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1、Diabetes MellitusZhao-xiaojuan1编辑版pptIntroduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.2编辑版pptIntroductionThe chronic hyperglycemia of diabetes is associated with long-term
2、 damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.3编辑版pptSymptomsPolyuriaPolydipsia (thirst)Weight lossWeaknessPolyphagiaBlurred visionRecurrent infectionImpairment of growth4编辑版pptCriteria for diagnosis of diabetes (WHO1999) Symptoms
3、 of diabetes +Casual plasma glucose 11.1mmol/l(200mg/dl) OrFPG 7.0mmol/l (126mg/dl)Or2-hPG 11.1mmol/l5编辑版pptDiagnostic Criteria WHO1999IGT -FPG7mmol/L -2-h PG7.8mmol/L and 11.1mmol/LIFG -FPG6.1mmol/L and 7.0mmol/L 6编辑版pptLaboratory FindingsUrinary glucoseUrinary ketoneBlood glucose (FPG and 2-hPG)Hb
4、A1c and FA(fructosamine)OGTTInsulin / CP releasing test7编辑版pptClassification (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 pred
5、ominantly an insulin secretory defect with insulin resistance8编辑版pptClassification (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
6、 9编辑版pptEtiologic classification 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 secre
7、tory defect with insulin 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.
8、Leprechaunism 3. Rabson- 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. Others10编辑版pptEtiologic classification of diabetes mel
9、litus(2) D. Endocrinopathies 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
10、agonists 8. Thiazides 9. Dilantin 10. -Interferon 11. Others F. Infections 1. Congenital rubella 2. Cytomegalovirus 3. Others 11编辑版pptEtiologic classification of diabetes mellitus(3) G. Uncommon forms of immune- mediated diabetes 1. “Stiff-man” syndrome 2. Anti-insulin receptor antibodies 3. Others
11、H. Other genetic syndromes sometimes 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. Ge
12、stational diabetes mellitus ( GDM )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.12编辑版pptType 1 DMGenerally 7.010.0HbA1c(%) 6.28.0Blood pressure (mmHg)130/80-160/95BMI(kg/m2)Malefemale252
13、42726 27 26Total cholesterol(mmol/L)1.11.1-0.90.9Triglycerides(mmol/L)1.52.2 2.2LDL- cholesterol(mmol/L)4.423编辑版pptManagementEssentials of managementMonitoring of glucose levelsFood planningPhysical activityTreatment of hyperglycemia24编辑版ppt2.Monitoring of Glucose LevelsBlood glucose levels - before
14、 each meal - at bedtime Urine glucose testingUrine ketone tests (should be performed during illness or when blood glucose is 20mmol/L ) 25编辑版ppt3.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.Restric
15、t alcohol intake.Restrict salt intake to below 7g/d. 26编辑版ppt4.Physical ActivityPhysical 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 sparingl
16、y avoid sedentary activitiesDo regularly participate in leisure activities and recreational sportsDo every day adopt healthy lifestyle habits27编辑版ppt5.Drug TreatmentIf the patient is very symptomatic or has a very high blood glucose level, diet and lifestyle changes are unlikely to achieve target va
17、lues. In this instance, pharmacological therapy should be started without delay.28编辑版pptTreatmentSulphonylureasBiguanides-Glucosidase inhibitorsThiazolidinedionesGlinidesInsulinCombination therapy29编辑版ppt1.SulphonylureasChlorpropamideTolbutamideGlibenclamideGlipizideGliclazideGliguidone Glimepiride3
18、0编辑版ppt2.BiguanidesMetforminPhenformin Buformin 31编辑版ppt3.-Glucosidase inhibitorsAcarboseVogliboseMiglitol32编辑版ppt4.ThiazolidinedionesRosiglitazonePioglitazoneCiglitazone 33编辑版ppt5.GlinidesNategliniderepaglinide34编辑版ppt6.InsulinInsulin is the most efficacious pharmacologic treatment for patients wit
19、h diabetes35编辑版ppt6.InsulinIndication PreparationTherapy Adverse reaction36编辑版pptManagement 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 insulin or c
20、hange to insulinCheck adherance at each step37编辑版pptManagement Algorithm for Non-Obese T2DMFailure 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 step38编辑版ppt
