- MeSH
- Glucagon-Like Peptide-1 Receptor Agonists administration & dosage pharmacology therapeutic use MeSH
- Diabetes Mellitus drug therapy MeSH
- Insulin, Long-Acting administration & dosage pharmacology therapeutic use MeSH
- Insulins * administration & dosage pharmacology therapeutic use MeSH
- Insulin, Short-Acting administration & dosage pharmacology therapeutic use MeSH
- Humans MeSH
- Insulin, Isophane administration & dosage therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Diabetes Mellitus * MeSH
- Physicians MeSH
- Humans MeSH
- Surveys and Questionnaires MeSH
- Check Tag
- Humans MeSH
Komplikace diabetu souvisí s dlouhodobě neuspokojivou kompenzací diabetu, kterou obvykle hodnotíme podle koncentrace glykovaného hemoglobinu (HbA1c). Kolísání hodnot koncentrace glukózy v krvi je spojeno s oxidačním stresem, dysfunkcí endotelu a zánětem, což jsou faktory tradičně spojené s patogenezí vaskulárního poškození. Variabilita koncentrace glukózy byla ve studiích spojena s makrovaskulárními komplikacemi, její souvislost s mikrovaskulárními komplikacemi je však nejasná. Hlavní otázkou zůstává, zda by se měla krátkodobá variabilita glukózy považovat za nezávislý rizikový faktor pro mikrovaskulární komplikace diabetu. Tento přehled shrnuje poznatky v oblasti variability glukózy a její možný vztah k diabetické retinopatii, nefropatii a neuropatii. Současná data ukazují na potřebu dalšího výzkumu parametrů jak krátkodobé, tak dlouhodobé variability glukózy. Tyto parametry variability mohou být důležité pro výběr optimálních léčebných strategií a také pro odhad rizika chronických diabetických komplikací.
Microvascular diabetes complications are linked to inadequate long-term diabetes control, as indicated by glycated haemoglobin (HbA1c) levels. Fluctuations in glucose levels are connected to oxidative stress, endothelial dysfunction, and inflammation, all of which are traditionally linked to the development of vascular damage. While some studies have linked glucose variability to macrovascular disease, its association with microvascular disease is still debated. The major question is whether short-term glucose variability should be regarded as an independent risk factor for microvascular complications in diabetes. This summary reviews research on glucose variability and its potential connections to diabetic retinopathy, nephropathy, and neuropathy. Current data indicate the need for further research into the parameters of both short-term and long-term glucose variability. These variability parameters may be important for selecting optimal treatment strategies and for estimating the risk of chronic diabetic complications.
- MeSH
- Diabetes Mellitus MeSH
- Diabetic Angiopathies metabolism MeSH
- Glycated Hemoglobin * metabolism MeSH
- Diabetes Complications * MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Proces glykace je zodpovědný za rozvoj chronických cévních komplikací diabetu, které jsou hlavní příčinou zvýšené mortality tohoto onemocnění. Celková individuální glykace je výsledkem interakce mezi proglykačními a deglykačními mechanismy a lze ji vypočítat například pomocí glykačního indexu hemoglobinu (HGI). Přibývá důkazů o tom, že pacienti s vyšší mírou glykace (a tedy vyšším HGI) mají četnější diabetické komplikace. V praxi by proto bylo výhodné takové pacienty identifikovat a léčit k přísnějším glykemickým cílům.
Glycation plays a crucial role in the development of chronic vascular complications in diabetes. The total individual glycation is a result of interaction between proglycation and deglycation mechanisms and can be expressed by hemoglobin glycation index (HGI). There is increasing evidence that patients with higher glycation (and higher HGI) suffer from more frequent diabetic complications. In practice, it would therefore be advantageous to identify and treat such patients to stricter glycemic goals.
- Keywords
- chiglitazar,
- MeSH
- Diabetes Mellitus, Type 2 * drug therapy MeSH
- Hypoglycemic Agents administration & dosage therapeutic use MeSH
- Insulin Resistance MeSH
- Carbazoles MeSH
- Humans MeSH
- Metabolic Syndrome drug therapy MeSH
- Propionates MeSH
- Peroxisome Proliferator-Activated Receptors agonists MeSH
- Glycemic Control MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comment MeSH
- Overall MeSH
- MeSH
- Diabetes Mellitus MeSH
- Education MeSH
- Publication type
- Festschrift MeSH
Glifloziny představují moderní a komplexně působící skupinu farmak s dynamicky se rozvíjejícími indikacemi. Kromě významného antidiabetického působení přibývá důkazů a zkušeností s kardioprotektivními a nefroprotektivními efekty, díky kterým se glifloziny stávají standardní léčbou pro pacienty se srdečním selháním či chronickým onemocněním ledvin, často i bez přítomného diabetu. Léčba glifloziny přináší některá rizika, která je třeba zvážit před jejich nasazením, resp. je nutné o nich adekvátně informovat každého pacienta.
Gliflozins represent modern and complex acting drugs with emerging indications. Apart from antidiabetic effects, there is increasing evidence of cardioprotective and renoprotective benefits pushing gliflozins among the standard treatment of patients with heart failure or chronic kidney disease, often without diabetes. Several risks of gliflozins should be acknowledged before their initiation and proper patient education in risks and benefits should be a common part of this initiation process.
The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5-6, 2024 ( http://www.cvot.org ).
- MeSH
- Renal Insufficiency, Chronic * diagnosis epidemiology therapy MeSH
- Diabetes Mellitus, Type 2 * drug therapy MeSH
- Diabetes Mellitus * drug therapy MeSH
- Cardiovascular Diseases * diagnosis epidemiology prevention & control MeSH
- Blood Glucose MeSH
- Kidney MeSH
- Humans MeSH
- Obesity complications MeSH
- Blood Glucose Self-Monitoring MeSH
- Heart Failure * complications MeSH
- Stroke Volume MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
- MeSH
- Diabetes Mellitus * MeSH
- Humans MeSH
- Preoperative Care * methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
