S Svacina

Charles University in Prague, Praha, Praha, Czech Republic

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Publications (135)119.01 Total impact

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    ABSTRACT: The aim was to find the differences in ketogenesis initiation in the early period after the exercise in obese patients and to find if these changes may predict the weight loss during the physical activity program. 96 females were enrolled. A clamped heart rate test (CHR) was performed to establish comparable exercise intensity. Blood samples for beta hydroxybutyrate (BOHB) assessment were collected prior, immediately after and 60 min after the test. Patients underwent a three month fitness program. Anthropometric measurements (fat mass and biochemical parameters) were measured. An energy intake was monitored and comparable in all subjects. A significant increase of BOHB was found in 60(th) minute after the test, when compared with initiation levels (BOHB1 vs. BOHB3; p=0.03). This increase correlates with % fat mass (R=0.196; p=0.02) and negatively with age (R= -0.147; p=0.05) and with weight reduction during the three-month program (R= -0.299; p=0.03). Serum BOHB increase after the single exercise may detect individuals with an ability to induce lipolysis in three-month program of physical activity for obese patients.
    Physiological research / Academia Scientiarum Bohemoslovaca 06/2014; 63(Supplementum 2):S321-S325. · 1.53 Impact Factor
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    ABSTRACT: The aim was to compare methods of body fat measurement in different BMI groups. An additional aim was to discuss differences reflecting the structural and functional changes of fat tissue. The study group included 130 adult Caucasian women stratified by body mass index (BMI): 18-24.99 (n=30), 25-29.99 (n=26), 30-34.99 (n=33), 35-39.99 (n=30), and BMI>/=40 (n=11). Bioelectrical impedance was performed using Tanita TBF 410 GS, Bodystat 1500, and Omron BF 300. A caliper type Best was also applied. Correspondence of four methods with DEXA was assessed using the Bland-Altman and ANOVA analyses. Measurements by BIA were not significantly different from DEXA up to BMI of 30, but DEXA significantly overestimated in the higher BMI subgroup by all three methods. Caliper measurement significantly underestimated DEXA in all BMI subgroups. BIA methods overestimated DEXA for the obese subjects. Tanita did statistically the best. The Caliper test appeared less preferable than the BIA methods, especially in the higher BMI subgroup. DEXA and Caliper measurements seem to be the best estimate of structural (anatomical) fat quantity. We hypothesize that BIA methods could also measure some other physiopathological conditions like inflammation, hydration or cell infiltration of fat.
    Physiological research / Academia Scientiarum Bohemoslovaca 06/2014; 63(Supplementum 2):S309-S320. · 1.53 Impact Factor
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    ABSTRACT: During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.
    Journal of diabetes science and technology 05/2014;
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    ABSTRACT: Adipocyte fatty acid binding protein (A-FABP) is a novel adipokine involved in the regulation of lipid and glucose metabolism and inflammation. To evaluate its potential role in the development of postoperative hyperglycemia and insulin resistance we assessed A-FABP serum concentrations and mRNA expression in skeletal and myocardial muscle, subcutaneous and epicardial adipose tissue and peripheral monocytes in 11 diabetic and 20 age- and sex-matched non-diabetic patients undergoing elective cardiac surgery. Baseline serum A-FABP did not differ between the groups (31.1+/-5.1 vs. 25.9+/-4.6 ng/ml, p=0.175). Cardiac surgery markedly increased serum A-FABP in both groups with a rapid peak at the end of surgery followed by a gradual decrease to baseline values during the next 48 hours with no significant difference between the groups at any timepoint. These trends were analogous to postoperative excursions of plasma glucose, insulin and selected proinflammatory markers. Cardiac surgery increased A-FABP mRNA expression in peripheral monocytes, while no effect was observed in adipose tissue or muscle. Our data suggest that circulating A-FABP might be involved in the development of acute perioperative stress response, insulin resistance and hyperglycemia of critically ill irrespectively of the presence of diabetes mellitus.
    Physiological research / Academia Scientiarum Bohemoslovaca 11/2013; · 1.53 Impact Factor
  • Stepán Svacina
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    ABSTRACT: Fat accumulation is a typical phenomenon in the pathogenesis of Type 2 diabetes. Also Type 1 diabetics are getting obese these days living in an environment with typical caloric overfeeding and low physical activity. Weight reduction is an important part of therapy in all obese diabetic patients. Orlistat is the only accessible antiobesity drug today. Weight neutral antidiabetics like metformin and DPP-4 inhibitors can be also used. Incretin analogues (exenatide and liraglutide) are also very important drugs inducing weight loss in diabetic and also in nondiabetic patients. Insulin therapy causes mostly weight gain. Long acting insulin analogues are able to induce small weight loss in Type 1 diabetes or only a small weight increase or weight loss in Type 2 diabetic patients. Procedures of bariatric surgery are very important in the treatment being able to induce remission of Type 2 diabetes. Weight reduction can be supported also using the new class of antiadiabetic drugs- SGLT inhibitors which are blocking glucose absorption in kidneys. The use of new incretine analogues injected at the interval of one to two weeks is the most important strategy for the treatment of obese Type 2 diabetic patients and perhaps also of Type 1 diabetic patients even in combination with insulin.
    Advances in experimental medicine and biology 01/2012; 771:459-64. · 1.83 Impact Factor
  • S Svacina
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    ABSTRACT: Type 2 diabetes is associated with increased risk of cancer. This risk is related to HbA1 increase and this influence is present also in prediabetes and in nondiabetics with HbA1c in upper normal range. In last 2 years, it was concluded that that the specific antidiabetic therapy could influence the cancer risk. In this review we show that reduction of HbA1c does not change cancer risk. Most important is the risk reduction of cancer risk by metformin. Insulin therapy and the use ofsulphonylurea related drugs, increases the risk of cancer. This risk can be eliminated in the combination with metformin. Other published results including the suspected effect related to the use of glargine, pioglitazone, sitagliptine and exenatide are inconsistent and analysis of long term effects of these drugs is necessary. The large discussion in many publications shows the important role of FDA and EMA. This agencies do not suspend drugs without consistent evaluation of results.
    Vnitr̆ní lékar̆ství 09/2011; 57(9):760-3.
  • S Svacina
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    ABSTRACT: Colorectal carcinoma is a tumour with higher incidence in patients with type 2 diabetes and obesity. Recently, a slightly higher risk has also been shown in prediabetic states. The most important latest finding is that of a reduced risk in patients treated with metformin; there is a trend now to also prescribe metformin in patients with disturbed glucose tolerance or increased fasting glycaemia. Regular physical activity and reduced animal fat intake with increased intake of fruits and vegetables may help to prevent the disease. Pathogenesis may include changes to intestinal flora. The most important current preventive clinical measure is colonoscopy. Type 2 diabetes patients should be considered as a risk group and thus prevention should be targeted at these patients.
    Vnitr̆ní lékar̆ství 04/2011; 57(4):378-80.
  • S Svacina
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    ABSTRACT: Incretin therapy includes treatment with incretin analogues (exenatid and liraglutid) and so called incretin enhancers (gliptins and DPP-4 inhibitors respectively--sitagliptin, vildagliptin, saxagliptin, linagliptin). In patients with type 2 diabetes, this novel antidiabetic treatment usually leads to successful reduction in fasting as well as postprandial glycaemia and glycosylated haemoglobin. At the same time, it importantly improves all components of metabolic syndrome (dyslipidemia, hypertension, systemic inflammation). Incretin analogues also reduce body weight while DPP-4 inhibitors are weight-neutral. Both groups of drugs are expected to have positive cardiovascular effects, although it is not clear whether these are likely to be direct or indirect, i.e. facilitated by improved compensation of metabolic syndrome components.
    Vnitr̆ní lékar̆ství 04/2011; 57(4):417-21.
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    ABSTRACT: Low-grade inflammation links obesity, type 2 diabetes mellitus (T2DM), and cardiovascular diseases. 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. Two-week intervention study with very-low-calorie diet (VLCD). University hospital. Patients: Twelve obese females with T2DM, 8 obese nondiabetic females (OB) and 15 healthy age-matched females. Two weeks of VLCD (2500 kJ/d). Metabolic parameters, circulating cytokines, hormones, and mRNA expression of 39 genes in sc adipose tissue (SCAT) and PM. 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. 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.
    The Journal of Clinical Endocrinology and Metabolism 02/2011; 96(4):E606-13. · 6.31 Impact Factor
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    ABSTRACT: 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). Design and setting: 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. Participants: 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). Main Outcome Measurements: 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 (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-1kg-1). Correlation coefficients, Pearson's between Gaussian distributed (Gd-v) variables and Spearman´s (non Gd-v) statistically significant (p<0.05): 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.
    Neuro endocrinology letters 01/2011; 32(1):102-8. · 0.93 Impact Factor
  • S Svacina
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    ABSTRACT: Metformin is considered to be the only drug suitable in patients with prediabetes and is the drug of choice in patients with type 2 diabetes. Apart from important antidiabetic effect, it also has some important additional effects: reduced incidence of tumours, positive effects on cardiovascular system, stimulation of immunity, positive effects on the bone, effect on ovulation, influence over body weight reduction, pancreas-protective effects (reduced incidence of carcinoma and possible effect on reduction in incidence of pancreatitis during incretin treatment), positive effects on liver steatosis. Since diabetes patients live with increased cardiovascular risk, it is important to continuously remind ourselves of the positive cardiovascular effects of metformin.
    Vnitr̆ní lékar̆ství 12/2010; 56(12):1225-7.
  • E Kravarová, S Slabá, S Svacina
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    ABSTRACT: Many relations are connecting obesity and eating disorders--one disease is often modifying the other. Anorexia Nervosa and Bulimia Nervosa are mostly treated by psychiatrists. Internal medicine specialists are mostly involved only in complications (e.g. malnutrition, ion disorders). Obesity is mostly treated only by internists. Psychiatrists are only involved in some depressive patients. Obese patients with eating disorders are mostly not sent to psychiatric diagnostics. In this article an overview of eating disorder symptoms and classification is given--binge eating disorder, night eating syndrome and grazing. These symptoms are defined and possibilities of diagnosis and treatment are described.
    Vnitr̆ní lékar̆ství 10/2010; 56(10):1093-5.
  • M Matoulek, S Svacina, J Lajka
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    ABSTRACT: Over the recent years, the incidence of obesity is continuously rising. A research conducted in 2008-2009 on a representative sample of Czech population (n = 2,058) suggests that 23% of adult population of the Czech Republic are obese and 34% are overweight. This represents an increase of 5% in the number of obese people (17% vs. 22%), while the number of overweight remains practically the same (35% vs. 34%). A more significant shift in female waist circumference compared to male has also been shown. The incidence of hypertension in the evaluated sample was more than a two-fold higher in obese participants (48% vs. 21%) and as much as 3-fold higher in type 2 diabetes mellitus (7% vs. 20%). The risk of body weight increase is the highest between 50th and 59th year of age, where hypertension and diabetes are the most frequently diagnosed. The risk of obesity in adulthood is mostly carried over from childhood and more than 3/4 (77%) of those, who were overweight or obese as children, are in these categories as adults. Quality of life and satisfaction with own health is more related to BMI than age. Even though body weigh is increasing with the same amplitude in sportsman and physically active people, they are reaching lower final BMI due to their lower starting body weight. It is clear that physically active lifestyle in younger age is the best predictor of lower BMI in adult life. Consumption of secondary processed meat and lower consumption of fruit and vegetables are important factors in adulthood.
    Vnitr̆ní lékar̆ství 10/2010; 56(10):1019-27.
  • Stepán Svacina
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    ABSTRACT: Weight reduction is an important component of comprehensive management of diabetes. Weight reduction can be achieved using 6 methods: 1. diet 2. physical activity, 3. psychotherapy, 4. bariatric surgery, 5. pharmacotherapy of obesity, 6. selection of an appropriate antidiabetic medication. Orlistat is the only antiobesity agent presently available in the Czech Republic. Weight neutral (metformin and gliptins) and weight reducing antidiabetics (incretine analogues exenatide and liraglutide) and insulin analogue detemir are suitable antidiabetic drugs. We thus have a sufficient range of options available for weight reduction in diabetic patients.
    Vnitr̆ní lékar̆ství 10/2010; 56(10):1078-81.
  • S Svacina
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    ABSTRACT: Diabetic osteopathy is usually not mentioned in the list of diabetic complications. This osteopathy is very important in clinical medicine. In the pathogenesis many factors are involved--bone formation, hyperglycaemia, glycosuria, glycation of collagene etc. Clinically important is the high risk of fractures present in diabetic patients. This risk can be positively and negatively modified by antidiabetic drugs. It is important to find some markers for fracture risk in diabetes. Nowadays only bone densitometry can be used with some limitations to quantify this risk.
    Vnitr̆ní lékar̆ství 07/2010; 56(7):736-8.
  • S Svacina
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    ABSTRACT: Hyperglycaemia is being linked to the development of vascular complications of diabetes--diabetic micro- as well as macro-angiopathies. It is, therefore, logical to assume that a reduction of glycaemia will result in a reduction of diabetic complications. However, recent clinical studies in type 2 diabetes described a range of observations that make this general statement less unambiguous: possibly increased incidence of coronary events following rosiglitazone use, discontinuation of some studies due to significantly decreased HbA1c in long-term diabetes, metabolic memory phenomenon, where early diabetes treatment exerts it effect for more than 10 years, and resulting differences in treatment approach to type 2 diabetes patients with respect to the duration of the disease. It can be concluded with respect to the issue of antihypeglycaemia treatment and its cardiovascular effect: 1. Early compensation of diabetes in newly diagnosed diabetic patients exerts its effect as long as 15 years and more. 2. Longer duration of diabetes implicates probably higher target value for diabetes compensation than the current 5.3% HbA1c according to IFCC. 3. No link has been proven between a specific anti-diabetic agent and worsened cardiovascular prognosis; the RECORD study provided conclusive evidence that rosiglitazone has no negative effect on the vascular system. 4. On contrary, it is very likely that some of the new anti-diabetic agents, for example from among the incretin analogues, will impact positively on the vascular system. 5. There is no doubt about the importance of hyperglycaemia correction in prevention of cardiovascular diseases in type 1 diabetes patients.
    Vnitr̆ní lékar̆ství 04/2010; 56(4):313-6.
  • Stepán Svacina
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    ABSTRACT: A short review of current opinions on a questionable and controversial disease--diabetic osteopathy--is presented. Bone metabolism is influenced by antidiabetic drugs. Positive effects are attributed to the insulin and metformin therapy. Use of thiazolidindiones is accompanied by a higher risk of bone fractures in diabetic women. Very interesting and also promising is the effect of glucagon like peptide-1 and the new antidiabetic drug class- incretin analogues on bone metabolism.
    Casopís lékar̆ů c̆eských 01/2010; 149(6):282-4.
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    ABSTRACT: Exenatide, a synthetic GLP-1 analogue, is a new antidiabetic agent from the group ofincretine mimetics coming into the daily clinical practice. In our study we evaluated the effect of 6-months treatment with exenatide on diabetes compensation, anthropometric and biochemical parameters in the patients with poorly controlled type 2 diabetes mellitus and obesity. We included 18 patients with poorly controlled diabetes (mean HbA1c 8.5 +/- 0.3%) treated with diet and peroral antidiabetic agents (4 patients were treated with insulin in the past). Exenatide was administered via subcutaneous injection twice daily for 6 months. Patients were examined after 1 month, when the dose ofexenatide was increased from 5 microg twice daily to 10 microg twice daily and after 3 and 6 months. We evaluated the diabetes compensation, biochemical parameters, body weight changes and side effects ofexenatide. 6-months exenatide treatment significant decreased body weight (baseline vs 6 month treatment 107.3 +/- 4.4 kg vs 103.7 +/- 4.6 kg, p = 0.02), BMI (36.7 +/- 1.2 kg/m2 vs 35.3 +/- 1.3 kg/m2, p = 0.01) a HbA1c (8.5 +/- 0.3% vs 7.4 +/- 0.4%, p = 0.04) and increased HDL-cholesterol (0.92 +/- 0.1 mmol/l vs 0.98 +/- 0.1 mmol/l, p = 0.02). Fasting glycemia tended to decline at the end of the study, but the difference did not reach the statistical significance. The area under the curve of glycemia levels after the standardized breakfast in the subgroup of 8 patients after the 6-months exenatide treatment was significantly lower when compared to baseline values (2,908 +/- 148 vs 2,093 +/- 194, p = 0.03). Concentrations of total and LDL-cholesterol and triglycerides did not change significantly. The most frequent side effects of exenatide treatments were transient anorexia and nausea (38.5%), dyspepsia and functional gastrointestinal discomfort (38.5%) and various neuropsychical symptoms (nervosity and insomnia - 30.8%). Most of the side effects disappeared during the treatment, none of these side effects was a reason for discontinuation of a treatment. 3 minor hypoglycemic episodes occured in patients simultaneously treated with derivates of sulfonylurea, but no serious hypoglycemia occured during the entire study. Exenatide treatment in obese patients with poor diabetes control was accompanied by statistically significant decrease of body weight, improvement of diabetes control and increase in HDL-cholesterol.
    Vnitr̆ní lékar̆ství 01/2010; 56(1):15-20.
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    ABSTRACT: Body composition assessment and determination of the amount and distribution of body fat, respectively, form an essential part of the basic clinical assessment of an obese patient. However, there are no recommended methods to determine the amount of fat in obese population. The aim of our study was to compare the methods most frequently used to determine the amount of body fat in overweight and obese women in clinical practice (multi-frequency bio-electrical impedance analysis--BIA using the Bodystat, Omron and Tanita machines and the skinfold test using a calliper) with a reference method (DEXA). The study further aimed to compile prediction formulae enabling clinicians to calculate the percentage of body fat when using the available body fat measurement techniques. The study included 61 overweight and obese women (mean age 48.6 years +/- 13.9 years). Four practice-based body fat assessment methods were used - bioimpedance technique with tetra-polar electrode arrangement (Bodystat machine), bioimpedance technique with bi-pedal electrode arrangement (Tanita machine), hand-held bioimpedance technique (Omron machine) and the anthropometry assessment--the skinfold calliper technique. These methods were compared to the method considered as the reference--the whole body densinometry (DEXA). The results obtained using the listed body fat assessment methods suggest that the resulting body fat measurements differ importantly depending on the method used. The highest correlation with DEXA was found for the Bodystat BIA (r = 0.9096, p < 0.001). Prediction formulae were constructed for a more accurate calculation of body fat content when using the techniques evaluated in the present study. When the newly compiled formulae are employed, the body fat assessment obtained with any of the methods applied in the present study will approximate DEXA. The BIA techniques were found to be particularly precise. Therefore, further evaluation of these techniques is recommendable to support their use as methods for monitoring the efficacy of weight reduction programmes in overweight and obese patients.
    Vnitr̆ní lékar̆ství 05/2009; 55(5):455-61.
  • S Svacina
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    ABSTRACT: Since the first application of insulin in the 1920s, many clinically necessary changes in the insulin action, effect reduction and extension, hypoglycemia risk reduction and positive weight development have been achieved by way of technological changes of insulin preparations. Such results have been achieved, in particular, by replacing insulin with insulin analogues. The impact on diabetes compensation and on the prevention of complications is not achieved by individual preparations but, in particular, by the quality of treatment and cooperation from the patient. The doctor should know, in particular, the clinical impacts of changes in the structure of insulin preparations as they are indicated in their respective SPCs. The necessary effect extension is achieved by similar technological changes, also with so-called incretin mimetics.
    Vnitr̆ní lékar̆ství 05/2009; 55(4):409-11.

Publication Stats

537 Citations
119.01 Total Impact Points

Institutions

  • 1988–2014
    • Charles University in Prague
      • • 1st Faculty of Medicine
      • • I. interní klinika (3. LF)
      • • Interní klinika (2. LF)
      Praha, Praha, Czech Republic
  • 2009
    • Medical University of Graz
      • Clinical Institute of Medical and Chemical Laboratory Diagnostics
      Gratz, Styria, Austria
  • 2005
    • University General Hospital
      Houston, Texas, United States