Curs BCM Feb 2006

Asist. Univ. Dr. Ariel FlorentiuINDNBM Prof. NC PaulescuUMF Carol Davila BucuretiDiabetul zaharat definiie, clasificare, epidemiologieDiabetul zaharat este o tulburare complex a metabolismului energetic al organismului datorat carenei absolute sau relative de insulin i care afecteaz deopotriv metabolismul glucidelor, lipidelor i proteinelor. n ansamblu este alterat ntreg metabolismul energetic al organismului.

Diabetul zaharat apare ca urmare a alterrii (condiionat genetic sau dobndit) secreiei de insulin i/ori a rezistenei celulelor periferice la aciunea insulinei.

Tulburrile metabolismelor glucidic, lipidic i proteic stau la baza apariiei unui spectru larg de complicaii cronice care afecteaz mai mult sau mai puin toate esuturile din organism.

Definiie Diabetul zaharat este definit ca un sindrom complex, incluznd mai multe forme cu etiologie, etiopatogenie i caracteristici clinice diferite Aproape toate definiiile includ ca element central al bolii hiperglicemia, dei aceasta nu reprezint, poate, elementul cel mai important al bolii

Ultima clasificare a DZ definete boala printr-o valoare glicemic: jeun de peste 126 mg/dl 2 h dup 75 g glucoz oral de peste 200 mg/dl.

Comentarii la definiie Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei

Diabetul zaharat

Criterii de diagnostic ADA 2015

Hemoglobina glicat HbA1cHbA1c (%)Glicemia medie (mg/dl)6126715481839212102401126912298Categorii de pacienti la risc pentru diabet (prediabet)

Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei

Diabetul zaharat

Clasificarea DZ (ADA 1997; OMS 1998) The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus Diabetes Care 20:11831197, 1997 DZ tip 1 (distrugerea celular, de obicei cu deficit absolut de insulin)DZ tip 1a (autoimun)DZ tip 1b (idiopatic)

DZ tip 2 (de la o predominan a insulinorezistenei, asociat cu deficit relativ dse secreie de insulin, pn la un deficit predominant de secreie insulinic, asociat cu insulinorezisten)Forma cu predominena insulinorezisteneiForma cu predominena insulinodeficienei

Alte tipuri specifice de diabet

Diabet zaharat gestaional Principalele diferene DZ tip 1 / DZ tip 2Ereditate

Patogenie

Autoimunitate

Vrst la debut

BMI

Insulinemie

Cetoz

Tratament ADO

Complicaii

Boli CV

concordan 30-50%

Deficit insulinic absolut

Prezent

Mai ales sub 30-40 ani

Sczut

Mult sczut

Frecvent

Ineficient

In special microvasculare

Rare n primii 20 aniconcordan 90%

Ins rezisten i sau deficit de insulin

Absent

Mai ales dup 30-40 ani

Crescut n 80% cazuri

Iniial crescut

De regul absent

Iniial eficient

Micro i Macrovasculare

Frecvent de la debutDZ tip 1DZ tip 2 Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei

Diabetul zaharat

HiperglicemiaSemne/simptome caracteristice Posibil asimptomatic chiar i la valori peste 200-300 mg%

Consecine ale poliuriei osmotice deshidratare, sete

Semne ale complicaiilor acute

Semne ale complicaiilor cronice

Semne de Alarm

Urinare frecvent / abundent13

Semne de AlarmSete excesiv14

Semne de AlarmScdere rapid n greutate15

Semne de AlarmObosealLips energie16

DAR ...

De regul n tipul 2 de diabet la debut simptomele lipsesc complet sau sunt foarte discrete17

Diagnostic clinic n DZForma caracteristic de debut apare doar n aprox. 25% din cazuri

Poliurie osmotic (consecutiv hiperglicemiei i glicozuriei) Sete, uscciunea mucoaselor, polidipsie

Polifagie

Scdere ponderal (frecvent trecut cu vederea, mai ales de pacienii obezi)

n 15% din cazuri, diagnosticul se face ntmpltor, cu ocazia unui examen de rutin sau a unei aciuni de screening

Semne/simptome caracteristice

Diagnostic clinic n DZAcest tip de debut apare la aprox. 25% din cazuri

Scderea acuitii vizuale Dureri, parestezii ale membrelor inferioare

Tulburri trofice la nivelul picioarelor, pn la necroze sau gangren

Semne de boal coronarian sau cerebrovascular

Tulburri de dinamic sexual

Prurit genitalSemne/simptome ale complicaiilor

Diagnostic clinic n DZAcest tip de debut apare la aprox. 30% din cazuri

Boal coronarian (angor de novo, angor instabil, IMA) AVC

Intervenii chirurgicale

Boal renal, pn la insuficien renalInternare pentru alte afeciuni

Diagnostic clinic n DZAceast form de debut apare n aprox. 2.5% din cazuri

Com hiperosmolar inaugural Com cetoacidotic inaugural

Acidoz lactic

DZ tip 1 sau la subiecii vrstnici (peste 60 ani) i doar n condiiile unui factor declanator major (sepsis, IMA, AVC, etc.)Complicaii acute ale DZ

Screening DZ la pacieni asimptomatici1. Testarea ar trebui recomandat la toi adulii supraponderali (BMI > 25 kg/m2) care au factori de risc adiionaliSedentarism- Rude de grad 1 cu diabet zaharat- Grupuri etnice de risc (Afroamericani, Latino-americani, etc.) - Femei cu istoric de natere fei macrosomi (> 4 kg) sau istoric DZ gestaional- HTA sau terapie pentru HTA- HDLc sub 35 mg/dL sau TAG peste 250 mg/dL- Femei cu PCOS- HBA1c > 5.7%, IGT sau IFG la testrile anterioare- Condiii clinice asocaite cu insulinorezistena- Istoric de BCV2. Testarea ar trebui nceput dup vrsta de 45 ani, mai ales la supraponderali/obezi3. n cazul rezultatelor normale, repetarea testrii la interval de 3 ani (anual la cei cu prediabet) Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei

Diabetul zaharat1. International Diabetes Federation. IDF Diabetes Atlas, 6th ed. Brussels, Belgium: International Diabetes Federation, 2013.Diabetul a atins proporii epidemice: n 2013 se estima c ~ 380 milioane de oameni sufer de diabet1

Diabetes is a chronic, progressive disease of epidemic proportions, with a growing number of patients facing severe consequences.1 It is commonly acknowledged that, worldwide, around 300 million adults have diabetes. Type 2 diabetes accounts for >90% of all cases.1 Considering the new figures available from China, the number of diabetic adults adds up to 340 million individuals.1,2This slide shows that the global burden of diabetes is far larger than previously estimated.

References:1.International Diabetes Federation. IDF Diabetes Atlas, 4th ed. Brussels, Belgium: International Diabetes Federation, 2009. http://www.idf.org/diabetesatlas, accessed July 6th 2011.2.Yang W, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090-101.

Romania

1.5

rile cu cel mai mare numr de diabetici

25

Peste jumtate din diabetici nu tiu c au boala

2627Se estimeaz c n 2030 numrul persoanelor cu diabet va ajunge la ~ 590 milioane1

1. International Diabetes Federation. IDF Diabetes Atlas, 6th ed. Brussels, Belgium: International Diabetes Federation, 2013.In view of the aging population and the growing trend toward obesity, the number of people presenting of diabetes is expected to increase to approximately 440 million by 2030.1 Taking into account the newly published study from China,2 the International Diabetes Federation now estimates that the number of people with diabetes in the year 2030 will be even greater, close to half a billion.As prosperity reaches developing and newly industrialized nations, diet and lifestyle changes contribute to the disproportionate increase in the prevalence of type 2 diabetes in these regions.1 China is expected to become the global epicenter of the diabetes epidemic by 2030.

References:1.International Diabetes Federation. IDF Diabetes Atlas, 4th ed. Brussels, Belgium: International Diabetes Federation, 2009. http://www.idf.org/diabetesatlas, accessed July 6th 2011.2.Yang W, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090-101. Frecvena estimat DZ tip 1 aproximativ 9 cazuri noi la 100.000 de copii pe an (aproximativ 300-400 cazuri noi pe an).

Frecvena estimat a DZ tip 2 aproximativ 11.5% din populaie

n Romnia

79.31% deja diagnosticati 20.69% cazuri noi

Prevalenta DZ in Romania in 2012-2013Studiul PREDATORR

DZ=1.752.000 locuitori au diabet29

2013Prevalenta Prediabet in Romania in 2012-2013Studiul PREDATORR Definiie Diagnostic Clasificare Diagnostic clinic Date epidemiologice Importana problemei

Diabetul zaharat

AmputaiiOrbireInfarct Accident vascular Insuficien renal The worldwide pandemic of type 2 diabetes

The next two decades will bring a worldwide pandemic of type 2 diabetes. As many as 300 million people worldwide may have type 2 diabetes by the year 2025.

Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997;14 (Suppl 5):S1-S85. International Diabetes Federation. Diabetes Atlas 2000.

Complicaii cronice invalidante Factor de risc major pentru bolile CV Prevlena bolilor CV este dubl la pacienii DZ Principala cauz de IRC i dializ Principala cauz de amputaie non-traumatic Principala cauz de orbire non-accidental

Consecine individuale Scderea speranei de via cu 10 20 ani Scderea calitii vieii Diet restrictiv Tratament complex, polimedicamentos Riscul de hipoglicemie Scderea capacitii de munc Dificultate de integrare social, profesional Tulburri de dinamic sexual

Consecine individuale Cea mai important cauz de morbiditate i mortalitate

Cea mai costisitoare afeciune cronic

Pn la 25% din cheltuielile legate de sntate n unele ri

200 miliarde USD n SUA n 2010

471 miliarde USD la nivel mondial n 2012

Consecine socialeVa multumesc!