教学课件 糖尿病

Diabetes Mellitus Zhao-xiaojuan Introduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Introduction The chronic hyperglycemia of diabetes is associated with long- term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Symptoms Polyuria Polydipsia (thirst) Weight loss Weakness Polyphagia Blurred vision Recurrent infection Impairment of growth Criteria for diagnosis of diabetes (WHO1999) Symptoms of diabetes + Casual plasma glucose 1.1mmol/l(200mg/dl) Or FPG 7.0mmol/l (126mg/dl) Or 2-hPG 11.1mmol/l Diagnostic Criteria WHO1999 IGT -FPG7.0 10.0 HbA1c(%)8.0 Blood pressure (mmHg) 130/80- 160/95 BMI (kg/m2) Male female 1.11.1-0.94.4 Management Essentials of management Monitoring of glucose levels Food planning Physical activity Treatment of hyperglycemia 2.Monitoring of Glucose Levels Blood glucose levels - before each meal - at bedtime Urine glucose testing Urine ketone tests (should be performed during illness or when blood glucose is 20mmol/L ) 3.Food Planning Weight 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 Activity Physical 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 activities Do regularly participate in leisure activities and recreational sports Do every day adopt healthy lifestyle habits 5.Drug Treatment If 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. Treatment Sulphonylureas Biguanides -Glucosidase inhibitors Thiazolidinediones Glinides Insulin Combination therapy 1.Sulphonylureas Chlorpropamide Tolbutamide Glibenclamide Glipizide Gliclazide Gliguidone Glimepiride 2.Biguanides Metformin Phenformin Buformin 3.-Glucosidase inhibitors Acarbose Voglibose Miglitol 4.Thiazolidinediones Rosiglitazone Pioglitazone Ciglitazone 5.Glinides Nateglinide repaglinide 6.Insulin Insulin is the most efficacious pharmacologic treatment for patients with diabetes 6.Insulin Indication Preparation Therapy Adverse reaction Management Algorithm for Overweight and Obese T2DM Diet Exercise and weight control Failure Add biguanide, TZD or -glucosidase inhibitors Failure Failure Combine two of these or add sulphonylurea or glinide Add insulin or change to insulin Check adherance at each step Management Algorithm for Non-Obese T2DM Failure Failure Failure Add sulphonylurea, biguanide, - glucosidase inhibitors or glinide