Lecture Diabetes mellitus - MD. Phạm Thu Ha

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Diabetes mellitus is a condition of chronic increase in blood sugar, is not contagious, hereditary, caused by lack of insulin (pancreatic insulin secretion or insulin does not work not effective). Lecture Diabetes mellitus to help you know: overview of diabetes, discussion about guidelines of diabetes management, implementation in clinical practice.

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Nội dung Text: Lecture Diabetes mellitus - MD. Phạm Thu Ha

Diabetes mellitus MD Phạm Thu Hà Dept. Endocrinology and Diabetes B¹ch mai Hospital
Objectifs • Overview of diabetes • Discussion about guidelines of diabetes management • Implementation in Clinical practice
Number of pts diabetes estimated in 2000 & to 2030 (Diabetes Care 2004;27:1047-1053)
Prevalence of diabetes & prediabetes 35-64 yrs 50 45 Poland 40 Denmark 35 Brazil 30 USA (white) 25 Alaska (inuit) 20 US rural hisp. 15 US urban hisp 10 Nauru 5 Pima(US) 0 Diabetes IGT IDF Diabetes Atlas 2003
GDM in 1990, 1995 and 2001 1990 1995 2001 No Data 10% Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).
US. Prevalence of diabetes 2010 • Diagnosed: 26 million people— 8.3% of population (90%+ have Type 2)b • Undiagnosed: 7 million people • 79 million people have pre-diabetes CDC 2011
Diabetes Diagnosis Category FPG (mg/dL) 2h 75gOGTT A1C Normal 6.5 Or patients with classic hyperglycemic symptoms with plasma glucose >200 ** On 2 separate occasions Diabetes Care 34:Supplement 1, 2011
OGTT XN ĐH sau uống 75 g Glucose trong 250 – 300 ml nước ở các thời điểm 0p, 120p Chẩn đoán ĐTĐ khi ĐH 120p ≥ 2g/l (11mmol/l) Giảm DN Glucose 7,8 mmol/l ≤ ĐH 120p < 11mmol/l Bình thường ĐH 120p < 7,8mmol/l
Classification Type 1  cell destruction, absolute deficit of insulin:children, 10% adults- LADA( Latent Autoimmune Diabetes in Adults).) Type 2  cell secretion dysfunction – insulin resistance ( 90% adults) Gestational :  cell secretion dysfunction –insulin rasistance/in pregnancy Others diabetes • Inheritanced  cell deficit (MODY) • Exocrine pancreatic deseases • Endocrinopathy • Drugs & Chemical • Other rare types 11
Treatment
How to control BG ? + Self-monitoring BG Dr : Control HbA1c patient Goals achieved
Nutritional regime • Important for both types • Well balanced:protein, lipid , CH,Vitamins,minerals • Avoid hyperglycemia postprandial ,hypoglycemia in distance from meal. • Energy enougth for activities • Ideal body weight, raisonable weight loss if indicated • Non potentional CV risk factors:Dysipidemia, Hypertention, Heart faillure... • Easy to follow, simple , not expensive • Not changing too fast habit and total amount of food.
Nutritional regime • Component ratio • CARBOHYDRAT + Main energy source + 60 – 70 % total calories • LIPID + 15 – 20% , less if CV risk • PROTID + 10 -20% ( 0,8 – 1,2 g/kg) + When renal faillure : 0,6g/ kg cân nặng
Nutrittional regime • Microelements + Supplement of Vitamins • Others + More vegetebles, fibers, less sweeet fruits + Alcohool 5 – 15 g/d • Distribution : 3 main meals+ 2 snacks (for pts on insulin inj)
Exercise help to get to glycemic control goals and protect pts from cardiovascular deseases Better glycemic control Ameliorate hemodynamic in the body Help Weight loss Better peripheral insulin sensitivity Healthy sensation
Physical activities • Progressive setting, regularly 20- 30 min a day. • Consult Dr opinion before practicing: caution if severe CV complication, eye compl., nephropathy, neuropathy, foot damage….. • Choose suitable discipline
exercise • Important notes when practicing exercise – Do not practicing if fasting Gl > 14mmol/l ( 250mg%) + cetonuria(+). Or fasting Gl > 16,5 mmol/l (300mg%) and cetonuria (-) – Fasting Gl < 5,5 mmol/l (100mg%)  Snack before exercise. – Blood sugar control before and after : choose suitable sport , nutritional advice when practicing . • Consumation rich in carbohydrate food before exercise
Medical treatment
Anti- hyperglycemic drugs 1. Insulin secretagogues - Sulfonylurea - Glinides - Gliptins ( DPP-4 inhibitor ) DPP-4 inhibitors -GLP-1 receptor agonists ( injectable) 2. Increasing Insulin sensitivity - Metformin - Thiazolidinedione 3. Inhibitor of intestinal glucose absortion - Ức chế men alpha- glucosidase
Main Pathophysiological Defects in T2DM pancreatic incretin insulin effect secretion pancreatic glucagon gut - secretion ? carbohydrate delivery & HYPERGLYCEMIA absorption - + peripheral hepatic glucose glucose uptake production Adapted from: Inzucchi SE, Sherwin RS in: Cecil Medicine 2011