody MeSH
- inzulin terapeutické užití MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- Check Tag
- lidé MeSH
To determine the optimal week for labor induction in women with diet-controlled gestational diabetes mellitus by comparing differences in perinatal and neonatal outcomes of labor induction to expectant management at different gestational weeks. Methods: This was a retrospective analysis of a prospectively recruited cohort of 797 singleton pregnancies complicated by diet-controlled gestational diabetes mellitus that were diagnosed, treated, and delivered after 37 weeks in a tertiary, university-affiliated perinatal center between January 2016 and December 2021. Results: The incidence of neonatal complications was highest when delivery occurred at 37 weeks, whereas fetal macrosomia occurred mostly at 41 weeks (20.7%); the frequency of large for gestational age infants did not differ between the groups. Conversely, the best neonatal outcomes were observed at 40 weeks due to the lowest number of neonates requiring phototherapy for neonatal jaundice (1.7%) and the smallest proportion of neonates experiencing composite adverse neonatal outcomes defined as neonatal hypoglycemia, phototherapy, clavicle fracture, or umbilical artery pH < 7.15 (10.4%). Compared with expectant management, the risk for neonatal hypoglycemia was increased for induction at 39 weeks (adjusted odds ratio 12.29, 95% confidence interval 1.35-111.75, p = 0.026) and that for fetal macrosomia was decreased for induction at 40 weeks (adjusted odds ratio 0.11, 95% confidence interval 0.01-0.92, p = 0.041), after adjusting for maternal pre-pregnancy body mass index, nulliparity, and mean pregnancy A1c. Conclusions: The lowest rate of neonatal complications was observed at 40 weeks. Labor induction at 40 weeks prevented fetal macrosomia.
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Insulin-like growth factors (IGFs) are involved in regulating growth and metabolism and increase insulin sensitivity, improve glucose metabolism, and are potentially related to gestational diabetes mellitus (GDM) and its complications for mothers and fetuses. DESIGN: This study aimed to assess serum levels and cord blood levels of IGF system components in pregnant women with (39 participants) and without GDM (22 participants). Blood samples were obtained at 28-32 and 36-38 weeks of gestation and 6-12 months after delivery. Cord blood samples were obtained during delivery. Results between both groups as well as between single visits were statistically compared. RESULTS: Both IGF1 and IGF2 maternal serum levels did not differ between the GDM and non-GDM groups. However, levels of IGF-binding proteins (IGFBPs) were different. IGFBP4 levels were decreased during pregnancy and after delivery in women with GDM, while IGFBP7 levels were increased during pregnancy in women with GDM. Cord blood IGFBP3 and IGFBP7 levels were increased (p < 0.001 for IGFBP3, p = 0.003 for IGFBP7), while IGFBP4 levels were decreased (p < 0.001) in the GDM group compared with the non-GDM group. CONCLUSIONS: Although IGF levels did not differ, changes in their function level could still persist possibly because of the effects of the binding proteins, especially their promoting or inhibitory effects on IGFs. These results should be considered in interpretation of IGF levels.
- MeSH
- biologická dostupnost MeSH
- fetální krev metabolismus MeSH
- gestační diabetes * metabolismus MeSH
- inzulinová rezistence * MeSH
- lidé MeSH
- proteiny vázající insulinu podobné růstové faktory metabolismus MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- abstrakt z konference MeSH
Background: The MTNR1B gene encodes a receptor for melatonin, a hormone regulating biorhythms. Disruptions in biorhythms contribute to the development of type 2 diabetes mellitus (T2DM). Genetic studies suggest that variability in the MTNR1B gene affects T2DM development. Our aim was to compare the distribution of the genetic variant rs10830963 between persons differing in glucose tolerance in a sample of the Czech population (N=1206). We also evaluated possible associations of the polymorphism with insulin sensitivity, beta cell function, with the shape of glucose, insulin and C-peptide trajectories measured 7 times during a 3-hour oral glucose tolerance test (OGTT) and with glucagon response. In a subgroup of 268 volunteers we also evaluated sleep patterns and biorhythm. Results: 13 persons were diagnosed with T2DM, 119 had impaired fasting blood glucose (IFG) and/or impaired glucose tolerance (IGT). 1074 participants showed normal results and formed a control group. A higher frequency of minor allele G was found in the IFG/IGT group in comparison with controls. The GG constellation was present in 23% of diabetics, in 17% of IFG/IGT probands and in 11% of controls. Compared to CC and CG genotypes, GG homozygotes showed higher stimulated glycemia levels during the OGTT. Homozygous as well as heterozygous carriers of the G allele showed lower very early phase of insulin and C-peptide secretion with unchanged insulin sensitivity. These differences remained significant after excluding diabetics and the IFG/IGT group from the analysis. No associations of the genotype with the shape of OGTT-based trajectories, with glucagon or with chronobiological patterns were observed. However, the shape of the trajectories differed significantly between men and women. Conclusion: In a representative sample of the Czech population, the G allele of the rs10830963 polymorphism is associated with impaired early phase of beta cell function, and this is evident even in healthy individuals.
- MeSH
- C-peptid MeSH
- diabetes mellitus 2. typu * epidemiologie genetika MeSH
- glukagon MeSH
- glukosa MeSH
- inzulin MeSH
- inzulinová rezistence * genetika MeSH
- kinetika MeSH
- krevní glukóza MeSH
- lidé MeSH
- porucha glukózové tolerance * epidemiologie genetika MeSH
- prediabetes * MeSH
- receptor melatoninový MT2 * genetika MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Výskyt prediabetu a DM 2. typu celosvětově stoupá. Řadu let může probíhat skrytě a často bývá zjištěn až při vzniku komplikací (ICHS, CMP, postižení zraku, ledvin, končetin s hrozícími amputacemi). Včasný záchyt onemocnění již ve stadiu prediabetu je zásadní pro včasné zahájení prevence, léčby a oddálení výskytu komplikací. Gestační diabetes mellitus (dále GDM) je významný rizikový faktor rozvoje prediabetu, DM 2. typu, kardiovaskulárních onemocnění a obezity. Ženy s anamnézou GDM mají 40–60% riziko rozvoje prediabetu a DM 2. typu. Jejich preventivním sledováním po porodu lze včas odhalit ženy se vznikající poruchou metabolismu glukózy a zahájit u nich léčbu. Rizikové jsou především ženy s genetickou predispozicí, starší ženy, obézní, PCOS, s vyšším váhovým přírůstkem během těhotenství, pro GDM léčené farmakoterapií. Spolu se stoupajícím výskytem GDM stoupá i výskyt poruchy glukózové tolerance po porodu, což je dáváno do souvislosti s vyšším BMI a věkem těhotných žen. Včasné zahájení léčby, jejíž součástí je dietní opatření, pravidelná fyzická aktivita, redukce hmotnosti a případně léčba metforminem, může zabránit rozvoji DM 2. typu s jeho komplikacemi nebo jej oddálit.
The incidence of prediabetes and type 2 diabetes is increasing worldwide. The course can be asymptomatic for several years and it is often diagnosed once the complications arise (e.g., coronary heart disease, stroke, sight, kidneys, or limbs impairment with impending amputations). Early detection of the disease at the stage of prediabetes is essential for timely prevention, treatment, and delaying complications. Gestational diabetes is a significant risk factor for prediabetes, type 2 diabetes, cardiovascular disease and obesity. Women with a history of gestational diabetes have a 40-60 % risk of developing prediabetes and type 2 diabetes. Postpartum surveillance leads to early detection and treatment of developing glucose metabolism disorders. Increased risk is particularly associated with a genetic predisposition, higher maternal age, obesity, PCOS, higher weight gain during pregnancy, and gestational diabetes treated with pharmacotherapy. In response to the increasing incidence of gestational diabetes, postpartum glucose metabolism disorders also increase. Early initiation of treatment, including dietary measures, regular physical activity, weight reduction, and possibly treatment with metformin, may prevent the onset of type 2 diabetes mellitus and associated complications.
- Klíčová slova
- hybridní uzavřená smyčka,
- MeSH
- diabetes mellitus 1. typu * diagnóza farmakoterapie MeSH
- dospělí MeSH
- inzulin aplikace a dávkování MeSH
- inzulinové infuzní systémy * MeSH
- krevní glukóza účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- selfmonitoring glykemie * metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Gestational diabetes mellitus (GDM) is a complication in pregnancy, but studies focused on the steroidome in patients with GDM are not available in the public domain. This article evaluates the steroidome in GDM+ and GDM- women and its changes from 24 weeks (± of gestation) to labor. The study included GDM+ (n = 44) and GDM- women (n = 33), in weeks 24-28, 30-36 of gestation and at labor and mixed umbilical blood after delivery. Steroidomic data (101 steroids quantified by GC-MS/MS) support the concept that the increasing diabetogenic effects with the approaching term are associated with mounting progesterone levels. The GDM+ group showed lower levels of testosterone (due to reduced AKR1C3 activity), estradiol (due to a shift from the HSD17B1 towards HSD17B2 activity), 7-oxygenated androgens (competing with cortisone for HSD11B1 and shifting the balance from diabetogenic cortisol towards the inactive cortisone), reduced activities of SRD5As, and CYP17A1 in the hydroxylase but higher CYP17A1 activity in the lyase step. With the approaching term, the authors found rising activities of CYP3A7, AKR1C1, CYP17A1 in its hydroxylase step, but a decline in its lyase step, rising conjugation of neuroinhibitory and pregnancy-stabilizing steroids and weakening AKR1D1 activity.
- MeSH
- 20-hydroxysteroid dehydrogenasy metabolismus MeSH
- chromatografie plynová MeSH
- cytochrom P-450 CYP3A metabolismus MeSH
- druhý trimestr těhotenství metabolismus MeSH
- gestační diabetes metabolismus MeSH
- lidé MeSH
- metabolomika metody MeSH
- oxidoreduktasy metabolismus MeSH
- steroid-17-alfa-hydroxylasa metabolismus MeSH
- steroidy analýza MeSH
- tandemová hmotnostní spektrometrie MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
