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Optimalisation of insulin treatment - continuous subcutaneous insulin infusion
Jankovec, Zdeněk ; Rušavý, Zdeněk (advisor) ; Jirkovská, Alexandra (referee) ; Vondra, Karel (referee) ; Prázný, Martin (referee)
Introduction: To be able to prove the efficiency and benefit of the treatment including its safety on a wide range of patients (as opposed to more or less strictly selected groups form clinical studies), we started to gather data about patients in the Czech register of patients treated with continuous subcutaneous insulin infusion (CSII) - further referred to as Register. The obtained data not only represent an effective feedback on our clinical practice and treatment, but also they serve as an important argument for promotion of the CSII efficacy during the negotiations of reimbursement from the health insurance system (the CSII treatment is significantly more expensive compared to other MDI regimens). Aim of study: The aim of the first study were to present data on current situation and treatment results of CSII on wide unselected population of patients with diabetes mellitus in the Czech Republic. In the second study patients were evaluated to compare treatment indication, efficacy and safety with specific regard to the type of diabetes. Patient and methods: The national register of patients treated with CSII exists in the Czech Republic since 1998. We gather data from 52 departments of diabetology in the Czech Republic from patients with diabetes of all types treated with CSII. The data were...
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Mikrocirculation in the diabetic foot syndrome
Tomešová, Jitka ; Lacigová, Silvie (advisor) ; Chlup, Rudolf (referee) ; Prázný, Martin (referee) ; Jirkovská, Alexandra (referee)
Abtrakt (EN) In spite of the fact that the diabetic foot syndrome is not considered a marginal complication of the patients with diabetes mellitus any more, its prevalence and incidence is not decreasing. The fact that early diagnosis and treatment or even prevention of foot ulcers is associated with a decrease in healthcare costs and, more importantly, with reducing patients' suffering, applies also in this case. The dissertation work originated in the Diabetologic Center of the Medical department I., University Hospital and Medical Faculty in Pilsen, Charles University in Prague, which has been dealing with diagnostic and therapeutic procedures in patients with diabetic foot syndrome for over 20 years. The examinations for diagnosis of the main etiologic factors, i.e. peripheral neuropathy and impaired perfusion, belong to already routine ordinary procedures here. My task was to move the diagnostics of this complication to earlier stages, even before the development of the ulcers, through diagnosing an impairment in skin microcirculation. The aim of the work was to evaluate reactivity of the skin microcirculation in patients with diabetes mellitus using laser doppler flowmetry and to introduce a new method - iontophoresis. Skin microcirculation assessment has become a center of interest of many studies...
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Critical limb ischemia and autologous cell therapy in diabetic foot disease, pathogenesis of Charcot osteoarthopathy.
Němcová, Andrea ; Jirkovská, Alexandra (advisor) ; Polák, Jan (referee) ; Prázný, Martin (referee)
Diabetic foot disease (DFD) is a serious complication of diabetes and, along with critical limb ischemia, significantly exacerbates the prognosis of patients. Peripheral arterial disease in patients with diabetes has an atypical clinical course, its diagnosis is challenging and is one of the most common causes of morbidity and mortality of patients with DFD. The aim of this dissertation focused on the diagnosis and treatment of DFD was to identify a suitable method for evaluating the effect of autologous cell therapy (ACT), to assess options for early diagnosis of Charcot osteoarthropathy (COA) and, possibly, to establish the association between the incidence of cardiovascular disease and DFD. In our studies concerning therapeutic vasculogenesis, we observed a significant increase in the antiangiogenic factor endostatin after ACT in contrast to its unchanged levels after standard percutaneous transluminal angioplasty; the transient increase in endostatin seems to be a marker of therapeutic vasculogenesis after ACT. A benefit of using calf muscle perfusion scintigraphy in the assessment of microcirculation and ACT effect was not clearly demonstrated. By contrast, a promising method for the evaluation of microcirculation and the effect of revascularization after ACT was MR spectroscopy of calf...
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Epidemiology of obstructive sleep apnea in patients with Type 2 diabetes - prevalence, screening and adherence to diagnostic proces and the treatment
Westlake, Kateřina ; Polák, Jan (advisor) ; Jirkovská, Alexandra (referee) ; Ludka, Ondřej (referee)
Introduction: Obstructive sleep apnea (OSA) is a condition significantly increasing cardiovascular mortality. In the population of Type 2 diabetes (T2D) patients, OSA is highly prevalent, but mostly undiagnosed. Screening for OSA in T2D patients is still not routine practice and it is also uncertain what the most effective screening method is. The aim of this study was 1) to establish the prevalence of OSA in T2D patients 2) to compare the performance of screening questionnaires and to determine a suitable screening method 3) to find out the adherence of T2D patients to the diagnostic process and OSA treatment 4) to compare adherence to treatment between T2D and regular sleep clinic patients. Methods: 494 consecutive patients with T2D were recruited and asked to fill in screening questionnaires, to undergo screening and, if indicated, diagnostic home sleep monitoring. Those with clinically significant OSA (apnea hypopnea index ≥ 15) were recommended CPAP (continuous positive airway pressure) treatment. Patient follow-up continued for 12 months and their adherence to CPAP was compared to adherence of sleep clinic patients. Results: Clinically significant OSA was found in 94 (31%) out of 294 T2D patients. The sensitivity and the specificity of all three scrutinized questionnaires (Berlin, STOP and...
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Determinants of microvascular and macrovascular diabetic complications
Piťhová, Pavlína ; Kvapil, Milan (advisor) ; Rušavý, Zdeněk (referee) ; Jirkovská, Alexandra (referee)
Background: Diabetes mellitus both type 1 and 2 rank among the strongest predictors of cardiovascular diseases (CVD). We studied differences between type 1 and 2 diabetic women regarding association of risk factors and microvascular complications and association of cardiovascular risk factors with preclinical atherosclerosis expressed as intima-media thickness of common carotid and femoral arteries. Patients and methods: Women with type 1 (n=203) and type 2 diabetes (n=123) were examined. Microvascular complications were analyzed as follow: retinopathy, nephropathy, neuropathy and diabetic foot syndrome and their risk factors. Preclinical atherosclerosis markers expressed as ankle- brachial index (ABI) and toe-brachial index (TBI) and intima-media thickness of common carotic (IMT CCA) and femoral (IMT CFA) arteries meassured by high resolution ultrasound were analyzed with regard to the presence of cardiovascular risk factors. Most important results: No serious differences in risk factors for development of microvascular diabetic complications were found. Concerning preclinical atherosclerosis risk factors in type 1 diabetic women strong association between IMT CCA and body mass index, waist circumference, and total body fat was found in contrast to type 2 diabetic women. In type 2 diabetic women...
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Mikrocirculation in the diabetic foot syndrome
Tomešová, Jitka ; Lacigová, Silvie (advisor) ; Chlup, Rudolf (referee) ; Prázný, Martin (referee) ; Jirkovská, Alexandra (referee)
Abtrakt (EN) In spite of the fact that the diabetic foot syndrome is not considered a marginal complication of the patients with diabetes mellitus any more, its prevalence and incidence is not decreasing. The fact that early diagnosis and treatment or even prevention of foot ulcers is associated with a decrease in healthcare costs and, more importantly, with reducing patients' suffering, applies also in this case. The dissertation work originated in the Diabetologic Center of the Medical department I., University Hospital and Medical Faculty in Pilsen, Charles University in Prague, which has been dealing with diagnostic and therapeutic procedures in patients with diabetic foot syndrome for over 20 years. The examinations for diagnosis of the main etiologic factors, i.e. peripheral neuropathy and impaired perfusion, belong to already routine ordinary procedures here. My task was to move the diagnostics of this complication to earlier stages, even before the development of the ulcers, through diagnosing an impairment in skin microcirculation. The aim of the work was to evaluate reactivity of the skin microcirculation in patients with diabetes mellitus using laser doppler flowmetry and to introduce a new method - iontophoresis. Skin microcirculation assessment has become a center of interest of many studies...
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Local and systemic pathological processes in diabetic foot diasease and their management
Dubský, Michal ; Jirkovská, Alexandra (advisor) ; Rušavý, Zdeněk (referee) ; Karetová, Debora (referee)
Local tissue factors, ischemia and infection (which are often the cause of re-ulceration) are the main pathogenetic factors for diabetic foot disease (DFD). Neuropathic bone metabolism disorder leads to Charcot osteoarthropathy (CHOA). The aim of this dissertation was to assess experimentally the effectiveness of new skin substitutes, evaluate local vasculogenesis in different types of cell therapy of DFD, the role of infection in recurrence of DFD and scintigraphic parameters of activity of CHOA. Our studies concerning local pathological processes in DFD experimentally proved that gelatine nanofibers accelerate wound healing and can be suitable scaffolds for cell transfer and skin regeneration and also that acellular porcine dermis is more effective in healing of chronic wounds then xenotransplants. Our studies concerning therapeutic vasculogenesis confirmed that efficacy of stem cells (SC) harvested from bone marrow is similar in efficacy to SC separated from peripheral blood after stimulation. We found no evidence for systemic vasculogenesis by means of a significant increase of pro-angiogenic cytokines, which confirms the paracrine effect of injected SC. We proved a significant correlation between angiogeneisis inhibitor (endostatin) and the number of injected SC, which could be an indicator of...
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Immune abnormalities and infectious complications in patients with diabetic foot and therapy of diabetic foot by off-loading
Fejfarová, Vladimíra ; Jirkovská, Alexandra (advisor) ; Lacinová, Silvie (referee) ; Stárka, Luboslav (referee)
The diabetic foot (DF) develops based on a complex of patophysiological processes which are presented in patients with diabetic complications. DF significantly increases a patient morbidity and mortality and markedly impairs the quality of life of these patients. The theme of the dissertation "immunological abnormalities and infection complications in patients with the DF and therapy of the DF by off-loading" was divided into 3 parts: - abnormalities of immune functions in connection with diabetes and its complications, especially with the DF - infectious complications of the DF - therapy of the DF by off-loading. Problems concerning the impairment of immune functions in connection with diabetes and the DF were resolved in 5 studies, infectious complications of the DF in 3 studies and the therapy of the DF by off-loading similarly in 3 studies. Abnormalities of immune functions in connection with diabetes and its complications, especially with the DF The first study deals with the effect of acute hyperglycemia and/or hyperinsulinemia on function of PMN cells in healthy subjects. The aim of this study was to assess the effect of short lasting acute metabolic changes on phagocytosis and the respiratory burst of PMN cells in healthy subjects in vivo. Acute hyperglycemia and/or hyperinsulinemia were...
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Bone metabolism, infection and ischemia in diabetic foot syndrome
Bém, Robert ; Jirkovská, Alexandra (advisor) ; Štěpán, Jan (referee) ; Broulík, Petr (referee)
The diabetic foot (DF) is one of the most frequent late complications of diabetes, which often leads to limb amputation and effects the quality of life in patients with diabetes. Ischaemia and infection play important role in pathogenesis of DF. One form of DF is Charcot neuroosteoarthropathy (CNO), defined as a noninfectious destruction of bones and joints in the foot due to diabetic neuropathy. The subject of the dissertation thesis was divided into 3 parts: bone metabolism and CNO, ischaemia and infection in DF and new methods in the treatment of DF. (...) In the third study, new quantitative scintigraphic parameters for assessment of CNO activity were defined and confirmed their satisfactory correlation with other parameters of CNO activity. In fourth and fifth study,good reproducibility was verified and efficiency of power spectral analysis of heart rate variability as a new method for diagnosis of autonomic neuropathy in patients with CNO. Sixth study refered to rare causes of atypical localization of CNO in the knee joint. Ischaemia and infection in DF were resolved in one study. In multivariate analysis of seventh study we approved, that risk factors for difficulty healing after minor amputation of the foot were low level of transcutaneous oxygen tension and high level of C-reactive protein before...
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Optimalisation of insulin treatment - continuous subcutaneous insulin infusion
Jankovec, Zdeněk ; Rušavý, Zdeněk (advisor) ; Jirkovská, Alexandra (referee) ; Vondra, Karel (referee) ; Prázný, Martin (referee)
Introduction: To be able to prove the efficiency and benefit of the treatment including its safety on a wide range of patients (as opposed to more or less strictly selected groups form clinical studies), we started to gather data about patients in the Czech register of patients treated with continuous subcutaneous insulin infusion (CSII) - further referred to as Register. The obtained data not only represent an effective feedback on our clinical practice and treatment, but also they serve as an important argument for promotion of the CSII efficacy during the negotiations of reimbursement from the health insurance system (the CSII treatment is significantly more expensive compared to other MDI regimens). Aim of study: The aim of the first study were to present data on current situation and treatment results of CSII on wide unselected population of patients with diabetes mellitus in the Czech Republic. In the second study patients were evaluated to compare treatment indication, efficacy and safety with specific regard to the type of diabetes. Patient and methods: The national register of patients treated with CSII exists in the Czech Republic since 1998. We gather data from 52 departments of diabetology in the Czech Republic from patients with diabetes of all types treated with CSII. The data were...
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