The introduction of glucose sensors has been a major shift in glycemic self-monitoring. The aim of the study was to analyze the medical effect of Flash Glucose Monitoring (FGM) in type 1 diabetes patients at our clinic, in the context of the introduction of full reimbursement of FGM technology from public health insurance. We studied 64 women and 51 men (median age 42 years). All patients were treated with an intensified insulin regimen. No previous experience with any glucose sensors was reported by 61 patients (43%). Data on diabetes control prior to the introduction of the full FGM reimbursement (2019) and 12 months later (2020) were compared. Additionally, cost-effectiveness analysis was done. Diabetes control improved significantly (p = 0.001 for HbA1c interannual decrease). Results were influenced mainly by the number of applied sensors; surprisingly only 30 patients (29.6%) used all covered sensors. If we consider, for example, a decrease of the risk of the progression of diabetic kidney disease to the end stage of chronic renal failure by 1/3 (due to diabetes control improvement which is achieved by using glucose sensors), there will also be an economic benefit as the cost-effectiveness ratio was calculated for this model situation 6 and the net cost of USD 7,281. The financial barrier is clearly not the only barrier to the widespread use of modern technologies. The results of the study led to the implementation of long-term nudge strategies targeted at both patients and health professionals in our center to improve patients' prognosis.

• MeSH
• analýza nákladové efektivity MeSH
• analýza nákladů a výnosů MeSH
• diabetes mellitus 1. typu prevence a kontrola   MeSH
• kontinuální monitorování glukózy MeSH
• lidé MeSH
• retrospektivní studie MeSH
• selfmonitoring glykemie * metody   MeSH
• úhrada zdravotního pojištění MeSH
• zdravotní pojištění ekonomika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

OBJECTIVE: Crohn's disease (CD) can be associated with a wide range of extraintestinal manifestations (EIMs), including neurological ones. Published studies differ in their conclusions about the epidemiology and etiopathogenesis of neurological EIMs. The aims of this study were to demonstrate the presence and find risk factors of peripheral (somatic and autonomic) neuropathy patients with severe CD on anti-TNFα biological therapy. MATERIAL AND METHODS: A clinical examination focusing on detection of peripheral sensor-motor nervous dysfunction (including Sudoscan) and examination of autonomic nervous system dysfunction (using Ewing ́s battery tests and spectral analysis) together with laboratory tests and collection of demographic data followed by administration of questionnaires were performed on a total of 30 neurologically asymptomatic outpatients with severe CD on anti-TNFα biological therapy. RESULTS: Peripheral sensor-motor nervous function via clinical neurological examination was pathological in 36.7% and Sudoscan in 33.3% of cases. Statistically significant associations between vibration perception test and age, CD and biological therapy duration, body mass index and Crohn's Disease Activity Index were proved while statistically significant associations between temperature perception test and age and BMI were proved as well. Additionally, a decrease of total protein in a patient ́s serum below the physiological cut-off in the 6 months prior to measurement was associated with a pathological result of a Sudoscan. Cardiovascular autonomic neuropathy based on Ewing ́s battery tests was present in 56.7% of patients, no statistically significant risk factors were found. Our peripheral neuropathy questionnaire correlated with the results of the Sudoscan test and some tests of the clinical examination of peripheral sensor-motor nervous function (discriminatory contact perception test, temperature perception test). CONCLUSIONS: This study demonstrated a relatively high prevalence of peripheral (especially autonomic) neuropathy and verified some risk factors for the development of peripheral somatic neuropathy in asymptomatic patients with severe form of CD on anti-TNFα biological therapy.

• MeSH
• autonomní nervový systém MeSH
• biologická terapie MeSH
• Crohnova nemoc * farmakoterapie   epidemiologie   komplikace   MeSH
• lidé MeSH
• nemoci autonomního nervového systému * MeSH
• nemoci periferního nervového systému * MeSH
• TNF-alfa terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark's Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.

• MeSH
• biofeedback (psychologie) MeSH
• fekální inkontinence * etiologie   MeSH
• kvalita života MeSH
• lidé MeSH
• manometrie MeSH
• pilotní projekty MeSH
• roztroušená skleróza * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Electrophysiological diagnosis of cardiac autonomic neuropathy (CAN) is based on the evaluation of cardiovascular autonomic reflex tests (CARTs). CARTs are relatively time consuming and must be performed under standardized conditions. This study aimed to determine whether thermal quantitative sensory testing (TQST) can be used as a screening tool to identify patients with diabetes at a higher risk of CAN. METHODS: Eighty-five patients with diabetes and 49 healthy controls were included in the study. Neurological examination, CARTs, TQST, biochemical analyses, and neuropathy symptom questionnaires were performed. RESULTS: CAN was diagnosed in 46 patients with diabetes (54%). CAN-positive patients with diabetes had significantly higher warm detection thresholds (WDT) and significantly lower cold detection thresholds (CDT) in all tested regions (thenar, tibia, and the dorsum of the foot). CDT on the dorsum < 21.8°C in combination with CDT on the tibia < 23.15°C showed the best diagnostic ability in CAN prediction, with 97.4 % specificity, 60.9% sensitivity, 96.6% positive predictive value, and 67.3% negative predictive value. CONCLUSION: TQST can be used as a screening tool for CAN before CART.

• MeSH
• autonomní nervový systém MeSH
• diabetes mellitus * MeSH
• diabetické neuropatie * diagnóza   MeSH
• lidé MeSH
• nemoci nervového systému * MeSH
• nemoci periferního nervového systému * diagnóza   MeSH
• senzorické prahy fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Jedná se o dvě kazuistiky pacientů s recentně zachycenou významnou dekompenzací diabetesmellitus 2. typu, u kterých terapie repaglinidem nahradila léčbu inzulínem.

The two case reports describe patients with recently discovered significant decompen-sation of type 2 diabetes mellitus. In these patients, the insulin therapy was replaced withrepaglinide.

• Klíčová slova
• Repaglinide Accord,
• MeSH
• diabetes mellitus 2. typu * farmakoterapie   MeSH
• glykovaný hemoglobin účinky léků   MeSH
• hypoglykemika terapeutické užití   MeSH
• inzulin aspart aplikace a dávkování   MeSH
• krevní glukóza účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metformin aplikace a dávkování   MeSH
• piperidiny aplikace a dávkování   farmakologie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• diabetes mellitus * MeSH
• dolní končetina MeSH
• lidé MeSH
• reakční čas MeSH
• řízení motorových vozidel * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH

Přesná prevalence diabetické neuropatie není známa, udává se rozmezí 25-90 %. EtioLogie je muLtifaktoriáLní, dominantní vliv má hypergLykemie, resp. délka expozice hypergLykemii. Základním příznakem diabetické periferní senzitivní neuropatie jsou parestezie, termináLně anestezie. Klinické příznaky kardiální autonomní neuropatie jsou nevýrazné - ortostatická hypotenze, snížená tolerance námahy. Základním příznakem je klidová tachykardie, závažnou komplikací jsou maligní arytmie. Diagnosticky pomáhá vyšetření variability intervalu RR. Základem terapie a zároveň prevence rozvoje diabetické neuropatie je intenzifikace léčby diabetu s co nejlepší kompenzací. Většina současné medikamentózní terapie je pouze symptomatická, se zaměřením na zmírnění subjektivních obtíží. Jedinou současně dostupnou léčivou látkou s prokazatelným vlivem na patofyziologické procesy, které vedou k diabetické neuropatii, je kyselina thioktová. Specifická prevence není známa.

Precise prevalence of neuropathic neuropathy is not known, ranging from 25 to 90%. Etiology is multifactorial, hyperglycemia or duration of exposure to hyperglycemia is dominant. The primary symptom of diabetic peripheral sensory neuropathy is paresthesia, terminal anesthesia. Clinical signs of cardiac autonomic neuropathy are subjectively insignificant (orthostatic hypotension, reduced tolerance of exertion). The primary symptom is restless tachycardia, a serious complication of malignant arthritis. Diagnostically helps to investigate RR interval variability. The basis of therapy and prevention of the development of diabetic neuropathy is the intensification of diabetes treatment with the best possible compensation. Most current medication therapy is symptomatic only, with a focus on alleviating subjective difficulties. The only currently available drug with a demonstrable influence on the pathophysiological processes that lead to diabetic neuropathy is thioctic acid. Specific prevention is not known.

• MeSH
• antidepresiva tricyklická aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• antikonvulziva aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• diabetické neuropatie * diagnóza   etiologie   farmakoterapie   klasifikace   MeSH
• kyseliny linolové farmakologie   terapeutické užití   MeSH
• lidé MeSH
• opioidní analgetika aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• parestezie farmakoterapie   MeSH
• Check Tag
• lidé MeSH