Download - Definitie DZ, Introducere Studenti
Curs BCM Feb 2006
Asist. Univ. Dr. Ariel FlorentiuINDNBM Prof. NC PaulescuUMF Carol Davila BucuretiDiabetul zaharat definiie, clasificare, epidemiologieDiabetul zaharat este o tulburare complex a metabolismului energetic al organismului datorat carenei absolute sau relative de insulin i care afecteaz deopotriv metabolismul glucidelor, lipidelor i proteinelor. n ansamblu este alterat ntreg metabolismul energetic al organismului.
Diabetul zaharat apare ca urmare a alterrii (condiionat genetic sau dobndit) secreiei de insulin i/ori a rezistenei celulelor periferice la aciunea insulinei.
Tulburrile metabolismelor glucidic, lipidic i proteic stau la baza apariiei unui spectru larg de complicaii cronice care afecteaz mai mult sau mai puin toate esuturile din organism.
Definiie Diabetul zaharat este definit ca un sindrom complex, incluznd mai multe forme cu etiologie, etiopatogenie i caracteristici clinice diferite Aproape toate definiiile includ ca element central al bolii hiperglicemia, dei aceasta nu reprezint, poate, elementul cel mai important al bolii
Ultima clasificare a DZ definete boala printr-o valoare glicemic: jeun de peste 126 mg/dl 2 h dup 75 g glucoz oral de peste 200 mg/dl.
Comentarii la definiie Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei
Diabetul zaharat
Criterii de diagnostic ADA 2015
Hemoglobina glicat HbA1cHbA1c (%)Glicemia medie (mg/dl)6126715481839212102401126912298Categorii de pacienti la risc pentru diabet (prediabet)
Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei
Diabetul zaharat
Clasificarea DZ (ADA 1997; OMS 1998) The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus Diabetes Care 20:11831197, 1997 DZ tip 1 (distrugerea celular, de obicei cu deficit absolut de insulin)DZ tip 1a (autoimun)DZ tip 1b (idiopatic)
DZ tip 2 (de la o predominan a insulinorezistenei, asociat cu deficit relativ dse secreie de insulin, pn la un deficit predominant de secreie insulinic, asociat cu insulinorezisten)Forma cu predominena insulinorezisteneiForma cu predominena insulinodeficienei
Alte tipuri specifice de diabet
Diabet zaharat gestaional Principalele diferene DZ tip 1 / DZ tip 2Ereditate
Patogenie
Autoimunitate
Vrst la debut
BMI
Insulinemie
Cetoz
Tratament ADO
Complicaii
Boli CV
concordan 30-50%
Deficit insulinic absolut
Prezent
Mai ales sub 30-40 ani
Sczut
Mult sczut
Frecvent
Ineficient
In special microvasculare
Rare n primii 20 aniconcordan 90%
Ins rezisten i sau deficit de insulin
Absent
Mai ales dup 30-40 ani
Crescut n 80% cazuri
Iniial crescut
De regul absent
Iniial eficient
Micro i Macrovasculare
Frecvent de la debutDZ tip 1DZ tip 2 Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei
Diabetul zaharat
HiperglicemiaSemne/simptome caracteristice Posibil asimptomatic chiar i la valori peste 200-300 mg%
Consecine ale poliuriei osmotice deshidratare, sete
Semne ale complicaiilor acute
Semne ale complicaiilor cronice
Semne de Alarm
Urinare frecvent / abundent13
Semne de AlarmSete excesiv14
Semne de AlarmScdere rapid n greutate15
Semne de AlarmObosealLips energie16
DAR ...
De regul n tipul 2 de diabet la debut simptomele lipsesc complet sau sunt foarte discrete17
Diagnostic clinic n DZForma caracteristic de debut apare doar n aprox. 25% din cazuri
Poliurie osmotic (consecutiv hiperglicemiei i glicozuriei) Sete, uscciunea mucoaselor, polidipsie
Polifagie
Scdere ponderal (frecvent trecut cu vederea, mai ales de pacienii obezi)
n 15% din cazuri, diagnosticul se face ntmpltor, cu ocazia unui examen de rutin sau a unei aciuni de screening
Semne/simptome caracteristice
Diagnostic clinic n DZAcest tip de debut apare la aprox. 25% din cazuri
Scderea acuitii vizuale Dureri, parestezii ale membrelor inferioare
Tulburri trofice la nivelul picioarelor, pn la necroze sau gangren
Semne de boal coronarian sau cerebrovascular
Tulburri de dinamic sexual
Prurit genitalSemne/simptome ale complicaiilor
Diagnostic clinic n DZAcest tip de debut apare la aprox. 30% din cazuri
Boal coronarian (angor de novo, angor instabil, IMA) AVC
Intervenii chirurgicale
Boal renal, pn la insuficien renalInternare pentru alte afeciuni
Diagnostic clinic n DZAceast form de debut apare n aprox. 2.5% din cazuri
Com hiperosmolar inaugural Com cetoacidotic inaugural
Acidoz lactic
DZ tip 1 sau la subiecii vrstnici (peste 60 ani) i doar n condiiile unui factor declanator major (sepsis, IMA, AVC, etc.)Complicaii acute ale DZ
Screening DZ la pacieni asimptomatici1. Testarea ar trebui recomandat la toi adulii supraponderali (BMI > 25 kg/m2) care au factori de risc adiionaliSedentarism- Rude de grad 1 cu diabet zaharat- Grupuri etnice de risc (Afroamericani, Latino-americani, etc.) - Femei cu istoric de natere fei macrosomi (> 4 kg) sau istoric DZ gestaional- HTA sau terapie pentru HTA- HDLc sub 35 mg/dL sau TAG peste 250 mg/dL- Femei cu PCOS- HBA1c > 5.7%, IGT sau IFG la testrile anterioare- Condiii clinice asocaite cu insulinorezistena- Istoric de BCV2. Testarea ar trebui nceput dup vrsta de 45 ani, mai ales la supraponderali/obezi3. n cazul rezultatelor normale, repetarea testrii la interval de 3 ani (anual la cei cu prediabet) Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei
Diabetul zaharat1. International Diabetes Federation. IDF Diabetes Atlas, 6th ed. Brussels, Belgium: International Diabetes Federation, 2013.Diabetul a atins proporii epidemice: n 2013 se estima c ~ 380 milioane de oameni sufer de diabet1
Diabetes is a chronic, progressive disease of epidemic proportions, with a growing number of patients facing severe consequences.1 It is commonly acknowledged that, worldwide, around 300 million adults have diabetes. Type 2 diabetes accounts for >90% of all cases.1 Considering the new figures available from China, the number of diabetic adults adds up to 340 million individuals.1,2This slide shows that the global burden of diabetes is far larger than previously estimated.
References:1.International Diabetes Federation. IDF Diabetes Atlas, 4th ed. Brussels, Belgium: International Diabetes Federation, 2009. http://www.idf.org/diabetesatlas, accessed July 6th 2011.2.Yang W, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090-101.
Romania
1.5
rile cu cel mai mare numr de diabetici
25
Peste jumtate din diabetici nu tiu c au boala
2627Se estimeaz c n 2030 numrul persoanelor cu diabet va ajunge la ~ 590 milioane1
1. International Diabetes Federation. IDF Diabetes Atlas, 6th ed. Brussels, Belgium: International Diabetes Federation, 2013.In view of the aging population and the growing trend toward obesity, the number of people presenting of diabetes is expected to increase to approximately 440 million by 2030.1 Taking into account the newly published study from China,2 the International Diabetes Federation now estimates that the number of people with diabetes in the year 2030 will be even greater, close to half a billion.As prosperity reaches developing and newly industrialized nations, diet and lifestyle changes contribute to the disproportionate increase in the prevalence of type 2 diabetes in these regions.1 China is expected to become the global epicenter of the diabetes epidemic by 2030.
References:1.International Diabetes Federation. IDF Diabetes Atlas, 4th ed. Brussels, Belgium: International Diabetes Federation, 2009. http://www.idf.org/diabetesatlas, accessed July 6th 2011.2.Yang W, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090-101. Frecvena estimat DZ tip 1 aproximativ 9 cazuri noi la 100.000 de copii pe an (aproximativ 300-400 cazuri noi pe an).
Frecvena estimat a DZ tip 2 aproximativ 11.5% din populaie
n Romnia
79.31% deja diagnosticati 20.69% cazuri noi
Prevalenta DZ in Romania in 2012-2013Studiul PREDATORR
DZ=1.752.000 locuitori au diabet29
2013Prevalenta Prediabet in Romania in 2012-2013Studiul PREDATORR Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei
Diabetul zaharat
AmputaiiOrbireInfarct Accident vascular Insuficien renal The worldwide pandemic of type 2 diabetes
The next two decades will bring a worldwide pandemic of type 2 diabetes. As many as 300 million people worldwide may have type 2 diabetes by the year 2025.
Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997;14 (Suppl 5):S1-S85. International Diabetes Federation. Diabetes Atlas 2000.
Complicaii cronice invalidante Factor de risc major pentru bolile CV Prevlena bolilor CV este dubl la pacienii DZ Principala cauz de IRC i dializ Principala cauz de amputaie non-traumatic Principala cauz de orbire non-accidental
Consecine individuale Scderea speranei de via cu 10 20 ani Scderea calitii vieii Diet restrictiv Tratament complex, polimedicamentos Riscul de hipoglicemie Scderea capacitii de munc Dificultate de integrare social, profesional Tulburri de dinamic sexual
Consecine individuale Cea mai important cauz de morbiditate i mortalitate
Cea mai costisitoare afeciune cronic
Pn la 25% din cheltuielile legate de sntate n unele ri
200 miliarde USD n SUA n 2010
471 miliarde USD la nivel mondial n 2012
Consecine socialeVa multumesc!