This report presents a fatal case of a young female Type I diabetic patient who developed convulsions and loss of consciousness after taking methamphetamine and spending some time in a dance club. During the convulsions, she was given sugar and when no response occurred, her boyfriend who was not experienced in the use of insulin administered a dose of insulin to her. The woman lost consciousness and died despite the efforts of the emergency service. A biochemical analysis revealed a high level of insulin (196.67 mU/L) and low levels of glucose (2.96 mmol/L) and C-peptide (26 pmol/L). Toxicological analysis revealed a methamphetamine concentration of 389 ng/mL and an amphetamine concentration of 19 ng/mL. The forensic perspective of the difficult determination of the contribution of each of the factors to the death, i.e., the pre-existing medical condition (Type I diabetes), the use of methamphetamine, the physical exertion at the dance club, and, finally, the non-indicated administration of insulin, is discussed. The ruling of the court is also reported.
- MeSH
- bezvědomí chemicky indukované MeSH
- C-peptid krev MeSH
- diabetes mellitus 1. typu * MeSH
- dospělí MeSH
- fatální výsledek MeSH
- hypoglykemika škodlivé účinky MeSH
- inzulin * aplikace a dávkování MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- methamfetamin * škodlivé účinky MeSH
- poruchy spojené s užíváním amfetaminu komplikace MeSH
- stimulanty centrálního nervového systému * škodlivé účinky MeSH
- tanec MeSH
- tělesná námaha MeSH
- záchvaty MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Diabetes mellitus (DM) is a chronic disease with prevalence increasing worldwide. The aim of this study was to investigate satisfaction with the current method of insulin delivery (INS) amongst patient with type 1 diabetes mellitus (T1DM) using multiple daily injection (MDI) or continuous subcutaneous insulin infusion (CSII). Furthermore, a sub-aim was to test the effect of selected variables on patient satisfaction with MDI or CSII using regression analysis. METHODS: A cross-sectional study carried out in the territory of Moravia in the Czech Republic. A quantitative approach using the Insulin Delivery System Rating Questionnaire (IDSRQ) among 197 respondents with T1DM with INS delivery with MDI or CSII for at least 1 year. Statistical methods used were descriptive statistics, Student's t-tests and regression analysis. RESULTS: Highly significant differences were found between CSII and MDI patients in satisfaction with the current method of INS delivery (p < 0.001), in how the current method of delivery helps patients maintain stable blood glucose values, prevent high blood glucose (p < 0.001), and in overall satisfaction with the current method of INS delivery (p < 0.001). The average overall satisfaction score was 56.19 points for MDI and 62.08 points for CSII. Regression analysis revealed predictors of overall satisfaction on the mean score on how the current method of INS delivery helps MDI patients (p < 0.01). The effect of other selected variables was not confirmed. CONCLUSION: The results of the study showed higher overall satisfaction with the method of INS delivery in CSII patients. The current method of INS delivery does not interfere with daily life and activities in most patients.
- MeSH
- diabetes mellitus 1. typu * farmakoterapie krev psychologie MeSH
- dospělí MeSH
- hypoglykemika * aplikace a dávkování terapeutické užití MeSH
- injekce subkutánní MeSH
- inzulin * aplikace a dávkování terapeutické užití MeSH
- inzulinové infuzní systémy * MeSH
- krevní glukóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- spokojenost pacientů * MeSH
- subkutánní infuze MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Multidimensional chromatography coupled to tandem mass spectrometry (MS/MS), including simple sample preparation with protein precipitation, anion conversion with ammonium hydroxide, and solid-phase extraction using mixed-mode anion exchange in a 96-well plate format, has been validated for rapid simultaneous analysis of human insulin and its six analogs (lispro, glulisine, glargine, degludec, detemir, and aspart) in human plasma. This method is critical for clinical diagnostics, forensic investigations, and anti-doping efforts due to the widespread use of these substances. In the present study, improved chromatographic resolution was achieved using a first-dimension trap-and-elute configuration with an XBridge C18 (2.1 × 20 mm, 3.5 μm) trap column combined with second dimension separation on a Cortecs Ultra-High-Performance Liquid Chromatography (UHPLC) C18+ (2.1 × 100 mm, 1.6 μm) analytical column implemented within a two-dimensional-LC-MS/MS system. The total chromatographic run time was 11 min. This setup increases both the resolution and sensitivity of the method. A mobile phase consisting of 0.8% formic acid (FA) in water and 0.7% FA in acetonitrile was used for gradient elution. Bovine insulin was used as the internal standard. MS detection was performed in positive electrospray ionization mode, and the ion suppression due to matrix effects was evaluated. Validation criteria included linearity, precision, accuracy, recovery, lower limit of quantitation, matrix effect, and stability tests with and without protease inhibitor cocktail under different conditions (short-term stability, long-term stability, and freeze-thaw stability). The concentration range for all insulins was 50-15 000 pg/mL, with limits of quantification below the therapeutic reference range for all analytes. Intra-run precision ranged from 1.1% to 5.7%, inter-run precision from 0.7% to 5.9%, and overall recovery from 96.9% to 114.3%. The validated method has been implemented successfully by the Department of Forensic Medicine at our hospital for the investigation of unexplained deaths.
AIM: To determine whether people with type 1 diabetes (T1D) initiating glucose sensor monitoring experience greater improvements in HbA1c when provided with education on carbohydrate counting and flexible insulin dosing than those who do not receive nutrition education. MATERIALS AND METHODS: Our retrospective observational study included 329 people with T1D initiating glucose sensor monitoring between 2015 and 2021. The participants were divided into two groups: one group attended at least one structured educational session with a registered dietitian (n = 126), while the other group did not receive structured education (n = 203). After 12 months of glucose sensor initiation, we compared glycaemic outcomes and CGM metrics between the two groups. RESULTS: At glucose sensor initiation, both groups with and without education had similar HbA1c levels (7.64% [60.0 mmol/mol] vs. 7.66% [60.2 mmol/mol]). After twelve months, the education group demonstrated greater improvement in glycemic outcomes (HbA1c 7.17% [54.9mmol/mol] vs. 7.37% [57.1 mmol/mol], p < 0.05) and spent significantly more time in the target range than did the group without structured education (68.8% vs. 64.1%, p < 0.05). We observed an inverse correlation between the number of completed educational sessions and HbA1c after 12 months, as well as between the number of educational sessions and the change in HbA1c. CONCLUSIONS: People with T1D who initiated glucose sensor monitoring alongside nutrition education showed greater improvements in HbA1c and increased time spent in the target glucose range compared to individuals who did not receive structured education. TRAIL REGISTRATION: ClinicalTrials.gov identifier: NCT06264271.
- MeSH
- diabetes mellitus 1. typu * krev MeSH
- dospělí MeSH
- glykovaný hemoglobin * analýza metabolismus MeSH
- hypoglykemika aplikace a dávkování MeSH
- inzulin aplikace a dávkování MeSH
- krevní glukóza * analýza metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- regulace glykemie MeSH
- retrospektivní studie MeSH
- selfmonitoring glykemie * MeSH
- vzdělávání pacientů jako téma * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Objev inzulinu v roce 1921 znamenal revoluci v léčbě diabetes mellitus. Od počátečních intravenózních aplikací inzulinu se léčba přesunula k subkutánním injekcím a následně k využití inzulinových per. Významný pokrok přinesly inzulinové pumpy, které umožňují kontinuální subkutánní podávání inzulinu a tím napodobení fyziologické sekrece. Propojení inzulinových pump s kontinuální monitorací glukózy vedlo k vývoji hybridních uzavřených smyček. Tyto systémy využívají algoritmy pro automatickou úpravu dávek inzulinu na základě aktuálních a predikovaných hodnot glykemie. Výsledkem je zlepšení glykemické kontroly, snížení variability glykemie a snížení rizika jak hypoglykemických, tak hyperglykemických epizod.
The discovery of insulin in 1921 revolutionized the treatment of diabetes mellitus. From initial intravenous applications, treatment progressed to subcutaneous injections and subsequently to the use of insulin pens. Insulin pumps represented a significant advancement, enabling continuous subcutaneous insulin infusion and thus mimicking physiological secretion. The combination of insulin pumps with continuous glucose monitoring has led to the development of hybrid closed-loop systems. These systems utilize algorithms to automatically adjust insulin doses based on current and predicted glucose levels. The result is improved glycemic control, reduced glycemic variability, and decreased risk of both hypoglycemic and hyperglycemic episodes.
- MeSH
- diabetes mellitus 1. typu farmakoterapie krev prevence a kontrola MeSH
- diabetes mellitus farmakoterapie prevence a kontrola MeSH
- hyperglykemie krev prevence a kontrola MeSH
- hypoglykemie krev prevence a kontrola MeSH
- inzulin aplikace a dávkování farmakologie terapeutické užití MeSH
- inzulinové infuzní systémy * MeSH
- kontinuální monitorování glukózy metody přístrojové vybavení MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Chronické onemocnění ledvin (chronic kidney disesase, CKD) je spojeno se zvýšenou morbiditou a mortalitou, zejména z kardiovaskulárních (KV) příčin, a to zejména u osob s diabetes mellitus (DM). Již přítomnost DM zvyšuje KV riziko a potencuje riziko CKD. Proto má vedle kontroly glykemie klinický význam i prevence a léčba CKD, která má zpomalit její progresi. Významný nefroprotektivní účinek nových antidiabetik, konkrétně inhibitorů sodíko-glukózového kotransportéru 2 (sodium-glucose cotransporter 2, SGLT2) a agonistů receptoru pro glukagonu podobný peptid 1 (glucagon-like peptide 1 receptor agonist, GLP-1 RA), byl prokázán vedle jejich účinku na snížení koncentrace glukózy ve velkých KV studiích. Léčba inhibitory SGLT2 podobně jako GLP-1 RA je spojena s nižším rizikem poklesu glomerulární filtrace (glomerular filtration rate, GFR) v průběhu času jak u diabetické, tak nediabetické populace. Podle současných doporučení se inhibitory SGLT2 a/nebo GLP-1 RA doporučují osobám s DM, které mají chronické onemocnění ledvin a/nebo zvýšené KV riziko. Nefroprotektivní vlastnosti však nabízejí i další antidiabetika, o nichž bude v tomto přehledu rovněž pojednáno.
Chronic kidney disease (CKD) is associated with increased morbidity and mortality, especially from cardiovascular (CV) causes, and especially in people with diabetes mellitus (DM). Already presence of DM increases CV risk and potentiates the risk of CKD. Therefore, besides glycemic control, prevention and treatment of CKD to slow its progression are of clinical importance. A significant nephroprotective effect of novel antidiabetic drugs, namely sodium-glucose cotransporter 2 inhibitors (SGLT2) and glucagon-like peptide 1 receptor agonists (GLP-1 RA), has been shown on top of their glucose-lowering effects and was confirmed in cardiovascular outcome trials. Inhibitors SGLT2 treatment, like GLP-1 RA, is associated with a lower risk of glomerular filtration rate (GFR) decline over time in both diabetic and non-diabetic populations. According to current guidelines, inhibitors SGLT2 and/or GLP-1 RA are recommended for people with DM who have CKD and/or increased CV risk. However, other antidiabetic drugs offer nephroprotective properties, which will also be discussed in this review.
- MeSH
- agonisté receptoru pro glukagonu podobný peptid 1 farmakologie terapeutické užití MeSH
- chronická renální insuficience * diagnóza mortalita prevence a kontrola MeSH
- diabetes mellitus diagnóza prevence a kontrola MeSH
- glifloziny farmakologie terapeutické užití MeSH
- hypoglykemika * farmakologie terapeutické užití MeSH
- inzulin farmakologie terapeutické užití MeSH
- komplikace diabetu farmakoterapie prevence a kontrola MeSH
- ledviny účinky léků MeSH
- lidé MeSH
- metformin farmakologie terapeutické užití MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- sulfonylmočovinové sloučeniny farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Potřeba simplifikace (deintenzifikace) intenzifikovaného inzulínového režimu (IIR) je u pacientů s diabetes mellitus 2. typu důsledkem častého zahajování této terapie v minulosti, kdy nebyly k dispozici jiné alternativy. Deintenzifikace je v současné době umožněna dostupností fixních kombinací bazálního inzulinu a agonistů receptoru glukagonu podobného peptidu 1 (giukagon-iike peptide 1, GLP-1) (iGlarLixi, IDegLira). Studie IDEAL prokázala, že deintenzifikace IIR přechodem na iGlarLixi je u pacientů s diabetes mellitus 2. typu účinnou a bezpečnou možností simplifikace terapie, která poskytuje porovnatelnou glykemickou kompenzaci, benefity redukce tělesné hmotnosti, snížení množství inzulinových injekcí a celkové denní dávky inzulínu, zlepšení hodnot při kontinuálním monitorování glykemie (continuous glucose monitoring, CGM), a to bez zvýšeného rizika hypoglykemie a s vyšší spokojeností pacientů s léčbou.
The need for simplification (deintensification) of multiple daily injections (MDI) regimen in people with type 2 diabetes is a consequence of its frequent use in the past when no other relevant options were available. At present, this has become possible due to the availability of new medications and formulations, such as the fixed ratio combinations of basal insulin analogues and glucagon-like peptide 1 (GLP-1) receptor agonists (iGlarLixi, IDegLira). The IDEAL randomised controlled trial showed that insulin therapy deintensification from MDI regimen into once-daily administered iGlarLixi is an efficient and safe treatment option for people with type 2 diabetes that provides comparable glycaemic control with the benefits of reduction of body weight, total daily dose of insulin, number of insulin injections, lower proportion of visits as which hypoglycaemia was reported and increased patients’ satisfaction with the treatment.
- Klíčová slova
- Suliqua, Xultophy,
- MeSH
- agonisté receptoru pro glukagonu podobný peptid 1 farmakologie terapeutické užití MeSH
- diabetes mellitus 2. typu * diagnóza farmakoterapie MeSH
- fixní kombinace léků MeSH
- hyperglykemie krev prevence a kontrola MeSH
- hypoglykemika farmakologie terapeutické užití MeSH
- inzulin * aplikace a dávkování farmakologie klasifikace terapeutické užití MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVE: This study examined the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SD score (SDS), and diabetes technology uptake in youth. RESEARCH DESIGN AND METHODS: Data were from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland, and U.S. [Colorado]), including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, nonsevere, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. RESULTS: The analysis included 9,269 individuals (54.8% males, mean age 9.0 years). DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After 1 year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared with nonsevere DKA (7.23%, P = 0.001) and no DKA groups (7.14, P < 0.001), and this difference persisted after 2 years (7.58% vs. 7.38% [P < 0.001] and vs. 7.32% [P < 0.001]). Higher BMI SDS was observed in both DKA groups compared with no DKA. The use of AID was associated with lower HbA1c levels compared with other treatment modalities and moderated differences between DKA groups after 2 years of follow-up (P = 0.072). CONCLUSIONS: Severe and nonsevere DKA at type 1 diabetes diagnosis were both associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.
- MeSH
- diabetes mellitus 1. typu * epidemiologie komplikace krev MeSH
- diabetická ketoacidóza * epidemiologie MeSH
- dítě MeSH
- glykovaný hemoglobin metabolismus MeSH
- hypoglykemika terapeutické užití MeSH
- inzulin terapeutické užití MeSH
- inzulinové infuzní systémy MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- předškolní dítě MeSH
- registrace MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Itálie MeSH
- Lucembursko MeSH
- Německo MeSH
- Nový Zéland MeSH
- Rakousko MeSH
- Slovinsko MeSH
- Švýcarsko MeSH
The study focused on the changes in C-peptide, glycemia, insulin concentration, and insulin resistance according to LDL-cholesterol concentration ranges. The metabolic profile of individuals in the Czech Republic (n = 1840) was classified by quartiles of LDL-cholesterol into four groups with the following ranges: 0.46-2.45 (n = 445), 2.46-3.00 (n = 474), 3.01-3.59 (n = 459), and 3.60-7.18 mmol/l (n = 462). The level of glucose, C-peptide, insulin, and area of parameters during OGTT and HOMA IR were compared with a relevant LDL-cholesterol range. The evaluation involved correlations between LDL-cholesterol and the above parameters, F-test and t-test. Generally, mean values of glucose homeostasis-related parameters were higher with increasing LDL-cholesterol levels, except for mean HOMA IR values which rapidly increased (2.7-3.4) between LDL-cholesterol ranges of 3.00-3.59 and 3.60-7.18 mmol/l. Glucose, C-peptide, insulin concentrations, and the area of parameters reached greater changes especially after glucose load during OGTT (p ≤ 0.001). Considerable changes were already observed for the above parameters between groups with LDL-cholesterol ranges of 2.46-3.00 and 3.01-3.59 mmol/l. HOMA IR increased with higher LDL-cholesterol concentrations, but the differences in mean values were not statistically significant. Most important differences appeared in glucose metabolism at LDL-cholesterol concentrations of 3.60-7.18 mmol/l in comparison to LDL-cholesterol lower ranges. In particular, the areas of C-peptide, glucose, and insulin ranges showed statistically significant differences between all groups with growing LDL-cholesterol ranges. The variances of HOMA IR statistically differed between groups created according to LDL-cholesterol concentrations ranges.
- MeSH
- C-peptid * krev MeSH
- dospělí MeSH
- glukózový toleranční test MeSH
- inzulin * krev MeSH
- inzulinová rezistence * MeSH
- krevní glukóza * analýza metabolismus MeSH
- LDL-cholesterol * krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Diabetická ketoacidóza (DKA) a hyperglykemický hyperosmolární stav (HHS) jsou nejzávažnější hyperglykemické stavy u pacientů s diabetem. V roce 2024 byla publikována po 15 letech nová mezinárodní konsenzuální doporučení zahrnující epidemiologii, patofyziologii, manifestaci i terapii těchto akutních stavů. Předkládaný článek stručně prezentuje nejdůležitější informace z těchto doporučení.
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most severe hyperglycemic situations in patients with diabetes. In 2024, a new consensual recommendation on epidemiology, pathophysiology, manifestation, and therapy of these acute situations was published after 15 years. The most important information from this document is presented in the manuscript.
- MeSH
- diabetes mellitus MeSH
- diabetická ketoacidóza diagnóza etiologie prevence a kontrola terapie MeSH
- draslík terapeutické užití MeSH
- hyperosmolární hyperglykemické kóma diagnóza etiologie terapie MeSH
- inzulin aplikace a dávkování terapeutické užití MeSH
- komplikace diabetu * prevence a kontrola terapie MeSH
- lidé MeSH
- tekutinová terapie MeSH
- Check Tag
- lidé MeSH
