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
SARS-CoV-2 respiratory infection is associated with significant morbidity and mortality in hospitalized patients. We aimed to assess the risk factors for hospital mortality in non-vaccinated patients during the 2021 spring wave in the Czech Republic. A total of 991 patients hospitalized between January 2021 and March 2021 with a PCR-confirmed SARS-CoV-2 acute respiratory infection in two university hospitals and five rural hospitals were included in this analysis. After excluding patients with unknown outcomes, 790 patients entered the final analyses. Out of 790 patients included in the analysis, 282/790 (35.7%) patients died in the hospital; 162/790 (20.5) were male and 120/790 (15.2%) were female. There were 141/790 (18%) patients with mild, 461/790 (58.3%) with moderate, and 187/790 (23.7%) with severe courses of the disease based mainly on the oxygenation status. The best-performing multivariate regression model contains only two predictors-age and the patient's state; both predictors were rendered significant (p < 0.0001). Both age and disease state are very significant predictors of hospital mortality. An increase in age by 10 years raises the risk of hospital mortality by a factor of 2.5, and a unit increase in the oxygenation status raises the risk of hospital mortality by a factor of 20.
- Publication type
- Journal Article MeSH
Glykovaný hemoglobin (HbA1c ) je zlatým standardem v hodnocení dlouhodobé kompenzace diabetu. Má však i své limitace a nespolehlivý může být především u chronické renální insuficience, anémií a dalších poruch červené krevní řady. S rostoucím využíváním kontinuálních glukózových senzorů v terapii diabetu je stále častěji vyjadřována kompenzace diabetu pomocí GMI (glucose management indicator) založeném na průměrné glykemii naměřené senzorem. U části pacientů se však liší od hodnoty glykovaného hemoglobinu HbA1c stanoveného v laboratoři. Tuto diskrepanci charakterizuje glykační index hemoglobinu – HGI (hemoglobin glycation index; HGI = HbA1c – GMI). Pacienti se zvýšeným HGI mají vyšší glykemickou variabilitu i vyšší četnost diabetických komplikací, což podporuje představu o nepříznivém vlivu glykace na rozvoj diabetických cévních změn. Pacienti s vysokým HGI by proto k prevenci chronických komplikací mohli profitovat z individuálně nastavených přísnějších glykemických cílů.
Glycated haemoglobin (HbA1c) is the golden standard in the assessment of long-term diabetes control. It has certain flaws and can be misleading especially in chronic kidney disease, anaemia and other RBC disturbances. The growing use of continuous glucose sensors has enabled the assessment of diabetes control by the glucose management indicator (GMI) based on average glycemia and thus glycation only. In certain patients, GMI differs significantly from HbA1c, which reflects both glycation and deglycation processes together. This difference is characterised by the haemoglobin glycation index (HGI). HGI = HbA1c - GMI. The higher HGI observed in patients is associated with higher glycaemic variability and greater incidence of diabetic complications. This association suggests the harmful role of increased glycation in the pathogenesis of diabetic vascular changes. Patients with high HGI could profit out of individually adjusted and stricter glycaemic targets.
- Keywords
- glykační index hemoglobinu,
- MeSH
- Diabetes Mellitus * diagnosis MeSH
- Glycated Hemoglobin * analysis MeSH
- Humans MeSH
- Blood Glucose Self-Monitoring MeSH
- Check Tag
- Humans MeSH
Data získaná z Národního registru hrazených zdravotních služeb (NRHZS) o vývoji poskytované péče diabetology, internisty a praktickými lékaři v letech 2010 až 2021 dokládají narůstající počet i procentuální zastoupení pacientů s diabetem léčených zejména neinzulinovými antidiabetiky praktickými lékaři (vzestup z 4,7 % na 22,8 % diabetiků). Zároveň data poskytují informaci o stagnaci počtu diabetiků léčených jen inzulinem. Registrovaný vývojový trend v poskytování péče lékaři podněcuje diskuzi o dalším směrování včetně potřeby zajistit kvalitní strukturovaný a multidisciplinární přístup k pacientům s diabetem v následujících letech.
Data obtained from the National register of covered medical services (NHRZS) on provided care developed by diabetologists, general practitioners and internists since 2010 to 2021 confirm an increased number and percentage of diabetic patients treated especially by non-insulin antidiabetic drugs by general practitioners (an increase from 4.7 % to 22,8 % diabetic patients). At the same time data offer an information on stagnation of diabetic patients treated by insulin only. The trend registered in provided care stimulates a discussion on future way including the needs for high quality of structured and multidisciplinary approach offered to diabetic patients in future years.
- MeSH
- Diabetes Mellitus * diagnosis epidemiology drug therapy MeSH
- Hypoglycemic Agents therapeutic use MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Geographicals
- Czech Republic MeSH
- MeSH
- Early Diagnosis MeSH
- Diabetes Mellitus * physiopathology MeSH
- Humans MeSH
- Pancreatic Neoplasms * diagnosis physiopathology MeSH
- Risk Factors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Background and Objectives: Insulinoma is a rare tumor of the Langerhans islets of the pancreas. It produces insulin and causes severe hypoglycemia with neuroglycopenic symptoms. The incidence is low, at about 1-2 per 1 million inhabitants per year. The diagnosis is based on the presence of Whipple's triad and the result of a fasting test. Surgery is the treatment of choice. Objectives: A retrospective observational study of patients operated on for insulinoma in our hospital focused on the diagnosis, the type of surgery, and complications. Materials and Methods: We retrospectively reviewed patients operated on due to insulinoma. There were 116 surgeries between 2000 and 2022. There were 79 females and 37 males in this group. A fasting test and a CT examination were performed on all the patients. Results: The average duration of the fasting test was 18 h. Insulinoma was found in the body and tail of the pancreas in more than half of the patients. Enucleation was the most frequent type of surgery. Complications that were Clavien Dindo grade III or more occurred in 18% of the patients. The most frequent complications were abscesses and pancreatic fistula. Five patients had malignant insulinoma. Conclusions: Surgery is the treatment of choice in the case of insulinomas. The enucleation of the tumor is a sufficient treatment for benign insulinomas, which are not in contact with the main pancreatic duct. Due to the low incidence of the condition, the centralization of patients is recommended.
- MeSH
- Hypoglycemia * etiology MeSH
- Insulinoma * diagnosis surgery MeSH
- Humans MeSH
- Pancreatic Neoplasms * diagnosis surgery MeSH
- Pancreas MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
