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Comprehensive evaluation of the occurrence and perception of hypoglycemia in patients with type 1 diabetes mellitus
Zadáková, Eliška ; Horová, Eva (advisor) ; Škrha, Jan (referee)
Backround: For many patients with Type 1 diabetes mellitus (T1DM), hypoglycemia is a major obstacle to achieving satisfactory compensation. Hypoglycemia unawareness is present in approximately 25 % of patients with T1DM. We use the validated Gold Score and Clarke Score questionnaires in combination with data from continuous (CGM) or instantaneous (FGM) glucose monitoring sensors to assess the perception disorder. Aims: The aim of this diploma thesis was a comprehensive assessment of the occurrence of hypoglycemia unawareness based on the validated Gold Score and Clarke Score questionnaires and the demonstration of the connection between impaired perception of hypoglycemia according to questionnaires and the percentage of time spent in hypoglycemia based on sensor data. Research methodology: In this observational and questionnaire non-interventional study, 73 patients treated with T1DM for more than 12 months and using CGM or FGM (age 41 years 16, duration of T1DM 16.7 years 11, HbA1c 52 mmol/mol 9 ,7) who completed the Gold Score, Clarke Score and HABS questionnaires to supplement the psychological level of the issue. In these patients, data from their sensors was obtained and the parameters such as average glycemia, percentage of time in the range in hypoglycemia (3.9-10 mmol/l), glycemic...
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Differences in food intake among obese and non-obese pacients with diabetes
Číhová, Anna ; Škrha, Jan (advisor) ; Šatný, Martin (referee)
Basis: Disorders of glucose metabolism, including prediabetes and diabetes, and obesity are very common diseases, the prevalence of which continues to rise worldwide. Overweight and obesity are usually associated with type 2 diabetes, and some authors use the term diabesity for the joint occurrence of these two diseases, but even in patients with type 1 diabetes, the prevalence of overweight and obesity is increasing. The basic measure in the treatment of an obese diabetic is a diet leading to weight reduction, ideally to achieve optimal body weight. Objective: This work focuses on the prevalence of overweight and obesity in patients with diabetes, respectively in individual types of diabetes and on the differences in food intake of obese and non- obese patients with diabetes, with the aim of determining whether overweight and obesity, or excessive energy intake, are related to worse diabetes compensation. Methodology: In the practical part of this diploma thesis, two methods of data collection were chosen, a questionnaire survey and anonymous data collection from electronic medical documentation. All data obtained were continuously recorded and then statistically analysed using the Welch t-test and the chi-squared test in the TIBCO STATISTICA 13 program. Findings: In the entire research population...
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Signalling of protein kinase B and expression of cyclooxygenase in early phases of diabetic nephropathy
Ždychová, Jana ; Komers, Radko (advisor) ; Haluzík, Martin (referee) ; Matoušovic, Karel (referee) ; Škrha, Jan (referee)
Introduction: Renal hypertrophy, extracellular matrix accumulation, aItered apoptosis as well as changes in regional hemodynamics have been implicated in the pathophysiology of nephropathy in diabetes mellitus (DM). On the molecular level the detailed mechanisms for development of diabetic nephropathy (DN) have becn intensively studied. Insulin induces a variety of biologicaI effects in a number of cell types via phosphatidylinositol-3 kinase (PI3K)/Akt kinase signaling pathway. Considering multiple function of Akt that incIude potentiaIly hannful pro-growth effects mediated by mTOR and cyclooxygenas-2 (COX-2), as well as protective effects mediated by endotheliaI nitric oxide synthase (eNOS), it is possible that aIterations in activities of Akt may play role in the pathophysiology ofDN. Renal corticaI activity and expression of Akt, its down-strearn effectors mTOR, eNOS, and "C<JIX-:Z. as well as PTEN, an endogenous Akt inhibitor, were investigated in streptozotocin (STZ): diabetic rats as a model of Type 1 DM with different levels of glycenůc control, and in Zucker ~d.iabetic fatty rats, a model ofDM2, and in nondiabetic rats as controls. Methods: Akt activity was measured by kinase assay. Protein expressions were measured by .immunoblotting and immunohistochemistry in renal cortex of 4- and 12- week old...
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Quantification of insulin secretion after administration of whey proteins in healthy subjects and in patients with type 2 diabetes
Wildová, Elena ; Anděl, Michal (advisor) ; Pelikánová, Terezie (referee) ; Škrha, Jan (referee)
INTRODUCTION: Milk and milk proteins have higher insulinogenic index than glycemic index. This feature is mainly attributed to whey proteins. The main goal of this thesis was to evaluate a C-peptide response after administration of whey proteins in healthy individuals (study 1) and in patients with type 2 diabetes mellitus (study 2) in comparison to other experimental stimulation tests. METHODS: Eight young, healthy (7 males, 1 female; aged 20-26 years), non-obese (BMI: 17 - 25.9 kg/mš) participants with normal glucose tolerance were enrolled for study 1. Each individual underwent six C-peptide secretion tests in total. Three secretion tests measured C-peptide response to orally administered substances: whey proteins only (OWT), whey proteins with glucose (OWGT) and glucose only (OGTT, reference); while the other three secretion tests measured C-peptide response to intravenously administered substances: arginine (AST), glucagon (GST) and glucose (IVGTT, reference). Sixteen overweight (BMI 26,4 - 29,8 kg/m2) patients with type 2 diabetes mellitus, good glycemic control and with preserved fasting serum C-peptide levels (0,94 ± 0, 07 nmol/l) were enrolled for study 2. Two oral stimulation tests - one with 75 g of glucose (OGTT) and the other with 75 g of whey proteins (OWIST) - were used for assessing...
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The role of nutritional therapist in education of patients with type 2 diabetes
Erban, David ; Škrha, Jan (advisor) ; Krátký, Jan (referee)
Aim of thesis: The research aimed to evaluate the importance of individual education by a clinical dietitian and compare it to information brochures only. Methods: 52 patients with type 2 diabetes from the Third Department of Internal Medicine of the General Hospital in Prague were selected for the research. Totally, 48 of them finished the research. These patients were divided into two groups. Group A was educated individually by a clinical dietitian. This group consisted of 27 patients, of which 13 were men and 14 were women. Group B was educated using a brochure only. This group consisted of 21 patients, of which 11 were men and 10 were women. Both groups were given the questionnaire before the education and then 4 months after the education. Additionally, glycated haemoglobin was measured in patients before the education and then 4 months after the education, during the next visit to their diabetologist. Results: In both groups, some improvement was observed after the education. Either in knowledge or their levels of glycated haemoglobin. In group A, the education had better cognitive results in all questions of the questionnaire except for one. Levels of glycated haemoglobin decreased by 9,4 in men and by 4,8 mmol/mol in women in group A. In group B, education did not affect the knowledge of...
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Effects of obesity on the course of Trypanosoma cruzi infection
Brima, Wunnie ; Zima, Tomáš (advisor) ; Šimánek, Vilím (referee) ; Škrha, Jan (referee)
Obesity is very widespread and detrimental to health. Obesity brings with it many changes including heightened immune function, and a higher prevalence of major cardiovascular disorders, cancer, diabetes, and Alzheimer disease. Obesity is also associated with shortened lifespan. The detrimental effects of obesity are linked to the "metabolic syndrome", a broad range of changes in metabolic processes and immune function. As a first approximation, we agree with this formulation but we will then proceed to document some of its weaknesses. (i) Crude mortality rates increase with increasing body mass index (BMI) but as the BMI approaches the normal range, mortality rates reverse (the now classic "J-shaped curve") so that individuals with reduced BMI have elevated mortality. (ii) A multiplicity of medical and surgical conditions have been reported where short term and medium term outcomes are better for overweight patients. These conditions are placed under the heading of "obesity paradox". (iii) The medical community has introduced a binary system for the metabolic syndrome ---- yes, patient has it or no, the patient does not have it, despite the fact that all of the changes that are considered components of the metabolic syndrome are continuous variables. Our work is focused on sharpening focus and improving...
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Quantification of insulin secretion after administration of whey proteins in healthy subjects and in patients with type 2 diabetes
Wildová, Elena ; Anděl, Michal (advisor) ; Pelikánová, Terezie (referee) ; Škrha, Jan (referee)
INTRODUCTION: Milk and milk proteins have higher insulinogenic index than glycemic index. This feature is mainly attributed to whey proteins. The main goal of this thesis was to evaluate a C-peptide response after administration of whey proteins in healthy individuals (study 1) and in patients with type 2 diabetes mellitus (study 2) in comparison to other experimental stimulation tests. METHODS: Eight young, healthy (7 males, 1 female; aged 20-26 years), non-obese (BMI: 17 - 25.9 kg/mš) participants with normal glucose tolerance were enrolled for study 1. Each individual underwent six C-peptide secretion tests in total. Three secretion tests measured C-peptide response to orally administered substances: whey proteins only (OWT), whey proteins with glucose (OWGT) and glucose only (OGTT, reference); while the other three secretion tests measured C-peptide response to intravenously administered substances: arginine (AST), glucagon (GST) and glucose (IVGTT, reference). Sixteen overweight (BMI 26,4 - 29,8 kg/m2) patients with type 2 diabetes mellitus, good glycemic control and with preserved fasting serum C-peptide levels (0,94 ± 0, 07 nmol/l) were enrolled for study 2. Two oral stimulation tests - one with 75 g of glucose (OGTT) and the other with 75 g of whey proteins (OWIST) - were used for assessing...
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The comparison of drinking regime of obese and non-obese type 2 diabetics
Görnerová, Lucie ; Vařeka, Tomáš (advisor) ; Škrha, Jan (referee)
This bachelor thesis is focused on topics of type 2 diabetes mellitus, obesity and drinking regime from the point of view of nutritional therapist. Objective of the bachelor thesis: Comparison of drinking regime in obese and non-obese type 2 diabetics. Methodology: The practical part of the bachelor thesis compares the drinking regime of obese and non-obese patients with type 2 diabetes. It monitors the quality and quantity of the proband drinking regime. There were 16 patients with type 2 diabetes approached in Diabetic Outpatient IV. of the VFN's internal clinic. 8 probands completed the research and their results are presented in the bachelor thesis. The participants filled out a form for seven days before and after the training seminar. They wrote down the quantity and type of drunk drinks. Prior to the training seminar, they filled out questionnaire number 1 focused on the patients' awareness about drinking regime in type 2 diabetes. After this seminar, they completed questionnaire number 2 examining the difficulty of monitoring compliance with this drinking regime. Questionnaire no. 2 tried to find out whether probands had thought about their drinking regime when putting it down and how they were motivated to take part in an educational seminar. Results: probands were divided into obese and...
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Pathobiochemistry of diabetes mellitus and its complications - oxidative stress, microinflammation and genetic predisposition.
Škrha, Jan ; Kalousová, Marta (advisor) ; Rybka, Jaroslav (referee) ; Bendlová, Běla (referee)
Diabetes is a chronic disease with high prevalence and significant morbidity. Chronic changes in the wall of small and large vessels lead to main diabetes complications. Apart from long- term hyperglycemia, several factors are involved in the development of diabetes vasculopathy. The aim of this work was to describe new early biomarkers of these vascular changes, to identify risky patients. Alongside, gene polymorphisms involved in protective pathways of glucose metabolism were studied. In three human studies with Type 1 (T1D) and Type 2 (T2D) diabetes patients special biochemical parameters of receptor for advanced glycation endproducts (RAGE) and its ligands, deglycation enzyme glyoxalase 1 (GLO1) and fructosamine 3-kinase (FN3K) gene polymorphisms were analyzed. Non-invasive measurement of glycation by skin autofluorescence (SAF) was assessed in all subjects. Soluble RAGE, HMGB1 and endothelial dysfunction markers were increased in patients with diabetes as compared with controls, however the differences between T1D and T2D were not significant. For the first time, an association between FN3K (rs1056534) and (rs3848403) polymorphism and sRAGE concentration in diabetes was shown. GLO1 (rs4746) polymorphism was associated with changes in endothelial dysfunction. Patients with diabetes had higher...
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