Acute Hyperglycemia Does Not Impair Microvascular Reactivity and Endothelial Function during Hyperinsulinemic Isoglycemic and Hyperglycemic Clamp in Type 1 Diabetic Patients

Aims. The aim of this study was to evaluate the effect of acute glycemia increase on microvasculature and endothelium in Type 1 diabetes during hyperinsulinemic clamp. Patients and Methods. Sixteen patients (51 ± 7 yrs) without complications were examined during iso- and hyperglycemic clamp (glucose increase 5.5 mmol·L−1). Insulin, lipid parameters, cell adhesion molecules and fibrinogen were analyzed. Microvascular reactivity (MVR) was measured by laser Doppler flowmetry. Results. Maximum perfusion and the velocity of perfusion increase during PORH were higher in hyperglycemia compared to baseline (47 ± 16 versus 40 ± 16 PU, P < 0.01, and 10.4 ± 16.5 versus 2.6 ± 1.5 PU·s−1, P < 0.05, resp.). Time to the maximum perfusion during TH was shorter and velocity of perfusion increase during TH higher at hyperglycemia compared to isoglycemic phase (69 ± 15 versus 77 ± 16 s, P < 0.05, and 1.4 ± 0.8 versus 1.2 ± 0.7 PU·s−1, P < 0.05, resp.). An inverse relationship was found between insulinemia and the time to maximum perfusion during PORH (r = −0.70, P = 0.007). Conclusion. Acute glycemia did not impair microvascular reactivity in this clamp study in Type 1 diabetic patients. Our results suggest that insulin may play a significant role in the regulation of microvascular perfusion in patients with Type 1 diabetes through its vasodilation effect and can counteract the effect of acute glucose fluctuations

Translating recent results from the Cardiovascular Outcomes Trials into clinical practice: recommendations from the Central and Eastern European Diabetes Expert Group (CEEDEG)

Aims: These recommendations aim to improve care for patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk in Central and Eastern Europe. Cardiovascular disease (CVD) and/or chronic kidney disease (CKD) are major interdependent comorbidities in patients with T2D, accounting for 50% of mortality. Following recent CV outcomes trial (CVOT) results, including those from EMPA-REG -OUTCOME (R), LEADER (R), SUSTAIN (TM)-6 and, most recently, the CANVAS study, it is essential to develop regional expert consensus recommendations to aid physicians in interpreting these newest data to clinical practice. Methods: The Central and Eastern European Diabetes Expert Group (CEEDEG) followed a Delphi method to develop treatment algorithms to aid physicians in the clinical management of patients with T2D at high CV risk. Results: In light of the latest CVOT results, and in particular the EMPA-REG -OUTCOME (R) and -LEADER (R) trials, the diagnosis, assessment, treatment choice and monitoring of patients with T2D and established CVD and/or CKD have been considered together with existing guidelines and presented in two reference algorithms. In addition, adherence, special prescribing considerations and a proposed multidisciplinary management approach have been discussed and are presented with the proposed algorithms. Conclusions: The latest available high-level evidence on glucose-lowering drugs has enabled CEEDEG to develop practical consensus recommendations for patients with established CVD and/ or CKD. These recommendations represent an update to international and country-level guidelines used for these patients, with the aim of providing a resource not only to endocrinologists, but to cardiologists, nephrologists and primary care physicians in the region

The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence?

Patients with Covid-19 place new challenges on the management of type 2 diabetes, including the questions of whether glucose-lowering therapy should be adjusted during infection and how to manage a return to normal care after resolution of Covid-19 symptoms. Due to the sudden onset of the pandemic, physicians have by necessity made such important clinical decisions in the absence of robust evidence or consistent guidelines. The risk to patients is compounded by the prevalence of cardiovascular disease in this population, which alongside diabetes is a major risk factor for severe disease and mortality in Covid-19. We convened as experts from the Central and Eastern European region to consider what advice we can provide in the setting of type 2 diabetes and Covid-19, considering the evidence before, during and after infection. We review recommendations that have been published to date, and consider the best available-but currently limited-evidence from large observational studies and the DARE-19 randomized control trial. Notably, we find a lack of guidance on restarting patients on optimal antidiabetic therapy after recovering from Covid-19, and suggest that this may provide an opportunity to optimize treatment and counter clinical inertia that predates the pandemic. Furthermore, we emphasize that optimization applies not only to glycaemic control, but other factors such as cardiorenal protection. While we look forward to the emergence of new evidence that we hope will address these gaps, in the interim we provide a perspective, based on our collective clinical experience, on how best to manage glucose-lowering therapy as patients with Covid-19 recover from their disease and return to normal care

Assessing the clarity and readability of knowledge questionnaire for patients with diabetes mellitus

Cíl: Cílem práce bylo provést hodnocení srozumitelnosti a čtivosti položek nově vytvořeného znalostního dotazníku pro pacienty s diabetes mellitus. Hodnocení srozumitelnosti a čtivosti dotazníku proběhlo jako dílčí část projektu dizertační práce, v rámci, které je dotazník vyvíjen. Metodika: Předvýzkum pro ověření srozumitelnosti položek nově vytvořeného dotazníku proběhl na vzorku 41 osob s diabetem 1. a 2. typu. Hodnocení dotazníku po stránce pravopisné a stylistické provedli dva odborníci na český jazyk. Čtivost textu dotazníku byla hodnocena pomocí Mistríkova vzorce, a to dvěma na sobě nezávislými osobami. Výsledky: Na základě vyplněných dotazníků a poznámek k položkám, jež uvedli respondenti, byly upraveny 3 položky pro obecnou část, 1 položka pro část týkající se diabetu 1. typu a 1 položka pro část týkající se diabetu 2. typu. Dále byla upravena 1 identifikační otázka. Čtivost textu všech položek dotazníku byla vypočtena na hodnotě 38,47 bodů. Závěr: Hodnocení srozumitelnosti a čtivosti je jedním z velmi podstatných kroků při tvorbě měřícího nástroje. U všech položek v dotazníku byla zhodnocena jejich srozumitelnost pomocí zpětné vazby od respondentů a následně byly provedeny drobné úpravy. Text položek dotazníku lze interpretovat jako lehce srozumitelný.Aim: The Aim of the work was to evaluate the clarity and readability of newly created knowledge questionnaire for patients with diabetes mellitus. The evaluation of clarity and readability was carried out as a part of the dissertation thesis within the frame of the questionnaire. Methodology: A pre-research to verify the clarity of newly created questionnaire was conducted on a sample of 41 people with diabetes (type 1 and type 2). The evaluation of the questionnaire on the spelling and stylistic aspects was carried out by two experts on the Czech language. The readability of the questionnaire text was evaluated using Mistrik’s formula, with two independent persons. Results: Based on completed questionnaires and item comments submitted by the respondents, 3 items for general part, 1 item for type 1 diabetes and 1 item for type 2 diabetes were modified. Additionally, 1 identification question was modified. The complete readability of all items in questionnaire was calculated at 38,47 points. Conclusion: The assessment of clarity and readability is one of the very important steps in the creation of measuring instruments. For all the items in the questionnaire, their clarity was evaluated using feedback from respondents and some minor adjustments were made. The questionnaire text can be interpreted as easy to understand

Assessing the clarity and readability of knowledge questionnaire for patients with diabetes mellitus

Cíl: Cílem práce bylo provést hodnocení srozumitelnosti a čtivosti položek nově vytvořeného znalostního dotazníku pro pacienty s diabetes mellitus. Hodnocení srozumitelnosti a čtivosti dotazníku proběhlo jako dílčí část projektu dizertační práce, v rámci, které je dotazník vyvíjen. Metodika: Předvýzkum pro ověření srozumitelnosti položek nově vytvořeného dotazníku proběhl na vzorku 41 osob s diabetem 1. a 2. typu. Hodnocení dotazníku po stránce pravopisné a stylistické provedli dva odborníci na český jazyk. Čtivost textu dotazníku byla hodnocena pomocí Mistríkova vzorce, a to dvěma na sobě nezávislými osobami. Výsledky: Na základě vyplněných dotazníků a poznámek k položkám, jež uvedli respondenti, byly upraveny 3 položky pro obecnou část, 1 položka pro část týkající se diabetu 1. typu a 1 položka pro část týkající se diabetu 2. typu. Dále byla upravena 1 identifikační otázka. Čtivost textu všech položek dotazníku byla vypočtena na hodnotě 38,47 bodů. Závěr: Hodnocení srozumitelnosti a čtivosti je jedním z velmi podstatných kroků při tvorbě měřícího nástroje. U všech položek v dotazníku byla zhodnocena jejich srozumitelnost pomocí zpětné vazby od respondentů a následně byly provedeny drobné úpravy. Text položek dotazníku lze interpretovat jako lehce srozumitelný.Aim: The Aim of the work was to evaluate the clarity and readability of newly created knowledge questionnaire for patients with diabetes mellitus. The evaluation of clarity and readability was carried out as a part of the dissertation thesis within the frame of the questionnaire. Methodology: A pre-research to verify the clarity of newly created questionnaire was conducted on a sample of 41 people with diabetes (type 1 and type 2). The evaluation of the questionnaire on the spelling and stylistic aspects was carried out by two experts on the Czech language. The readability of the questionnaire text was evaluated using Mistrik’s formula, with two independent persons. Results: Based on completed questionnaires and item comments submitted by the respondents, 3 items for general part, 1 item for type 1 diabetes and 1 item for type 2 diabetes were modified. Additionally, 1 identification question was modified. The complete readability of all items in questionnaire was calculated at 38,47 points. Conclusion: The assessment of clarity and readability is one of the very important steps in the creation of measuring instruments. For all the items in the questionnaire, their clarity was evaluated using feedback from respondents and some minor adjustments were made. The questionnaire text can be interpreted as easy to understand

Creation of a czech knowledge questionnaire for patients with diabetes mellitus: evaluation of items‘ difficulty and its internal consistency.

Cíl: Popsat proces dvou finálních fází tvorby znalostního dotazníku pro pacienty s diabetem mellitem 1. typu (DM1T) a diabetem mellitem 2. typu (DM2T), která spočívala ve vyhodnocení obtížnosti jeho položek a jeho vnitřní konzistence. Metody: Poslední fáze sběru dat pro výpočet obtížnosti položek a vnitřní konzistence dotazníku probíhala v období 08–11/2018. Z výsledků získaných od 258 pacientů (DM2T 226; DM1T 32) byla hodnocena obtížnost položek dotazníku pomocí výpočtu hodnoty obtížnosti Q (hodnota 0 = jednoduchá položka; hodnota 1 = obtížná položka). Reliabilita vytvořeného nástroje byla hodnocena výpočtem koeficientu vnitřní konzistence dle vzorce Kuder-Richardson 20 (minimální přijatelná hodnota 0,7). Výsledky: Hodnoty obtížnosti položek se pohybovaly v rozmezí 0,24–0,72. Dle obecně platných doporučení nespadá žádná z položek do oblasti extrémně jednoduchých či extrémně obtížných položek. Vnitřní konzistence pro jednotlivé části dotazníku se pohybovala v rozmezí 0,70–0,88. Závěr: Položky nově vytvořeného znalostního dotazníku lze na základě výpočtu obtížnosti z dat získaných od respondentů zhodnotit jako průměrně obtížné. Všechny části dotazníku dosáhly na minimálně přijatelnou hodnotu vnitřní konzistence. Vytvořený dotazník je ověřen a vhodný pro užití u česky hovořících pacientů.Aim: To describe the process of two final phases of creating a knowledge questionnaire for patients with type 1 diabetes mellitus (DM1T) and type 2 diabetes mellitus (DM2T), which consisted in evaluating the difficulty of its items and its internal consistency. Methods: The last phase of data collection for calculating the difficulty of items and the internal consistency of the questionnaire took place in the period 08–11/2018. From the results obtained from 258 patients (DM2T 226; DM1T 32), the difficulty of the questionnaire items was evaluated by calculating the value of difficulty Q (value 0 = simple item; value 1 = difficult item). The reliability of the created tool was evaluated by calculating the coefficient of internal consistency according to the formula Kuder-Richardson 20 (minimum acceptable value 0.7). Results: The difficulty values of the items ranged from 0.24–0.72. According to generally accepted recommendations, none of the items falls into the area of extremely simple or extremely difficult items. The internal consistency for the individual parts of the questionnaire ranged from 0.70–0.88. Conclusion: The items of the newly created knowledge questionnaire can be evaluated as average difficult based on the calculation of the difficulty from the data obtained from the respondents. All parts of the questionnaire reached a minimum acceptable value of internal consistency. The created questionnaire is verified and suitable for use in Czech-speaking patients

Comparison of Different Treatment Modalities for Type 1 Diabetes, Including Sensor-Augmented Insulin Regimens, in 52 Weeks of Follow-Up: A COMISAIR Study

Photograph of Roger Parks, a Gulf War veteran