Maja Ravnik-Oblak Diabetes mellitus type 2
Dec 26, 2015
Maja Ravnik-Oblak
Diabetes mellitus type 2
DIABETES MELLITUS
very old diagnosed disease
very frequent chronic disease
unpredictable disease
very psychological burdersome disease
EPIDEMIOLOGY
y. 2000 151 million patients y. 2010 285 million patients y. 2030 439 million patients
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 %
PREVALENCE OF DIABETES MELLITUS IN SLOVENIA (1990-2000)
YEAR 1990 1996 2000 DIABETICS 62.821 76.480 89.000
POPULATION 1.998.090 1.986.989 1.985.557
PREVALENCE 3,14% 3,85% 4,48%
NEW PATIENTS 4.837 5.274 INCIDENCE 0,24% 0,27%
Vrtovec, Urbančič, Koselj, Vončina (2001)
DIABETES MELLITUSIMPACT ON PSYCHOSOCIAL STATUS OF A
PATIENT
CHRONIC DISEASE chronic treatment
regular outpatient controls
(GP, diabetologist,
ophthalmologist, other
specialists)
regular lab controls permanent education
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
PSYCHOSOCIAL WELL-BEING OF DIABETIC PATIENTS
42 % of diabetic patients reported bad psychosocial well-being
WHO 5-item questionnaire
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.
SYMPTOMS ANS SIGNS OF DIABETES MELLITUS
dry mouth, thirstpolyuria, nocturiaweight loss (despite of increased appetite)fatiguevisual disturbancesgenital pruritus
ORGANIC SYNDROME OF TYPE 2 DIABETES MELLITUS
diabetic peripheral neuropathy: 8-15 %
diabetic retinopathy: 5-10% cataract
macroangiopathy
DETECTION
randomly:systematic checking
examination of blood for other reasons
targeted:historysystematic reviews of groups with increased risk
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)
DIAGNOSTIC VALUES OF BLOOD GLUCOSE
Diabetes
Diabetes unlikely
IGT IFG
Fasting BG ≥ 7,0 < 6,1
6,1- 6,9
Random BG ≥ 11,1 < 6,1
BG in l20.
min. OGTT ≥ 11,1
7,8-11.1
< 7,8
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 %
AETIOLOGICAL CLASSIFICATION OF DM AND OTHER GLUCOSE
INTOLERANCE
DIABETES MELLITUS
I. Diabetes mellitus type 1
II. Diabetes mellitus type 2III. Other types IV. Gestational diabetesImpaired glucose tolerance (IGT) Impaired fasting glucose (IFG)
AETIOLOGICAL CLASSIFICATION OF DM AND OTHER CATEGORIES OF GLUCOSE REGULATION
III. Other types of diabetes mellitus1. Genetic defects of β-cell function 2. Genetic defects in insulin action 3. Diseases of the exocrine pancreas 4. Endocrinopathies 5. Drug or chemical induced 6. Infections 7. Uncommon forms of immune-mediated diabetes 8. Other genetic syndromes sometimes associated
with diabetes
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
ETIOPATHOGENESIS OF TYPE 2 DIABETES MELLITUS
environmental factors
and
genetics
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
DIABETES MELLITUS AND CHRONIC
COPMPLICATIONS
diabetic retinopathydiabetic nephropathydiabetic polyneuropathy
erectile dysfunction
METABOLIC SYNDROME (SYNDROME X)
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
METABOLIC SYNDROME (SYNDROME X)
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
NATURAL COURSE OF DIABETES MELLITUS TYPE 2
obesity IGT Diabetes uncontrolled hyperglycaemia
2,8
5,6
8,3
11,1
14,0
16,4
19,4
50
100
150
200
250
gly
caem
ia(m
mol/l)
rela
tive
funct
ion
(%
)
-10-10 -5-5 00 55 1010 1515 2020 2525 3030
post-prandial glycaemia
fasting blood glucose
insulin resistance
insulin level beta cell function
years
TREATMENT OF DIABETES MELLITUS TYPE 2
non-pharmacological measures healthy eating normal body weight physical activity
drugs tablets insulin
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
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?
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?
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?
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?
DIABETES MELLITUS AND DEPRESSION
condition for successful treatment :
the two diseases should be treated at the same time!