Rudolf Chlup

By Rudolf Chlup, Richard Kaňa, Lada Hanáčková, Hana Zálešáková and Blanka Doubravová

This overview summarizes the evolution of pathophysiologic treatment of diabetes type 2 (T2D) in the period of the last 40 years. Randomized Controlled Trials (RCT) and Real World Evidence (RWE) studies resulted in recent Statements of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) in the year 2020. Case reports and studies of a single-centre in Czech Republic are reported. The authors demonstrate the impact of (1) multiple doses of rapid insulin, (2) multiple doses of rapid or ultrarapid insulin analogs (3) continuous subcutaneous insulin infusion (CSII) (4) incretin receptor agonists, (5) fixed combination of insulin degludec with liraglutide (IDegLira) and (6) SGLT2 inhibitor dapagliflozin, on plasma glucose concentration, HbA1c, body mass and patient satisfaction. The importance of therapeutic patients’ education and technology (personal glucometers, continuous/flash glucose monitors, insulin pens/pumps) is emphasized. Most of the observations were already published. Hence, individually adopted education, lifstyle, technical equipment, incretin receptor agonists and/or metformin and/or gliflozins and/or insulin analogs appear to be the core of an effective pathophysiologic approach. Scientific conclusions from RCTs, RWE trials and own clinical case reports may prevail over clinical inertia and induce early implementation of effective methods into routine T2D treatment.

Part of the book: Type 2 Diabetes

By Rudolf Chlup, Ondřej Krystyník, Petr Mlčák, Jana Zapletalová and Josef Bartek

This chapter deals with clinical trials and routine management of persons with type 1 diabetes (PWD1) carried out at the Teaching Hospital and Palacký University Olomouc since 1970 in cooperation with experts from other centres. The following outcomes are presented: (1) physical training resulted in (a) enhancement of physical working capacity; (b) increased insulin effectiveness (c) increased S-HDL cholesterol; (d) improvement of neuropathy, memory, attention and general condition of PWD1. (2) Intensive basal and prandial insulin substitution with only short-acting insulin given seven times a day and night appeared to be the most effective approach to the conventional insulin substitution; group education and pens motivated to the intensification of insulin therapy. (3) Continuous subcutaneous insulin infusion, conventional self-monitoring, continuous/flush glucose monitoring and prolongation of time in range opened new horizons. Intensive education, early application of hybrid insulin pumps and specialised prevention of late diabetes complications are deemed to improve the life expectancy and quality. Cooperation with insurance companies should be acknowledged.

Part of the book: Type 1 Diabetes in 2023

By Rudolf Chlup, Hana Zálešáková, Jiřina Gottwaldová, Michal Trefil, Jana Zapletalová, Richard Kaňa, Lada Hanáčková, Milena Bretšnajdrová, Přemysl Falt and Zdenka Polzerová

The purpose of this chapter was (1) to identify the frequency of employing different kinds of medication (beta-stimulators, metformin, gliflozins, incretins and/or insulins, pioglitazone, statins, fibrates), (2) to assess global metabolic effectiveness of this medication in a walk-in diabetes center, and (3) to estimate frequency of HbA1c measurements in people admitted to hospital. Methods: In 200 people with T2D (age 24–95 y, 105 men) HbA1c, BM, BMI, blood pressure [BP], lipoproteins HDL, LDL, TAG, eGFR, proteinuria were assessed. Individual observation periods took in the range of 0.5–8.8 years. Student’s t-test, Wilcoxon signed-rank test with Bonferroni correction and Spearman analysis were used to asses changes between the first and the last visit. P < 0.05 was considered as significant. In conclusion, reduction of HbA1c from start values of 52.6 (31.5–173.0) to 46.6 (31.5–116.6) mmol/mol along with reduction of BMI from 26.7 (16.0–45.3) to 25.4 (15.4–42.2) kg/m² (P < 0.0001) and correlation of delta HbA1c with delta BMI (r = 0.209, p = 0.003) confirmed global metabolic effectiveness of medication used in the walk-in diabetes center where the HbA1c was estimated 2–3 times per year in each subject whereas in hospital wards mostly once in up to 15% of admitted T2D patients.

Part of the book: Type 2 Diabetes in 2024