• MeSH
• komplikace diabetu patologie   terapie   MeSH
• lidé MeSH
• nemoci novorozenců patologie   terapie   MeSH
• nemoci plodu patologie   terapie   MeSH
• novorozenec MeSH
• prenatální diagnóza metody   MeSH
• prognóza MeSH
• riziko MeSH
• těhotenství při diabetu * patologie   terapie   MeSH
• těhotenství MeSH
• vedení porodu MeSH
• vrozené vady klasifikace   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• Publikační typ
• přehledy MeSH

The introduction of glucose sensors has been a major shift in glycemic self-monitoring. The aim of the study was to analyze the medical effect of Flash Glucose Monitoring (FGM) in type 1 diabetes patients at our clinic, in the context of the introduction of full reimbursement of FGM technology from public health insurance. We studied 64 women and 51 men (median age 42 years). All patients were treated with an intensified insulin regimen. No previous experience with any glucose sensors was reported by 61 patients (43%). Data on diabetes control prior to the introduction of the full FGM reimbursement (2019) and 12 months later (2020) were compared. Additionally, cost-effectiveness analysis was done. Diabetes control improved significantly (p = 0.001 for HbA1c interannual decrease). Results were influenced mainly by the number of applied sensors; surprisingly only 30 patients (29.6%) used all covered sensors. If we consider, for example, a decrease of the risk of the progression of diabetic kidney disease to the end stage of chronic renal failure by 1/3 (due to diabetes control improvement which is achieved by using glucose sensors), there will also be an economic benefit as the cost-effectiveness ratio was calculated for this model situation 6 and the net cost of USD 7,281. The financial barrier is clearly not the only barrier to the widespread use of modern technologies. The results of the study led to the implementation of long-term nudge strategies targeted at both patients and health professionals in our center to improve patients' prognosis.

• MeSH
• analýza nákladové efektivity MeSH
• analýza nákladů a výnosů MeSH
• diabetes mellitus 1. typu prevence a kontrola   MeSH
• kontinuální monitorování glukózy MeSH
• lidé MeSH
• retrospektivní studie MeSH
• selfmonitoring glykemie * metody   MeSH
• úhrada zdravotního pojištění MeSH
• zdravotní pojištění ekonomika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

In women with chronic autoimmune thyroiditis and vitamin D deficiency we have found reference levels of relevant metabolic-hormonal parameters except for parathormone and total calcium. Three months supplementation with vitamin D (4300 IU/day, cholekalciferol) did not lead to significant changes of investigated hormonal parameters, while the levels of parathormone and calcium reached normal levels. However, a correlation analysis revealed marked changes in mutual relations. First, an inverse correlation of vitamin D with parathormone, insulin secretion (C peptide, insulin) and its efficiency (HOMA IR) disappeared. Relationships of vitamin D to hepatic insulin resistance (insulin/C peptide), to DHEA (both negative), and to DHEAS/DHEA ratio (positive) were newly found. Second, a positive correlation of CRP with insulin secretion remained, while its relation to insulin efficiency (HOMA IR, insulin/C peptide) was newly observed. Analogical positive correlations appeared also among anti TPO and insulinemia, insulin/C peptide, HOMA IR, and anti Tg to C peptide. A relationship of the CRP with anti TPO became significant (+). Third, out of glucose metabolism parameters only insulin/C peptide and glycemia did not correlate with vitamin D during its deficiency, while after supplementation insulin/C peptide alone correlated positively with both DHEAS and DHEA, and negatively with vitamin D.

• MeSH
• autoimunitní tyreoiditida krev   farmakoterapie   epidemiologie   MeSH
• dospělí MeSH
• krevní glukóza účinky léků   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nedostatek vitaminu D krev   farmakoterapie   epidemiologie   MeSH
• potravní doplňky MeSH
• vitamin D aplikace a dávkování   krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

There is a lack of data on the state of iodine reserves and the possible consequences of iodine deficits in diabetic patients. The main aims of this study were to: a) obtain information about iodine saturation in patients with type 1 diabetes; b) determine to what extent this saturation differs from the non-diabetic population; and c) determine whether iodine levels are related to several clinical and laboratory parameters characteristic of diabetic syndrome, including thyroid status. Subjects and methods: A total of 54 males and 51 females treated for type 1 diabetes mellitus (DM1) were included in this cross-sectional study. In addition to iodine saturation determined as the concentration of iodine in the first urine sample of the day, we measured clinical, anthropometric, and biochemical parameters in relation to DM1. Results: Measured iodine levels were: median 152 μg/l, first quartile 117 μg/l, and third quartile 219 μg/l. More than 50% of iodine levels varied within the optimal saturation range of 100–200 μg/l, while about 14% showed incomplete saturation (<100 μg/l), and 34% had increased saturation (>200 μg/l). Multi-dimensional regression showed significant positive relationships; (an OPLS model explaining 9% of the variability) between ioduria and male sex, body weight and height, and serum creatinine levels, which to date have not yet been published. Relationships to the other analyzed parameters (glycated hemoglobin, insulin dose, DM duration, body mass index, microalbuminuria, glomerular filtration rate, thyroid function and volume, thyroid autoimmune markers) were not significant. Conclusions: Iodine saturation levels in our study group were within the ICCIDD (WHO) recommendations for optimal/good saturation for the non-diabetic population, and patients with diabetic syndrome did not differ with respect to the chosen normal ioduria concentrations, i.e. 100 or 150 μg/l. The question remains, however, whether past attempts to deal with iodine deficits in the Czech Republic are responsible for this satisfactory iodine status of the type 1 diabetic population, or if there are other factors involved.

• MeSH
• albuminurie diagnostické zobrazování   MeSH
• autoprotilátky krev   MeSH
• diabetes mellitus 1. typu * patofyziologie   MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace MeSH
• jod metabolismus   moč   nedostatek   MeSH
• jodidperoxidasa imunologie   krev   MeSH
• kreatinin krev   MeSH
• lidé MeSH
• thyreotropin krev   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

Úvod: O stavu zásobení jodem a důsledcích ev. jodového deficitu jsou u nemocných s diabetem obou typů k dispozici překvapivě jen sporadická data. Hlavním cílem naší studie bylo získat základní informace (a) o stavu saturace jodem u diabetiků 1. typu, (b) do jaké míry se odlišuje od nediabetické populace, (c) zda zásobení jodem souvisí s některými klinickými a laboratorními charakteristikami diabetického syndromu, včetně stavu štítné žlázy. Soubor a metody: Bylo vyšetřeno 54 mužů a 51 žen léčených pro diabetes mellitus 1. typu (DM1T). Studie má průřezový charakter. Saturaci jodem jsme posuzovali podle koncentrace jodu ve vzorku první ranní moči. Výsledky: Jodurie v celém souboru: medián 152 μg/l, 25. kvartil 117 μg/l, 75. kvartil 219 μg/l. Více než 50 % vyšetřených jodurií se pohybovalo v pásmu optimální saturace (100–200 μg/l), 13 % v pásmu nedostatečné saturace (< 100 μg/l), v pásmu zvýšené saturace (> 200 μg/l) bylo 35 % pacientů. Využitím vícerozměrné regrese dat jsme prokázali významnou pozitivní závislost mezi jodurií a mužským pohlavím, hmotností, výškou a kreatininem v séru. K hodnotě HbA1c, dávce inzulinu, trvání diabetes mellitus, BMI, mikroalbuminurii, eGF a ukazatelům funkce a volumu štítné žlázy včetně markerů tyreoidální autoimunity se významné korelace neprokázaly. Závěrem lze konstatovat: Saturace jodem u námi vyšetřovaných nemocných s DM1T odpovídala ICCIDD (WHO) požadavkům na optimální/dobrou saturaci u nediabetické populace. S ohledem na zvolenou normální koncentraci jodurie, to je 100, resp. 150 μg/l se obraz diabetického syndromu nelišil. Otázka, zda se na dobrém stavu zásobení populace pacientů s DM1T jodem podílejí ještě jiné faktory než opatření podniknutá v minulosti pro řešení jodového deficitu v České republice, by měla být předmětem dalšího výzkumu na větších souborech nemocných.

Introduction: In patients with type 1 and 2 diabetes mellitus only rare data concerning the status of iodine supplementation and impact of possible iodine deficiency is available. Aim: To get basic information about (a) state of supply with iodine in patients with type 1 diabetes mellitus (DM1T), (b) the difference from non-diabetic population, (c) possible association of iodine saturation with some clinical and laboratory features of the diabetic syndrome, including the state of thyroid gland. Subjects and methods: We examined 54 men and 51 women treated with DM1T in a cross-sectional study. Age: median 42 years (25th quartil 31, 75th quartil 55), DM1T duration: 18 years (13, 23), BMI: 25.9 (23.3, 29.7), HbA1c: 61 mmol/mol (51, 71), creatinine: 71 μmol/l (61, 83), micro-albuminuria 4.3 μg/min (1.9, 11.8), TSH: 1.77 mIU/l (1.12, 2.80). The iodine saturation was evaluated using iodine concentration in a sample of first morning urine. Results: Urinary iodine concentration in the whole group: median 152 μg/l, 25th quartile 117 μg/l, 75th quartile 219 μg/l. More than 50 % of the urinary iodine samples fell within range of optimal saturation (100–200 μg/l), 13 % within insufficient saturation (< 100 μg/l), 35 % of the samples showed increased saturation (> 200 μg/l), in which 2/3 were men. Using multiple regression analysis we found significant positive association of urinary iodine concentration and male gender, body weight, stature, and serum creatinine. No relation between urinary iodine and clinical and laboratory features of the diabetic syndrome was found. Conclusions: Iodine saturation in examined patients with DM1T was in accordance with ICCIDD (WHO) requirements for optimal/good saturation in non-diabetic population. With respect to the chosen normal urinary iodine concentration, eg. 100, resp. 150 μg/l the features of diabetic syndrome were not different. The question whether other factors than general measures taken in the past for solution of the iodine deficiency in the Czech Republic are involved in good level of iodine saturation in patients with DM1T should be addressed in further investigations comprising larger cohorts of patients.

• MeSH
• albuminurie moč   MeSH
• diabetes mellitus 1. typu * komplikace   krev   moč   MeSH
• dospělí MeSH
• glykovaný hemoglobin metabolismus   MeSH
• hodnoty glomerulární filtrace MeSH
• hormony štítné žlázy krev   MeSH
• index tělesné hmotnosti MeSH
• jod * moč   nedostatek   MeSH
• kreatinin krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• průřezové studie MeSH
• regresní analýza MeSH
• štítná žláza ultrasonografie   MeSH
• vitamin D krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH