单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,编辑版ppt,*,Diabetes Mellitus,Zhao-xiaojuan,1,编辑版ppt,Introduction,Diabetes mellitus,is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion,insulin action,or both.,2,编辑版ppt,Introduction,The chronic hyperglycemia of diabetes,is associated with long-term damage,dysfunction,and failure of various organs,especially the eyes,kidneys,nerves,heart,and blood vessels,.,3,编辑版ppt,Symptoms,Polyuria,Polydipsia,(,thirst),Weight loss,Weakness,Polyphagia,Blurred vision,Recurrent infection,Impairment of growth,4,编辑版ppt,Criteria for diagnosis of diabetes,(,WHO1999),Symptoms of diabetes,+,Casual plasma glucose 11.1mmol/l(200mg/dl),Or,FPG 7.0mmol/l(126mg/dl),Or,2-,hPG,11.1mmol/l,5,编辑版ppt,Diagnostic Criteria WHO1999,IGT,-,FPG7mmol/L,-,2-h PG7.8mmol/L and 11.1mmol/L,IFG,-,FPG6.1mmol/L and 7.0mmol/L,6,编辑版ppt,Laboratory Findings,Urinary glucose,Urinary,ketone,Blood glucose(FPG and 2-,hPG,),HbA1c and FA(,fructosamine,),OGTT,Insulin/CP releasing test,7,编辑版ppt,Classification(1),Type 1 diabetes,-cell destruction,usually leading to absolute deficiency,Immune-mediated diabetes,Idiopathic diabetes,Type 2 diabetes,Ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin,secretory,defect with insulin resistance,8,编辑版ppt,Classification(2),Other specific types of diabetes,Due to other causes,e.g.,genetic defects in insulin action,diseases of the exocrine pancreas,drug or chemical induced,Gestational diabetes,mellitus(GDM),diagnosed during pregnancy,9,编辑版ppt,Etiologic classification of diabetes mellitus(1),I.Type 1diabetes,(,-cell destruction,usually leading to absolute insulin deficiency),A.immune mediated,B.Idiopathic,II.Type 2diabetes,(may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance),III.Other specific types,A.genetic defects of,-cell function,1.Chromosome 12,HNF-1,(MODY3),2.,Chromosome 7,glucokinase,(MODY2),3.,Chromosome 20,HNF-4,(MODY1),4.Mitochondrial DNA,5.Others,B.Genetic defects in insulin action,1.Type A insulin resistance,2.Leprechaunism,3.Rabson-Mendenhall syndrome,4.Lipoatrophic disease,5.Others,C.Diseases of the exocrine pancreas,1.Pancreatitis,2.Trauma/pancreatectomy,3.Neoplasia,4.Cystic fibrosis,5.Hemochromatosis,6.Fibrocalculous pancreatopathy,7.Others,10,编辑版ppt,Etiologic classification of diabetes mellitus(2),D.Endocrinopathies,1.Acromegaly,2.Cushings syndrome,3.Glucagonoma,4.Pheochromocytoma,5.Hyperthyroidism,6.Somatostatinoma,7.Aldosteronoma,8.Others,E.Drud-or chemical-induced,1.Vacor,2.Pentamidine,3.Nicotinic acid,4.Glucocorticoid,5.Thyroid hormone,6.Diazoxide,7.,-adrenergic agonists,8.Thiazides,9.Dilantin,10.,-Interferon,11.Others,F.Infections,1.Congenital rubella,2.Cytomegalovirus,3.Others,11,编辑版ppt,Etiologic classification of diabetes mellitus(3),G.Uncommon forms of immune-mediated diabetes,1.“Stiff-man”syndrome,2.Anti-insulin receptor antibodies,3.Others,H.Other genetic syndromes sometimes associated with diabetes,1.Downs syndrome,2.Klinefelters syndrome,3.Turners syndrome,4.Wolframs syndrome,5.Friedreichs ataxia,6.Huntingtons chorea,7.Laurence-moon-Biedl syndrome,8.Myotonic dystrophy,9.Porphyria,10.Prader-Willi syndrome,11.Others,IV.Gestational diabetes mellitus(GDM),Patients with any form of diabetes may require insulin treatment at some stage of their disease.Such use of insulin dose not,of itself,classify the patient.,12,编辑版ppt,Type 1 DM,Generally 7.0,10.0,HbA1c(%),6.2,8.0,Blood pressure,(mmHg),130/80-160/95,BMI,(kg/m,2,),Male,female,25,24,27,26,27,26,Total cholesterol,(mmol/L),1.1,1.1-0.9,0.9,Triglycerides,(mmol/L),1.5,2.2,2.2,LDL-cholesterol,(mmol/L),4.4,23,编辑版ppt,Management,Essentials of management,Monitoring of glucose levels,Food planning,Physical activity,Treatment of hyperglycemia,24,编辑版ppt,2.,Monitoring of Glucose Levels,Blood glucose levels,-before each meal,-at bedtime,Urine glucose testing,Urine,ketone,tests,(should be performed during illness or when blood glucose is,20mmol/L,),25,编辑版ppt,3.,Food Planning,Weight control.,50-60%of the total dietary energy should come from complex carbohydrates.,20-25%form fats and oils.,15-20%from protein.,Restrict alcohol intake.,Restrict salt intake to below 7g/d.,26,编辑版ppt,4.,Physical Activity,Physical activity play an important role in the management of diabetes particularly in T2DM.Physical activity improves insulin sensitivity,thus improving,glycemic,control,and may help with weight reduction,Do sparingly,avoid sedentary activities,Do regularly,participate in leisure activities and recreational sports,Do every day,adopt healthy lifestyle habits,27,编辑版ppt,5.,Drug Treatment,If the patient is very symptomatic or has a very high blood glucose level,diet and lifestyle changes are unlikely to achieve target values.In this instance,pharmacological therapy should be started without delay.,28,编辑版ppt,Treatment,Sulphonylureas,Biguan