英文糖尿病课件

DiabetesMellitusZhao-xiaojuan1编辑版pptIntroductionDiabetesmellitus

isaheterogeneousgroupofmetabolicdiseasescharacterizedbyhyperglycemiaresultingfromdefectsininsulinsecretion,insulinaction,orboth.2编辑版pptIntroductionThechronichyperglycemiaofdiabetesisassociatedwithlong-termdamage,dysfunction,andfailureofvariousorgans,especiallytheeyes,kidneys,nerves,heart,andbloodvessels.3编辑版pptSymptomsPolyuriaPolydipsia

(thirst)WeightlossWeaknessPolyphagiaBlurredvisionRecurrentinfectionImpairmentofgrowth4编辑版pptCriteriafordiagnosis

ofdiabetes(WHO1999)

Symptomsofdiabetes

+Casualplasmaglucose≥11.1mmol/l(200mg/dl)

OrFPG≥7.0mmol/l(126mg/dl)Or2-hPG≥11.1mmol/l5编辑版pptDiagnosticCriteria

WHO1999IGT-FPG<7mmol/L

-2-hPG≥7.8mmol/Land<11.1mmol/LIFG-FPG≥6.1mmol/Land<7.0mmol/L

6编辑版pptLaboratoryFindingsUrinaryglucoseUrinaryketoneBloodglucose(FPGand2-hPG)HbA1candFA(fructosamine)OGTTInsulin/CPreleasingtest7编辑版pptClassification(1)Type1diabetes

β-celldestruction,usuallyleadingtoabsolutedeficiency<1>Immune-mediateddiabetes<2>IdiopathicdiabetesType2diabetes

Rangingfrompredominantlyinsulinresistancewithrelativeinsulindeficiencytopredominantlyaninsulinsecretorydefectwithinsulinresistance8编辑版pptClassification(2)OtherspecifictypesofdiabetesDuetoothercauses,e.g.,geneticdefectsininsulinaction,diseasesoftheexocrinepancreas,drugorchemicalinducedGestationaldiabetes

mellitus(GDM)

diagnosedduringpregnancy

9编辑版pptEtiologicclassificationofdiabetesmellitus(1)I.Type1diabetes(-celldestruction,usuallyleadingtoabsoluteinsulindeficiency)

A.immunemediatedB.IdiopathicII.Type2diabetes(mayrangefrompredominantlyinsulinresistancewithrelativeinsulindeficiencytoapredominantlysecretorydefectwithinsulinresistance)III.Otherspecifictypes

A.geneticdefectsof-cellfunction1.Chromosome12,HNF-1(MODY3)2.Chromosome7,glucokinase(MODY2)3.Chromosome20,HNF-4(MODY1)4.MitochondrialDNA5.Others

B.Geneticdefectsininsulinaction

1.TypeAinsulinresistance2.Leprechaunism3.Rabson-Mendenhallsyndrome4.Lipoatrophicdisease5.Others

C.Diseasesoftheexocrinepancreas1.Pancreatitis2.Trauma/pancreatectomy3.Neoplasia4.Cysticfibrosis5.Hemochromatosis6.Fibrocalculouspancreatopathy7.Others10编辑版pptEtiologicclassificationofdiabetesmellitus(2)

D.Endocrinopathies1.Acromegaly2.Cushing’ssyndrome3.Glucagonoma4.Pheochromocytoma5.Hyperthyroidism6.Somatostatinoma7.Aldosteronoma8.Others

E.Drud-orchemical-induced1.Vacor2.Pentamidine3.Nicotinicacid4.Glucocorticoid5.Thyroidhormone6.Diazoxide7.-adrenergicagonists

8.Thiazides9.Dilantin10.-Interferon11.Others

F.Infections1.Congenitalrubella2.Cytomegalovirus3.Others11编辑版pptEtiologicclassificationofdiabetesmellitus(3)

G.Uncommonformsofimmune-mediateddiabetes1.“Stiff-man”syndrome2.Anti-insulinreceptorantibodies3.Others

H.Othergeneticsyndromessometimesassociatedwithdiabetes1.Down’ssyndrome2.Klinefelter’ssyndrome3.Turner’ssyndrome4.Wolfram’ssyndrome5.Friedreich’sataxia6.Huntington’schorea7.Laurence-moon-Biedlsyndrome8.Myotonicdystrophy9.Porphyria10.Prader-Willisyndrome11.Others

IV.Gestationaldiabetesmellitus(GDM)Patientswithanyformofdiabetesmayrequireinsulintreatmentatsomestageoftheirdisease.Suchuseofinsulindosenot,ofitself,classifythepatient.12编辑版pptType1DMGenerally<30yearsRapidonsetModeratetoseveresymptomsSignificantweightlossLeanKetonuriaorketo-acidosisLowfastingorpost-prandialC-peptideImmunemarkers(anti-GAD,ICA,IA-2)13编辑版pptType2DMGenerally＞40yearsSlowlyonsetNotseveresymptomsObesityKetoacidosisseldomoccurNonketotic

hyperosmolarsyndromeNormalorelevatedC-peptidelevelsGeneticpredisposition14编辑版pptPathophysiologicalmodelfordevelopmentofobesityandT2DMBeta-celldefectIntra-uteringrowthretardationInsulinResistancegenesObesitygenesInsulinResistance+IntraabdominalobesityIGTT2DMWesternlifestyleGlucosetoxicityMetabolicInsulinResistance(FFA)080402060Year15编辑版pptDisorderofglycemia:etiologicaltypesclinicalstagesStagesTypesNormoglycemia

Hyperglycemia

DiabetesmellitusType1Type2OtherspecifictypesGestationaldiabetesNormalglucosetoleranceIGTand/orIFGNotinsulinrequiringInsulinrequiringforcontrolInsulinrequiringforsurvival16编辑版pptAcute,life-threateningconsequencesHyperglycemiawithketoacidosisNonketotic

hyperosmolarsyndrome17编辑版pptMicrovascularcomplicationsRetinopathyNephropathyPeripheralneuropathyAutonomicneuropathy18编辑版pptMacrovascularcomplicationsAtheroscleroticcardiovasculardiseasePeripheralvasculardiseasecerebrovasculardisease19编辑版pptOthersHypertensionAbnormalitiesoflipoproteinmetabolismPeriodontaldisease20编辑版pptPotentialchroniccomplicationsofelevatedHbA1cgoodpoorcontrolRISKMicroalbuminuriaMildRetinopathyMildNeuropathyAlbuminuriaMacularEdemaProliferativeRetinopathyPeridontalDiseaseImpotenceGastroparesisDepressionFootUlcersAnginaHeartAttackCoronaryBypassSurgeryStrokeBlindnessAmputationDialysisKidneyTransplant21编辑版pptTheAimsofTreatmentReliefofhyperglycemicsymptomsCorrectionofhyperglycemia,ketonuriaandhyperlipidemiaEstablishmentandmaintenanceofadesirablebodyweight,andinchildrennormalgrowthanddevelopmentAvoidanceofacutemetabolicdisturbancePreventordelaytheonsetofthelong-termcomplications22编辑版pptTargetsforcontrolOptimalFairPoorPlasmaglucose

(mmol/L)FPG2-hPG4.4-6.14.4-8.07.010.0>7.0>10.0HbA1c(%)<6.2<6.2-8.0>8.0Bloodpressure

(mmHg)<130/80>130/80-<160/95>160/95BMI(kg/m2)Malefemale<25<24<27<262726Totalcholesterol(mmol/L)<HDL-cholesterol(mmol/L)>1.11.1-0.9<0.9Triglycerides(mmol/L)<1.5<2.22.2LDL-cholesterol(mmol/L)<2.52.5-4.4>4.423编辑版pptManagementEssentialsofmanagementMonitoringofglucoselevelsFoodplanningPhysicalactivityTreatmentofhyperglycemia24编辑版ppt2.MonitoringofGlucoseLevelsBloodglucoselevels-beforeeachmeal-atbedtimeUrineglucosetestingUrineketonetests(shouldbeperformedduringillnessorwhenbloodglucoseis20mmol/L)25编辑版ppt3.FoodPlanningWeightcontrol.50-60%ofthetotaldietaryenergyshouldcomefromcomplexcarbohydrates.20-25%formfatsandoils.15-20%fromprotein.Restrictalcoholintake.Restrictsaltintaketobelow7g/d.26编辑版ppt4.PhysicalActivityPhysicalactivityplayanimportantroleinthemanagementofdiabetesparticularlyinT2DM.Physicalactivityimprovesinsulinsensitivity,thusimprovingglycemiccontrol,andmayhelpwithweightreduction

DosparinglyavoidsedentaryactivitiesDoregularlyparticipateinleisureactivitiesandrecreationalsportsDoeverydayadopthealthylifestylehabits27编辑版ppt5.DrugTreatmentIfthepatientisverysymptomaticorhasaveryhighbloodglucoselevel,dietandlifestylechangesareunlikelytoachievetargetvalues.Inthisinstance,pharmacologicaltherapyshouldbestartedwithoutdelay.28编辑版pptTreatmentSulphonylureasBiguanides-GlucosidaseinhibitorsThiazolidinedionesGlinidesInsulinCombinationtherapy29编辑版ppt1.SulphonylureasChlorpropamideTolbutamideGlibenclamideGlipizideGliclazideGliguidoneGlimepiride30编辑版ppt2.BiguanidesMetforminPhenforminBuformin31编辑版ppt3.-GlucosidaseinhibitorsAc