diabetes mellitus
TRANSCRIPT
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Diabetes Mellitus
Hamid reza Sadeghi
Shahid Beheshti University of Medical Sciences Saturday, July 11, 2015
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Definition
a group of metabolic diseases characterised by elevated levels of glucose in the
blood : - defects in insulin secretion, - insulin action, - insulin receptors or any combination of conditions.
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Classification of Diabetes
Type 1 diabetes : - β-cell destruction -“Juvenile Onset”
Type 2 diabetes ( NON-Insulin Dependent ) : -Decreased sensitivity of insulin receptor to insulin -“Adult Onset”
Gestational diabetes : - glucose intolerance
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TYPE 1 DM
Due to B-cell destruction.
Require insulin for survival.
Presence of certain autoantibodies. Type 1A – presence of autoantibodies (anti-GAD, IA2, ICAA,
and anti-insulin antibodies). Type 1B – absence of autoantibodies (idiopathic)
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Etiology
Genetic factors multiple genes involved : chromosome 6 ,HLA-DR4, HLA-DR3 or both (DR3/4 heterozygote) Environmental factors : - infections : include viruses (rubella, coxsackievirus) B4) -exposure to cow’s milk in infancy - Chemicals and drugs : pyrinuron, Zanosar
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Pathophysiology
destruction of beta cell in the pancreas - autoimmune response towards beta cells : CD4+ T helper cells and CD8+ T cells autoantibody-producing B cells and activation of the innate immune system (GAD . ICA)
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Prognosis
60% of patients : do not develop serious complications over the long term, 40% of patients : blindness, end-stage renal disease (ESRD) early death ESRD and proliferative retinopathy is twice as high in men as in
women
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type2
Most common form of DM
Characterized by disorder in insulin action and insulin secretion or both.
Specific etiology unknown
Insulin resistance
Progressive B-cell failure.
They are obese.
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Pathophysiology
insufficient insulin production from beta cells increased glucose production in liver insulin resistance 1- acanthosis nigricans 2- metabolic syndrome 3- polycystic ovary syndrome
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Ethiology
Lifestyle obesity and overweight : - leptin - TNFa - IL6 Genetics involve many genes ( unknown) Medical conditions medications : - glucocorticoids -thiazides -beta blockers and statins
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Major risk factors
Age ˃45 Obesity Family history History of previous impaired glucose tolerance (IGT) Hypertension (>140/90 mm Hg) or dyslipidemia History of gestational diabetes mellitus pcos (which results in insulin resistance)
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Prevention
weight loss exercise Medication : 1- metformin 2- acarbose 3-orlistat
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Prognosis
strongly influenced by the degree of control of disease
intensive therapy : decreased risk of microvascular complications
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Gestational diabetes
Definition: Hyperglycemia with onset or first recognition during Pregnancy
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Risk of developing GDM
Old women (especially for women over 35 years of age)
Previous history of glucose intolerance
A previous pregnancy which resulted in a child with a macrosomia
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Diagnostic Criteria
Note: In the absence of unequivocal hyperglycemia, result(s) should be confirmed by repeat testing.
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DIAGNOSTIC CRITERIA FOR GDM
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Acute complications
Diabetic ketoacidosis (DKA)
Hyperglyceamic hyperosmolar state(HHS)
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Chronic Complications
Affects many organ systems.
Vascular : 1-Microvascular 2-Macrovascular
Non vascular: 1-Gastroparesis 2-Sexual dysfunction 3-Skin changes
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Management
1-Lifestyle 2-Insulin 3-Pancreas transplantation 4-Islet cell transplantation
Type 21 -Lifestyle2 -Medications3- Surgery
Type 1
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Glycemic Recommendations
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Blood Pressure and Lipid Goals
Blood pressure <130/80 mmHg
LDL cholesterol
TG
<100 mg/dL
<150 mg/dL
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thankyou