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Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of General Practitioner / Praktický Lékař is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of General Practitioner / Praktický Lékař is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of General Practitioner / Praktický Lékař is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Continuous glucose monitoring (CGM) provides detailed information about the course of glycaemic changes during the day, which allows for a much more accurate setting of insulin therapy. Also, it offers new parameters, which can then be used in clinical practice to assess the degree of compensation for diabetes. The strongest indicator of glycaemic compensation is the percentage of time spent in the target glycaemic range, the so-called time-in-range (TIR). It is considered to range from 3.9 to 10 mmol/L. Since 2019, there have been specific TIR recommendations for different groups of diabetic patients (type 1 and type 2 diabetics, pregnant diabetics, and at-risk/fragile patients) that allow CGM results to be interpreted on a more individual basis. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Praktický Lékař is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hypoglycaemia is a consistent risk of the type 2 diabetes (T2DM) therapy, especially insulin or some older oral hypoglycaemic agents as the insulin secretagogues. It is also associated with various range of health disorders, increased cardiovascular risk or death. Hypoglycaemia can present with diverse symptoms or can be asymptomatic. Almost 10% of patients with T2DM suffer from hypoglycaemia unawareness. The risk of hypoglycaemia is associated with a level of glycaemic control and increases also with age, comorbidities and strength of diabetes therapy. Warning value, in which patients with diabetes should considered initiation of appropriate therapeutic steps, is the level of glycaemia 3.9 mmol/l. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Praktický Lékař is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

General Practitioner's surgery is the place where diabetes is diagnosed probably the most often. In case of MODY (Maturity Onset Diabetes of the Young) this is true more likely due to its characteristic features - diabetes onset in early age (before the age of 25 years) and usually mild hyperglycaemia. Despite a growing awareness of this relatively common type of diabetes, up to 90% of patients are classified incorrectly and remain hidden for a long time or permanently under the diagnosis of other types of diabetes, especially type 1 or 2. The aim of this article is to summarize the diagnostic criteria of MODY to help its early diagnosis, especially in those MODY patients concealed under the previously mislabelled type of diabetes. [ABSTRACT FROM AUTHOR]

• Vytvoření nové položky v Seznamu nemocí z povolání a Nařízení vlády o odškodnění pracovního úrazu a nemoci z povolání. • Změna hodnoty bodu ve vztahu k bolestnému a ztížení společenského uplatnění (ZSU) způsobené pracovním úrazem nebo nemocí z povolání ve formě 1 % průměrné mzdy v národním hospodářství. • Letáky pro poskytovatele zdravotních služeb a pacienty k rychlejší orientaci v položce chronické onemocnění bederní páteře. [ABSTRACT FROM AUTHOR]

Hypoglycaemia is a side effect primarily of the insulin, sulfonylurea derivates or glinides therapy. Management of hypoglycaemia is based on the immediate ingestion of carbohydrates – preferably glucose, in the recommended amount of 15–20 g. Several recent studies, however, suggest using amount calculated from the patient's body weight. The therapy of severe hypoglycaemia in the non-professional settings is still based on glucagon injection; in the professional ones the intravenous administration of glucose is the preferable option. Currently studies with the new forms and options of glucagon administration are finishing. [ABSTRACT FROM AUTHOR]

Maturity-onset Diabetes of the Young (MODY) is autosomal dominant-inherited, yet clinically heterogeneous type of diabetes. In case of prognostically benign GCK-MODY no specific antidiabetic treatment is required (with pregnancy as an exception). However, in MODY of transcription factors, especially HNF1A-MODY, but also in less common HNF4A-MODY, the therapy, traditionally based on sulphonylurea derivatives (alternatively on glinides), is necessary. In case of failure of this therapy (usually after the long duration of HNF1A-MODY and HNF4A-MODY) initiation of insulin therapy is required. Insulin is also the first drug of choice in HNF1B-MODY. Use of other hypoglycaemic agents is yet experimental and the promising effects of particularly incretin therapy and gliflozins (probably rather in combination) will be needed to verify in larger studies. This review summarizes current available information about therapeutical options in MODY patients. [ABSTRACT FROM AUTHOR]

Aims Islet cell autoantibodies are associated with autoimmune insulitis and belong to the diagnostic criteria of Type 1 diabetes mellitus. However, growing evidence suggests that autoantibodies are present in other types of diabetes. Here, we focus on the autoantibody incidence in Czech patients with maturity-onset diabetes of the young and analyse their functional relevance in terms of diabetes onset and control. Methods Autoantibodies against glutamic acid decarboxylase ( GAD) 65 and protein tyrosine phosphatase islet antigen 2 ( IA-2) were measured in a cohort of 28 Czech patients with maturity-onset diabetes of the young, all confirmed by genetic testing. Selected clinical data were correlated to the status and kinetics of autoantibodies. Results One quarter of patients with maturity-onset diabetes of the young examined (7/28; 25%) was positive for GAD or IA-2 autoantibodies. GAD autoantibodies were more prevalent (7/7) than IA-2 autoantibodies (1/7). The incidence of autoantibodies did not correlate with human leukocyte antigen status. The patients who were positive for the autoantibodies developed diabetes later than those who were autoantibody-negative, but had worse glycaemic control (increased HbA1c). Expression of autoantibodies decreased with any improvement of diabetes compensation. Only one patient did not correspond to the above and displayed signs of combined signs of maturity-onset diabetes of the young and Type 1 diabetes. Conclusions The data suggest transient but highly prevalent islet cell autoantibody expression in Czech patients with maturity-onset diabetes of the young. The autoantibodies were found in patients with delayed diabetes onset, and in times of insufficient diabetes control. As improvement of glycaemic control was associated with a decrease in levels of autoantibodies, their presence may reflect the kinetics of β-cell destruction induced by causes other than autoimmune ones. [ABSTRACT FROM AUTHOR]

Jan Brož,1 Denisa Janickova Zdarska,1 Jana Urbanova,2 Marek Brabec,3 Bohumila Krivska,4 Viera Donicova,5 Radka Stepanova,6 Emil Martinka,7 Milan Kvapil1 1Department of Internal Medicine, Second Faculty of Medicine, 2Center for Research on Diabetes, Metabolism and Nutrition, Second Department of Internal Medicine, Third Faculty of Medicine, Charles University, 3Institute of Computer Science of the ASCR, vvi, 4Sanofi, Prague, Czech Republic; 5Private Department of Diabetology, Internal Medicine and Metabolism, Kosice, Slovak Republic; 6ADDS sro, Brno, Czech Republic; 7National Institute of Endocrinology and Diabetology, Lubochna, Slovak Republic Background: Despite the improvements in insulin therapy, a large number of patients fail to achieve their target glycated hemoglobin (HbA1c) levels. Control of diabetes is often unsatisfactory because the patient does not know about the principles of successful insulin therapy (ie, blood glucose self-monitoring, the principles of insulin administration, titration, current dose adjustments, dietary recommendations, and physical activity preventive measures) or because these principles are applied incorrectly or insufficiently. Furthermore, the fear of hypoglycemia may lead to maintaining higher than recommended blood glucose levels. Methods/design: This is a noninterventional, international study focusing on a questionnaire survey of diabetes patients (patient-reported outcome) treated with insulin for at least 1 year. It is designed so that the data obtained reflect real access of patients to insulin treatment. The primary objective is to show the results of glycemic control of diabetes (HbA1c) achieved in diabetes patients treated with at least one dose of insulin. The secondary objective is to monitor the factors potentially affecting these results, which include the frequency and other characteristics of hypoglycemia, the frequency of blood glucose self-monitoring, and the effects produced when the results are employed in adjusting the therapy. Furthermore, the study investigates factors related to the principles of insulin administration, dietary regime, and exercise habits. The study will enroll a total of 1,500 patients with type 1 and type 2 diabetes in 150 centers: two-thirds in the Czech Republic and one-third in the Slovak Republic. Discussion: The study is primarily aimed at determining the percentage of insulin-treated diabetes patients reaching the recommended targets for glycemic control (HbA1c). Furthermore, it attempts to identify and describe in detail the factors of failure in achieving the therapeutic goals. An analysis of the data thus obtained may result in recommendations on how to reduce and eliminate all the identified negative factors in the future. Keywords: insulin therapy, glycemic control, HbA1c, hypoglycemia, education, diabetes regimen adherence

Background: Despite accessible diagnostics and treatment of hypertension, a high proportion of patients worldwide remain unaware of their diagnosis, and even more remain untreated. Several studies suggest that absence of comorbidities is a predictive factor for unawareness and consequently non-treatment of hypertension. There are only a few studies that have assessed the hypertension prevalence and management among apparently healthy individuals., Objective: The aim of the study was to assess and compare hypertension prevalence, awareness, treatment and control among apparently healthy individuals, patients with internal diseases, and patients with non-internal diseases., Methods: Data from standardised blood pressure measurements conducted during the Czech European Health Examination Survey 2014 and information on health status and health care use collected during the Czech European Health Interview Survey 2014 were analyzed. We focused on participants aged 25-64. Data were weighted on sex and age to ensure an appropriate sex and age structure of the population. The χ2-test and binary logistic regression analyses were used to compare distribution of cascade of care for hypertension between the health-status groups of respondents., Results: The final eligible sample consisted of 1121 participants. The prevalence of hypertension was 32.8% in the healthy group, 29.8% in the non-internal disease group and 52.4% in the internal disease group, (p < 0.001). Awareness was 54.1%, 59.1% and 85.2% respectively, (p < 0.001). Treatment was 44.2%, 52.6% and 86.4%, respectively, (p < 0.001). Among apparently healthy respondents 62.6% had their blood pressure measured by a medical professional in the last year, compared to 71.1% in the non-internal disease group and 91.7% in the internal disease group, (p < 0.001). Differences in hypertension control were not statistically significant., Conclusions: Generally, our data show a discordance in hypertension management within the Czech population. Apparently healthy individuals are the least aware of their diagnosis and the highest proportion of them remain untreated., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Berka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Fecal immunochemical test (FIT) once a year or colonoscopy once in 10 years is the option approved for colorectal cancer (CRC) screening for asymptomatic individuals aged ≥ 50 years in the Czech Republic. We analyzed participation in the screening program to determine possible improvements., Methods: In this observational cross-sectional study, data were collected from 4044 randomly chosen individuals from the Czech population (1866 men, 2178 women) aged ≥ 50 years by questionnaires. Individuals who underwent colonoscopy within the last 10 years or/and FIT within the last 2 years were classified as participants in the screening., Results: 1050 individuals underwent FIT, 464 colonoscopy, and 558 underwent both. Adjusted for age, gender, and education, a higher chance of participation in the screening was observed in groups of non-smokers (OR = 1.25; CI 1.05-1.48), ex-smokers (OR = 1.51; CI 1.26-1.83), consuming smoked meat products less than once a week (OR = 1.26; CI 1.09-1.45), practicing physical activity at least once a week (OR = 1.25; CI 1.03-1.51), hospitalized in the past 12 months (OR = 1.73; CI 1.47-2.05), or consulting a general practitioner (GP) in the past 12 months (OR = 2.26; CI 1.87-2.74). The chance of participation of individuals having a risk factor for CRC (obesity, smoking, diabetes, low physical activity, alcohol drinking) was not higher compared to those without the risk factors., Conclusion: Individuals with a tendency to a healthy lifestyle or being in recent contact with the healthcare system by various means, mainly visiting a GP, had a higher participation in the screening for CRC. Among groups with an increased risk for CRC, higher participation was not shown., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Today's diabetes-oriented telemedicine systems can gather and analyze many parameters like blood glucose levels, carbohydrate intake, insulin doses, and physical activity levels (steps). Information collected can be presented to patients in a variety of graphical outputs. Despite the availability of several technical means, a large percentage of patients do not reach the goals established in their diabetes treatment., Objective: The objective of the study was to evaluate the benefits of the Diani telemedicine system for the treatment of patients with type 1 diabetes mellitus., Methods: Data were collected during a 24-week feasibility study. Patients responded to the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire and a system evaluation questionnaire. The level of glycated hemoglobin (HbA 1c ) and the patient's body weight were measured, and the patient's use of the telemedicine system and their daily physical activity level were monitored. All data were sent from the patient's device to the Diani server using a real-time diabetes diary app. Wilcoxon and Friedman tests and the linear mixed effects method were used for data analysis., Results: This study involved 10 patients (men: n=5; women: n=5), with a mean age of 47.7 (SD 19.3) years, a mean duration of diabetes of 10.5 (SD 8.6) years, and a mean HbA 1c value of 59.5 (SD 6.7) mmol/mol. The median number of days the patients used the system was 84. After the intervention, the mean HbA 1c decreased by 4.35 mmol/mol (P=.01). The patients spent 18.6 (SD 6.8) minutes on average using the app daily. After the intervention, the number of patients who measured their blood glucose level at least 3 times a day increased by 30%. The graphical visualization of the monitored parameters, automatic transmission of measured data from the glucometer, compatibility, and interconnection of individual devices when entering data were positively evaluated by patients., Conclusions: The Diani system was found to be beneficial for patients with type 1 diabetes mellitus in terms of managing their disease. Patients perceived it positively; it strengthened their knowledge of diabetes and their understanding of the influences of the measured values on the management of their disease. Its use had a positive effect on the HbA 1c level., (©Martina Vlasakova, Jan Muzik, Anna Holubová, Dominik Fiala, Eirik Arsand, Jana Urbanová, Denisa Janíčková Žďárská, Marek Brabec, Jan Brož. Originally published in JMIR Formative Research (https://formative.jmir.org), 28.04.2023.)

The available literature suggests that the most significant barriers to undergoing colonoscopy in general include &#8220;fear of pain and discomfort&#8221;, &#8220;fear of bowel preparation&#8221;, as well as directly unrelated influences such as &#8220;lack of support from family and friends&#8221;, &#8220;busy family and work schedules&#8221;, &#8220;other health problems&#8221; and the current &#8220;fear of getting COVID-19 in hospital&#8221;. A marital union may play a positive role, previous cancer a negative one. Another important factor is that patients are not used to talking about their barriers spontaneously; a guided conversation is a useful tool. Respondents in this qualitative study addressed these barriers as significant in their answers.

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.

Nonsevere hypoglycemia in people with diabetes is usually treated with rapid-acting carbohydrate, of which glucose is the most suitable form. A quantity of 15 g is recommended and repeated after 15 min if hypoglycemia persists. This recommendation has not changed for several years despite the introduction of continuous glucose monitoring, newer and more flexible insulin regimens and improved insulin delivery. The present review has examined published studies that have explored how effectively defined amounts of carbohydrate treat nonsevere hypoglycemia in adults with insulin-treated diabetes. For most nonsevere episodes of hypoglycemia, the optimal treatment is 15 to 20 g of oral glucose. However, this dose may not be appropriate with many current insulins and insulin pump therapy, where doses of glucose may have to be individualized, based on body weight or type of insulin delivery system. Current guidelines on hypoglycemia treatment for newer glucose-lowering therapies may require re-evaluation., (Copyright © 2022 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Diabetes mellitus (type 2 diabetes in particular) and colorectal carcinoma are relatively frequent diseases in our population. At the same time, these units share some common risk factors, for example obesity, lack of physical activity and hyperinsulinemia. Available data show patients with diabetes have increased risk of colorectal adenoma and carcinoma, increased risk of colorectal carcinoma at a lower age, as well as increased risk of relapse and increased mortality with colorectal cancer. The aim of this article is to point out the relationship between diabetes and colorectal carcinoma, with emphasis on the information important for clinical practice, particularly the screening of colorectal carcinoma and lifestyle recommendations for patients with diabetes. Therefore, we offer an overview of the important available publications which consider this topic.

Objective: The aim of the study was to determine the prevalence of arterial hypertension and its awareness rate and control rate among diabetes mellitus (DM) patients in the Czech Republic between 25-64 years of age and to compare the results with those in age-matched non-diabetic patients., Materials and Methods: Blood pressure measurement data of 1 170 respondents (467 men and 703 women) obtained during the EHES study in 2014 were analysed. DM was diagnosed in 95 (8.2%) respondents (44 men and 51 women)., Results: Mean systolic blood pressure in DM patients was 130.7 ± 18.3 vs. 123.2 ± 16.8 mmHg in non-DM subjects (p &lt; 0.001). The difference in diastolic blood pressure was on the borderline of statistical significance (82.2 ± 9.4 mmHg in DM vs. 80.0 ± 10.6 mmHg in non-DM subjects, p = 0.051). Among the study population, 69.5% of DM and 34.2% of non-DM subjects suffered from arterial hypertension (p &lt; 0.001). The hypertension awareness rates were 87.9% in the DM group and 66.8 % in the non-DM group. (p = 0.001). The percentage of treated arterial hypertension was 94.8% in DM patients vs. 80.5% in the non-DM group (p = 0.010). The blood pressure target of &lt; 140/90 mmHg was achieved in 47.3% of DM patients vs. 60.6% in non-DM subjects (p = 0.077). Using a blood pressure target of &lt; 130/80 mmHg, adequate arterial hypertension control was achieved in only 29.1% of DM patients. When comparing the achievement of the blood pressure targets recommended for diabetic patients (&lt; 130/80 mmHg) and non-DM patients (&lt; 140/90 mmHg), the difference between these groups was statistically significant (p &lt; 0.001) in favour of the non-diabetic group., Conclusion: The study has shown the prevalence of arterial hypertension to be twice as high in DM patients aged 25-64 compared to the age-matched non-DM subjects in the Czech Republic. The adequate blood pressure control rate is significantly lower in DM patients than in the non-diabetic population. The study results indicate that the blood pressure targets recommended for diabetic patients (&lt; 130/80 mmHg) are not always reached in clinical practice.

Choosing wisely in metabolic and endocrine diseases shows the inutility of some, in clinical practice often used, ways of management. In diabetology, the routine recommendation for selfmonitoring of type 2 diabetic patients not treated with insulin represents a contraversial issue. On the contrary, there is a consensus on rational targets of glycemic control in elderly frailty patients with limited life expectancy. In endocrinology (thyroid diseases), the iniciative fights against the overuse of some laboratory examinations and ultrasonography. The recommendations on the rational indications of densitometry are discussed. In conclusion, these recommendations within Choosing wisely initiative of different professional associations usualy arise from expert views, supported by relevant clinical studies. They represent a challange to think over rational management of care.

Alarms in continuous glucose monitoring systems (CGM) represent a very important feature enabling to patients with diabetes who use these systems to keep their blood glucose level in the target range and to avoid excursion to hypoglycemia or hyperglycemia. The possibility to warn the patient that the target range has been crossed means one of the main advantages of CGM over the selfmonitoring of blood glucose with personal glucometers, but also (so far) flash glucose monitoring systems. However, there is surprisingly few studies concerning specifically the relationship between the alarms settings and glucose control. Therefore, there are currently no recommendations nor guidelines for optimal settings of alarms in CGM. Limited number of studies suggest that the setting of the hypoglycemia alarm to a level higher than 4 mmol/L is associated with lower frequency and shorter duration of hypoglycemia, and may be temporarily increased to 6 mmol/L in patients with impaired hypoglycemia awareness.

The glycemic response to ingested glucose for the treatment of hypoglycemia following exercise in type 1 diabetes patients has never been studied. Therefore, we aimed to characterize glucose dynamics during a standardized bout of hypoglycemia-inducing exercise and the subsequent hypoglycemia treatment with the oral ingestion of glucose. Ten male patients with type 1 diabetes performed a standardized bout of cycling exercise using an electrically braked ergometer at a target heart rate (THR) of 50% of the individual heart rate reserve, determined using the Karvonen equation. Exercise was terminated when hypoglycemia was reached, followed by immediate hypoglycemia treatment with the oral ingestion of 20 g of glucose. Arterialized blood glucose (ABG) levels were monitored at 5 min intervals during exercise and for 60 min during recovery. During exercise, ABG decreased at a mean rate of 0.11 ± 0.03 mmol/L·min -1 (minimum: 0.07, maximum: 0.17 mmol/L·min -1 ). During recovery, ABG increased at a mean rate of 0.13 ± 0.05 mmol/L·min -1 (minimum: 0.06, maximum: 0.19 mmol/L·min -1 ). Moreover, 20 g of glucose maintained recovery from hypoglycemia throughout the 60 min postexercise observation window.