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Importance of Metformin in the Treatment of Type 2 Diabetes Mellitus
Kučerová, Andrea ; Vlček, Jiří (advisor) ; Šmahelová, Alena (referee)
Importance of metformin in the treatment of type 2 diabetes mellitus Mgr. Andrea Kučerová, Department of Social and Clinical Pharmacy, Pharmaceutical Faculty in Hradec Králové, doctorate thesis, 2010 Metformin is biquanid which, during its therapeutic use, has undergone a period of perdition and fall followed by again rising up to the imaginary pharmacological-therapeutic summit when it became a "gold standard" in the treatment of patients with type 2 diabetes mellitus. Currently, it is recommended by the professional authorities abroad and in the Czech Republic as a first choice drug after determination of diagnosis together with diet and physical exercise. How these recommendations follow and reflect the diabetological prescription situation? What prevents the physicians-prescriptors from implementation of the recommendations into their daily practice? The aim and subject of this thesis is the issue of therapy of type 2 diabetes mellitus (DM) by means of oral antidiabetics (PADs) with a special focus on the decision mechanisms of selected prescription groups of physicians. A historical development of metformin must be reminded in the theoretical part of this thesis in order to better understand and substantiate these prescription habits, and furthermore a development and changes of its position in...
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Pharmacotherapy analysis of diabetes mellitus in diabetologic consulting room.
Buriánková, Lenka ; Vlček, Jiří (advisor) ; Šmahelová, Alena (referee)
PHARMACOTHERAPY ANALYSIS OF DIABETES MELLITUS IN DIABETOLOGIC CONSULTING ROOM Student: Buriankova L. Tutor: Vlcek J., Dept. of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague,Czech Republic Background: Diabetes mellitus type 2 is a group of metabolic diseases whose common trait is hyperglycaemia. Aim: To assess the group of patients, diabetics with type 2 diabetes mellitus according to different points of view and to assess their treatment. Methods: 106 patients with DM type 2 (49 male, 57 female, mean age 61,8) were retrospectively studied for 23 months. The data were obtained from patient's data in diabetologic consulting room. Results: The concentrations of glycosylated haemoglobin were in 45 % of patients less than 6,5, 13 % of patients had these concentrations 6,5-7,5 and this can be considered as satisfying state of disease. 42 % respondents had higher concentrations of glycosylated haemoglobin. The most common medication in monotherapy were sulfonylureas in 25 % of patients and metformin in 16 % of patients. The most common combination of antidiabetics were metformin with sulfonylureas in 17 % and metformin with insulin in 12 % of patients. Insulin therapy was indicated in 39 % of patients (25 % in combination with oral antidiabetics, 14 % in...
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Education of the diabetics in the area of selfmonitoring
Petříčková, Lenka ; Machalová, Iva (advisor) ; Schneiderová, Michaela (referee) ; Šmahelová, Alena (referee)
96 Annotation Author: Lenka Petříčková Organisation: Institute of Social Medicine, Charles University - Faculty of Medicine in Hradec Králové Name of the thesis: Education of Diabetics in the Area of Selfmonitoring Supervisor: Mgr. Machalová Iva, prim. MUDr. Jiří Veselý Number of pages: 125 Number of annexes: 10 Year of defence: 2010 Key words: education, diabetes mellitus, selfmonitoring of diabetes, glucose blood, glycaemic haemoglobin Bachelor thesis is about education of diabetics in the area of selfmonitoring. Theoretical part of this thesis is oriented on education which is essential part of treatment and on the meaning of education, goals, phases, form, resources of education, organisation and contents. This part further demonstrates dilemma of selfmonitoring that is selfmonitoring of glucose blood, glycaemic haemoglobin, selfmonitoring of ketonuria and glycosuria, weight and blood pressure monitoring. An emphasis of this thesis consist in a quantitative research investigation of knowledge in the area of selfmonitoring of glycaemia by diabetics in Broumov - Regional hospital of Náchod. Diabetics were separated into two age groups: 20-59 years and 60 years and more. Resulting information should be due to education similar in both groups of diabetics. Outcome of this thesis is proposal of educational...
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Dyslipidemia of metabolic syndrome and physical activity
Stránská, Zuzana ; Svačina, Štěpán (advisor) ; Šmahelová, Alena (referee) ; Radvanský, Jiří (referee)
Objective: In obese patients, we hypothesized physical exercise (PE) to affect lipids rather through its intrahepatic fat accumulation-lowering effect, associated with a decrease of total body fat (Fat%) and even weight (Mass), than through muscle work and an improvement of physical fitness. Design and setting: Thirty seven sedentary, non-diabetic women (BMI median 34.8 kg/m2) from our out- patient department were tested. Elimination criteria: recent weight reduction, lipid-influencing or heart rate-modifying medication. Interventions: PE protocol: 60 min supervised trainings, intensity at 65% of VO2max, modified by the Clamped Heart Rate test. Median (M) of total training hours was 34 during 115 days . Main Outcome Measurements: an effect of PE on total cholesterol (CH), triacylglycerols, HDL- cholesterol (HDL-C), LDL-cholesterol (LDL-C), index of atherogenity (IA), atherogenic index of plasma (AIP), maximum peak oxygen consumption (VO2max), Mass, body mass index (BMI), waist circumference (Waist) and Fat%. Results: Statistically significant differences at start (_s) and at the end (_e) of PE (p<0.05): AIP -0.049, Mass -3.6 (kg), BMI -1.7 (kg/m2), Waist -2.5 (cm), Fat% -2.5, VO2max 2.92 (l.min-1.kg-1), W 16.4 (Watt). Correlation coefficients, Pearson's between Gaussian distributed (Gd-v) variables and...
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Relationship of oxidative stress to parameters of diabetes control in development of vascular complications.
Pelcl, Tomáš ; Prázný, Martin (advisor) ; Rušavý, Zdeněk (referee) ; Šmahelová, Alena (referee)
The aim of this thesis is to contribute to the clarification of the pathogenesis of chronic complications of diabetes mellitus. The main goal of the research was glycaemic variability, its contribution to the activation of oxidative stress and its possible role in the process of advanced glycation, all beyond the scope of persistent hyperglycaemia itself. Another aim of the work is to contribute to the clarification of a possible relationship between glycaemic variability and vascular complications of diabetes. We were the first to describe the association between the concentrations of reactive aldehydes formed during lipid peroxidation and disorders of skin microvascular reactivity in patients with type 1 diabetes (DM1). Elevated markers of oxidative stress were found in this group, furthermore during the 3 years of follow-up higher plasma antioxidant activity was observed. These findings were not dependent of the method of glucose monitoring and glucose variability, which was lower in a subgroup of patients using real-time continuous glucose monitoring (rt-CGM), compared to a subgroup using conventional glucometers. However, it is clear, that hyperglycaemia alone induces increased oxidative stress in patients with diabetes. Simultaneously we observed the opposite process of oxidative stress...
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Insulin resistance and postprandial state in type 2 diabetes. The effect of meal frequency and composition on glucose metabolism and other manifestations of the metabolic syndrome
Thieme, Lenka ; Pelikánová, Terezie (advisor) ; Kunešová, Marie (referee) ; Šmahelová, Alena (referee)
The project focuses on dietary interventions in type 2 diabetes(T2D). The aim was to investigate how glucose metabolism and other manifestations of insulin resistance should be influenced by a) the composition of macronutrients and b) frequency of meals; and to characterize the possible mechanisms of these dietary interventions in patients with T2D. A. In a randomized crossover study, 50 patients T2D and 50 age-matched healthy subjects underwent in a random order meal tolerance tests with three isocaloric meals (vegan sandwich; V-meal, hamburger; M-meal, or cheese sandwich; S-meal. Blood samples for analysis were taken at time 0 and after 30, 60, 120 and 180 minutes after meal ingestion. Plasma concentrations of plasma glucose, insulin, C-peptide, lipids, oxidative stress markers and gastrointestinal hormones (GIHs) were investigated. Both basal and postprandial plasma concentrations of glucose and insulin were significantly higher in patients with T2D (p<0.001); basal and postprandial concentrations of almost all other GIHs (except for ghrelin) and thiobarbituric acid reactive substances (TBARS) were significantly increased (p<0.001), while ascorbic acid, reduced glutathione and superoxide dismutase activity were decreased in patients with T2D compared to healthy controls (p<0.001). The meal rich...
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Insulin resistance and cholesterol metabolism in obese patients with type 1 diabetes mellitus - impact of weight reduction
Jiráčková, Jana ; Šmahelová, Alena (advisor) ; Souček, Miroslav (referee) ; Svačina, Štěpán (referee)
Insulin resistance and cholesterol metabolism in obese patients with type 1 diabetes mellitus - impact of weight reduction. Diabetes mellitus type 1 is characterized with an absolute insulin deficiency. Deterioration of cholesterol metabolism is well known in this disease, cholesterol absorption is typically elevated. Obesity, on the other hand, is accompanied with lower insulin sensitivity, that is known to increase cholesterol synthesis and decrease cholesterol absorption. Obese type 1. diabetics thus represent, from the metabolic view, an interresting combination of absolute and relative insulin deficiency. Aims: The aim of this study was to characterize relation of insulin resistance and representative markers of cholesterol metabolism in obese type 1 diabetics; and to characterise their dynamics during defined weight reduction programme. Methods: Metabolic and antropometric parameters of obese and lean patients with diabetes mellitus type 1. were compared one time (Phase I). The dynamics of followed parameters of subgroup of obese patients was characterized during the weight reduction programme in Phase I (before intervention), Phase II (after one week of fasting + three weeks on a diet with 150g saccharides per day) and in Phase III (after one year on a diet with 225 saccharides per day). In...
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Dyslipidemia of metabolic syndrome and physical activity
Stránská, Zuzana ; Svačina, Štěpán (advisor) ; Šmahelová, Alena (referee) ; Radvanský, Jiří (referee)
Objective: In obese patients, we hypothesized physical exercise (PE) to affect lipids rather through its intrahepatic fat accumulation-lowering effect, associated with a decrease of total body fat (Fat%) and even weight (Mass), than through muscle work and an improvement of physical fitness. Design and setting: Thirty seven sedentary, non-diabetic women (BMI median 34.8 kg/m2) from our out- patient department were tested. Elimination criteria: recent weight reduction, lipid-influencing or heart rate-modifying medication. Interventions: PE protocol: 60 min supervised trainings, intensity at 65% of VO2max, modified by the Clamped Heart Rate test. Median (M) of total training hours was 34 during 115 days . Main Outcome Measurements: an effect of PE on total cholesterol (CH), triacylglycerols, HDL- cholesterol (HDL-C), LDL-cholesterol (LDL-C), index of atherogenity (IA), atherogenic index of plasma (AIP), maximum peak oxygen consumption (VO2max), Mass, body mass index (BMI), waist circumference (Waist) and Fat%. Results: Statistically significant differences at start (_s) and at the end (_e) of PE (p<0.05): AIP -0.049, Mass -3.6 (kg), BMI -1.7 (kg/m2), Waist -2.5 (cm), Fat% -2.5, VO2max 2.92 (l.min-1.kg-1), W 16.4 (Watt). Correlation coefficients, Pearson's between Gaussian distributed (Gd-v) variables and...
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Osteoporosis management in primary care in the Czech Republic
Blažková, Šárka ; Vlček, Jiří (advisor) ; Šmahelová, Alena (referee) ; Živný, Pavel (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of social and clinical pharmacy Candidate Sarka Blazkova Supervisor Jiri Vlcek Title of Doctoral Thesis Osteoporosis management in primary care in the Czech Republic Introduction: Osteoporosis (OP) is a systemic disease of the skeleton characterized by decreased bone mass and a disturbed microarchitecture of the bone tissue associated with increased risk of bone fragility and fracture. OP and its consequences are a major health, social, and economic concern, growing with aging of the population. Currently, most OP patients are not properly diagnosed and treated. In the Czech Republic, primary care that is provided by general practitioners (GPs), gynecologists and pharmacists should play a key role in identifying patients with OP. Generally available guidelines recognize GPs as fully qualified for OP management. GPs are expected to be proactive in OP risk assessment and OP prevention and treatment. In the Czech Republic, due to prescribing limitations, GPs are only authorized to prescribe anti-OP drugs via delegated prescribing. Given the primary care structure in this country, it can be expected that gynecologists will be involved in OP management in women. Unlike GPs, they are authorized to prescribe anti-OP drugs and...
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Analysis of Possibility of Applying Clinical pharmacy to Pharmaceutical Care
Malý, Josef ; Vlček, Jiří (advisor) ; Šmahelová, Alena (referee) ; Halačová, Milada (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Department: Social and Clinical Pharmacy Candidate: Josef Maly Supervisor: Jiri Vlcek Tittle of Doctoral Thesis: Analysis of possibility of applying clinical pharmacy to pharmaceutical care Introduction and Aim Clinical Pharmacy (CP) is a modern, scientific, and multidisciplinary oriented medical field located on the border between pharmacy and medicine. CP follows the patterns and factors affecting the rational selection and use of drugs, dietary supplements, and medical devices used to health protection and the disease prevention and treatment. CP utilizes the methods and research outputs of other disciplines (e.g. pharmacology, pharmacoepidemiology, pharmacoinformatics, pharmacoeconomics, social pharmacy, or medical disciplines). The principles of CP may involve all pharmacists working in various types of health facilities. Furthermore, in practice the ideas of PC are developed by pharmaceutical care (PC). The aim of PC is to promote the optimal therapeutic value of prescribed drugs and OTC (over-the-counter), i.e. to reduce drug related problems (DRP) in the sense of maximization effect and minimization risk of therapy at optimal health care costs. DRP is defined as an event or circumstance associated with drug therapy that...
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