教學(xué)課件 糖尿病

1、Diabetes MellitusZhao-xiaojuan共三十九頁Introduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.共三十九頁IntroductionThe chronic hyperglycemia of diabetes is associated with long-term dam

2、age, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.共三十九頁SymptomsPolyuriaPolydipsia (thirst)Weight lossWeaknessPolyphagiaBlurred visionRecurrent infectionImpairment of growth共三十九頁Criteria for diagnosis of diabetes (WHO1999) Symptoms of diab

3、etes +Casual plasma glucose 1.1mmol/l(200mg/dl) OrFPG 7.0mmol/l (126mg/dl)Or2-hPG 11.1mmol/l共三十九頁Diagnostic Criteria WHO1999IGT -FPG7mmol/L -2-h PG7.8mmol/L and 11.1mmol/LIFG -FPG6.1mmol/L and 7.0mmol/L 共三十九頁Laboratory FindingsUrinary glucoseUrinary ketoneBlood glucose (FPG and 2-hPG)HbA1c and FA(fr

4、uctosamine)OGTTInsulin / CP releasing test共三十九頁Classification (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 in

5、sulin secretory defect with insulin resistance共三十九頁Classification (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 共三十九頁Etiologic c

6、lassification 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 secretory defect with in

7、sulin 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. Leprechaunism 3. Ra

8、bson- 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. Others共三十九頁Etiologic classification of diabetes mellitus(2) D. Endocrinop

9、athies 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 agonists 8. Thiazides

10、9. Dilantin 10. -Interferon 11. Others F. Infections 1. Congenital rubella 2. Cytomegalovirus 3. Others 共三十九頁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 syndrome

11、s 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. Gestational diabetes mellit

12、us ( 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.共三十九頁Type 1 DMGenerally 7.010.0HbA1c(%) 6.28.0Blood pressure (mmHg)130/80-160/95BMI(kg/m2)Malefemale252427262726Total cholesterol(m

13、mol/L)1.11.1-0.90.9Triglycerides(mmol/L)1.52.22.2LDL- cholesterol(mmol/L)4.4共三十九頁ManagementEssentials of managementMonitoring of glucose levelsFood planningPhysical activityTreatment of hyperglycemia共三十九頁2.Monitoring of Glucose LevelsBlood glucose levels - before each meal - at bedtime Urine glucose

14、 testingUrine ketone tests (should be performed during illness or when blood glucose is 20mmol/L ) 共三十九頁3.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.Restrict alcohol intake.Restrict salt intake to

15、 below 7g/d. 共三十九頁4.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 sparingly avoid sedentary activitiesDo regularly pa

16、rticipate in leisure activities and recreational sportsDo every day adopt healthy lifestyle habits共三十九頁5.Drug TreatmentIf 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 therap

17、y should be started without delay.共三十九頁TreatmentSulphonylureasBiguanides-Glucosidase inhibitorsThiazolidinedionesGlinidesInsulinCombination therapy共三十九頁1.SulphonylureasChlorpropamideTolbutamideGlibenclamideGlipizideGliclazideGliguidone Glimepiride共三十九頁2.BiguanidesMetforminPhenformin Buformin 共三十九頁3.

18、-Glucosidase inhibitorsAcarboseVogliboseMiglitol共三十九頁4.ThiazolidinedionesRosiglitazonePioglitazoneCiglitazone 共三十九頁5.GlinidesNategliniderepaglinide共三十九頁6.InsulinInsulin is the most efficacious pharmacologic treatment for patients with diabetes共三十九頁6.InsulinIndication PreparationTherapy Adverse reaction共三十九頁Management Algorithm for Overweight and Obese T2DMDiet Exercise and weightcon