英文糖尿病PPT课件.ppt

DiabetesMellitus,Zhao-xiaojuan,.,Introduction,Diabetesmellitusisaheterogeneousgroupofmetabolicdiseasescharacterizedbyhyperglycemiaresultingfromdefectsininsulinsecretion,insulinaction,orboth.,Introduction,Thechronichyperglycemiaofdiabetesisassociatedwithlong-termdamage,dysfunction,andfailureofvariousorgans,especiallytheeyes,kidneys,nerves,heart,andbloodvessels.,Symptoms,PolyuriaPolydipsia(thirst)WeightlossWeaknessPolyphagiaBlurredvisionRecurrentinfectionImpairmentofgrowth,Criteriafordiagnosisofdiabetes(WHO1999),Symptomsofdiabetes+Casualplasmaglucose11.1mmol/l(200mg/dl)OrFPG7.0mmol/l(126mg/dl)Or2-hPG11.1mmol/l,DiagnosticCriteriaWHO1999,IGT-FPG7mmol/L-2-hPG7.8mmol/Land11.1mmol/LIFG-FPG6.1mmol/Land7.0mmol/L,LaboratoryFindings,UrinaryglucoseUrinaryketoneBloodglucose(FPGand2-hPG)HbA1candFA(fructosamine)OGTTInsulin/CPreleasingtest,Classification(1),Type1diabetes-celldestruction,usuallyleadingtoabsolutedeficiencyImmune-mediateddiabetesIdiopathicdiabetesType2diabetesRangingfrompredominantlyinsulinresistancewithrelativeinsulindeficiencytopredominantlyaninsulinsecretorydefectwithinsulinresistance,Classification(2),OtherspecifictypesofdiabetesDuetoothercauses,e.g.,geneticdefectsininsulinaction,diseasesoftheexocrinepancreas,drugorchemicalinducedGestationaldiabetesmellitus(GDM)diagnosedduringpregnancy,Etiologicclassificationofdiabetesmellitus(1),I.Type1diabetes(-celldestruction,usuallyleadingtoabsoluteinsulindeficiency)A.immunemediatedB.IdiopathicII.Type2diabetes(mayrangefrompredominantlyinsulinresistancewithrelativeinsulindeficiencytoapredominantlysecretorydefectwithinsulinresistance)III.OtherspecifictypesA.geneticdefectsof-cellfunction1.Chromosome12,HNF-1(MODY3)2.Chromosome7,glucokinase(MODY2)3.Chromosome20,HNF-4(MODY1)4.MitochondrialDNA5.OthersB.Geneticdefectsininsulinaction1.TypeAinsulinresistance2.Leprechaunism3.Rabson-Mendenhallsyndrome4.Lipoatrophicdisease5.OthersC.Diseasesoftheexocrinepancreas1.Pancreatitis2.Trauma/pancreatectomy3.Neoplasia4.Cysticfibrosis5.Hemochromatosis6.Fibrocalculouspancreatopathy7.Others,Etiologicclassificationofdiabetesmellitus(2),D.Endocrinopathies1.Acromegaly2.Cushingssyndrome3.Glucagonoma4.Pheochromocytoma5.Hyperthyroidism6.Somatostatinoma7.Aldosteronoma8.OthersE.Drud-orchemical-induced1.Vacor2.Pentamidine3.Nicotinicacid4.Glucocorticoid5.Thyroidhormone6.Diazoxide7.-adrenergicagonists8.Thiazides9.Dilantin10.-Interferon11.OthersF.Infections1.Congenitalrubella2.Cytomegalovirus3.Others,Etiologicclassificationofdiabetesmellitus(3),G.Uncommonformsofimmune-mediateddiabetes1.“Stiff-man”syndrome2.Anti-insulinreceptorantibodies3.OthersH.Othergeneticsyndromessometimesassociatedwithdiabetes1.Downssyndrome2.Klinefelterssyndrome3.Turnerssyndrome4.Wolframssyndrome5.Friedreichsataxia6.Huntingtonschorea7.Laurence-moon-Biedlsyndrome8.Myotonicdystrophy9.Porphyria10.Prader-Willisyndrome11.OthersIV.Gestationaldiabetesmellitus(GDM),Patientswithanyformofdiabetesmayrequireinsulintreatmentatsomestageoftheirdisease.Suchuseofinsulindosenot,ofitself,classifythepatient.,Type1DM,Generally30yearsRapidonsetModeratetoseveresymptomsSignificantweightlossLeanKetonuriaorketo-acidosisLowfastingorpost-prandialC-peptideImmunemarkers(anti-GAD,ICA,IA-2),Type2DM,Generally40yearsSlowlyonsetNotseveresymptomsObesityKetoacidosisseldomoccurNonketotichyperosmolarsyndromeNormalorelevatedC-peptidelevelsGeneticpredisposition,PathophysiologicalmodelfordevelopmentofobesityandT2DM,Beta-celldefect,Intra-uteringrowthretardation,InsulinResistancegenes,Obesitygenes,InsulinResistance+Intraabdominalobesity,IGT,T2DM,Westernlifestyle,Glucosetoxicity,MetabolicInsulinResistance(FFA),0,80,40,20,60,Year,Disorderofglycemia:etiologicaltypesclinicalstages,Stages,Types,NormoglycemiaHyperglycemia,Diabetesmellitus,Type1Type2OtherspecifictypesGestationaldiabetes,Normalglucosetolerance,IGTand/orIFG,Notinsulinrequiring,Insulinrequiringforcontrol,Insulinrequiringforsurvival,Acute,life-threateningconsequences,HyperglycemiawithketoacidosisNonketotichyperosmolarsyndrome,Microvascularcomplications,RetinopathyNephropathyPeripheralneuropathyAutonomicneuropathy,Macrovascularcomplications,AtheroscleroticcardiovasculardiseasePeripheralvasculardiseasecerebrovasculardisease,Others,HypertensionAbnormalitiesoflipoproteinmetabolismPeriodontaldisease,PotentialchroniccomplicationsofelevatedHbA1c,good,poor,control,RISK,MicroalbuminuriaMildRetinopathyMildNeuropathy,AlbuminuriaMacularEdemaProliferativeRetinopathyPeridontalDiseaseImpotenceGastroparesisDepression,FootUlcersAnginaHeartAttackCoronaryBypassSurgeryStrokeBlindnessAmputationDialysisKidneyTransplant,TheAimsofTreatment,ReliefofhyperglycemicsymptomsCorrectionofhyperglycemia,ketonuriaandhyperlipidemiaEstablishmentandmaintenanceofadesirablebodyweight,andinchildrennormalgrowthanddevelopmentAvoidanceofacutemetabolicdisturbancePreventordelaytheonsetofthelong-termcomplications,Targetsforcontrol,Management,EssentialsofmanagementMonitoringofglucoselevelsFoodplanningPhysicalactivityTreatmentofhyperglycemia,2.MonitoringofGlucoseLevels,Bloodglucoselevels-beforeeachmeal-atbedtimeUrineglucosetestingUrineketonetests(shouldbeperformedduringillnessorwhenbloodglucoseis20mmol/L),3.FoodPlanning,Weightcontrol.50-60%ofthetotaldietaryenergyshouldcomefromcomplexcarbohydrates.20-25%formfatsandoils.15-20%fromprotein.Restrictalcoholintake.Restrictsaltintaketobelow7g/d.,4.PhysicalActivity,PhysicalactivityplayanimportantroleinthemanagementofdiabetesparticularlyinT2DM.Physicalactivityimprovesinsulinsensitivity,thusimprovingglycemiccontrol,andmayhelpwithweightreductionDosparinglyavoidsedentaryactivitiesDoregularlyparticipateinleisureactivitiesandrecreationalsportsDoeverydayadopthealthylifestylehabits,5.DrugTreatment,Ifthepatientisverysymptomaticorhasaveryhighbloodglucoselevel,dietandlifestylechangesareunlikelytoachievetargetvalues.Inthisinstance,pharmacologicaltherapyshouldbestartedwithoutdelay.,Treatment,SulphonylureasBiguanides-GlucosidaseinhibitorsThiazolidinedionesGlinidesInsulinCombinationtherapy,1.Sulphonylureas,ChlorpropamideTolbutamideGlibenclamideGlipizideGliclazideGliguidoneGlimepiride,2.Biguanides,MetforminPhenforminBuformin,3.-Glucosidaseinhibitors,AcarboseVogliboseMiglitol,4.Thiazolidinediones,Rosiglitazon