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Diabetes mellitus MD Phạm Thu Hà Dept Endocrinology and Diabetes Bạch mai Hospital Objectifs ã Overview of diabetes ã Discussion about guidelines of diabetes management • Implementation in Clinical practice Number of pts diabetes estimated in 2000 & to 2030 (Diabetes Care 2004;27:1047-1053) Prevalence of diabetes & prediabetes 35-64 yrs 50 45 40 35 30 25 20 15 10 Poland Denmark Brazil USA (white) Alaska (inuit) US rural hisp US urban hisp Nauru Pima(US) Diabetes IGT IDF Diabetes Atlas 2003 GDM in 1990, 1995 and 2001 1990 1995 2001 No Data 10% Mokdad AH, Ford ES, Bowman BA, et al Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001 JAMA 2003 Jan 1;289(1) US Prevalence of diabetes 2010 • Diagnosed: 26 million people— 8.3% of population (90%+ have Type 2)b • Undiagnosed: million people • 79 million people have pre-diabetes CDC 2011 Diabetes Diagnosis Category FPG (mg/dL) 2h 75gOGTT Normal 6.5 Diabetes Or patients with classic hyperglycemic symptoms with plasma glucose >200 ** On separate occasions Diabetes Care 34:Supplement 1, 2011 OGTT XN ĐH sau uống 75 g Glucose 250 – 300 ml nước thời điểm 0p, 120p Chẩn đoán ĐTĐ ĐH 120p ≥ 2g/l (11mmol/l) Giảm DN Glucose 7,8 mmol/l ≤ ĐH 120p < 11mmol/l Bình thường ĐH 120p < 7,8mmol/l Classification Type  cell destruction, absolute deficit of insulin:children, 10% adults- LADA( Latent Autoimmune Diabetes in Adults).) Type  cell secretion dysfunction – insulin resistance ( 90% adults) Gestational :  cell secretion dysfunction –insulin rasistance/in pregnancy Others diabetes • Inheritanced  cell deficit (MODY) • Exocrine pancreatic deseases • Endocrinopathy • Drugs & Chemical • Other rare types 11 Treatment ADA-EASD Position Statement: Management of Hyperglycemia in T2DM OTHER CONSIDERATIONS •Comorbidities - Coronary Disease - Heart Failure - Renal disease - Liver dysfunction - Hypoglycemia  Emerging concerns regarding association with increased mortality  Proper drug selection in the hypoglycemia prone Diabetes Care, Diabetologia 19 April 2012 [Epub ahead Adapted Recommendations: When Goal is to Avoid Hypoglycemia Adapted Recommendations: When Goal is to Minimize Costs Guidelines for Glycemic, BP, & Lipid Control American Diabetes Assoc Goals HbA1C Preprandial glucose Postprandial glucose < 7.0% (individualization) 70-130 mg/dL (3.9-7.2 mmol/l) < 180 mg/dL Blood pressure < 130/80 mmHg LDL: < 100 mg/dL (2.59 mmol/l) Lipids < 70 mg/dL (1.81 mmol/l) (with overt CVD) HDL: > 40 mg/dL (1.04 mmol/l) > 50 mg/dL (1.30 mmol/l) TG: HDL = high-density lipoprotein; LDL = low-density lipoprotein; PG = plasma glucose; TG = triglycerides < 150 mg/dL (1.69 mmol/l) ADA Diabetes Care 2012;35:S11-63 Blood Pressure • Done at every visit • Target is