糖尿病基础知识英文课件.pptx

《糖尿病基础知识英文课件.pptx》由会员分享，可在线阅读，更多相关《糖尿病基础知识英文课件.pptx（45页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、Diabetes MellitusDr.Rasha SalamaPhD Public Health,Suez Canal University,Egypt Diabetes MSc,Cardiff University,United Kingdom Diabetes mellitus(DM)is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production,insulin action,or both.The term diabetes

2、 mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate,fat and protein metabolism resulting from defects in insulin secretion,insulin action,or both.The effects of diabetes mellitus include longterm damage,dysfunction

3、and failure of various organs.What is diabetes?Diabetes mellitus may present with characteristic symptoms such as thirst,polyuria,blurring of vision,and weight loss.In its most severe forms,ketoacidosis or a nonketotic hyperosmolar state may develop and lead to stupor,coma and,in absence of effectiv

4、e treatment,death.Often symptoms are not severe,or may be absent,and consequently hyperglycaemia sufficient to cause pathological and functional changes may be present for a long time before the diagnosis is made.Diabetes The longterm effects of diabetes mellitus include progressive development of t

5、he specific complications of retinopathy with potential blindness,nephropathy that may lead to renal failure,and/or neuropathy with risk of foot ulcers,amputation,Charcot joints,and features of autonomic dysfunction,including sexual dysfunction.People with diabetes are at increased risk of cardiovas

6、cular,peripheral vascular and cerebrovascular disease.Diabetes Long-term Effects The development of diabetes is projected to reach pandemic proportions over the next10-20 years.International Diabetes Federation(IDF)data indicate that by the year 2025,the number of people affected will reach 333 mill

7、ion 90%of these people will have Type 2 diabetes.In most Western societies,the overall prevalence has reached 4-6%,and is as high as 10-12%among 60-70-year-old people.The annual health costs caused by diabetes and its complications account for around 6-12%of all health-care expenditure.Burden of Dia

8、betes Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Gestational Diabetes Other types:vLADA(vMODY(maturity-onset diabetes of youth)vSecondary Diabetes MellitusTypes of Diabetes Was previously called insulin-dependent diabetes mellitus(IDDM)or juvenile-onset diabetes.Type 1 diabetes develops when

9、the bodys immune system destroys pancreatic beta cells,the only cells in the body that make the hormone insulin that regulates blood glucose.This form of diabetes usually strikes children and young adults,although disease onset can occur at any age.Type 1 diabetes may account for 5%to 10%of all diag

10、nosed cases of diabetes.Risk factors for type 1 diabetes may include autoimmune,genetic,and environmental factors.Type 1 diabetes Was previously called non-insulin-dependent diabetes mellitus(NIDDM)or adult-onset diabetes.Type 2 diabetes may account for about 90%to 95%of all diagnosed cases of diabe

11、tes.It usually begins as insulin resistance,a disorder in which the cells do not use insulin properly.As the need for insulin rises,the pancreas gradually loses its ability to produce insulin.Type 2 diabetes is associated with older age,obesity,family history of diabetes,history of gestational diabe

12、tes,impaired glucose metabolism,physical inactivity,and race/ethnicity.African Americans,Hispanic/Latino Americans,American Indians,and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes.Type 2 diabetes is increasingly being diagnos

13、ed in children and adolescents.Type 2 diabetes A form of glucose intolerance that is diagnosed in some women during pregnancy.Gestational diabetes occurs more frequently among African Americans,Hispanic/Latino Americans,and American Indians.It is also more common among obese women and women with a f

14、amily history of diabetes.During pregnancy,gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant.After pregnancy,5%to 10%of women with gestational diabetes are found to have type 2 diabetes.Women who have had gestational diabetes have

15、 a 20%to 50%chance of developing diabetes in the next 5-10 years.Gestational diabetes Other specific types of diabetes result from specific genetic conditions(such as maturity-onset diabetes of youth),surgery,drugs,malnutrition,infections,and other illnesses.Such types of diabetes may account for 1%

16、to 5%of all diagnosed cases of diabetes.Other types of DM Latent Autoimmune Diabetes in Adults(LADA)is a form of autoimmune(type1 diabetes)which is diagnosed in individuals who are older than the usual age of onset of type 1 diabetes.Alternate terms that have been used for LADA include Late-onset Au

17、toimmune Diabetes of Adulthood,Slow Onset Type 1 diabetes,and sometimes also Type 1.5 Often,patients with LADA are mistakenly thought to have type2 diabetes,based on their age at the time of diagnosis.LADALADA(cont.)About 80%of adults apparently with recently diagnosed Type 2 diabetes but with GAD a

18、uto-antibodies(i.e.LADA)progress to insulin requirement within 6 years.The potential value of identifying this group at high risk of progression to insulin dependence includes:the avoidance of using metformin treatment the early introduction of insulin therapyLADA(cont.)MODY Maturity Onset Diabetes

19、of the Young MODY is a monogenic form of diabetes with an autosomal dominant mode of inheritance:Mutations in any one of several transcription factors or in the enzyme glucokinase lead to insufficient insulin release from pancreatic-cells,causing MODY.Different subtypes of MODY are identified based

20、on the mutated gene.Originally,diagnosis of MODY was based on presence of non-ketotic hyperglycemia in adolescents or young adults in conjunction with a family history of diabetes.However,genetic testing has shown that MODY can occur at any age and that a family history of diabetes is not always obv

21、ious.MODYMODY(cont.)Within MODY,the different subtypes can essentially be divided into 2 distinct groups:glucokinase MODY and transcription factor MODY,distinguished by characteristic phenotypic features and pattern on oral glucose tolerance testing.Glucokinase MODY requires no treatment,while trans

22、cription factor MODY(i.e.Hepatocyte nuclear factor-1alpha)requires low-dose sulfonylurea therapy and PNDM(caused by Kir6.2 mutation)requires high-dose sulfonylurea therapy.MODY(cont.)Secondary causes of Diabetes mellitus include:Acromegaly,Cushing syndrome,Thyrotoxicosis,Pheochromocytoma Chronic pan

23、creatitis,Cancer Drug induced hyperglycemia:Atypical Antipsychotics-Alter receptor binding characteristics,leading to increased insulin resistance.Beta-blockers-Inhibit insulin secretion.Calcium Channel Blockers-Inhibits secretion of insulin by interfering with cytosolic calcium release.Corticostero

24、ids-Cause peripheral insulin resistance and gluconeogensis.Fluoroquinolones-Inhibits insulin secretion by blocking ATP sensitive potassium channels.Naicin-They cause increased insulin resistance due to increased free fatty acid mobilization.Phenothiazines-Inhibit insulin secretion.Protease Inhibitor

25、s-Inhibit the conversion of proinsulin to insulin.Thiazide Diuretics-Inhibit insulin secretion due to hypokalemia.They also cause increased insulin resistance due to increased free fatty acid mobilization.Secondary DM Prediabetes is a term used to distinguish people who are at increased risk of deve

26、loping diabetes.People with prediabetes have impaired fasting glucose(IFG)or impaired glucose tolerance(IGT).Some people may have both IFG and IGT.IFG is a condition in which the fasting blood sugar level is elevated(100 to 125 milligrams per decilitre or mg/dL)after an overnight fast but is not hig

27、h enough to be classified as diabetes.IGT is a condition in which the blood sugar level is elevated(140 to 199 mg/dL after a 2-hour oral glucose tolerance test),but is not high enough to be classified as diabetes.Prediabetes:Impaired glucose tolerance and impaired fasting glucose Progression to diab

28、etes among those with prediabetes is not inevitable.Studies suggest that weight loss and increased physical activity among people with prediabetes prevent or delay diabetes and may return blood glucose levels to normal.People with prediabetes are already at increased risk for other adverse health ou

29、tcomes such as heart disease and stroke.Prediabetes:Impaired glucose tolerance and Prediabetes:Impaired glucose tolerance and impaired fasting glucose(cont.)impaired fasting glucose(cont.)Diagnosis of Diabetes MellitusValues of Diagnosis of Diabetes Mellitus Research studies have found that lifestyl

30、e changes can prevent or delay the onset of type 2 diabetes among high-risk adults.These studies included people with IGT and other high-risk characteristics for developing diabetes.Lifestyle interventions included diet and moderate-intensity physical activity(such as walking for 2 1/2 hours each we

31、ek).In the Diabetes Prevention Program,a large prevention study of people at high risk for diabetes,the development of diabetes was reduced 58%over 3 years.Prevention or delay of diabetes:Life style modification Studies have shown that medications have been successful in preventing diabetes in some

32、population groups.In the Diabetes Prevention Program,people treated with the drug metformin reduced their risk of developing diabetes by 31%over 3 years.Treatment with metformin was most effective among younger,heavier people(those 25-40 years of age who were 50 to 80 pounds overweight)and less effe

33、ctive among older people and people who were not as overweight.Similarly,in the STOP-NIDDM Trial,treatment of people with IGT with the drug acarbose reduced the risk of developing diabetes by 25%over 3 years.Other medication studies are ongoing.In addition to preventing progression from IGT to diabe

34、tes,both lifestyle changes and medication have also been shown to increase the probability of reverting from IGT to normal glucose tolerance.Prevention or delay of diabetes:MedicationsManagement of Diabetes Mellitus The major components of the treatment of diabetes are:Management of DM Diet and Exer

35、ciseOral hypoglycaemic therapyA Insulin TherapyBC Diet is a basic part of management in every case.Treatment cannot be effective unless adequate attention is given to ensuring appropriate nutrition.Dietary treatment should aim at:ensuring weight control providing nutritional requirements allowing go

36、od glycaemic control with blood glucose levels as close to normal as possible correcting any associated blood lipid abnormalitiesA.DietThe following principles are recommended as dietary guidelines for people with diabetes:Dietary fat should provide 25-35%of total intake of calories but saturated fa

37、t intake should not exceed 10%of total energy.Cholesterol consumption should be restricted and limited to 300 mg or less daily.Protein intake can range between 10-15%total energy(0.8-1 g/kg of desirable body weight).Requirements increase for children and during pregnancy.Protein should be derived fr

38、om both animal and vegetable sources.Carbohydrates provide 50-60%of total caloric content of the diet.Carbohydrates should be complex and high in fibre.Excessive salt intake is to be avoided.It should be particularly restricted in people with hypertension and those with nephropathy.A.Diet(cont.)Phys

39、ical activity promotes weight reduction and improves insulin sensitivity,thus lowering blood glucose levels.Together with dietary treatment,a programme of regular physical activity and exercise should be considered for each person.Such a programme must be tailored to the individuals health status an

40、d fitness.People should,however,be educated about the potential risk of hypoglycaemia and how to avoid it.Exercise There are currently four classes of oral anti-diabetic agents:i.Biguanidesii.Insulin Secretagogues Sulphonylureasiii.Insulin Secretagogues Non-sulphonylureasiv.-glucosidase inhibitorsv.

41、Thiazolidinediones(TZDs)B.Oral Anti-Diabetic Agents If glycaemic control is not achieved(HbA1c 6.5%and/or;FPG 7.0 mmol/L or;RPG 11.0mmol/L)with lifestyle modification within 1 3 months,ORAL ANTI-DIABETIC AGENT should be initiated.In the presence of marked hyperglycaemia in newly diagnosed symptomati

42、c type 2 diabetes(HbA1c 8%,FPG 11.1 mmol/L,or RPG 14 mmol/L),oral anti-diabetic agents can be considered at the outset together with lifestyle modification.B.1 Oral Agent MonotherapyAs first line therapy:Obese type 2 patients,consider use of metformin,acarbose or TZD.Non-obese type 2 patients,consid

43、er the use of metformin or insulin secretagogues Metformin is the drug of choice in overweight/obese patients.TZDs and acarbose are acceptable alternatives in those who are intolerant to metformin.If monotherapy fails,a combination of TZDs,acarbose and metformin is recommended.If targets are still n

44、ot achieved,insulin secretagogues may be addedB.1 Oral Agent Monotherapy(cont.)Combination oral agents is indicated in:Newly diagnosed symptomatic patients with HbA1c 10 Patients who are not reaching targets after 3 months on monotherapyB.2 Combination Oral Agents If targets have not been reached af

45、ter optimal dose of combination therapy for 3 months,consider adding intermediate-acting/long-acting insulin(BIDS).Combination of insulin+oral anti-diabetic agents(BIDS)has been shown to improve glycaemic control in those not achieving target despite maximal combination oral anti-diabetic agents.Com

46、bining insulin and the following oral anti-diabetic agents has been shown to be effective in people with type 2 diabetes:Biguanide(metformin)Insulin secretagogues(sulphonylureas)Insulin sensitizers(TZDs)(the combination of a TZD plus insulin is not an approved indication)-glucosidase inhibitor(acarb

47、ose)Insulin dose can be increased until target FPG is achieved.B.3 Combination Oral Agents and InsulinDiabetes Management Algorithm Oral Hypoglycaemic Medications In elderly non-obese patients,short acting insulin secretagogues can be started but long acting Sulphonylureas are to be avoided.Renal fu

48、nction should be monitored.Oral anti-diabetic agent s are not recommended for diabetes in pregnancy Oral anti-diabetic agents are usually not the first line therapy in diabetes diagnosed during stress,such as infections.Insulin therapy is recommended for both the above Targets for control are applic

49、able for all age groups.However,in patients with co-morbidities,targets are individualized When indicated,start with a minimal dose of oral anti-diabetic agent,while reemphasizing diet and physical activity.An appropriate duration of time(2-16 weeks depending on agents used)between increments should

50、 be given to allow achievement of steady state blood glucose controlGeneral Guidelines for Use of Oral Anti-Diabetic General Guidelines for Use of Oral Anti-Diabetic Agent inDiabetes Agent inDiabetesShort-term use:Acute illness,surgery,stress and emergencies Pregnancy Breast-feeding Insulin may be u