The results of randomized double-blind studies provide scientifically accurate data on the efficacy of antidiabetic drugs. With the widening understanding of heterogeneity of the group of patients with type 2 diabetes mellitus and the broadening possibilities of interventions available, a differentiated approach to therapy is now accentuated. From the perspective of pathophysiology, 8-10 different disorders have been described which contribute to the occurrence of hyperglycemia, but they cannot be quantified in common practice. However, it is possible to evaluate the amount of insulin secretion (C-peptide), the presence or severity of insulin resistance (triacylglycerols), glomerular filtration and, of course, patient compliance. The strategic goal of treatment of diabetes mellitus is to reduce the risk of late complications, both specific and non-specific (atherosclerotic), and if they arise, then slowing-down of their progression. All of this as a means of reducing mortality and improving quality of life. The tactics of therapy for type 2 diabetes mellitus must first of all be chosen individually. We bear in mind the general circumstances (life expectancy, comorbidities, age, compliance, social background, type of work) and specific characteristics of the current development of diabetes (the dominant nature of metabolic disorder, the level of preservation of insulin secretion or response to prandial stimulation, presence and progression of complications). A timely combination of 2 or more antidiabetic drugs targeting individual pathophysiological mechanisms can be considered useful.

• Klíčová slova
• antidiabetics, compliance, therapy failure, type 2 diabetes mellitus,
• MeSH
• diabetes mellitus 2. typu * farmakoterapie   MeSH
• hypoglykemika * terapeutické užití   MeSH
• inzulin * terapeutické užití   MeSH
• kvalita života MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• hypoglykemika * MeSH
• inzulin * MeSH

In the genesis and development of type 2 diabetes in the great majority of subjects the contemporary lifestyle characterized by inadequate physical activity and an excessive energy intake is of basic importance. The majority of abnormalities and defects revealed by laboratory tests is probably secondary and caused by the above mentioned factors. Contemporary views of the etiopathogenesis of the disease are demotivating for patients: if the cause of their disease were an inborn disorder at the level of transmission of a signal on membranes then probably nothing else can be done than to take prescribed drugs. If the mistake involves the lifestyle, the latter can be changed and the disease avoided. Any medicamentous treatment is associated with the risk of undesirable effects--the complication of hyperinsulinism in treatment with sulphonyl urea derivatives and insulin or lactate acidosis after treatment with biguanides. This risk is not influenced by early prevention: dietary restraint and adequate physical exercise. Diabetes type 2 and 1--despite the common sign of hyperglycaemia--are characterized by a fundamental difference: (not influenced by treatment) DM type 1 is characterized by enhanced catabolic processes, starvation at the cellular level. Type 2 is characterized by enhanced anabolic processes, excessive amounts of nutrients in cells. The authors submit recommendations which respect the secondary character of deviations for the development of DM 2 which can be detected by laboratory methods: The following are the basic etiopathogenetic mechanism for the development of DM 2: 1. Chronic excessive intake and inadequate output of energy a) increased nutrient supply to the liver with secondary increase of gluconeogenesis in the liver, b) chronic increased supply of glucose to peripheral tissues, in particular muscles and adipose tissue, inadequate physical exercise, with secondary restriction of nutrient supplies to these tissues. 2. Secondary affection of insulin secretion in the islets of Langerhans in the pancreas.

• MeSH
• diabetes mellitus 2. typu etiologie   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

The article informs about current views of the ethiopathogenesis of type 2 diabetes mellitus (DM). It presents diabetes as a disease which is chronic and progressive, therefore requiring a dynamic approach to treatment. Based on the above concept, the article lists the current armamentarium of oral antidiabetic drugs and the possibilities of their combining. In addition to the existing therapeutic options, it also brings information about innovative drugs from the above group to be made available in the near future.

• MeSH
• aplikace orální MeSH
• diabetes mellitus 2. typu farmakoterapie   patofyziologie   MeSH
• hypoglykemika aplikace a dávkování   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH

UNLABELLED: Type 2 diabetes mellitus is associated with a substantial increase in the risk of development of heart failure. The mechanisms causing this complication are complex and include coronary heart disease, myocardial changes induced by hypertension, increased aortic stiffness, arrhythmias, renal failure and last but not least by direct metabolic alterations causing diabetic cardiomyopathy. The heart failure could be induced by several drugs used for diabetes therapy. This review debates the current evidence of harms and benefits of diabetes treatment related to heart failure in the light of results of recent randomized trials. An increased risk of heart failure was reported with sulphonylureas, glizatones and some DPP4 inhibitors. In contrast a considerable risk reduction was demonstrated in the EMPA-REG OUTCOME trial using empagliflozin. KEY WORDS: aortic stiffness - arrhythmias - coronary heart disease - diabetes treatment - diabetic cardiomyopathy - hypertension - type 2 diabetes mellitus.

• MeSH
• diabetes mellitus 2. typu komplikace   farmakoterapie   MeSH
• hypoglykemika terapeutické užití   MeSH
• lidé MeSH
• srdeční selhání farmakoterapie   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH

Type 2 diabetes mellitus develops as a combination of genetic background and external factors. The disease development is caused by increased oxidative stress under various metabolic factors and in parallel by complex inflammatory reaction without clinical signs. The resulting subclinical inflammation is a consequence of defensive anti-inflammatory reactions. Such Type 2 diabetes conception brings various possibilities in the treatment and prevention.

• MeSH
• diabetes mellitus 2. typu patofyziologie   prevence a kontrola   terapie   MeSH
• glukosa fyziologie   MeSH
• inzulinová rezistence MeSH
• lidé MeSH
• lipidy fyziologie   MeSH
• oxidační stres MeSH
• zánět patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• glukosa MeSH
• lipidy MeSH

A new class of drugs that affect incretin system has been introduced in clinical practice, and renal glucose reabsorption inhibitors are soon to follow. Clinical practice thus has an access to drugs with mechanisms of action that differ from those of the currently available antidiabetics, and extend our ability to influence the multifaceted metabolic disorder associated with the type 2 diabetes. Nonpeptide molecules affecting GLP1 receptor and insulin mimetics are being tested in clinical trials. Research also continues in metabolic modulators of nuclear receptors, glucagon receptor antagonists and cellular glucocorticoid inhibitors. Promising are the compounds that increase glucose utilization (glucokinase activators) and decrease its release (fructose-1,6-diphosphatase inhibitors). Gene therapy is also likely to be used for the treatment of type 2 diabetes and its complications.

• MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• hypoglykemika terapeutické užití   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hypoglykemika MeSH

Risk of type 2 diabetes mellitus (T2DM) is higher in tobacco smokers compared to non-smokers. The risk declines after smoking cessation. However, ex-smokers are also more prone to the metabolic syndrome. The question thus is, whether ex-smokers could temporarily have a higher risk of T2DM than current smokers. The available studies on this topic are not in agreement in their conclusions, as most of them also primarily do not compare ex-smokers to current smokers, but to non-smokers. However, based on the available studies, it rather seems the risk of T2DM is temporarily higher after smoking cessation. The higher risk of T2DM seems to be enhanced by weight gain that typically occurs first years after smoking cessation without intervention. Therefore, smoking cessation in patients who are in an increased risk of T2DM should be accompanied by T2DM preventative measures (lifestyle modification, weight monitoring and recommendation of pharmacotherapy of tobacco addiction to lower the risk of weight gain) and more frequent checks of blood glucose level to ensure early T2DM detection.

• Klíčová slova
• doppler ultrasound of uterine artery, hypoglycemia, risk factors, smoking, smoking cessation, type 2 diabetes mellitus,
• MeSH
• diabetes mellitus 2. typu * etiologie   MeSH
• hmotnostní přírůstek MeSH
• kouření škodlivé účinky   farmakoterapie   MeSH
• lidé MeSH
• odvykání kouření * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Hypoglycemia particularly severe one is important side effect of diabetes therapy with impact on patient´s quality of life and mortality. The highest risk of hypoglycemia is connected with insulin therapy followed by derivates of sulfonylurea (SU) and glinides. The risk of hypoglycemia found in observational studies were 2-3 times higher in patients treated with SU and 3-4 higher when treated with insulin compared with other types of antidiabetics. The risk of hypoglycemia is increased in patients over 75 years of age, with longer period of treatment with insulin and in those treated with several types of antidiabetics.

• Klíčová slova
• epidemiology, hypoglycemia, type 1 diabetes, type 2 diabetes,
• MeSH
• diabetes mellitus 1. typu * komplikace   farmakoterapie   MeSH
• diabetes mellitus 2. typu * komplikace   farmakoterapie   MeSH
• hypoglykemie * MeSH
• hypoglykemika terapeutické užití   MeSH
• inzulin MeSH
• kvalita života MeSH
• lidé MeSH
• senioři MeSH
• sulfonylmočovinové sloučeniny MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• hypoglykemika MeSH
• inzulin MeSH
• sulfonylmočovinové sloučeniny MeSH

Pathophysiological mechanisms accompanying Type 2 diabetes mellitus are the basement for the rational therapy of this disease. The finding of the relationship between impaired insulin secretion and its action including the regulatory mechanisms is of importance for successful treatment. In a review article there are included the most important pathways influencing therapeutical considerations in clinical practice.

• MeSH
• diabetes mellitus 2. typu farmakoterapie   patofyziologie   MeSH
• inzulin fyziologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• inzulin MeSH

Administration ofGLP-1 analogue resistant to DPPIV or therapeutic inhibition ofthe enzymes, allowing for an increase in the levels of GLP-1, are the very new approaches to the treatment of type 2 diabetes mellitus. Incretin therapy has an immense potential of improving unsatisfactory compensation in diabetic patients thus reducing the risk of manifestation of all arterial complications. Low fasting circulating levels of GLP-1 (and also GIP) grow rapidly after eating and are subsequently degraded to inactive forms by dipeptidyl peptidases IV (DPPIV). DPPIV are enzymes widely present in the body which proteolytically degrade GLP-1 and GIP (as well as other active substances). The preventing of their inactivation effect by administering DPPIV inhibitors allows for increasing the GLP-1 levels, which are reduced in type 2 diabetic patients, and subsequently improves glucose homeostasis in such patients. DPPIV inhibitors represent the principal new class of PAD, and their metabolic profile offers a number of unique clinical advantages for the treatment of patients with type 2 diabetes mellitus.

• MeSH
• diabetes mellitus 2. typu krev   farmakoterapie   MeSH
• glukagonu podobný peptid 1 antagonisté a inhibitory   fyziologie   MeSH
• inkretiny farmakologie   terapeutické užití   MeSH
• inzulin krev   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• glukagonu podobný peptid 1 MeSH
• inkretiny MeSH
• inzulin MeSH