Презентация на тему Diabetes Anterior hypophysis Diabetes insipidus

chronic complications , treatment

characterized by elevated blood glucose concentration secondary to either

destruction, usually leading to absolute insulin deficiency
1. Autoimmune
2.

absence of unequivocal hyperglycemia, result to be confirmed by

American Diabetes Association. Diabetes Care. 2016;39(suppl 1):S1-S106.

of beta-cells.
The prevailing immune process that destructs beta-cells is

diabetes.
Two peaks:5-7 year and adolescence.
Yearly incidence of 15-25 cases

GAD(Glutamic Acid Decarboxilase) 65 .
Anti ICA (IA-2) 512.
Anti –Insulin.
Anti

world
9.3% of USA population in 2014(29.1 million people),8.1 million

cases of diabetes mellitus
Heterogeneous group of diabetes mellitus including

of diabetes in one parent and first-degree relatives, age

mutations.
Onset before age of 30.
Accented postprandial hyperglycemia (increases over

catalyzes the rate limiting step of glucose phosphorylation –”glucose

abdomen ,teethand nail abnormalities
Leprehuanism: IUGR,fasting hypoglycemia ,death within the

years of disease -80-90% risk of DM.
Pancreatectomy, pancreatic cancer,

(30 %).
Acromegaly –direct anti- insulin effect - from IGT

all diabetes in USA)
Glucocorticoids: inhibition of insulin secretion and

,coxsackieviruses B, adenoviruses .
Congenital rubella ? .
Abscess and phlegmone

antibodies to insulin receptors - severe hyperglycemia,acanthosis nigricans
Hirata

of blood glucose that are lower than in the

insulin resistance especially in the third trimester.
Any degree

to be screened for diabetes as essential part of

(IHD, diabetic cardiomyopathy, TIA, fatal and non- fatal CVA).
Prevent

obesity treatment
Medical nutritional therapy
Control of high blood

DCCT –EDIC(Diabetes Control and Complication Trial-
Epidemiology

vs. \ Conventional (1-2 injections per day)

DM type 1: 1-5 years, no retinopathy or severe

goals: to prevent symptoms attributable to glycemia or glycosuria,

3 or more insulin injection or pump therapy.
Self monitoring

prevention group by intensive treatment versus conventional group .
Influence

Research Group. N Engl J Med 1993;329:977-986.
Primary Prevention
Secondary

76% RRR
(95% CI 62-85%)

54% RRR
(95% CI 39-66%)

RRR = relative risk reduction CI = confidence interval

= risk of developing macroalbuminuria
DCCT: Reduction in Albuminuria
The Diabetes

34% RRR (p<0.04)

43% RRR
(p=0.001)

56% RRR
(p=0.01)

Primary Prevention

Secondary Intervention

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca
Copyright © 2013 Canadian Diabetes Association

RRR = relative risk reduction
CI = confidence interval

Research Group. N Engl J Med 1993;329:977-986.

2005;353:2643–2653.
Reduction of cardiovascular event in DCCT –EDIC
57% risk

MI, stroke or CV death

Conventional treatment

Intensive treatment

Years since entry

0.12
0.10
0.08
0.06
0.04
0.02
0.00

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

severe hypoglycemia 3 times higher in intensively treatment group

trial from 1977 to 1997.
5,102 patients with newly-diagnosed type

Type 2 diabetes will prevent clinical complications

Does therapy

patients

age 25 - 65 y mean 53 y
gender

1138
initially with diet alone
aim for near normal weight, best

Intensive Policy with sulphonylurea or insulin n = 2729
aim for fasting plasma glucose < 6 mmol/L(108 mg/dl), asymptomatic
when marked hyperglycaemia develops on sulphonylurea add metformin, move to insulin therapy on insulin, transfer to complex regimens

control reduces complications in type 2 diabetes

Sulphonylurea 951
overweight (>120% Ideal Body Weight) UKPDS patients could be

32% risk reduction in any diabetes-related endpoints, p=0.0023
42% risk

7.6-8.9 randomly assigned to intensive therapy in order to

N Engl J Med. 2008;358:2545–2559.
Results of the Randomized Comparison

Unadjusted HR for P-value
Intensive vs. Standard (95% CI)

All-cause mortality 1.22 (1.01-1.46) 0.04

Primary endpoint:
CV death, MI, stroke 0.90 (0.78-1.04) 0.16

CV death 1.35 (1.04-1.76) 0.02
Non-fatal MI 0.76 (0.62-0.92) 0.004
Non-fatal stroke 1.06 (0.75-1.50) 0.74

lowering of HbA1c from 7.2 to 6.5%
Similar base line

versus standard therapy.
Primary endpoint: first CVD event after randomization.
Subjects

Duckworth W, Abraira C, Moritz T, et al. N Engl J Med. 2009;360:129-139.

RO, et al. Diabetes Care. 2009;32:187-192.

cardiovascular morbidity.
No change in incidence of neuropathy or no

control

type 1 and 2

type 1 and 2 diabetes
Glycemic targets for women with

Optimal Hba1C :6-6,5% (avoid maternal hypoglycemia!)

bolus
Prescription of short and long acting insulins imitating physiologic

© 2013 Canadian Diabetes Association

1.1Minimum 150 minutes weekly moderate intensity physical activity (50-70%

carbohydrates
500-750 kcal/d deficit:1200-1500 kcal /d for women,1500-1800 kcal/d for

proteins
0.8 g/kg daily allowance.
Enhance insulin response to carbohydrates.
Don’t use

glycosidase inhibitor
Thiazolidinedione
GLP1 agonists
SGLT2 inhibitors
Insulin

record of efficacy and safety and lowering CV outcomes(UKPDS).
Mechanism:

kidney as active compound.
May be safely continued down to

lower dose with or after meals, make rotation with

KATP channel on beta-cells :
2 generation
First generation: now

failure : sulfonylureas require functional beta -cells ,they lose

Burst phase-1 insulin secretion
In vitro- glucose dependent but

pancreas—limiting insulin response.

That in turn decreases the signal to

X

of GLP-1

Very few side effects: mostly gastrointestinal
Neutral weight effect

,cardiovascular (LEADER study)benefit , significant weight loss .
Side

*3/d
May have cardiovascular benefits (STOP – NIDDM trial)
Prohibited in

tissue skeletal muscle and liver.
Warning about potential increase of

Dapafliglozin(Forxiga) 10 mg
Positive effects :glucose lowering without hypoglycemia ,lowering

pressure to targets :less than140/90 mmHg: ADVANCE – BP

atherosclerotic cardiovascular disease(ACVD) risk factor- moderate intensity statin+ life