• 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

AIM: To evaluate the efficacy and safety of twice-daily insulin degludec/insulin aspart vs. twice-daily biphasic insulin aspart 30 in people with Type 2 diabetes mellitus who were naïve to insulin. METHODS: In this 26-week, multinational, open-label, controlled, two-arm, parallel-group, treat-to-target trial, participants [mean (± sd) age 58.9 (±8.9) years, duration of diabetes 9.5 (±5.9) years, HbA1c 68 (±8.7) mmol/mol or 8.4 (±0.8)% and BMI 31.2 (±4.2) kg/m(2) ) were randomized (1:1) to insulin degludec/insulin aspart (n = 197) or biphasic insulin aspart 30 (n = 197), administered with breakfast and the main evening meal, titrated to a self-monitored plasma glucose target > 3.9 and ≤ 5.0 mmol/l. RESULTS: The mean HbA1c was reduced to 49 mmol/mol (6.6%) with insulin degludec/insulin aspart and 48 mmol/mol (6.5%) with biphasic insulin aspart 30. Insulin degludec/insulin aspart achieved the prespecified non-inferiority margin (estimated treatment difference 0.02%; 95% CI -0.12, 0.17). Insulin degludec/insulin aspart was superior in lowering fasting plasma glucose (estimated treatment difference -1.00 mmol/l; 95% CI -1.4, -0.6; P < 0.001) and reducing overall and nocturnal confirmed hypoglycaemia at a similar overall insulin dose compared with biphasic insulin aspart 30. Similar proportions of participants in each arm experienced severe hypoglycaemia. Adverse events were equally distributed. CONCLUSIONS: Consistent with previous findings, insulin degludec/insulin aspart twice daily effectively improved long-term glycaemic control, with superior reductions in FPG, and significantly less overall and nocturnal confirmed hypoglycaemia compared with biphasic insulin aspart 30 in people with Type 2 diabetes who were insulin-naïve.

• MeSH
• Biphasic Insulins administration & dosage   adverse effects   therapeutic use   MeSH
• Diabetes Mellitus, Type 2 blood   drug therapy   MeSH
• Insulin, Long-Acting administration & dosage   adverse effects   chemistry   therapeutic use   MeSH
• Drug Combinations MeSH
• Glycated Hemoglobin analysis   MeSH
• Hyperglycemia prevention & control   MeSH
• Hypoglycemia chemically induced   epidemiology   physiopathology   prevention & control   MeSH
• Hypoglycemic Agents administration & dosage   adverse effects   chemistry   therapeutic use   MeSH
• Insulin Aspart administration & dosage   adverse effects   therapeutic use   MeSH
• Meals MeSH
• Blood Glucose analysis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Drug Monitoring MeSH
• Insulin, Isophane administration & dosage   adverse effects   therapeutic use   MeSH
• Risk MeSH
• Solubility MeSH
• Drug Administration Schedule MeSH
• Blood Glucose Self-Monitoring MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

Kazuistika popisuje rozdíly v terapii ve dvou graviditách u diabetičky 1. typu. Diabe-tes mellitus (DM) 1. typu byl u pacientky spojen s tyreotoxikózou Graves-Basedowova typu v rámci sdružených autoimunitních chorob.

The case study describes differences in therapy in two pregnancies in type 1 diabetic patient. Diabetes mellitus (DM) type 1 in the patient is associated with Graves-Basedow thyreotoxicosis type within the associated autoimmune diseases.

• Keywords
• inzulinoterapie,
• MeSH
• Medication Adherence MeSH
• Patient Compliance * MeSH
• Diabetes Mellitus, Type 1 * drug therapy   complications   MeSH
• Insulin, Long-Acting * administration & dosage   MeSH
• Adult MeSH
• Glycated Hemoglobin analysis   MeSH
• Hypoglycemic Agents administration & dosage   MeSH
• Insulin Aspart administration & dosage   MeSH
• Insulin, Regular, Human administration & dosage   MeSH
• Diabetes Complications MeSH
• Humans MeSH
• Insulin, Isophane administration & dosage   MeSH
• Drug Administration Schedule MeSH
• Pregnancy in Diabetics * drug therapy   MeSH
• Pregnancy MeSH
• Thyrotoxicosis drug therapy   complications   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: Glucose variability combined with glycosylated hemoglobin (HbA1c) assessments more reliably represents the level of glycemic control. The study was aimed to compare blood glucose variability with insulin glargine vs. neutral protamine Hagedorn (NPH) in patients with type 2 diabetes mellitus using a continuous glucose-monitoring system (CGMS), in patients treated with basal insulin using stable dose of oral antidiabetic agents and HbA1c in the range of 4.5-8.0 % International Federation of Clinical Chemistry (IFCC) units. [6.2-9.4 % Diabetes Control and Complications Trial (DCCT) units]. METHODS: This was a multicenter, prospective, open-label, single-arm study in patients (N = 116) treated for ≥ 2 months with NPH and metformin combined with sulfonylurea or glinide. Glucose variability was measured after a 4-week NPH treatment phase and after a subsequent 12-week glargine treatment phase using CGMS. Based on 72-hour CGMS, glucose variability was assessed by area under the curve [AUC (mmol/L · h)]. Differences (glargine-NPH) in AUC within 24 h in the glucose ranges of ≤ 3.3, ≤ 3.9, 7.5-3.9 (margins excluding), ≥ 7.5, ≥ 10, and ≥ 15 mmol/L were evaluated. Circadian fluctuation of glucose was assessed by M-value (log-transformation of the deviation from an arbitrary standard). RESULTS: AUCs of glucose in the lowest ranges (≤ 3.3 and ≤ 3.9 mmol/L) did not change significantly after treatment with glargine. Those in the higher ranges (≥ 7.5, ≥ 10, and ≥ 15 mmol/L) were significantly lower (p < 0.001 for all ranges), whereas AUC of glucose in the normal range (3.9-7.5 mmol/L) was significantly higher (p < 0.001) at the end of glargine treatment phase. Circadian fluctuation of glucose assessed by M-value showed a significant decrease after glargine treatment (p < 0.003). No significant differences in hypoglycemia confirmed by glucose value ≤ 3.3 mmol/L were found between treatment phases. This trial is registered at ClinicalTrials.gov, NCT00659477. CONCLUSIONS: As monitored by CGMS, switching from NPH to glargine with active titration shifted glucose from abnormally high to normal levels with reduced fluctuation and without increased risk of hypoglycemia.

• MeSH
• Diabetes Mellitus, Type 2 blood   diagnosis   drug therapy   MeSH
• Insulin, Long-Acting administration & dosage   MeSH
• Adult MeSH
• Hypoglycemic Agents administration & dosage   MeSH
• Blood Glucose analysis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Drug Monitoring methods   MeSH
• Drug Substitution MeSH
• Insulin, Isophane administration & dosage   MeSH
• Reproducibility of Results MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Controlled Clinical Trial MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

• MeSH
• Diabetes Mellitus, Type 1 MeSH
• Diabetes Mellitus, Type 2 MeSH
• Diabetes Mellitus * drug therapy   metabolism   physiopathology   MeSH
• Insulin, Long-Acting administration & dosage   pharmacokinetics   pharmacology   MeSH
• Insulin * analogs & derivatives   administration & dosage   physiology   classification   secretion   therapeutic use   MeSH
• Drug Therapy, Combination methods   trends   MeSH
• Blood Glucose drug effects   MeSH
• Humans MeSH
• Insulin, Isophane administration & dosage   pharmacokinetics   therapeutic use   MeSH
• Drug Administration Schedule MeSH
• Drug Administration Routes MeSH
• Check Tag
• Humans MeSH

• MeSH
• Diabetes Mellitus, Type 1 drug therapy   MeSH
• Weight Gain drug effects   MeSH
• Hypoglycemia epidemiology   MeSH
• Hypoglycemic Agents administration & dosage   adverse effects   MeSH
• Insulin Aspart administration & dosage   MeSH
• Insulin Detemir administration & dosage   MeSH
• Humans MeSH
• Insulin, Isophane administration & dosage   MeSH
• Drug Administration Schedule MeSH
• Pregnancy in Diabetics * drug therapy   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH

Kazuistika popisuje postup v iniciální fázi léčby diabetu 2. typu u obézní pacientky s výraznou hyperglykemií při záchytu onemocnění za hospitalizace. Od úvodní intenzifikované inzulínové terapie s postupnou titrací dávky metforminu, následně je popsána ambulantní léčba cílená na redukci hmotnosti a postupné vysazení inzulínu s náhradou DPP-4 inhibitorem.

The case report describes the course of the initial treatment of type 2 diabetes mellitus in an obese female patient with a significant hyperglycemia at the time of the diagnosis during the hospitalization. The initial intensified treatment with insulin and gradual titration of the dose of metformin, then the out-patient treatment targeted on the weight loss and the gradual withdrawal of insulin treatment and the replacement by the DPP-4 inhibitor are described.

• Keywords
• sitagliptin,
• MeSH
• Patient Compliance MeSH
• Diabetes Mellitus, Type 2 * drug therapy   MeSH
• Glycated Hemoglobin drug effects   MeSH
• Weight Loss MeSH
• Hypoglycemic Agents therapeutic use   MeSH
• Dipeptidyl-Peptidase IV Inhibitors therapeutic use   MeSH
• Incretins therapeutic use   MeSH
• Insulin, Regular, Human administration & dosage   MeSH
• Drug Therapy, Combination * MeSH
• Middle Aged MeSH
• Humans MeSH
• Metformin * administration & dosage   MeSH
• Insulin, Isophane administration & dosage   MeSH
• Obesity diet therapy   MeSH
• Pyrazines administration & dosage   MeSH
• Triazoles administration & dosage   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Kontinuální monitorace glykemie (CGM) je efektivním nástrojem pro snížení HbA1c při dlouhodobém používání. Efektivita této metody při intermitentním používání zatím nebyla v klinických hodnoceních doložena. Kazuistika demonstruje případ pacientky s diabetem 1. typu, u níž došlo ke zlepšení kompenzace pomocí intermitentní CGM třikrát ročně po dobu jednoho týdne při léčbě intenzifikovaným inzulínovým režimem.

Continuous glucose monitoring (CGM) is an effective tool for lowering HbA1c, when used in a long-term setting. The effectiveness of this method with an intermittent use has not been confirmed in clinical studies yet. The case study presents a type 1 diabetic patient on the multiple daily injections insulin treatment. She improved her metabolic control after introducing CGM for one week, three times per year.

• Keywords
• selfmonitoring,
• MeSH
• Patient Compliance MeSH
• Angiotensin II Type 1 Receptor Blockers administration & dosage   MeSH
• Diabetes Mellitus, Type 1 diagnosis   diet therapy   drug therapy   MeSH
• Insulin, Long-Acting administration & dosage   MeSH
• Adult MeSH
• Dyslipidemias complications   MeSH
• Financing, Organized MeSH
• Hyperglycemia MeSH
• Hypertension complications   MeSH
• Hypoglycemia prevention & control   MeSH
• Hypoglycemic Agents therapeutic use   MeSH
• Insulin Aspart administration & dosage   MeSH
• Insulin, Regular, Human administration & dosage   MeSH
• Insulin administration & dosage   MeSH
• Humans MeSH
• Insulin, Isophane administration & dosage   MeSH
• Obesity complications   MeSH
• Blood Glucose Self-Monitoring methods   utilization   MeSH
• Patient Education as Topic MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Cystic fibrosis related diabetes (CFRD) is an insulinopenic condition. We aimed to detect insulinopenia early and to evaluate the impact of low dose insulin on nutritional status and forced expiratory volume in first second (FEV1). Out of 142 cystic fibrosis patients (CFpts) older than 10 years, 28 with abnormal oral glucose tolerance test in spite of normal fasting glycemia were found to have decreased first phase insulin release and started low dose insulin therapy (median age 15.4 years). Sex and age matched CFpts with normal glucose tolerance (NGT) were observed for comparison. Whereas nutritional status improved following 3 years of insulin administration, FEV1 stabilized in insulin-treated insulinopenic subjects (73.8 +/- 4.3% vs. 73.5 +/- 4.4%), but decreased in the parallel group with NGT who remained without insulin treatment (71.1 +/- 3.8% vs. 61.0 +/- 4.0%; p = 0.001). We conclude that low dose insulin improves nutritional status and stabilizes pulmonary functions. Regular estimation of stimulated insulin secretion in CFpts may allow optimizing treatment.

• MeSH
• Early Diagnosis MeSH
• Time Factors MeSH
• Cystic Fibrosis complications   MeSH
• Child MeSH
• Glucose Tolerance Test MeSH
• Glycated Hemoglobin analysis   MeSH
• Hypoglycemic Agents administration & dosage   therapeutic use   MeSH
• Insulin Resistance MeSH
• Cohort Studies MeSH
• Blood Glucose analysis   MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Insulin, Isophane administration & dosage   therapeutic use   MeSH
• Lung drug effects   physiopathology   MeSH
• Glucose Intolerance blood   complications   drug therapy   physiopathology   MeSH
• Prediabetic State blood   complications   drug therapy   physiopathology   MeSH
• Prospective Studies MeSH
• Respiratory Function Tests MeSH
• Case-Control Studies MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Předložené sdělení se zabývá problematikou správné aplikace NPH inzulínu. Nejprve se věnuje rozboru práce Keisera et al. Posouzení účinnosti promíchání zásobních vložek NPH (Neutral Protamine Hagedorn Cartridges). Dále jsou diskutovány další práce zabývající se způsobem a možnými důsledky různého způsobu aplikace NPH inzulínu. Po zhodnocení dostupných studií autoři došli k závěru, že Insuman Basal je jediná zásobní vložka, která zajistí účinné promíchání obsahu cartridge i při nízkém počtu překlopení zásobní vložky (3x až 6x).

The presented report addresses the problem of a correct administration of NPH insulin. Firstly, we analyze the paper by Keiser at. al. Assessment of the Mixing Efficiency of Neutral Protamine Hagedorn Cartridges. Then we discuss other papers dealing with the way and possible consequences of different ways of administration of NPH insulin. Following assessment of available studies, the authors concluded that Insuman Basal was the only cartridge that ensured effective mixing of its content even if the cartridge was turned up and down only a few times (3-6).

• Keywords
• cartridge, správná aplikace inzulínu,
• MeSH
• Reimbursement Mechanisms utilization   MeSH
• Diabetes Mellitus therapy   MeSH
• Financing, Organized MeSH
• Hypoglycemia prevention & control   MeSH
• Humans MeSH
• Insulin, Isophane administration & dosage   MeSH
• Drug Administration Schedule MeSH
• Check Tag
• Humans MeSH