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,d
2、ysfunction,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(WHO1999)Sympto
3、ms 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)HbA1c and FA(fru
4、ctosamine)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 predominantly an insulin secr
5、etory 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 classification of diabetes
6、 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 insulin resistance)III.Other specifi
7、c 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.Rabson-Mendenhall syndrome 4.Lipoatrophic disease 5.Ot
8、hers 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.Endocrinopathies 1.Acromegaly 2.Cushings syndrome 3.Glucagonoma 4.Pheochromocytoma
9、 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.Dilantin 10.-Interferon 11.Others F.Infections 1.Congenital rubella 2.Cytomegalovirus 3.
10、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 sometimes associated with diabetes 1.Downs syndrome 2.Klinefelters syndrome 3.Turners syndrome 4.Wolframs sy
11、ndrome 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)Patients with any form of diabetes may require insulin treatment at some stage of their disease.Such use of insulin
12、 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)1.11.1-0.90.9Triglycerides(mmol/L)1.52.2 2.2LDL-cholesterol(mmol/L)4.4ManagementEssentials of managementMonitoring of glucose l
13、evelsFood planningPhysical activityTreatment of hyperglycemia2.Monitoring of Glucose LevelsBlood glucose levels -before each meal -at bedtime Urine glucose testingUrine ketone tests(should be performed during illness or when blood glucose is 20mmol/L)3.Food PlanningWeight control.50-60%of the total
14、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 ActivityPhysical activity play an important role in the management of diabetes particularly in T2DM.Physical activity improves insul
15、in sensitivity,thus improving glycemic control,and may help with weight reduction Do sparingly avoid sedentary activitiesDo regularly participate in leisure activities and recreational sportsDo every day adopt healthy lifestyle habits5.Drug TreatmentIf the patient is very symptomatic or has a very h
16、igh blood glucose level,diet and lifestyle changes are unlikely to achieve target values.In this instance,pharmacological therapy should be started without delay.TreatmentSulphonylureasBiguanides-Glucosidase inhibitorsThiazolidinedionesGlinidesInsulinCombination therapy1.SulphonylureasChlorpropamide
17、TolbutamideGlibenclamideGlipizideGliclazideGliguidone Glimepiride2.BiguanidesMetforminPhenformin Buformin 3.-Glucosidase inhibitorsAcarboseVogliboseMiglitol4.ThiazolidinedionesRosiglitazonePioglitazoneCiglitazone 5.GlinidesNategliniderepaglinide6.InsulinInsulin is the most efficacious pharmacologic
18、treatment for patients with diabetes6.InsulinIndication PreparationTherapy Adverse reactionManagement Algorithm for Overweight and Obese T2DMDiet Exercise and weightcontrol Failure Add biguanide,TZD or -glucosidase inhibitorsFailure Failure Combine two of these or add sulphonylurea or glinideAdd ins
19、ulin 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
