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Maja Ravnik-Oblak

Maja Ravnik-Oblak. Diabetes mellitus type 2. very old diagnosed disease very frequent chronic disease. unpredictable disease very psychological burdersome disease. DIABETES MELLITUS. EPIDEMIOLOGY. y. 2000 151 million patients y. 2010 285 million patients y. 2030

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Maja Ravnik-Oblak

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  1. Maja Ravnik-Oblak Diabetes mellitus type 2

  2. very old diagnosed disease very frequent chronic disease unpredictable disease very psychological burdersome disease DIABETES MELLITUS

  3. EPIDEMIOLOGY • y. 2000 151 million patients • y. 2010 285 million patients • y. 2030 439 million patients

  4. PREVALENCE OF DIABETES MELLITUS IN EUROPE(y. 2000) • inhabitants: 654,9 milijona • adults (20-79 yrs):462,7 milijona • diabetics (adults): 22,5 milijona • prevalence (adults): 4,9 % • type 1 diabetics: 1,29 milijona • prevalence of typ 1: 0,19 %

  5. PREVALENCE OF DIABETES MELLITUS IN SLOVENIA(1990-2000) YEAR1990 1996 2000 • DIABETICS62.82176.48089.000 • POPULATION 1.998.090 1.986.9891.985.557 • PREVALENCE3,14%3,85%4,48% • NEW PATIENTS4.8375.274 • INCIDENCE 0,24% 0,27% Vrtovec, Urbančič, Koselj, Vončina (2001)

  6. DIABETES MELLITUSIMPACTON PSYCHOSOCIAL STATUS OF A PATIENT • CHRONIC DISEASE • chronic treatment • regular outpatient controls (GP, diabetologist, ophthalmologist, other specialists) • regular lab controls • permanent education

  7. DIABETES MELLITUS AND MENTAL DISTURBANCES • fear of very low and very high lood glucose values • fear of occurrence of chronic diabetic complications • feeling of guilt for failure to comply therapists instructions and failure to achieve therapeutic goals CHRONIC STRESS

  8. PSYCHOSOCIAL WELL-BEING OF DIABETIC PATIENTS WHO 5-item questionnaire 42 % of diabetic patients reported bad psychosocial well-being

  9. DEFINITION Diabetes is a group of metabolic disorders with hyperglycemia due to insufficient secretion of insulin and / or its non-efficiency. Chronic hyperglycemia is associated with chronic failures and dysfunction of various organs including renal (kidney) failure, nerve damage, heart disease, stroke, and blindness.

  10. SYMPTOMS ANS SIGNS OF DIABETES MELLITUS dry mouth, thirstpolyuria, nocturiaweight loss (despite of increased appetite)fatiguevisual disturbancesgenital pruritus

  11. ORGANIC SYNDROME OF TYPE 2 DIABETES MELLITUS • diabetic peripheral neuropathy: 8-15 % • diabetic retinopathy: 5-10% • cataract • macroangiopathy

  12. DETECTION randomly:systematic checking examination of blood for other reasons targeted:historysystematic reviews of groups with increased risk

  13. DIAGNOSTIC METHODS • fasting blood glucose • random blood glucose • blood glucose in 120. minute of oral glucose test with 75 g glucose (OGTT) • symptoms – YES (1 values) • symptoms – NO (2 values on 2 different testing days)

  14. DIAGNOSTIC VALUES OF BLOOD GLUCOSE Diabetes IFG Diabetes IGT unlikely Fasting BG ≥ 7,0 < 6,1 6,1- 6,9 Random BG ≥ 11,1 < 6,1 < 7,8 BG in l20. ≥ 11,1 7,8 -11.1 min. OGTT

  15. GLYCATED HEMOGLOBIN- HbA1c Hemoglobin is a protein that is a normal constituent of red blood cells. Erythrocytes in blood containing chains of hemoglobin, which binds sugars non-encimatic and irreversible. Glucose which binds to hemoglobin, is proportional to the concentration of glucose in the blood. HbA1c reflects blood sugar for about eight last weeks. The average blood glucose = 2x % HbA1c – 6 Referal value: 4,4 % - 6,4 %

  16. AETIOLOGICAL CLASSIFICATION OF DM AND OTHER GLUCOSE INTOLERANCE DIABETES MELLITUS I. Diabetes mellitus type 1 II. Diabetes mellitus type 2 • Other types • Gestational diabetes Impaired glucose tolerance (IGT) Impaired fasting glucose (IFG)

  17. AETIOLOGICAL CLASSIFICATION OF DM AND OTHER CATEGORIES OF GLUCOSE REGULATION III. Other types of diabetes mellitus • Genetic defects of β-cell function • Genetic defects in insulin action • Diseases of the exocrine pancreas • Endocrinopathies • Drug or chemical induced • Infections • Uncommon forms of immune-mediated diabetes • Other genetic syndromes sometimes associated with diabetes

  18. PATHOGENESIS OFDIABETES MELLITUS TYPE 2 • inadequate secretion of insulin from pancreatic beta cells • increased insulin resistance (mainly in muscles) • increased formation of glucose in the liver by gluconeogenesis

  19. ETIOPATHOGENESIS OF TYPE 2 DIABETES MELLITUS environmental factors and genetics

  20. INCIDENCE OD TYPE 2 DIABETES MELLITUS • sharp rise after 50 year of age • women: men = 55 %:45% • difference between races • increase after change of mode life

  21. DIABETES MELLITUS AND CHRONIC COPMPLICATIONS • diabetic retinopathy • diabetic nephropathy • diabetic polyneuropathy • erectile dysfunction

  22. METABOLIC SYNDROME (SYNDROMEX) • A quarter of the world’s adults have metabolic syndrome • People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome • People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes

  23. METABOLIC SYNDROME (SYNDROMEX) • waist circumference: • men≥ 94 cm • women≥ 80 cm • triglycerides • 1,7 ≥ mM • HDL • men<1,0 mmol/l • women <1,3 mmol/l • blood pressure ≥130 in/ali ≥ 85 mm Hg (or treatment of BP) • glycaemia ≥5,6 mmol/l (or diabetes mellitus) CRITERIA FOR DIAGNOSIS: 3 of 5

  24. 19,4 16,4 14,0 11,1 8,3 5,6 2,8 NATURAL COURSE OF DIABETES MELLITUS TYPE 2 obesity IGT Diabetes uncontrolled hyperglycaemia post-prandial glycaemia glycaemia (mmol/l) fasting blood glucose 250 insulin resistance 200 150 relative function (%) 100 insulin level 50 beta cell function -10 -5 0 5 10 15 20 25 30 years

  25. TREATMENT OF DIABETES MELLITUS TYPE 2 • non-pharmacological measures • healthy eating • normal body weight • physical activity • drugs • tablets • insulin

  26. TREATMENT WITH DRUGS • promoters of insulin secretion • sulfonylureas • glinidi • promoters of tissue sensitivity to insulin • biguanides (metformin) • (tiazolidinedione) • alpha glucosidase inhibitors in the gut • acarbose • drugs acting on the incretin system • inhibitors of the enzyme DPP-4 • incretin mimetics • insulins

  27. Case • man, 70 yrs, pensioner, height 168 cm, weight 75 kg • family history: no diabetes mellitus • history: gallstones surgery, mild prostatic hyperthrophy • treatment : no drugs • problem: friend, diabetic patient, measured him blood glucose 10 mmol/l (with glucometer) • approach?

  28. Case • man, 56 yrs, height 170 cm, weight 95 kg, bank officer • family history: mother, brother and 2 paternal aunts are diabetics • history: 1 year hot feet at night • problem: during pneumonia he had glycaemia 12 mmol/l • approach?

  29. Case • woman, 65yrs, height 154 cm, weight 72 kg, retired seamstress • family history: mother is diabetic • history: 15 years hypertension and hyperlipidaemia • problem: because of deterioration of vision she visited ophatalmologist, who found initial cataract and diabetic retinopathy, fasting blood glucose 10,5 mmol/, HbA1c 8,1 %. • type of diabetes?

  30. Case • man, 52 yrs, height 174 cm, weight 63 kg, central heating installer • family history: no data • history: 5 years ago pancreatitis • problem: few months thirst, weighf loss 3 kg, frequent urinations, 1-2 x during night, because of thristy he drank 2 l of water-wine mixture per day + occasionally beer, glycaemia 16 mmol/l • type of diabetes mellitus?

  31. DIABETES MELLITUS AND DEPRESSION condition for successful treatment : the two diseases should be treated at the same time!

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