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Physical activity is an integral part of the obesity treatment. Curiously, even among health professionals, the evaluation of obesity treatment persists only based on weight loss. However, the treatment of obesity is not only a simple weight loss, but above all the treatment of associated diseases such as hypertension, diabetes, dyslipidemia, etc. Physical fitness is very rarely assessed, although it best predicts the future and reduces mortality from all causes. It is mainly a cardiovascular disease, where it is shown that the parameter VO2Max is the strongest predictor of not only cardiovascular mortality. The specifics of the prescription of physical activity bring with it the presence not only of diabetes, hypertension and cardiovascular diseases, but also osteoarthritis, possibly undergoing bariatric surgery. To objectify physical activity, including subjective symptoms, it is appropriate to use modern methods of telemedicine, which is the future in the treatment of not only obesity.

V době pandemie COVID-19 dochazelo k omezovani některých vysetřovacich metod, mezi nimi i zatěžových testů. Zatěžova vysetřeni jsou vsak v diagnostickem algoritmu casto nezastupitelna. Na druhou stranu jejich provedeni může představovat zvýsene riziko přenosu infekcnich onemocněni. Nasledujici doporuceni ma za cil navrhnout možna řeseni, jak co nejbezpecněji pro pacienty i pro zdravotnický personal zatěžove vysetřeni provadět i v době zvýseneho rizika přenosných infekci. Epidemicka situace se může dynamicky měnit a je potřeba se řidit doporucenimi hygienicke služby.

Telemedicina se rozviji v poslednich dekadach 20. stoleti a je založena na přenosu zvuku, obrazu a dat stale castěji za využiti bezdratových technologii. V obezitologii se objevuje v praxi od konce 20. stoleti, kdy doslo nejen k rozvoji komunikacnich technologii a objevily se prvni zaznamy přijmu potravy přes pocitacový software, ale předevsim k velkemu narůstu poctu obeznich pacientů. V Ceske republice je v soucasne době vice jak 60 % dospěle populace s diagnozou nadvahy nebo obezity. Telemedicina se uplatňuje předevsim při sběru dat o energetickem přijmu, monitoringu pohybove aktivity, zaznamu hladin glykemii a komunikaci mezi terapeutem a pacientem. Využiti telemediciny zvysuje compliance i adherenci obeznich pacientů k lecbě a zvysuje take jejich motivaci. Telemedicina s možnosti uchovavani dat, sdileni dat a jejich analýzou je tak postupem, jak snižit naklady na diagnostiku a lecbu obezity.

Telemedicine has been gaining in importance recently. The term telemedicine is derived from two Greek words - tele (“distance”) and medicine (meden = treatment “)...

OBJECTIVE This study assessed the clinical impact of four treatment strategies in adults with type 1 diabetes (T1D): real-time continuous glucose monitoring (rtCGM) with multiple daily insulin injections (rtCGM+MDI), rtCGM with continuous subcutaneous insulin infusion (rtCGM+CSII), self-monitoring of blood glucose with MDI (SMBG+MDI), and SMBG with CSII (SMBG+CSII). RESEARCH DESIGN AND METHODS This 3-year, nonrandomized, prospective, real-world, clinical trial followed 94 participants with T1D (rtCGM+MDI, n = 22; rtCGM+CSII, n = 26; SMBG+MDI, n = 21; SMBG+CSII, n = 25). The main end points were changes in A1C, time in range (70–180 mg/dL [3.9–10 mmol/L]), time below range ( RESULTS At 3 years, the rtCGM groups (rtCGM+MDI and rtCGM+CSII) had significantly lower A1C (7.0% [53 mmol/mol], P = 0.0002, and 6.9% [52 mmol/mol], P < 0.0001, respectively), compared with the SMBG+CSII and SMBG+MDI groups (7.7% [61 mmol/mol], P = 0.3574, and 8.0% [64 mmol/mol], P = 1.000, respectively), with no significant difference between the rtCGM groups. Significant improvements in percentage of time in range were observed in the rtCGM subgroups (rtCGM+MDI, 48.7–69.0%, P < 0.0001; and rtCGM+CSII, 50.9–72.3%, P < 0.0001) and in the SMBG+CSII group (50.6–57.8%, P = 0.0114). Significant reductions in time below range were found only in the rtCGM subgroups (rtCGM+MDI, 9.4–5.5%, P = 0.0387; and rtCGM+CSII, 9.0–5.3%, P = 0.0235). Seven severe hypoglycemia episodes occurred: SMBG groups, n = 5; sensor-augmented insulin regimen groups, n = 2. CONCLUSIONS rtCGM was superior to SMBG in reducing A1C, hypoglycemia, and other end points in individuals with T1D regardless of their insulin delivery method. rtCGM+MDI can be considered an equivalent but lower-cost alternative to sensor-augmented insulin pump therapy and superior to treatment with SMBG+MDI or SMBG+CSII therapy.

IntroductionAtrial fibrillation (AF), with a prevalence of 2%, is the most common cardiac arrhythmia. Catheter ablation (CA) has been documented to be superior to treatment by antiarrhythmic drugs (AADs) in terms of sinus rhythm maintenance. However, in obese patients, substantial weight loss was also associated with AF reduction. So far, no study has compared the modern non-invasive (AADs combined with risk factor modification (RFM)) approach with modern invasive (CA) treatment. The aim of the trial is to compare the efficacy of modern invasive (CA) and non-invasive (AADs with risk factor management) treatment of AF.Methods and analysisThe trial will be a prospective, multicentre, randomised non-inferiority trial. Patients with symptomatic AF and a body mass index >30 will be enrolled and randomised to the CA or RFM arm (RFM+AAD) in a 1:1 ratio. In the CA arm, pulmonary vein isolation (in combination with additional lesion sets in non-paroxysmal patients) will be performed. For patients in the RFM+AAD arm, the aim will be a 10% weight loss over 6–12 months, increased physical fitness and a reduction in alcohol consumption. The primary endpoint will be an episode of AF or regular atrial tachycardia lasting >30 s. The secondary endpoints include AF burden, clinical endpoints associated with AF reoccurrence, changes in the quality of life assessed using dedicated questionnaires, changes in cardiorespiratory fitness and metabolic endpoints. An AF freedom of 65% in the RFM+AAD and of 60% in the CA is expected; therefore, 202 patients will be enrolled to achieve the non-inferiority with 80% power, 5% one-sided alpha and a non-inferiority margin of 12%.Ethics and disseminationThe PRAGUE-25 trial will determine if modern non-invasive AF treatment strategies are non-inferior to CA. The study was approved by the Ethics Committee of the University Hospital Kralovske Vinohrady. Results of the study will be disseminated on scientific conferences and in peer-reviewed scientific journals. After the end of follow-up, data will be available upon request to principal investigator.Trial registration numberClinicalTrials.gov Registry (NCT04011800).

Background: The aim of this trial was to compare the efficacy of real-time and intermittently-scanned continuous glucose monitoring (rtCGM and isCGM, respectively) in maintaining optimal glycemic control. Methods: In this randomized study, adults with T1D and normal hypoglycemia awareness (GOLD score Results: Sixty adults with T1D (mean age 38±13 years, A1C 62±12 mmol/mol [7.8±1.1%]) were randomized to rtCGM (n=30) or isCGM (n=30). All participants completed the study. Percentage of time in hypoglycemia ( Conclusion: rtCGM was superior to isCGM in reducing hypoglycemia and improving time in range in T1D adults with normal hypoglycemia awareness, demonstrating the value of rtCGM alarms during exercise and in daily diabetes self-management.

Primary aldosteronism (PA) is associated with objectively measured lower physical fitness and blunted response of the renin-angiotensin-aldosterone system to exercise. The purpose of this pilot study was to objectively measure exercise response of the renin-angiotensin-aldosterone system and cardiopulmonary fitness changes after laparoscopic adrenalectomy (ADE) in patients with unilateral PA. We examined a total of 14 patients with confirmed PA before and after ADE, by means of spiroergometry and hormonal evaluation. As expected, after adrenalectomy basal aldosterone (Aldo) levels before exercise decreased significantly, with a concomitant increase in plasma renin (PR). The increase in Aldo (285.9±171.3 to 434.1±278.2 ng/l; p=0.02) and blunted increase in PR (7.1±0.4 to 8.9±10.4 pg/ml; NS) post-exercise before ADE became significant after ADE Aldo post-ADE (46.8±18.8 to 106.5±68.1 ng/l; p

Aim: Human exposure to organic pollutants (some of them also called endocrine disruptors) can be associated with adverse metabolic health outcomes including type 2 diabetes. The aim of this study was to compare the urine levels of bisphenol A and phthalate metabolites in subgroups of patients with metabolic syndrome composed of patients with and without three important components of metabolic syndrome (hypertension, dyslipidemia and diabetes). Methods: We have investigated 24 hours urine samples of 168 patients with metabolic syndrome from the Metabolic Outpatient Department of General University Hospital in Prague. Using standard metabolic syndrome criteria, we classified patients as dyslipidemic (n=87), hypertensive (n=96), and type 2 diabetic (n=58). Bisphenol A and 15 metabolites of phthalates were evaluated in relation to creatinine excretion. Samples were analysed with enzymatic cleavage of glucuronide using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in one laboratory with external quality control. Results: Four metabolites, mono-n-butyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-carboxypentyl) phthalate showed significantly higher levels in diabetic compared to non-diabetic patients (p

Fibroblast growth factor 21 (FGF21) is a hepatokine with beneficial effects on metabolism. Our aim was to evaluate the relationship between the serum FGF21, and energy and glucose metabolism in 40 patients with pheochromocytoma/functional paraganglioma (PPGL), in comparison with 21 obese patients and 26 lean healthy controls. 27 patients with PPGL were examined one year after tumor removal. Basic anthropometric and biochemical measurements were done. Energy metabolism was measured by indirect calorimetry (Vmax-Encore 29N). FGF21 was measured by ELISA. FGF21 was higher in PPGL than in controls (174.2 (283) pg/mL vs. 107.9 (116) pg/mL, p &lt, 0.001) and comparable with obese (174.2 (283) pg/mL vs. 160.4 (180), p = NS). After tumor removal, FGF21 decreased (176.4 (284) pg/mL vs. 131.3 (225) pg/mL, 0.001). Higher levels of FGF21 were expressed, particularly in patients with diabetes. FGF21 positively correlated in PPGL with age (p = 0.005), BMI (p = 0.028), glycemia (p = 0.002), and glycated hemoglobin (p = 0.014). In conclusion, long-term catecholamine overproduction in PPGL leads to the elevation in serum FGF21, especially in patients with secondary diabetes. FGF21 levels were comparable between obese and PPGL patients, despite different anthropometric indices. We did not find a relationship between FGF21 and hypermetabolism in PPGL. Tumor removal led to the normalization of FGF21 and the other metabolic abnormalities.

Objective: To compare different treatment modalities for patients with type 1 diabetes (T1D) based on real-time continuous glucose monitoring (RT-CGM) or self-monitoring of blood glucose (SMBG) combined with multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII). Research Design and Methods: Sixty-five T1D patients were followed up for a year. Of these, 27 started RT-CGM as part of a sensor-augmented insulin regimen (SAIR); within this SAIR group, 15 subjects started sensor-augmented pump (SAP) therapy and the remaining 12 continued with MDIs (MDIs + RT-CGM). A second group of 20 patients initiated CSII without RT-CGM, while a third group of 18 subjects continued on MDIs and SMBG. The main endpoints were reduction of HbA1c, glycemic variability (GV), and incidence of hypoglycemia. Results: After a year, the baseline mean HbA1c in the SAIR group (8.3%) decreased to 7.1% (P

Uvod: V soucasne době neexistuje shoda na definici normalniho zvýseni krevniho tlaku (TK) v průběhu dynamicke zatěže, a tudiž ani na definici hypertonicke reakce. Cilem předkladane prace bylo kvantifikovat zavislost mezi TK a intenzitou dynamicke zatěže na bicyklovem ergometru korigovane na tělesnou hmotnost pacienta. Druhotným cilem bylo zjistit determinanty teto zavislosti.Metodika: Předkladame výsledky nasi observacni studie s retrospektivni analýzou hodnot TK zjistěných během 313 standardnich zatěžových vysetřeni na bicykloergometru. Pro ucely statisticke analýzy byla intenzita zatěže korigovana hmotnosti pacienta.Výsledky: Z krokove linearni regresni analýzy vyplynulo, že systolický TK (STK) na prvnim stupni zatěže byl zavislý na systolickem TK zjistěnem za klidových podminek (p = 0,001), na intenzitě zatěže (W/kg) (p = 0,001), na BMI (p = 0,005) a na věku (p = 0,002): STK = -25,059 + 0,927 * STKklid + 31,625 * W/kg1 + 0,840 * BMI + 0,235 * věk; a diastolický TK (DTK) je zavislý na diastolickem TK zjistěnem za klidových podminek (p = 0,001) a na systolickem TK zjistěnem za klidových podminek (p = 0,033): DTK = 29,790 + 0,583 * DTKklid + 0,071 * STKklid. Na dalsich stupnich zatěže věk již neovlivňoval STK a klidova hodnota DTK byla hlavni determinantou zatěžove hodnoty DTK.Zavěr: Krevni tlak při zatěži zavisi na klidových hodnotach TK a na intenzitě zatěže a v mensi miře take na BMI a věku. V budoucich studiich zabývajicich se tlakovou reakci na dynamickou zatěž by měla být submaximalni intenzita zatěže korigovana hmotnosti pacienta.

Movement is the basic attribute of life. It is not surprising that the return to regular physical activity is a very effective and cheap means of preventing and treating most non-cummunicable diseases. Therefore, every physician should be able to prescribe a suitable physical activity. The minimum amount of physical activity with proven effects in primary prevention of chronic diseases is relatively low: 150 minutes of moderate physical activity or 75 minutes of high intensity exercise per week or a combination of the two. The simplest and safe way of physical activity is walking (at least 10 000 steps/day or 6 000 steps/day on top of daily activities). The FITT model is a more sophisticated way of prescribing physical activity that already requires a stress test. Patients at risk of atherosclerosis or with any manifestation of atherosclerosis (patients with coronary artery disease, post-stroke, peripheral artery disease) benefit from exercise as well as patients with chronic heart failure. Physical activity also helps patients with lung disease (COPD, asthma), metabolic diseases (diabetes mellitus, obesity, osteoporosis) and also rheumatologic diseases. Regular exercise improves cognitive function, reduces depression and anxiety, and helps addicted people. Recently, it has been shown that exercise also changes the gut microbiome. One of the mechanisms that contribute to the beneficial effect of exercise is so-called "exercise factors" - myokines. Physical activity, when properly prescribed, is an inexpensive and universal medication with minimal side effects. It is our "home pharmacy" we always have with us.Key words: cancer - cardiovascular diseases - neuropsychiatric diseases - physical activity - type 2 diabetes.

Omentin is a novel adipokine with insulin-sensitizing effects expressed predominantly in visceral fat. We investigated serum omentin levels and its mRNA expression in subcutaneous adipose tissue (SCAT) of 11 women with type 2 diabetes mellitus (T2DM), 37 obese non-diabetic women (OB) and 26 healthy lean women (C) before and after various weight loss interventions: 2-week very-low-calorie diet (VLCD), 3-month regular exercise and laparoscopic sleeve gastrectomy (LSG). At baseline, both T2DM and OB groups had decreased serum omentin concentrations compared with C group while omentin mRNA expression in SCAT did not significantly differ among the groups. Neither VLCD nor exercise significantly affected serum omentin concentrations and its mRNA expression in SCAT of OB or T2DM group. LSG significantly increased serum omentin levels in OB group. In contrast, omentin mRNA expression in SCAT was significantly reduced after LSG. Baseline fasting serum omentin levels in a combined group of the studied subjects (C, OB, T2DM) negatively correlated with BMI, CRP, insulin, LDL-cholesterol, triglycerides and leptin and were positively related to HDL-cholesterol. Reduced circulating omentin levels could play a role in the etiopathogenesis of obesity and T2DM. The increase in circulating omentin levels and the decrease in omentin mRNA expression in SCAT of obese women after LSG might contribute to surgery-induced metabolic improvements and sustained reduction of body weight.

Appropriate differentiation capacity of adipose tissue significantly affects its ability to store lipids and to protect nonadipose tissues against lipid spillover and development of insulin resistance. Preadipocyte factor-1 (Pref-1) is an important negative regulator of preadipocyte differentiation. The aim of our study was to explore the changes in circulating Pref-1 concentrations in female subjects with obesity (OB) (n=19), females with obesity and type 2 diabetes mellitus (T2DM) (n=22), and sex- and age-matched healthy control subjects (C) (n=22), and to study its modulation by very low calorie diet (VLCD), acute hyperinsulinemia during isoglycemic-hyperinsulinemic clamp, and 3 months' treatment with PPAR-α agonist fenofibrate. At baseline, serum Pref-1 concentrations were significantly higher in patients with T2DM compared to control group, while only nonsignificant trend towards higher levels was observed in OB group. 3 weeks of VLCD decreased Pref-1 levels in both OB and T2DM group, whereas 3 months of fenofibrate treatment had no significant effect. Hyperinsulinemia during the clamp significantly suppressed Pref-1 levels in both C and T2DM subjects and this suppression was unaffected by fenofibrate treatment. In a combined population of all groups, circulating Pref-1 levels correlated positively with insulin, leptin and glucose levels and HOMA (homeostasis model assessment) index. We conclude that elevated Pref-1 concentrations in T2DM subjects may contribute to impaired adipose tissue differentiation capacity associated with insulin resistance in obese patients with T2DM. The decrease of Pref-1 levels after VLCD may be involved in the improvement of metabolic status and the amelioration of insulin resistance in T2DM patients.

BACKGROUND Blood pressure (BP) increases with age and obesity. We have assessed the relative contribution of age and fatness to BP regulation in a healthy population investigated by nurse practitioners. MATERIAL AND METHODS Preventive investigation and counseling was offered at the entrance hall of the regional authority´s office in the town of Nitra by 2 nursing specialists who investigated 120 men and 276 women. In men the mean body mass index (BMI) was 26.8 kg/m2, mean weight was 84.4 kg, mean fat percentage was 23.3, mean age was 46.1 years, mean systolic BP was 133.1 mmHg, and mean diastolic BP was 82.5 mmHg. In women the mean BMI was 24.8 kg/m2, mean weight was 67.3 kg, mean fat percentage was 29.4, mean age was 45.4 years, mean systolic BP was 127.7 mmHg, and mean diastolic BP was 78.5 mmHg. Correlation analysis was performed and in multiple regression analysis we used BP values as the dependent variable and fat percentage and age as independent variables. Normality of variables distribution was checked and found satisfactorily. RESULTS Most of the subjects had an untreated component of metabolic syndrome. There was a correlation between BP values, age, and percent body fat. BP was regulated only to a certain degree by fatness and age, with the influence being relatively small. Our results showed that BP was more influenced by fatness than age, and body fatness was more related to higher systolic than to diastolic BP. CONCLUSIONS Age and fatness could explain BP values by only 3-30%, although BP was more influenced by fatness than by age. Nurse practitioners can effectively detect and motivate people with metabolic syndrome.

OBJECTIVE: The aim of our study was to evaluate the effect of a lifestyle intervention program on beta-cell function and to explore the role of gastrointestinal peptides in subjects with T2D. METHODS: Subjects with T2D (n=74) received 24 weeks of intervention: 12 weeks of slimming diet (-500 kcal/day) and the subsequent 12 weeks of diet were combined with aerobic exercise. All subjects were examined at weeks 0, 12 and 24. beta-cell function was assessed during standard meal tests. Insulin secretory rate (ISR) was calculated by C-peptide deconvolution, and beta-cell function was quantified with a mathematical model. Plasma concentrations of gastrointestinal peptides were measured in a fasting state and during hyperinsulinemia induced by hyperinsulinemic isoglycemic clamp. RESULTS: Mean weight loss was 5.03+/-4.38 kg (p

Objective Cardiopulmonary fitness depends on daily energy expenditure or the amount of daily exercise. Patients with narcolepsy spent more time being sleepy or asleep than controls; thus we may speculate that they have a lower quantity and quality of physical activity. The aim of the present study was thus to test the hypothesis that exercise tolerance in narcolepsy negatively depends on sleepiness. Patients and methods The cross-sectional study included 32 patients with narcolepsy with cataplexy, 10 patients with narcolepsy without cataplexy, and 36 age- and gender-matched control subjects, in whom a symptom-limited exercise stress test with expired gas analysis was performed. A linear regression analysis with multivariate models was used with stepwise variable selection. Results In narcolepsy patients, maximal oxygen uptake (VO 2peak ) was 30.1 ± 7.5 mL/kg/min, which was lower than 36.0 ± 7.8 mL/kg/min, p = 0.001, in controls and corresponded to 86.4% ± 20.0% of the population norm (VO 2peak %) and to a standard deviation (VO 2peak SD) of −1.08 ± 1.63 mL/kg/min of the population norm. VO 2peak depended primarily on gender ( p = 0.007) and on sleepiness ( p = 0.046). VO 2peak % depended on sleepiness ( p = 0.028) and on age ( p = 0.039). VO 2peak SD depended on the number of cataplexy episodes per month ( p = 0.015) and on age ( p = 0.030). Conclusions Cardiopulmonary fitness in narcolepsy and in narcolepsy without cataplexy is inversely related to the degree of sleepiness and cataplexy episode frequency.

Diabet. Med. 28, 549–559 (2011) Abstract Aims The aim of this study was to compare the effects of calorie-restricted vegetarian and conventional diabetic diets alone and in combination with exercise on insulin resistance, visceral fat and oxidative stress markers in subjects with Type 2 diabetes. Methods A 24-week, randomized, open, parallel design was used. Seventy-four patients with Type 2 diabetes were randomly assigned to either the experimental group (n = 37), which received a vegetarian diet, or the control group (n = 37), which received a conventional diabetic diet. Both diets were isocaloric, calorie restricted (-500 kcal/day). All meals during the study were provided. The second 12 weeks of the diet were combined with aerobic exercise. Participants were examined at baseline, 12 weeks and 24 weeks. Primary outcomes were: insulin sensitivity measured by hyperinsulinaemic isoglycaemic clamp; volume of visceral and subcutaneous fat measured by magnetic resonance imaging; and oxidative stress measured by thiobarbituric acid reactive substances. Analyses were by intention to treat. Results Forty-three per cent of participants in the experimental group and 5% of participants in the control group reduced diabetes medication (P

ObjectiveMacrophage inhibitory cytokine-1 (MIC-1) is a novel regulator of energy homeostasis. We explored whether alterations in MIC-1 levels contribute to metabolic disturbances in patients with obesity and/or obesity and type 2 diabetes mellitus (T2DM).DesignWe measured serum MIC-1 levels and its mRNA expression in subcutaneous and visceral adipose tissue of 17 obese nondiabetic women, 14 obese women with T2DM and 23 healthy lean women. We also explored the relationship of MIC-1 with anthropometric and biochemical parameters and studied the influence of 2-week very low calorie diet (VLCD) on serum MIC-1 levels.MethodsSerum MIC-1 levels were measured by ELISA and its mRNA expression was determined by RT-PCR.ResultsBoth obese and T2DM group had significantly elevated serum MIC-1 levels relative to controls. T2DM group had significantly higher serum MIC-1 levels relative to obese group. Serum MIC-1 positively correlated with body weight, body fat, and serum levels of triglycerides, glucose, HbAlc, and C-reactive protein and it was inversely related to serum high-density lipoprotein cholesterol. Fat mRNA MIC-1 expression did not significantly differ between lean and obese women but it was significantly higher in subcutaneous than in visceral fat in both groups. VLCD significantly increased serum MIC-1 levels in obese but not T2DM group.ConclusionElevated MIC-1 levels in patients with obesity are further increased by the presence of T2DM. We suggest that in contrast to patients with cancer cachexia, increased MIC-1 levels in obese patients and diabetic patients do not induce weight loss.

Apolipoprotein C-III (ApoC-III) is a glycoprotein carrying the most common O-linked glycan structure and is abundantly present in serum, what renders it a suitable marker for analysis of O-glycosylation abnormalities. Isoelectric focusing followed by a Western blot of ApoC-III, using PhastSystem™ Electrophoresis System (GE Healthcare), was introduced as a rather simple and rapid method for screening of certain subtypes of inherited glycosylation disorders. The study’s aim was to establish this method in our laboratory, what included performing the analysis in a group of 170 healthy individuals to set the reference range of detected relative amounts of sialylated ApoC-III isoforms and to evaluate the gender- and age-dependent differences. A significant relative increase of asialo-ApoC-III with growing age was found. Secondly, we examined serum from patients with selected metabolic disorders and detected minor O-glycosylation changes in diseases such as Prader-Willi syndrome, PGM1 (phosphoglucomutase 1) or MAN1B (class 1B alpha-1,2-mannosidase) deficiency. Our results show that this method allows for a sensitive detection of ApoC-III O-glycosylation status, however this might be modulated by several factors (i.e. nutrition, medication) whose exact role remains to be determined.

Physical activity is often underestimated and little used in the treatment of diabetes. The fear of damage, especially in patients with diabetes complications is one of the reasons why it occurs. Physical activity plays an important role in prevention of the progression of peripheral neuropathy and its impact is primarily on the development of muscle strength and the ability to replace the function of nerve fibers damaged disabilities. Demonstrable effect on neuropathy is already recorded a few weeks of regular exercise, long-term programs then demonstrate the safety of occurrence of ulcers in compliance with basic foot care. Present autonomic neuropathy cannot predict response to cardiac respectively, heart rate and blood pressure. Due to other risks (silent ischemia, arrhythmia etc.), it is appropriate to stress test before a prescription of exercise programs. Monitoring of blood pressure, heart rate and blood glucose during the first hours of physical activity is necessary. In patients with autonomic neuropathy of the gastrointestinal tract may significantly affect the composition of the diet not only the ability of physical activity, but can also affect hypoglycaemia due to a slow carbohydrate absorption in these patients. Another risk in patients with autonomic neuropathy is orthostatic hypotension, which may potentiate antihypertensive drugs in "white coat" hypertension. Prescription of patients with retinopathy depends on the form and degree of retinopathy. Only proliferative retinopathy can significantly reduce exercise prescription, and it is always necessary to consult with ophthalmologist. In patients with nephropathy is an important stage of renal insufficiency for prescription of physical activity. Prescription is then influenced by the degree of renal insufficiency in addition to the presence of other associated diseases (anemia, hypertension, osteopathy etc.). Physical activity is essential in patients on dialysis respectively. After renal transplantation as maintaining peripheral muscle and its functions not only improves the prognosis, but also improves the quality of life and self-sufficiency is maintained.

Obesity is a very common disease with very difficult treatment. Most patients are not able to change their behaviour. Most hopeful for the future is a safe pharmacotherapy which could be widely used. In this review, old and potentially new drugs decreasing weight are mentioned (centrally acting anorectics, orlistat, incretine analogues and gliphlozines). Review of newly in U.S.A used antiobesitics is also mentioned. Finally potentially new principles of obesity pharmacotherapy are enumerated.

Introduction: Since January 1st, 2010 the care for uncomplicated diabetic patients has moved from the diabetes specialists in the Czech Republic and it can be provided by the general practitioners henceforth. We refer about the technologies supporting this new system of care. Aim and methods: This paper reports on the information systems used to support the diabetes care in GP office and on the technologies connected to this system. Results: There have been two types of information systems in use: PC DOKTOR, and MEDICUS. Two Internet standards: “Diabetes“, and “Prediabetes“, have been published and regularly updated. In the offices, there have been several laboratory devices for laboratory measurements used and directly connected to the information system. Conclusion: The technical support for diabetes care has enabled a complex care for diabetic patient at the general practitioner’s office even in the critical situation when the number of diabetic patients is extremely increasing.

BACKGROUND AND AIMS: Fatty acids are important cellular constituents that may affect many metabolic processes relevant for the development of diabetes and its complications. We showed previously that vegetarian diet leads to greater increase in metabolic clearance rate of glucose (MCR) than conventional hypocaloric diet. The aim of this secondary analysis was to explore the role of changes in fatty acid composition of serum phospholipids in diet- and exercise-induced changes in MCR in subjects with type 2 diabetes (T2D). METHODS: Subjects with T2D (n=74) were randomly assigned into a vegetarian group (VG, n=37) following vegetarian diet or a control group (CG, n=37) following a conventional diet. Both diets were calorie restricted (−500 kcal day–1). Participants were examined at baseline, 12 weeks of diet intervention and 24 weeks (subsequent 12 weeks of diet were combined with aerobic exercise). The fatty acid composition of serum phospholipids was measured by gas liquid chromatography. MCR was measured by hyperinsulinemic isoglycemic clamp. Visceral fat (VF) was measured by magnetic resonance imaging. RESULTS: Linoleic acid (LA; 18:2n6) increased in VG (P=0.04), whereas it decreased in CG (P=0.04) in response to dietary interventions. It did not change significantly after the addition of exercise in either group (group × time Pr=+0.22; P=0.04) and negatively with changes in VF (r=−0.43; P=0.01). After adjustment for changes in body mass index, the association between 18:2n6 and MCR was no longer significant. The addition of exercise resulted in greater changes of phospholipid fatty acids composition in VG than in CG. CONCLUSION: We demonstrated that the insulin-sensitizing effect of a vegetarian diet might be related to the increased proportion of LA in serum phospholipids.

Metabolic (Reaven's) syndrome is a set of metabolic abnonnalities including common diseases e.g. diabetes, hypertension. According to unknown pathogenesis quantitative approaches are used to analyse the adherence of the syndrome components. We have described quantitative changes in components adherence in obese patients during quantified weight loss. The number of factors describing the components of the disease is decreasing. Using an other approach (odds ratio calculation) we have described the adherence of colon cancer to diabetes. Statistical modelling was successfully used to quantify the adherence of disease components.

Background: Obesity aects one in four people in the Czech Republic and its incidence is growing worldwide. In this article we focused on evaluation of treatment of obesity in diabetic patients by bariatric surgery and we also tried to evaluate the costs of the surgery and antidiabetics. Methods: The total number of patients was 200 and 30 of them with type 2 diabetes mellitus. In the 1-year followup we evaluated remission or compensation of diabetes in patients after particular bariatric methods. We also calculated the decrease of average costs for pharmacotherapy by antidiabetics after 6 and 12 months and the costs for the bariatric surgery. Results: We found that costs for the treatment by antidiabetics were reduced nearly 3 already in the 6th month after the surgery. Insurance companies currently do not take in consideration dierent costs for the partial surgery methods and the payment is in one package for approx. 60 thousands CZK. Conclusion: The positive eect of the surgery appeared in the 6th month of the follow-up. However, to achieve more accurate results we need to evaluate the data after 3 years of the follow-up.

Context: Low-grade inflammation links obesity, type 2 diabetes mellitus (T2DM), and cardiovascular diseases. Objective: To explore the expression profile of genes involved in inflammatory pathways in adipose tissue and peripheral monocytes (PM) of obese patients with and without T2DM at baseline and after dietary intervention. Design: Two-week intervention study with very-low-calorie diet (VLCD). Setting: University hospital. Patients: Twelve obese females with T2DM, 8 obese nondiabetic females (OB) and 15 healthy age-matched females. Intervention: Two weeks of VLCD (2500 kJ/d). Main Outcome Measures: Metabolic parameters, circulating cytokines, hormones, and mRNA expression of 39 genes in sc adipose tissue (SCAT) and PM. Results: Both T2DM and OB group had significantly increased serum concentrations of circulating proinflammatory factors (C-reactive protein, TNFα, IL-6, IL-8), mRNA expression of macrophage antigen CD68 and proinflammatory chemokines (CCL-2, -3, -7, -8, -17, -22) in SCAT and complementary chemokine receptors (CCR-1, -2, -3, -5) and other proinflammatory receptors (toll-like receptor 2 and 4, TNF receptor superfamily 1A and 1B, IL-6R) in PM, with OB group showing less pronounced chemoattracting and proinflammatory profile compared to T2DM group. In T2DM patients VLCD decreased body weight, improved metabolic profile, and decreased mRNA expression of up-regulated CCRs in PM and chemokines [CCL 8, chemokine (C-X-C motif) ligand 10] in SCAT. VLCD markedly increased mRNA expression of T-lymphocyte attracting chemokine CCL-17 in SCAT. Conclusion: Obese patients with and without T2DM have increased mRNA expression of chemotactic and proinflammatory factors in SCAT and expression of corresponding receptors in PM. Two weeks of VLCD significantly improved this profile in T2DM patients.

In obese patients, we hypothesized physical exercise (PE) to affect lipids through its intrahepatic fat accumulation-lowering effect, associated with a decrease of total body fat (Fat%) and even weight (Mass).Thirty seven sedentary, non-diabetic women (BMI median 34.8) from our out-patient department were tested. Elimination criteria: recent weight reduction, lipid-influencing or heart rate-modifying medication.50 entering, 37 finishing, 7 excluded for processing failure, 6 did not fulfill the protocol.PE protocol: 60 min supervised trainings, intensity at 65% of VO2max, modified by the clamp heart rate test. Median of total training hours was 34 during 115 days (median).an effect of PE on total cholesterol (CH), triglycerides (TG), 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%.Statistically significant differences at start (_s) and the end (_e) of PE (p0.05): AIP -0.049, Mass -3.6 (kg), BMI -1.7 (kg/m2), Waist -2.5 (cm), Fat% -2.5, VO2max 2.92 (L.min-1kg-1). Correlation coefficients, Pearson's between Gaussian distributed (Gd-v) variables and Spearman´s (non Gd-v) statistically significant (p0.05): IA and BMI, IA and Mass, IA and Waist, IA and Fat%, LDL and BMI, LDL and Mass, LDL and Fat%, LDL and Waist, IA and VO2max, LDL_C and VO2max.PE improves lipid profile towards production of antiatherogenic particles more likely due to changes in anthropometric parameters than in improvement of physical fitness.

Summary Objective Fibroblast growth factor-21 (FGF21) is a novel endocrine and paracrine regulator of metabolic homeostasis. The aim of our study was to measure its serum concentrations in patients with obesity, obesity and type 2 diabetes mellitus (T2DM) and healthy subjects (C), and to assess the changes of its circulating levels and mRNA expression after dietary and pharmacological interventions. Design We measured biochemical parameters, serum FGF21, adiponectin, leptin and insulin levels by commercial ELISA and RIA kits, and mRNA expression in the liver, subcutaneous and visceral fat by RT PCR in 26 obese patients, 11 T2DM patients and 32 control subjects. The interventions were acute hyperinsulinaemia during isoglycaemic–hyperinsulinaemic clamp, very low calorie diet (VLCD) and 3 months treatment with PPAR-α agonist fenofibrate. Results Baseline serum FGF21 levels were significantly higher in both obese and T2DM patients relative to healthy controls. FGF21 levels in obesity did not significantly differ from T2DM group. Both 3 weeks of VLCD and 3 months of fenofibrate treatment significantly increased FGF21 levels. FGF21 mRNA expression in visceral fat was twofold higher in obesity relative to C group, while it did not differ in subcutaneous fat. VLCD significantly increased FGF21 mRNA expression in subcutaneous fat of obesity. 3-h hyperinsulinaemia during the clamp increased FGF21 levels in T2DM but not in C group. Conclusion An increase in FGF21 levels after VLCD and fenofibrate treatment may contribute to positive metabolic effect of these interventions and suggests the possibility of direct positive metabolic effects of FGF21 in humans.

Scientific objectives Physically active subjects have superior aerobic performance and effort tolerance compared to the less active subjects. There was observed association between high exercise capacity and low mortality. The protective effect of physical activity and exercise capacity preventing the progression of diseases, and thus on premature death, could be one of explanations for this association. Most of this protection is assumed to result from the beneficial effects of physical exercise on blood lipids, blood pressure, glucose metabolism, vascular function, autonomic tone, blood coagulation, and inflammation.

Background: The influence of metabolic state and the presence of diabetes before surgery on the weight changes following non-adjustable gastric banding, were studied. Methods: The total of 50 patients referred for gastric banding had the following parameters measured: insulinemia, glycemia, total cholesterol, triglycerides (TAG), dehydroepiandrostendione (DHEA) and its sulphate (DHEA-S), triiodothyronine, thyroxine, and thyroxine-stimulating hormone. We evaluated 28 of these, who completed at least 6 months of follow-up. 12 of these patients had diettreated non-insulin dependent diabetes mellitus (NIDDM) and 16 were non-diabetics, and 9 of them had a positive family history of NIDDM (FH DM). We compared the change in weight of the diabetics, non-diabetics and those with positive FH DM, at 3, 6 and 12 months after the operation. Multiple linear regression tested the influence of the measured parameters on patients' weight. Results: Weight loss was greatest in the group of patients without a positive family history of diabetes, and lowest in the diabetic group. Due to the high dispersion, differences in the t-test are not significant. When individual factors and their influence on weight development were tested by multiple linear regression, weight loss was greatest in patients with high TAG and low insulin levels and lowest in patients with diabetes or positive FH DM. Conclusions: Although post-operative weight can be influenced by other factors, eg. psychological ones, it is advisable to test each patient pre-operatively for insulin and TAG levels, and to establish family history of diabetes and presence of diabetes to give an idea of the prognosis of weight change.

Hypokalemia as a typical feature of primary aldosteronism (PA) is associated with muscle weakness and could contribute to lower cardiopulmonary fitness. The aim of this study was to describe cardiopulmonary fitness and exercise blood pressure and their determinants during a symptom-limited exercise stress test in patients with PA. We performed a cross-sectional study of patients with confirmed PA who were included before adrenal vein sampling on whom a symptom-limited exercise stress test with expired gas analysis was performed. Patients were switched to the treatment with doxazosin and verapamil at least two weeks before the study. In 27 patients (17 male) the VO2peak was 25.4±6.0 ml/kg/min which corresponds to 80.8±18.9 % of Czech national norm. Linear regression analysis shows that VO2peak depends on doxazosin dose (DX) (p=0.001) and kalemia (p=0.02): VO2peak = 4.2 – 1.0 * DX + 7.6 * Kalemia. Patients with higher doxazosin doses had a longer history of hypertension and had used more antihypertensives before examination, thus indicating that VO2peak also depends on the severity of hypertension. In patients with PA, lower cardiopulmonary fitness depends inversely on the severity of hypertension and on lower plasma potassium level.

The metabolic syndrome is a severe human disease -a combination of common diseases (type 2 diabetes, hypertension, obesity, hypertriglyceridemia, hyperuricemia and some other changes). The leading and perhaps primary pathogenic feature is insulin resistance. There are 4 types of information in metabolic syndrome patients: static describing the number of components of disease, basic metabolic describing of metabolites and hormone levels, functional model based description of disease, dynamic ability of patients to change quantitative parameters. Prognosis of patient can be calculated using this information but prognosis of therapy could be determined only calculating the dynamic ability to change the metabolic state.

Background Several hypotheses suggest a temporary increase in blood pressure following smoking cessation. This may be the result of endocrine changes (e.g. alteration in adrenocorticotropic hormone and cortisol levels in post-cessation period) and/or post-cessation weight gain. Our aim was to identify factors that may be associated with the diagnosis of hypertension after quitting smoking. Methods In 2010, we conducted a cross-sectional survey in a sample of 2065 Czech adults, chosen by quota selection and representative according to age, gender, education, region of residence and the size of settlement, aged 18 to 94 years. We examined the association between age, gender, body mass index, smoking status, and education with the hypertension diagnosis in their personal history. Data were compiled and weighed by age categories. Statistical significance was measured by Pearson Chi-square test at the level of significance 95 %. Results Diagnosis of hypertension was reported in 461 (22 %) subjects, with no difference by gender. Based on univariate analysis, former smokers were more likely than non-smokers to be diagnosed for hypertension (OR 1.450 (1.110-1.900), p = 0.006). However, after adjusting for body mass index and age, the occurrence of hypertension diagnosis did not differ among non-smokers, smokers and former smokers (OR 0.760 for smokers, p = 0.082 and OR 1.020 for former smokers, p = 0.915). Conclusions We did not find any differences in hypertension diagnosis prevalence according to smoking status.