Marián Mokáň, Michal Mokáň, Peter Galajda
Diabetes mellitus is typically associated with microvascular and macrovascular complications as well as with increased risk of additional diseases – comorbidities. Comorbidities such as cardiovascular (CV) diseases due to atherosclerotic vessels, heart failure, chronic renal disease with decreased function, liver insufficiency and septic states have influence on therapeutic management of a patient with diabetes mellitus. In patients of a higher age, with longer disease duration and CV disease there are recommended target levels of HBA1c more than 7 % according to DCCT. In the case of heart failure use of pioglitazone is contraindicated. Decreased function of the kidneys and liver is associated with changes of pharmacokinetics of antidiabetic drugs so there is necessary to modify the dose and use of some drugs is contraindicated. Modification of antidiabetic treatment is necessary also in septic states due to worsening of glycaemic control, but intensive treatment regimen is not generally accepted due to an increased risk of hypoglycaemia and not clear mortality risk.