Mikrovaskulární komplikace diabetu jsou významnou příčinou morbidity a kardiovaskulární mortality pacientů s diabetes mellitus. Jejich rozvoj a progrese souvisí s chronickou hyperglykemií, ale k dalším rizikovým faktorům patří hypertenze, dyslipidemie, kouření a genetické faktory. Preventivní postupy zahrnují optimální, individualizovanou kompenzaci diabetu a také léčbu dalších ovlivnitelných faktorů. Včasný záchyt jednotlivých komplikací pomocí screeningu a včasná a adekvátní léčba snižují riziko pokročilých stádií jednotlivých komplikací a následných fyzických, sociálních a ekonomických dopadů.
Microvascular complications of diabetes are a cause of significant morbidity and cardiovascular mortality of patients with diabetes. Their development and progression is associated with chronic hyperglycemia, and other risk factors are hypertension, dyslipidemia, smoking and genetic factors. Preventative startegies should focus on optimal individualized glycemic control, and also treatment of other modifiable factors. Early detection of complications using screening procedures and early and appropriate treatment lower the risk of advanced complications and of their subsequent physical, social and economic impact.
- MeSH
- Diabetic Foot etiology prevention & control MeSH
- Diabetic Retinopathy diagnosis classification prevention & control therapy MeSH
- Diabetic Nephropathies diagnosis classification prevention & control therapy MeSH
- Diabetic Neuropathies diagnosis classification complications therapy MeSH
- Light Coagulation MeSH
- Diabetes Complications * diagnosis classification prevention & control therapy MeSH
- Humans MeSH
- Neurologic Examination methods MeSH
- Mass Screening methods MeSH
- Risk Factors MeSH
- Vascular Endothelial Growth Factors antagonists & inhibitors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Diabetes Mellitus prevention & control MeSH
- Diabetic Neuropathies classification complications MeSH
- Diabetes Complications * classification physiopathology prevention & control MeSH
- Humans MeSH
- Malnutrition etiology prevention & control MeSH
- Deglutition Disorders * diagnosis etiology prevention & control therapy MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Review MeSH
- MeSH
- Diabetic Neuropathies * drug therapy classification physiopathology MeSH
- Humans MeSH
- Neuralgia * drug therapy physiopathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Diabetes Mellitus * diagnosis drug therapy classification therapy MeSH
- Diabetic Retinopathy diagnosis classification prevention & control therapy MeSH
- Diabetic Nephropathies classification prevention & control MeSH
- Diabetic Neuropathies drug therapy classification MeSH
- Dyslipidemias drug therapy MeSH
- Sodium-Glucose Transporter 2 Inhibitors administration & dosage pharmacology MeSH
- Hyperglycemia drug therapy MeSH
- Hypoglycemia diagnosis therapy MeSH
- Hypoglycemic Agents administration & dosage classification MeSH
- Dipeptidyl-Peptidase IV Inhibitors administration & dosage pharmacology MeSH
- Insulins administration & dosage classification MeSH
- Drug Therapy, Combination MeSH
- Diabetes Complications drug therapy classification prevention & control therapy MeSH
- Humans MeSH
- Metformin administration & dosage MeSH
- Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use MeSH
- Check Tag
- Humans 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
- Antidepressive Agents, Tricyclic administration & dosage pharmacology adverse effects MeSH
- Anticonvulsants administration & dosage pharmacology adverse effects MeSH
- Diabetic Neuropathies * diagnosis etiology drug therapy classification MeSH
- Linoleic Acids pharmacology therapeutic use MeSH
- Humans MeSH
- Analgesics, Opioid administration & dosage pharmacology adverse effects MeSH
- Paresthesia drug therapy MeSH
- Check Tag
- Humans MeSH
- MeSH
- Diabetic Neuropathies * diagnosis drug therapy classification complications physiopathology MeSH
- Diagnostic Techniques and Procedures classification MeSH
- gamma-Aminobutyric Acid pharmacology adverse effects therapeutic use MeSH
- Hypoglycemic Agents pharmacology adverse effects therapeutic use MeSH
- Serotonin and Noradrenaline Reuptake Inhibitors pharmacology adverse effects therapeutic use MeSH
- Diabetes Complications diagnosis drug therapy physiopathology MeSH
- Thioctic Acid administration & dosage pharmacology adverse effects MeSH
- Central Nervous System Agents pharmacology adverse effects therapeutic use MeSH
- Humans MeSH
- Risk Factors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Antidepressive Agents administration & dosage pharmacology adverse effects MeSH
- Anticonvulsants administration & dosage pharmacology adverse effects MeSH
- Administration, Topical MeSH
- Diabetic Neuropathies * drug therapy classification MeSH
- Capsaicin administration & dosage MeSH
- Thioctic Acid administration & dosage pharmacology MeSH
- Humans MeSH
- Lidocaine administration & dosage MeSH
- Neuralgia etiology drug therapy MeSH
- Analgesics, Opioid administration & dosage pharmacology adverse effects MeSH
- Check Tag
- Humans MeSH
Diabetes mellitus spôsobuje celé spektrum periférnych neuropatických komplikácií vrátane akútnych a chronických foriem a postihuje všetky úrovne periférneho nervu, počnúc nervovým koreňom a končiac distálnym axónom. Na diabetickú neuropatiu (DN) sa v súčasnosti pozeráme ako na heterogénne ochorenie s odlišnými patogenetickými mechanizmy u rozdielnych klinických syndrómov. Najčastejšiou formou DN je distálna symetrická polyneuropatia (DSPN), ktorá často prebieha zákerne a bezpríznakovo a jej najzávažnejšou komplikáciou je diabetická noha. Okrem už známych rizikových faktorov ako sú trvanie diabetu či dlhodobá úroveň metabolickej kontroly sa ako dôležité ukazujú kardiovaskulárne faktory (hypertenzia, hyperlipidémia, obezita), vek, fajčenie a prekonanie opakovaných epizód ketoacidózy. V prevencii rozvoja neuropatie majú rozhodujúce miesto kontrola glykémie, úprava životného štýlu a cvičenie. Z patogenetických liečiv má svoje pevné miesto kyselina alfalipoová. Terapia neuropatickej bolesti je potrebná najmä z hľadiska zlepšenia celkovej kvality života diabetikov. Veľký význam má včasná diagnostika diabetickej neuropatie, na včasné podchytenie pacientov s možnosťou terapeutickej intervencie.
Diabetes causes a broad sprectrum of neuropathic complications, including acute and chronic forms affecting each level of theperipheral nerve, from the root to the distal axon. Diabetic neuropathy (DN) is currently considered a heterogeneous disease withdifferent pathogenetic mechanisms in different clinical syndromes. The most common form is distal symmetric polyneuropathy(DSPN), which often goes insidious and unnoticed and its most serious complication is diabetic foot. In addition to knownrisk factors such as diabetes duration or long-term metabolic control, new factors such as cardiovascular factors (hypertension,hyperlipidemia, obesity), age, smoking, and recurrent episodes of ketoacidosis have recently been identified. In preventing thedevelopment of neuropathy, metabolic control, lifestyle modification and exercise are very important. Among the pathogeneticdrugs, alphalipoic acid has a dominant position. Neuropathic pain treatment is particularly needed to improve the overall patient´s quality of life. Early diagnosis of diabetic neuropathy is crucial for early medical intervention.
Kazuistiky popisujú výskyt menej častého typu diabetickej neuropatie - proximálnej diabetickej amyotrofie, ktorá sa u pacientov manifestovala subakútnym vznikom bolestí a následne pomerne rýchlym rozvojom atrofie a svalovej slabosti predovšetkým proximálneho svalstva lumbálneho pletenca. Klinická diagnóza sa opierala predovšetkým o klinický obraz pacientov. Ďalšími pomocnými elektrofyziologickými a zobrazovacími metodikami sme vylúčili iné príčiny postihnutia periférnych nervov. Základným terapeutickým opatrením je dobrá kompenzácia diabetes mellitus a stabilizácia orgánových komplikácií, sprevádzaná symptomatickou liečbou bolesti a patogenetickou terapiou, v oblasti ktorej v budúcnosti očakávame výraznejší pokrok. Dôležitú úlohu v liečebnom manažmente zohráva i dlhodobá intenzívna rehabilitácia.
The case reports describe the incidence of a less frequent type of diabetic neuropathy - proximal diabetic amyotrophy, manifested by subacute arising of pain and the following rather rapid development of atrophy and muscle weakness of primarily the proximal muscles of the lumbar plexus. The clinical diagnosis was mainly based on patients´ clinical pictures. We used further auxiliary electrophysiological and imaging methodologies to eliminate other causes of peripheral nerve disorders. A basic therapeutic arrangement includes good compensation of diabetes mellitus and stabilization of organ complications, accompanied by symptomatic treatment of pain and pathogenetic therapy, in the area where we are expecting some significant progress in future. Long-term intensive rehabilitation also plays an important role in the treatment management.
- MeSH
- Antioxidants MeSH
- Diabetes Mellitus drug therapy MeSH
- Diabetic Neuropathies * diagnosis classification therapy MeSH
- Diagnosis, Differential MeSH
- Hypoglycemic Agents therapeutic use MeSH
- Immunologic Factors MeSH
- Immunoglobulins, Intravenous administration & dosage therapeutic use MeSH
- Comorbidity MeSH
- Diabetes Complications MeSH
- Thioctic Acid therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Brain diagnostic imaging MeSH
- Neuralgia diagnosis etiology therapy MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
