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Neuropathic complications and nutrition in patients with type 2 diabetes
Klauzová, Dagmar ; Prázný, Martin (advisor) ; Karen, Igor (referee)
Introduction: Diabetic neuropathy is a chronic complication of diabetes that decreases the quality of life of diabetic patients, mainly because there is currently no effective treatment for diabetic neuropathy and it increases the risk of developing other complications (e. g. diabetic foot syndrome). The development of late complications of diabetes can be delayed by preventive practices, and therefore, it is necessary to focus on prevention and raise awareness among patients about the possible complications associated with diabetes and how to prevent them. Objectives: The aim of this study was to investigate whether lifestyle and dietary habits differ between patients with type 2 diabetes with diabetic peripheral neuropathy and those without diabetic peripheral neuropathy. Methodology: Data collection was done using a self-administered questionnaire with a weekly dietary record. The questionnaire also included a validated sensorimotor neuropathy questionnaire. The questionnaire was distributed on the social media to a closed group of patients with DM2T and was personally offered to patients from the III. Department of Internal Medicine - Endocrinology and Metabolism of the 1st Faculty of Medicine of the Charles University in Prague, specifically at the VFN Clinic in the ambulance of Obesitology...
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Nutritional Factors Affecting The Intestinal Microbiome and Metabolic Health
Krbcová, Magdaléna ; Gojda, Jan (advisor) ; Beneš, Jiří (referee) ; Prázný, Martin (referee)
Background. A plant-based diet, rich in dietary fiber, is associated with health benefits in glucose and lipid metabolism. Dietary fiber is an important substrate for gut microorganisms, by which it is metabolized into numerous compounds, many of which positively affect the metabolic phenotype of the host. Understanding the mechanisms behind these phenomena could lead to discovery of new approaches in the treatment and prevention of metabolic diseases. Objectives. This study aims to describe the relationship between dietary fiber intake, intestinal microbiome composition and function, and metabolic phenotype. In the first (observational) part, we investigated the mentioned parameters in two groups of healthy volunteers whose dietary habits differed in daily fiber intake. In the second (interventional) part, we described the dynamics of these parameters in response to an increase in daily fiber intake and we tried to identify markers predicting a favorable metabolic response. Methodology. Sixty-two vegans and 33 omnivores were included in the observational study. The following examinations were performed: anthropometry, nutritional record evaluation, blood sampling for serum metabolome analysis and evaluation of static parameters of glucose and lipid metabolism, oral glucose tolerance test (oGTT)...
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Significance of Assessment of Glycemic Index of Foods in the Treatment of Insulin Resistance Syndrome
Víšek, Jakub ; Rušavý, Zdeněk (advisor) ; Rosolová, Hana (referee) ; Blaha, Vladimír (referee) ; Prázný, Martin (referee)
OBJECTIVE - The aim of this study was to compare the impact effectiveness of a diet with a low glycemic index versus a common diabetic diet in selected metabolic and anthropometric parameters. RESEARCH DESIGN AND METHODS - 20 volunteers with the type 2 diabetes treated only with metformin were randomly split into two groups. Each group was advised to follow a common diabetic diet (DD) or a diet with a low glycemic index (GI) for a period of 3 months in a crossover design. The effectiveness of the two diets was evaluated according to the selected metabolic and anthropometric parameters using a hyperinsulinemic euglycemic clamp with endogenous glucose production measurement, indirect calorimetry and bioimpedance analysis. RESULTS - Body weight after 3 months following DD was 93kg (83-104) vs. GI 92kg (85- 104) p<0.05, BMI DD 31.3 kg/m2 (27.5-35.9) vs. GI 30.7 kg/m2 (27-35.3) p<0.05, body fat DD 28% (25.5-43) vs. GI 27% (23-43) p<0.05. The diets did not differ in effects on glycosylated hemoglobin, fasting glucose, lipid profile, insulin sensitivity or hepatic glucose production. CONCLUSIONS - In comparison with a common diabetic diet, the diet with low GI leads to a slight weight loss, as well as the BMI and body fat reduction. No significant differences regarding glycemic control, lipid profile, insulin...
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Mechanisms of insulin resistance in humans with focus on adipose tissue
Švehlíková, Eva ; Pelikánová, Terezie (advisor) ; Vondra, Karel (referee) ; Prázný, Martin (referee)
Endocrine activity of adipose tissue is implicated in the development of insulin resistance (IR). The thesis aimed to extend the knowledge of mechanisms contributing to IR. Study I - To investigate the effect of acute hyperinsulinaemia and acute angiotensin II type 1 receptor blockade (ARB) on plasma concentrations and subcutaneous adipose tissue (SAT) expressions of selected adipokines in patients with type 2 diabetes and healthy controls Study II - To investigate the effect of 3-week telmisartan treatment on insulin resistance and plasma concentrations and SAT expressions of selected adipokines in subjects with metabolic syndrome and impaired fasting glucose (IFG) Study III - To investigate the effect of prolonged hypertriglyceridaemia on plasma concentrations and SAT expressions of selected adipokines in patients with type 2 diabetes and healthy control subjects Study IV - To assess the plasma concentrations and SAT expressions of selected adipokines in subjects with different categories of glucose intolerance Methodology: Hyperinsulinaemic-euglycaemic clamp, Intralipid infusion and saline infusion were used to simulate specific metabolic conditions in vivo in 4 groups: 8 young healthy men, 11 overweight/obese patients with type 2 diabetes, 12 age-matched healthy controls and 12 overweight/obese patients...
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The effect of regular physical activity on a long-term control of Type 1 Diabetes Mellitus
Schöppelová, Lucie ; Pelcl, Tomáš (advisor) ; Prázný, Martin (referee)
Introduction: Physical activity should be part of our everyday life. However, for people with Type 1 Diabetes Mellitus it is the most common cause of hypoglycemia. To control diabetes in the right way, it is therefore necessary to follow certain rules and recommendations that help preventing hypoglycemia while the physical activity remains beneficial at the same time. Aim of the work: The main aim of this study is to clarify the influence of physical activity in connection to long-term control of Type 1 Diabetes Mellitus. Methods: 102 respondents with diagnosed Type 1 Diabetes Mellitus in the age of 19-69 years participated in a quantitative analysis. This research was conducted in a form of multicentric examination at two independent medical centers. The data collection was done through questionnaires focused on physical activity and daily regime. The data from questionnaires were then compared to the values of glycated hemoglobin (HbA1C), HDL cholesterol and the total daily dose of insulin of certain patients. For statistical evaluation, analytical tools of Microsoft Office program were used (F-test and t-test). Results: We found correlation between HbA1C values in patients physically active for less than 2 hours/week compared to those who are physically active for more than 2 hours/week (62,72...
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Examination methods of skin microcirculation in diabetes foot syndrome
Krčma, Michal ; Rušavý, Zdeněk (advisor) ; Filipovský, Jan (referee) ; Horký, Karel (referee) ; Prázný, Martin (referee)
Introduction: Since the mid 1980s, a lot of attention has been dedicated to the importance of microcirculation; a part of arterial bed including arterioles, precapillary sphincters, capillaries, venules and arteriovenous shunts. It is a structure of decisive importance for an organism; in its domain an exchange of blood gases and metabolic products takes place and it contributes to thermoregulation. Mediation of vasomotor reaction and vasoarterial reflex maintaining a stable hydrostatic pressure is also an important function. Microcirculation is for its dimensions (capillary diameter approx. 5 x 10-5 mm2, blood flow velocity around 0.4 mm.s-1) relatively difficult to access for more detailed examination, yet its impairments are very severe and dominate in many metabolic disorders. Microcirculation impairment is crucial in diabetes mellitus, where arteriovenous shunts open at the expense of nutritive bed due to a loss of sympathetic tone in peripheral circulation in diabetic neuropathy (Netten, Houben). Blood flow is therefore seemingly sufficient, but the affected tissue undergoes ischemia (warm ischemia). To what extent hyperinsulinemia contributes to this effect is not yet clearly known, one of the possible explanations may be a stimulation of sympathetic activity. Not a few studies are dealing with...
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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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Nutritional Factors in Skeletal Muscle Insulin Resistance Development
Gojda, Jan ; Anděl, Michal (advisor) ; Saudek, František (referee) ; Prázný, Martin (referee)
Nutritional Factors in Skeletal Muscle Insulin Resistance Development Jan Gojda Abstract Background. Diet composition ranks among etiological factors of insulin resistance (IR) and diabetes. Vegans, people consuming exclusively plant-based diet, have significantly lower prevalence of IR and thus represent a suitable model population for study of nutritional factors on IR development. Branched chain amino acids (BCAA) ranks among these factors. Aims and hypothesis. Aim of the observational study was to prove that vegans have better glucoregulatory functions and thus to validate "vegan vs. omnivore" model. Aim of the consecutive interventional study was to prove in this model that dietary intervention with BCAA leads to a group sepcific changes in the insulin function mesures. Methods. 11 vegans and 10 omnivorous controls were recruited in the observational study. Hyperinsulinemic euglycemic clamp (HEC) and muscle (SM) biopsies (amount of intramyocellular lipids (IMCL), mtDNA and the activity of citrate synthase (CS)) were performed. 8 vegans and 8 omnivores were consequently subjected to the intervention with 15 or 20 g of BCAA respectively. The examination was performed at the baseline, after the intervention and after 6 months wash-out period: anthropometry, HEC, arginine test, SM biopsy (CS, activity of...
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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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Microvascular reactivityand endothelial function in patients with diabetes mellitus and other endocrinopathies
Horová, Eva ; Prázný, Martin (advisor) ; Rybka, Jaroslav (referee) ; Rušavý, Zdeněk (referee)
(EN) Endothelial dysfunction is an early marker of atherosclerotic and cardiovascular complications. It is also a target of research aimed at the factors and mechanisms leading to the vascular impairment. The aim of the thesis was to evaluate the microvascular reactivity and endothelial function in patients with specific metabolic and hormonal disorders. Four separate studies are included in the thesis. First, the influence of hypercortisolism and associated diseases on microvascular reactivity was evaluated in patients with Cushing's syndrome. Second, the changes in microvascular reactivity and endothelial function after standard breakfast were studied in patients with type 2 diabetes. Next two studies were done in type 1 diabetic patients. The impact of acute hyperglycemia on microvascular reactivity was evaluated during hyperinsulinemic isoglycemic and hyperglycemic clamp. Finally, the influence of glycemic variability and insulin treatment on microvascular reactivity and its possible relationship were studied in type 1 diabetic patients. The results indicate that microvascular reactivity and endothelial function are, among other factors, influenced by insulinemia and insulin resistance. Microvascular reactivity was predominantly impaired by the arterial hypertension and diabetes in patients...
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