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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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Role of Helthy Life Style as Primary Prevention of Civilization Diseases
Pavlová, Veronika ; Zlatohlávek, Lukáš (advisor) ; Prázný, Martin (referee)
The main aim of this diploma thesis is to focus on prevention of chronic non-infectious diseases with epidemic occurrence (so called civilizational diseases). The theoretical part deals with each illness separately, it describes cause factors, which are or are not possible to influence, and introduces primary preventive precautions that are available in the Czech Republic nowadays. The author evaluates the qualities of these programmes and their potential to work as an effective primary prevention. Preventive effect of education was tested in the practical part of the thesis. Eating habits and physical activity of grammar school students from Strakonice were found out through the questionnaire method. Following lecture on healthy lifestyle involved the thinking of students and the second round of questioning was done one month later. Students' answers confirmed the possitive influence of the educational programme as the eating habits improved as well as frequency of their physical activity. Educational programmes play an important role in primary prevention of civilizational diseases. Key words: overweight, obesity, risk factors, primary preventive, eating habbits, physical activity, adolescence, education, nutrition, life style
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Insulin Resistance and Metabolic inFlexibility : the Influence of Renin Angiotensin System Inhibition
Wohl, Petr ; Pelikánová, Terezie (advisor) ; Prázný, Martin (referee) ; Vondra, Karel (referee)
Insulin resistance (IR) is considered to be an important factor influencing the progression of atherosclerosis and is associated with higher morbidity and mortality. IR is a common feature of diabetes mellitus Type 2 and obesity. Many authors consider IR being the crucial abnormality of the metabolic syndrome which is characterized by the essential hypertension, hyperliproteinemia, visceral obesity, endothel dysfunction and many other abnormalities. Impaired insulin action (IR) is also described in diabetes mellitus Type 1, however this phenomenon has not been fully explained. The subjects of dissertation thesis was directed on the IR importance in diabetic Type 1 patients as well as on the renin angiotensin system inhibition in patients with IR and metabolic syndrome with impaired glucose homeostasis. Hyperinsulinemic euglycemic clamp is used in combination with indirect calorimetry to estimate the IR in vivo in humans. In our project we focused on a) the existence of the metabolic inflexibility phenomenon in type 1 diabetic patients b) the methodological evaluation of the hyperinsulinemic euglycemic clamp procedure in the same group c) the influence of renin angiotensin system inhibition with angiotensin II type 1 receptor inhibitor telmisartan in patients with metabolic syndrome and impaired glucose...
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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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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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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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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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