Type 2 diabetes is a disorder characterized by insulin resistance and progressive deterioration of B-cell insulin secretion. B-cell protective strategies for lowering glucolipotoxicity by rapid achievement of normoglycemia using exogenous insulin improve their function and prolong diabetes remission. Insulin pump is an effective treatment method in newly diagnosed diabetes, where even short-term pump therapy is B-cell protective. Combination therapy with insulin pump and antidiabetics targeting the incretin system acts in synergy to protect the B-cell. While the positive effect of insulin pump is apparent even a year after stopping the therapy, the effect of incretins lasts only while on the medication. Short-term insulin treatment, especially delivered by insulin pump, is an effective method of B-cell protection in recent type 2 diabetes.Key words: B-cell function - diabetes mellitus - insulin pump - insulin resistance - type 2 diabetes.

• MeSH
• beta-buňky metabolismus   MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• hypoglykemika aplikace a dávkování   terapeutické užití   MeSH
• inkretiny metabolismus   MeSH
• inzulin aplikace a dávkování   terapeutické užití   MeSH
• inzulinová rezistence MeSH
• inzulinové infuzní systémy MeSH
• krevní glukóza účinky léků   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH
• inkretiny MeSH
• inzulin MeSH
• krevní glukóza MeSH

During the last decades, metabolic syndrome has become an important healthcare problem worldwide. Main components of metabolic syndrome are insulin resistance (resulting often in impaired glucose tolerance and diabetes mellitus), dyslipidemia, hypertension and abdominal obesity. Incidence of metabolic syndrome is high and it substantially increases the risk of cardiovascular diseases. Dyslipidemia is a prominent factor contributing to the increased cardiovascular risk in metabolic syndrome, and lipid-lowerign therapy plays an important role in treating patients with this disorder. Most patients with dyslipidemia are treated with statins and/or fibrates. Statins are used for treatment of hypercholesterolemia; fibrates are indicated for treatment of hypertriglyceridemia and/or low HDL-cholesterol. In high risk patients with severe mixed hyperlipidemia, combination ofstatins with fibrates may be necessary to achieve the lipid goals.

• MeSH
• chování snižující riziko MeSH
• dyslipidemie krev   komplikace   farmakoterapie   MeSH
• lidé MeSH
• lipidy krev   MeSH
• metabolický syndrom komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• lipidy MeSH

The author presents a list of physical activity effects in metabolic and cardiovascular adaptation and current knowledge of the molecular mechanism of the effect of exercise on insulin resistance. The main principles for the prescription of exercise therapy for patients with metabolic syndrome are presented. The role of patient motivation and compliance is emphasised as part of a complex approach to the treatment of metabolic syndrome; it has a substantial influence on the results of treatment.

• MeSH
• lidé MeSH
• metabolický syndrom patofyziologie   terapie   MeSH
• terapie cvičením * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Fat accumulation is an important pathogenetic factor in metabolic syndrome. Weight reduction, at the same time, has a positive effect on metabolic syndrome components. Lifestyle changes are important in the treatment of obesity although they are usually unlikely to provide permanent effect. At present, bariatric surgery and pharmacotherapy represent easily accessible and effective treatment options. In addition, bariatric surgery often results in full remission of type 2 diabetes. Unlike older anti-obesity agents, currently available anti-obesitics sibutramine and orlistat might be taken long-term for years, allowing avoidance of the typical weight increase following treatment completion phenomenon. Furthermore, both agents provide broad therapeutic effect as they affect all components ofmetabolic syndrome. The weigh of obese patients with impaired glucose tolerance and increased fasting glycaemia might be reduced with metformin. A range of other substances is in development, of which incretin analogues, expected to be used in obese non-diabetic patients, appear the most promising. Bariatric surgery decreases significantly mortality of obese patients with metabolic syndrome. It is likely that mortality reduction following the use of anti-obesity agents will soon be proven as well.

• MeSH
• bariatrická chirurgie MeSH
• látky proti obezitě terapeutické užití   MeSH
• lidé MeSH
• metabolický syndrom komplikace   MeSH
• obezita komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• látky proti obezitě MeSH

Hypertension in metabolic syndrome is common. Basic principles of therapeutic approach like decrease of body weight are discussed. Goal blood pressure levels are < or = 130/80mm Hg. ACE-inhibitors/AT1-blockers are considered drugs of choice. In most cases it is necessary to combine at least two drugs. Preferred combination is ACE-inhibitor/AT1-blocker + calcium channel blocker.

• MeSH
• antihypertenziva terapeutické užití   MeSH
• hypertenze komplikace   farmakoterapie   patofyziologie   MeSH
• krevní tlak MeSH
• lidé MeSH
• metabolický syndrom komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antihypertenziva MeSH

Incretin therapy includes treatment with incretin analogues (exenatid and liraglutid) and so called incretin enhancers (gliptins and DPP-4 inhibitors respectively--sitagliptin, vildagliptin, saxagliptin, linagliptin). In patients with type 2 diabetes, this novel antidiabetic treatment usually leads to successful reduction in fasting as well as postprandial glycaemia and glycosylated haemoglobin. At the same time, it importantly improves all components of metabolic syndrome (dyslipidemia, hypertension, systemic inflammation). Incretin analogues also reduce body weight while DPP-4 inhibitors are weight-neutral. Both groups of drugs are expected to have positive cardiovascular effects, although it is not clear whether these are likely to be direct or indirect, i.e. facilitated by improved compensation of metabolic syndrome components.

• MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• inkretiny agonisté   terapeutické užití   MeSH
• krevní tlak účinky léků   MeSH
• lidé MeSH
• metabolický syndrom farmakoterapie   patofyziologie   MeSH
• tělesná hmotnost MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• inkretiny MeSH

Hyperglycaemia is a typical feature of metabolic syndrome (MeTS) and one of its independent diagnostic criteria. The term includes impaired glucose homeostasis (impaired fasting glucose and impaired glucose tolerance) and type 2 diabetes mellitus. Although glycaemic control has been shown to lower the risk of microvascular events, the effect of intensive glycaemic control on macrovascular outcomes is less clear. Epidemiological studies show hyperglycaemia, particularly the postprandial one, to be a clear risk factor for cardiovascular (CV) mortality and morbidity. However, the intervention studies are less conclusive. The large interventional studies published in 2008 and 2009 (UKPDS, VADT, ACCORD, ADVANCE, RECORD) advocate the controlling of nonglycemic risk factors (through blood pressure control, lipid lowering with statin therapy, aspirin therapy, and lifestyle modifications) as the primary strategies for reducing the burden of CV disease in people with diabetes, and demonstrated the need for individualized approach to the patients' care in terms of blood glucose control. The patients with shorter duration of type 2 diabetes and without established atherosclerosis might reap CV benefit from intensive glycemic control. Conversely, it is possible that potential risks of intensive glycaemic control (hypoglycaemia) may outweigh its benefits in other patients, such as those with a very long duration ofdiabetes, known history of severe hypoglycemia, advanced atherosclerosis, and advanced age/frailty. According to the latest recommendations of the Czech Diabetes Society that are in line with the European and US standards the best way to protect type 2 diabetic patients against coronary and cerebrovascular disease is to target all cardiovascular risk factors (blood pressure treatment, including lipid-lowering with statins, aspirin prophylaxis, smoking cessation, and healthy lifestyle behaviors hypertension, dyslipidemia, obesity and other symptoms of metabolic syndrome. The target HbA1c levels in patients with the low CV risk shoul be below 4.5%. Less strict goals (HbA1c below 6%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, or extensive comorbid conditions or those with long-standing diabetes. The individual targets should be achieved safely (without hypoglycaemias). Slow advancing in diabetes compensation is preferred. Lifestyle changes are the cornerstone of therapy. Metformin is the drug of choice; its administration, together with lifestyle changes, should be initiated immediately after the diagnoses of diabetes. If monotherapy does not provide satisfactory glucose control, other oral antidiabetic agents or insulin are added to the combination. Since it is not known which hypoglycaemic agents are beneficial from the perspective of long-term patient prognosis, the selection is liberal. Contraindication of the various farmaceuticals must be respected. It is possible to use a range of different combinations, metformin is administered with a glitazone (zero risk of hypoglycaemias is the advantage) with sulphonylurea derivatives (low price is the advantage) with glinides, with incretins, acarbose, antiobesity agents or insulin. The next step is a triple combination of hypoglycaemic agents with different mechanisms of action. Therapy also includes education focusing on changes to dietary and lifestyle habits, including smoking cessation, and education related to the prevention of complications, with particular regard to prevention of diabetic foot and atherosclerosis.

• MeSH
• diabetes mellitus 2. typu krev   komplikace   farmakoterapie   MeSH
• hypoglykemika MeSH
• krevní glukóza analýza   MeSH
• lidé MeSH
• metabolický syndrom komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH
• krevní glukóza MeSH

Dyslipidemia, often present in patients with metabolic syndrome and chronic kidney disease, contributes to increased cardiovascular risk and progression of renal impairment. In these patients, the probability of death from cardiovascular complications is higher than death consequent to terminal renal failure. Positive neuroprotective effects ofstatins and fibrates are being attributed to hypolipidemic as well as other, lipid-unrelated, properties. Statins are able to slow down the decline in glomerular filtration rate and may decrease proteinuria. Nevertheless, conclusive evidence that statins decrease the incidence of cardiovascular complications in patients with advanced chronic kidney disease is still lacking. Through their effect on albuminuria, fibrates contribute to slowing down ofthe progression of diabetic nephropathy. Controlled trials and clinical practice have shown that monotherapy with statins as well as fibrates is safe. Management of combined dyslipidemia requires, apart from the selection of a suitable statin-fibrate combination, careful monitoring of potential adverse effects and treatment tolerability and compliance. The results of the Czecho-Slovakian pivot study KOLCHRI have demonstrated the efficacy and safety of fenofibrate combined with low dose statin in patients with metabolic syndrome and stage 2-4 chronic kidney disease.

• MeSH
• chronická renální insuficience komplikace   patofyziologie   MeSH
• dyslipidemie komplikace   farmakoterapie   MeSH
• hypolipidemika škodlivé účinky   terapeutické užití   MeSH
• kyselina klofibrová škodlivé účinky   terapeutické užití   MeSH
• lidé MeSH
• metabolický syndrom komplikace   MeSH
• statiny škodlivé účinky   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypolipidemika MeSH
• kyselina klofibrová MeSH
• statiny MeSH

Studies over the past 30 years have revealed that adipose tissue is the major endocrine and paracrine organ of the human body. Arguably, adiopobiology has taken its reasonable place in studying obesity and related cardiometabolic diseases (CMDs), including Alzheimer's disease (AD), which is viewed herein as a neurometabolic disorder. The pathogenesis and therapy of these diseases are multiplex at basic, clinical and translational levels. Our present goal is to describe new developments in cardiometabolic and neurometabolic adipobiology. Accordingly, we focus on adipose- and/or skeletal muscle-derived signaling proteins (adipsin, adiponectin, nerve growth factor, brain-derived neuroptrophic factor, neurotrophin-3, irisin, sirtuins, Klotho, neprilysin, follistatin-like protein-1, meteorin-like (metrnl), as well as growth differentiation factor 11) as examples of metabotrophic factors (MTFs) implicated in the pathogenesis and therapy of obesity and related CMDs. We argue that these pathologies are MTF-deficient diseases. In 1993 the "vascular hypothesis of AD" was published and in the present review we propose the "vasculometabolic hypothesis of AD." We discuss how MTFs could bridge CMDs and neurodegenerative diseases, such as AD. Greater insights on how to manage the MTF network would provide benefits to the quality of human life.

• Klíčová slova
• Alzheimer’s disease, BDNF, Klotho, NGF, adipokines, adiponectin, cardiometabolic diseases, irisin, metabotrophic factors,
• MeSH
• adipokiny metabolismus   MeSH
• cílená molekulární terapie metody   MeSH
• lidé MeSH
• metabolický syndrom farmakoterapie   metabolismus   MeSH
• neurodegenerativní nemoci farmakoterapie   metabolismus   MeSH
• neuropeptidy metabolismus   MeSH
• neurotrofní faktory metabolismus   MeSH
• signální transdukce MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• adipokiny MeSH
• neuropeptidy MeSH
• neurotrofní faktory MeSH

Male hypogonadism and civilization diseases Age dependant decrease of testosterone levels leads in many men to hypogonadism called as late-onset hypogonadism. Morbidity and mortality of men with subnormal testosterone levels is higher than that of men sufficiently supplied with androgens. Cardiovascular diseases, obesity or diabetes take often part in these events. Low testosterone level is risk factor for these diseases. However, it is until now not clear whether testosterone deficiency is a cause or consequence of atherosclerosis or metabolic syndrome. A handful of symptoms and metabolic parameters present in hypogonadal men can be ameliorated by testosterone supplementation. Testosterone has a beneficial effect on cardiovascular risk factors, but it is not clear whether it can reduce mortality.

• MeSH
• diabetes mellitus etiologie   MeSH
• hormonální substituční terapie MeSH
• hypogonadismus komplikace   MeSH
• kardiovaskulární nemoci etiologie   MeSH
• lidé MeSH
• metabolický syndrom etiologie   MeSH
• testosteron nedostatek   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• testosteron MeSH