Phác đồ điều trị đái tháo đường type 2

TIÊU CHUẨN CHẨN ĐOÁN ADA-2010 HbA1c ≥ 6,5% Go ≥ 7,0 mmol/l G2 ≥ 11,1 mmol/l XN lần G ≥ 11,1 mmol/l + triệu chứng tăng glucose máu điển hình tăng glucose máu cấp  XN lần MỤC TIÊU ĐIỀU TRỊ ADA 2009 AACE 2009 3.9 – 7.2 (70-130) < 6.1 (< 110) G2 (sau ăn 2h) < 10 (180) < 7,8 (< 140) HbA1c < 7% ≤ 6,5% Go Phác đồ điều trị ĐTĐ typ ADA/EASD - 2009 BƯỚC Chẩn đoán: Th.đổi lối sống + Metformin HbA1c ≥ 7% BƯỚC Đtrị chấp thuận nhiều Läúi säúng + Metf + SU *: Hba1c > 8,5% BƯỚC * Läúi säúng + Metf + Ins Đtrị chấp thuận Läúi säúng + Metf + GLP1-A Läúi säúng + Metf + Pio + SU Läúi säúng + Metf + Pio Läúi säúng + Metf + Ins Läúi säúng + Metf + Ins tăng cường PHÁC ĐỒ MŨI / NGÀY Sáng: 60% Sáng: Chiều: 40% Ins NPH, Ins chậm: Ins nhanh: Chiều: Ins NPH, Ins chậm: Ins nhanh: 40% 20% 20% 20% PHÁC ĐỒ MŨI / NGÀY Liều Insulin bản: 0,4 UI/kg/ngày (45-55%) Liều Insulin theo bữa ăn: 0,13 UI/kg/bữa ăn # 1/6 tổng liều CHỈNH LiỀU INSULIN - G trước ăn trưa  chỉnh liều Ins nhanh buổi sáng - Go sáng  chỉnh liều Ins trung gian hay chậm ban đêm HbA1c < 7,0% ? Lancet 1.2010 HbA1c Tử vong 6,4% 1,52 7,5% 1,0 10,5% 1,79                                                                                     Case Report: Treating type diabetes Using four oral hypoglycemic drugs L.E. Lockman, MB CHB, M FAM  MED(SA), CCFP  Can Fam Physician 2003;49:775-776.  Case report Mr J.H., a 56-year-old man, has diabetes, atrial fibrillation, peripheral vascular disease, and chronic renal insufficiency He was taking enalapril maleate (Vasotec) 10 mg bid, digoxin 0.25 mg daily, furosemide (eg, Lasix) 120 mg daily, allopurinol 300 mg daily, glyburide 10 mg bid, metformin g bid, and metolazone (Zaroxolyn) 2.5 mg bid His initial fasting blood sugar levels while using the two diabetic drugs ranged from 17.66 mmol/L to 29.39 mmol/L The initial plan after taking over his management was to give him insulin, but he was afraid of needles and after mutual agreement opted for intense dietary modification, exercise, and home glucose self-monitoring accompanied by drug therapy added repaglinide at a titrated dose of mg tid Over a 2- to 3-month period, his fasting blood sugar level fluctuated between 10 and 17 mmol/L, and rosiglitazone maleate was added at a dose of mg bid  a fall in his fasting blood sugar level to between 5.67 and mmol/L During this time, his hemoglobin HbA1C came down to 9% and was steadily improving • Conclusion This case report highlights that using a combination of four oral hypoglycemic drugs appears to have been successful Mnemonic for Diabetes Office Visits (Yale Diabetes Center 2006) G L U B A D C O S E G Glycemic Control L Lipids Rx Statins in pts with total cholesterol > 135 mg/dl (3,5 mmol/l) U Urine Screen for microalbuminuria, Creatinin If albumin ≥ 30 mg/24h (20 mg/L)  Rx ACE inhibitor or ARB, even if normotensive C Cigarettes O Ophthalmological S Sex-Related Topics E Extremities B Blood Pressure Target ≤ 130 / 80 A Aspirin 81 – 325 mg D Dental [...]... (Yale Diabetes Center 20 06) G L U B A D C O S E G Glycemic Control L Lipids Rx Statins in pts with total cholesterol > 135 mg/dl (3,5 mmol/l) U Urine Screen for microalbuminuria, Creatinin If albumin ≥ 30 mg /24 h (20 mg/L)  Rx ACE inhibitor or ARB, even if normotensive C Cigarettes O Ophthalmological S Sex-Related Topics E Extremities B Blood Pressure Target ≤ 130 / 80 A Aspirin 81 – 325 mg D Dental ... added repaglinide at a titrated dose of 4 mg tid Over a 2- to 3-month period, his fasting blood sugar level fluctuated between 10 and 17 mmol/L, and rosiglitazone maleate was added at a dose of 4 mg bid  a fall in his fasting blood sugar level to between 5.67