1、编辑版ppt1Diabetes MellitusZhao-xiaojuanIntroduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.IntroductionThe chronic hyperglycemia of diabetes is associated with long-term damage
2、, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.SymptomsPolyuriaPolydipsia (thirst)Weight lossWeaknessPolyphagiaBlurred visionRecurrent infectionImpairment of growthCriteria for diagnosis Criteria for diagnosis of diabetes of diabetes (WHO
3、1999) Symptoms of diabetes + Casual plasma glucose 11.1mmol/l(200mg/dl) Or FPG 7.0mmol/l (126mg/dl)Or2-hPG 11.1mmol/lDiagnostic Criteria WHO1999IGT -FPG7mmol/L -2-h PG7.8mmol/L and 11.1mmol/LIFG -FPG6.1mmol/L and 7.0mmol/L Laboratory FindingsUrinary glucoseUrinary ketoneBlood glucose (FPG and 2-hPG)
4、HbA1c and FA(fructosamine)OGTTInsulin / CP releasing testClassification (1)Type 1 diabetes -cell destruction, usually leading to absolute deficiency Immune-mediated diabetes Idiopathic diabetesType 2 diabetes Ranging from predominantly insulin resistance with relative insulin deficiency to predomina
5、ntly an insulin secretory defect with insulin resistanceClassification (2)Other specific types of diabetes Due to other causes, e.g.,genetic defects in insulin action, diseases of the exocrine pancreas, drug or chemical inducedGestational diabetes mellitus(GDM) diagnosed during pregnancy Etiologic c
6、lassification of diabetes mellitus(1)I.Type 1diabetes ( -cell destruction, usually leading to absolute insulin deficiency ) A. immune mediated B. IdiopathicII.Type 2diabetes ( may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with in
7、sulin resistance )III.Other specific types A. genetic defects of -cell function 1. Chromosome 12, HNF-1 (MODY3) 2. Chromosome 7, glucokinase (MODY2) 3. Chromosome 20, HNF-4 (MODY1) 4. Mitochondrial DNA 5. Others B. Genetic defects in insulin action 1. Type A insulin resistance 2. Leprechaunism 3. Ra
8、bson- Mendenhall syndrome 4. Lipoatrophic disease 5. Others C. Diseases of the exocrine pancreas 1. Pancreatitis 2. Trauma / pancreatectomy 3. Neoplasia 4. Cystic fibrosis 5. Hemochromatosis 6. Fibrocalculous pancreatopathy 7. OthersEtiologic classification of diabetes mellitus(2) D. Endocrinopathie
9、s 1. Acromegaly 2. Cushings syndrome 3. Glucagonoma 4. Pheochromocytoma 5. Hyperthyroidism 6. Somatostatinoma 7. Aldosteronoma 8. Others E. Drud- or chemical-induced 1. Vacor 2. Pentamidine 3. Nicotinic acid 4. Glucocorticoid 5. Thyroid hormone 6. Diazoxide 7. -adrenergic agonists 8. Thiazides 9. Di
10、lantin 10. -Interferon 11. Others F. Infections 1. Congenital rubella 2. Cytomegalovirus 3. Others Etiologic classification of diabetes mellitus(3) G. Uncommon forms of immune- mediated diabetes 1. “Stiff-man” syndrome 2. Anti-insulin receptor antibodies 3. Others H. Other genetic syndromes sometime
11、s associated with diabetes 1. Downs syndrome 2. Klinefelters syndrome 3. Turners syndrome 4. Wolframs syndrome 5. Friedreichs ataxia 6. Huntingtons chorea 7. Laurence-moon-Biedl syndrome 8. Myotonic dystrophy 9. Porphyria 10. Prader-Willi syndrome 11. Others IV. Gestational diabetes mellitus ( GDM )
12、Patients with any form of diabetes may require insulin treatment at some stage of their disease. Such use of insulin dose not, of itself, classify the patient.Type 1 DMGenerally 7.010.0HbA1c(%) 6.28.0Blood pressure (mmHg)130/80-160/95BMI(kg/m2)Malefemale25242726 27 26Total cholesterol(mmol/L)1.11.1-
13、0.90.9Triglycerides(mmol/L)1.52.2 2.2LDL- cholesterol(mmol/L)4.4ManagementEssentials of managementMonitoring of glucose levelsFood planningPhysical activityTreatment of hyperglycemia2.Monitoring of Glucose LevelsBlood glucose levels - before each meal - at bedtime Urine glucose testingUrine ketone t
14、ests (should be performed during illness or when blood glucose is 20mmol/L ) 3.Food PlanningWeight control.50-60%of the total dietary energy should come from complex carbohydrates.20-25% form fats and oils.15-20% from protein.Restrict alcohol intake.Restrict salt intake to below 7g/d. 4.Physical Act
15、ivityPhysical activity play an important role in the management of diabetes particularly in T2DM. Physical activity improves insulin sensitivity, thus improving glycemic control, and may help with weight reduction Do sparingly avoid sedentary activitiesDo regularly participate in leisure activities
16、and recreational sportsDo every day adopt healthy lifestyle habits5.Drug TreatmentIf the patient is very symptomatic or has a very high blood glucose level, diet and lifestyle changes are unlikely to achieve target values. In this instance, pharmacological therapy should be started without delay.Tre
17、atmentSulphonylureasBiguanides-Glucosidase inhibitorsThiazolidinedionesGlinidesInsulinCombination therapy1.SulphonylureasChlorpropamideTolbutamideGlibenclamideGlipizideGliclazideGliguidone Glimepiride2.BiguanidesMetforminPhenformin Buformin 3.-Glucosidase inhibitorsAcarboseVogliboseMiglitol4.Thiazol
18、idinedionesRosiglitazonePioglitazoneCiglitazone 5.GlinidesNategliniderepaglinide6.InsulinInsulin is the most efficacious pharmacologic treatment for patients with diabetes6.InsulinIndication PreparationTherapy Adverse reactionManagement Algorithm for Overweight and Obese T2DMDiet Exercise and weight
19、control Failure Add biguanide, TZD or -glucosidase inhibitorsFailure Failure Combine two of these or add sulphonylurea or glinideAdd insulin or change to insulinCheck adherance at each stepManagement Algorithm for Non-Obese T2DMDietExerciseand weightcontrolFailure FailureFailureAdd sulphonylurea, biguanide, -glucosidase inhibitors or glinideCombine sulphonylurea or glinide with biguande and/or -glucosidase inhibitors and/or add TZDAdd insulin or change to insulinCheck adherance at each step
