A/ S'd N Ngily,

Chuyen:

Ltru h6 Can art u:atKitam benh, chua benh nom 2009;

Can cu Nghi dinh so 75/2017/ND-CP ngay 20 thing 6 nom 2017 cua Chinh phu quy dinh chirc nang, nhiem vv, quyen han va co cAu to chfic dm BO Y te;

Theo de nghl. cua Cvc truOng Cvc Quan 1)", kham, ch0a. benh,

QUYET DINH:

Dieu 1. Ban hanh kern theo Quyet dinh nay Quy trinh chuyen mon kham, chCra benh dai thdo dining typ 2, Om Quy trinh chuyen mon kham, chila benh ngoai trit dai thao throng typ 2 va Quy trinh chuyen mon kham, china berth not nal dai thao dtrang typ 2.

Dieu 2. Quy trinh chuyen mon kham, chaa benh dai thao dtremg typ 2 dugs dp dung tai cac co so kham benh, chira benh. trong ca mak.

Ditu 3. Bali be nOi dung Quy trinh chuyen mon chin down, dieu tri va cham soc ngueYi benh dai thao dtremg typ 2 khong bien cherng trong "Iiiremg dAn bien sop quy trinh chuyen mon kham benh, chfira benh" eta dugc ban hanh tai Quyet dinh so 4068/QD-BYT ngay 29 thing 7 nom 2016 dm BO twang BO Y te.

Dieu 4. Quyet dinh nay c6 hieu1vc ke tin ngay kY, ban hanh.

Dieu 5. Cac Ong, ba: Chanh Van phang BO, Chanh thanh tra BO, Timg Cvc trtrong,,Cpc throng va Vv twang cac Tong eve, Cvc, Vv th.u0c BO Y te, Giant doe so Y te cac tinh, thanh pho tare thuOc trung acing, G kiln doe cac Benh vien: Vien live thuOc BO Y te, Thu trtre'rng Y te cac nganh ch.iu trach nhiem thi hanh Quyet dinh nay./.

/QD-BYT

TETINH HA TINH

CONG HOA XA- HOI CHID NGH1A VItT NAM

DO 14p - Tkr do - Hanh phut

Ha Nai, ngay41 thong Sinai?? 2017

QUYET DINH Ve vqc ban hanh "Quy trinh chuyen mon kham, china benh dai Chao dtromg typ 2"

BO TRUONG BO Y TE

BO Y TE

Noi - Nhu Di&I - B6 trtr6ng (d6 ban coo); - Cac Thu. truirng; - C6ng thong tin din tit B6 Y t6; Website Cnc KCB; - Luu: VT, KCB, PC.

Chting thu: BO Y to Ngay )(9: 22/08/2017 17:26:05 He thong VOfficel3O Y Te

KT. BO TRUIfiNG THt TRU3NG

NguyZn Viet Tien 2

BQ V TE CONG HOA XA HQ! CHI; NGHIA VIET NAM Woe lap - Tly do - Elkinh phtic

QUY TRINH LAM SANG CHAN DOAN VA TRI DAI THAO DU'ONG TIP 2

(Bun lionh kern then Quoit clinh seJSMOD-BYT nga)2,Phang 8 narn 2017 cliu By trul'ing Bci Y te)

1. ChAn doan dai iliac, thr&ng tip 2

Phat hifn sdem as chgn doin thao owing (OM) tip 2

1 Tui5i 2 45 Kheing co trieu chirng DTD CO trieu chirng (D

BMI 23 kg/m2 hoc can nang >120% can ning ly toeing

va co them 2. 1 yeu t6 nguy ca (YTNC) nia f)TI1 rip 7 (Phu loc. 1)

xet nghiem chin doin 070: Glucose hdytit toting: tic dbi (PPG); that digm sau 2 gib lam OUT 75g; k that

mem bat kl va HbA1C. Land 17i XN Ian 2, each ran 1 tie 1-7 ngay d4 chin doan icac

dinh nhiing BN khong co trieu cht?rtg kinh di4n cue tang glucose huyet (tieu nhieu, ueng nhieu, On nhleu, cut can khgng r8 nguyin nhan).

Chan doan Tien OTO • Rai loan dating hi/yet 5k dbl fnG to 100

125 ling/c11. :5.6 6,9 mmol/L), hogc • 55i loan dung nap dating huygt (IGT)i Glucose

hay* tuvng & thtti Vim 2 gib sau lam OGIT 75 g tit 140 149 mg,/dt. (7,9 11 rnmcg/L), hat

• rIbA1c: tit 5,745 6,445)39- 47 mmolfmol), (Kern Phu iLic 02)

Kim tra 101 hang nom. Giao duc ve rev chink 16i song

Chin doan ()TD

'.

i i•

•

7 %l2G 'ig

.

-7n”'l'L)ih3'7ttcoelia.m;cti,-dt4,., .

Grr 7C;a213 ,1.': ir•,-pk , HbAlc 5,5 Ole; Ii r..,0,1 ?. hpr

/ - ,

• 41 cD•rig.t chime k',h. inn c-;,,i•-•,,, i, ..:c..•• nin,Pt nolr -1-Or 01 t.'(),, err rpiv, f., !.1 r

S. ' cli&ri ta5:1,1 .7.• 2011••ip:ii. ;Fir; P. 11 Ir•r,, ,"_' xem ?nu iy.t U1,

Dieu trj

(Quy trinh dreu tri)

Binh thutmg

Kim tra lei sau m6i 1- 3 nom.

Giao Out thus hien foi song lanh man h

2. Minh gin town dien tinh trnng benh

Minh gia town diOn tinh trang b.nh tai 15n khant Mu flan khi d3 chin doan xac dinh DTfl

Binh sir rues, d4c dim luc khr0I 0105 benh OTO Cach an uang, tuyen tap thg duc Khal this ten six benh Cat Tian *u dung thuds a, rack, chat gay righign. "gm soil ciac rt5i loan. tram cam, m Su, loan an uang... Cic benh deng mac I-4 oaf, sink grin chime mach matt mho, mach mau Ion Hanh rt sv dung thubc uOng, tiem, wan thu dieu Sri

(chi tigt xem Phu lac 04)

Kham thus th6 • Tang [rang, chigu coo. an rang, BMI, qua trinh phat

trian ve day thi litre em, thanh thlgu Men. • Do huigt Op (ngu an do HA am va dung da dm he HA

to the). • kham tim mach: nghe tim, bOt mach chi, d3c biet chi

du•01, nghe mach cinh. • Kham day mat • KhAm tuygn (Op. • Kharn dar tim dgu gel den, sOc they ddi de do OTO teem

scat kart!. kharn cac Yung tlgrn chichi nett benh nhsin dung insulin).

• Kham ben chin town diem (chi oat aem Phu lyc 04)

Xet ngh i HbAlc, ogu chsra lam trong 3 thing Qua Niu Ova thus hien ho9c khong DS sin Meng tin sau trong mot nom qua thl lem ret rtghtem: o Re thong tin v9 lipid maw bao gRrts

Cholesterol Loan phOn, l.Dl, HEX va Trigtycerides k hi an thigt.

o Xet nghlem chile ning gas, AST ALT, met rightem khic ngu an

• siAlbuitan/uratinin rivbs tIgu lay 1 lan vao bad sang Creatinin huyOt thanh, de roc au thgn

• TSH b bent, nhan (9N) DTO Up 1

• Xec dinh chgn dodo ri ph Mn loVaC icldwrnh; • Phat hien do blin chiing OTD ye sec berth dpng • Xem get diku tri to/6*c ve stet klgm sogt ygu tzs nguy cob benh nhan

On) da dace thigt • Bat deu nut them Oa 13N trong ay cluing kg hooch quen Ty them sPc • Say citing kg poach ve sham sec Men tuc.

Tinh trang sire khoe

Ca so. de HbAlc chop Ikra (%)

Glucose huyect ltic doi ho#

trtrofrc an (mg/dL)

Glucose lac di ngti

(mg/d1)

Huy& ap mmHg

Monk khoe Con song tau

Phirc tap/ sire KY vQng khoe trung song trung binh

binh

RAt phirc tap/ Khong con sire khoe kern song lau

<7.5% 90-130 90-150 <140/90

<8.0% 90-150 I 00-180 <140/90

<8.5% 100-180 110-200 <150/90

• Lipid mau:

LDL cholesterol < 100 mg/dL (2.6 mmol/L), neu chtra co bien chi:mg tim mach.

LDL cholesterol < 70 mg/cIL (1.8 mmol/L) neu da co benh tim mach.

- Triglycerides < 150 mg/dL (1.7 mmol/L) • HDL cholesterol > 40 mg/dL (1,0

mmol/L) t7 nam va > 50 mg/dL (1.3 in.mol/L) a nth.

• HbAlc < 7%*

• Glucose huyet tuong mao mach lUc d6i, trtrac baa an: 80-130 mg/dL (4.4-7.2 mmol/L).

• Dinh glucose huyet tuang mao mach sau an 1-2 gia: <180 mg/dL (10.0 mmol/L)*

• Huy& tip: Tam thu <140 mmllg Tam truang <90 mmHg.

Ma tieu dit.0 tri dal than dtrimg a :wad gia

3. M uc

Mlle tieu ditlu tri cho b?rth nhan DID it nguiti trtarog thanh, Ming có thai

* Muc fiat' dieu tri c cac ca nhan CO the khac nhau tuy tinh trang ctia benh nhan.

Muc tieu dieu tri co the nghiem ng4t hen: HbAlc <6.5%,(48 mmol/mol) neu co the dat &rat N/A khong co dau hieu clang ke dm ha throng huyet va nh(rng tric dung co hai cua thuoc: Doi viii nguai bi,benh dai thao &rang trong thai gian ngan. benh DTD tip 2 dirge dieu tri bang thay dal 101 song hoac chi dimg metformin, tre mei hoac khong CO b'enh tim mach quan trong.

Nguac lai, muc tieu dieu tri cO the it nghiem ngat (nai lOng hart): HbAlc < 8% (64 mmol/mol) phi hap vai nhCrng benh nhan co tien sir ha glucose huyet tram trong. lon

cac hien chimg mach mau nhe ho4c mach mau Ian, có nhieu benh 13; di kern ho(ic benh DID trong thti gian dai va khO dat muc tieu dieu tri.

Neu da dat mix tieu glucose huy& luc doi, nhtrng HbAlc con cao. can xem lai muc tieu glucose huyet sau an, do vao luc 1-2 gi& sau khi benh nhan bit (tau an.

120 s,Sc DPP-Ad

insultre GLP,I-RA

4. Lira awl thu4c era phtrovg phap di&1 tri

Insulin

Cass nhSt

nguy co cap

aryl

ha dinYng husEt

Khai eau dun trj lieu trir khi

HbAlC tan hon hoe( bAng 3%. tan ethic Lieu phap hai thudc

HbAIC ion hon tioac bang 10%. glucose huyet Ian hon hoac bang 300 rrtgldt hoac b4nh nhan ca trieu chtrng 50 rang, can nhar Liau phap Gem phei hv-a

San trj lieu Metformin Thay d6i 161 sting

H1U QUA. cap

NGLIY CO HA OVONG HVY£T Noy tnap CAN NANO IchAng thay IMSigIarn can

TAC NAG PHV his, haat loan lactic

CHI PHI' thSp

Neu khong dat quo tithe A1C sau khoing 3 Chang dung don tri lieu, teen hanh phoi hop 2 thuds (Oat iv thuds oho) hdp kheng CO rigtiu 4 bieti hien b,3t ky VU nett cu the- Etta chop phu thuck vao rnbi benh nhan khac nhau va cac yeu t6 benh cy the.)

lieu phdp hail thugr

Metformin + Thay 66i 161 sang

Suit onykrrea Thiasolicanedione in mu DPP-4 Vc cha SGLT2

Csbng rpm Mu th4 GLP-1

HO QUA' can can trUral bink, trung Dinh

can

NGUY CO HA DH nguy LEI trung bush nguy co : hSp "VS co thip new co thip nguy co thSp

CAN NAM Ong Ong khOng Soh holm% gam can

Oro do

TAC DUNG PHI) hp dutong host't phu, toy Um hien, gip ,n c, dac gnat wen

beu hem 0410140 VISp thip can can can can

NPu khOng cal 'nue tits) AlC saw khoing 3 thang dung lieu phap hai thuds, Lien hanh pheil bop 3 lhn6c Wit to thuds phei hap lihetng co nghia 4 bleu hiPn bet ky vu t,en cu th4- Iva chop ohu thia3c vao rtiLi berth nhan Olaf nhan va cic yeti to' benh Et, the.}

phip ba thu6c

Metformin +

Thay doe loi sung

Sultonylurra • P114111011d111•61./4*': trc chi orrA . et cis scan • Obergven thy the Oil .

Insulin

su su Su

DPP-4 -r ,.c OPP-4.s no4, 1213 ,iki 12D ,,

i '‘ ..' 5!;ikiiin.i : ii,,sc GPO-A•, sons

noils Cst,Rit-RA nika. GLPi-t-RA kuac 11==111 ii,a3, Gi-P-1-RA 'i'3'

not, hnic 1111=111111 mac Insulin'

Neu klia3rig dat mut tieu A IC sou kneeing 3 thane vet phac dei lieu phap 3 thu6c via bean nhan eh.(I) Bang chrng thuAr wing rhAi hyr rh, rh”pan sang insulin hop.- rIA,ng

van 11,4 the GLP-1, 12); dans thing GlPil the them insulin, hoac (3) Bang dung insulin a chugn lieu t6i tru Chi, be sung done van Chu the Gi_P-Ihoac insulin Oita in Nen duy era Metformin, con cat thuds tiling khat co the ogling tuy than twig bent, nhan tranh lam phut tap knong can thief phac d8 dieu tri hoac tang chi phi tvi du, them thy& dies) tri day than duierng HIV wt.

Xem: So' da etiu tri v&l Insulin Lieu phapTiem ph61 Inns

3

So' voi insulin

Wit dau dung Insulin Nen / Tr4n, han hqp Tinning phai hop yeti metformin +1- thu6e kheing phai insulin kha'c

Ins an nen 84t dau ertutri: 10 ngsy ha.: 0.1-02 av/lug/N4y Dieu chink lieu: 10-15% ho4c 2-4 don vi (not ho4c. hai Ii, moi tuan cho den k% dat mut tiaii glucose khidd Neu hi dirtvng huyili (OHI: vac dinh ve g131 duvet nguyin nhin, lieu khdng rr5 nguyen nhan gay ha duttng huyet.. lieu 4 C1414 '211,4•4r 10-10%

Insulin Wen, hIsn Iwo Neu dUng 111n/ ngly dung lieu 12 dv van trutic Oita An ter. Neu dung 2 len/ngay' lieu thin diu thuyen cav cilia la 6 dv vim tnia sang va 6 dv vac, Wa t41

Dieu chinh lieu: Ong lieu 10- 15% hay tang 1 - 2 dv mot mot hoac 2 ran 7,5. tuAn sin den khr dat rmic neu dirtmg huvit Na DM: .r dinh nguyen nhin ha duhng huy6t. lieu linEing no nguyen 0520 15

gdm lieu insulin 2 - 4 don vi hay On: 10 - 2IP4

Neu khong kern soat datac A1C, can nnac lieu ph6ip trem phi hqp theo 1 trong 3 ph uTing an sau

Them 1 insulin tic dung nhanh Meat( bira an cd

rthiitu carbonhydrat nhait

Bit dau: 4 don vi, 0,1 d.v/kg, hoac 10% lieu nen. Neu MC <8%, xem set v lieu insulin nen cur-1g s6 luting fdiau chinh:'" lieu 1-2 don vi hoac 10-15% mot ran hoac hai ran mSitt5n cho den khi (tat den mut tieu throng huyet Ha OH: Xac dinh v5 xir tri nguyen nhan; Neu khdng c6 1y do r6 rang, 1, lieu turrng frog 2-4 dan vj hoac 10-20%

Neu sibAiC van khong m :Oat difor, thuyen sang nen-

nhanh

Them a 2 mai hem insulin tic dung nhanh truirc bEra

(`nen-nhanh')

Phi5i hqp yeti dung von thti the 61.P-1

(GLP 464

Neu khong dat mud tieu HbAlC, chuyen sang the

do tiam insulin 2 Ian

Neu :sac mut lieu khong -tot— stem xet thay rTni phar

insulin thay the

t' trj insurintn*Wm

D lAn hang NAY qrtift, tam an sang va an ttu i

Bit nu: Chia li4u nen hien tat thanh sang, % chieu tdi hoac Si sang, Si tdi Dieu chinh: lieu 1-2 ISn boat 10-15% mcjt hoAc hai Ian mtii tuan cho cl4n khi dat mac tieu duang huyet 144 OH: Xac dinh va xir tri nguyen nhan; Neu khong co ly do r6 rang, 1. lieu 2-4 don vi hoac 10-20%

Neu HbA1C yin kiting kcem sow ciLwr, trim mai ttux 3

Thay insuen tra)n, hen hqp truth- 3 bika sang, tnra, Mr*

(3 1Sningay)

Bit dau: 4 don vi, 0,1 d.v/ kg, hoac 10% lieu nen/ b&a an. Neu MC <8%, hey xem xat V lieu insulin nen ciing s6 [Leong Oieu thinh:1' Lieu dung 1-2 lan hoac 10- -01111—i 15% mot hoac hai 15n mot tuen de dat mut tieu dutmg huyet Ho OH: Xac dinh va xis tri nguyen nhan: Neu khdng co ly do ro rang, -- lieu 2-4 don vi hoac ttrcmg ling 10-20%

fat dau: Khi sir dung insulin iron han hap ma lieu de len din 30 dv thi co the chuyin sang ngay 3 ran: Uiu budi sang to the chia thanh lieu bud, sang va gia in trua (sir dung 3 Ian/ ngay) OtOu chinh: T lieu 1-2 don vi haat 10-15% mot tic:4c hap MI m& tuan de dat cluvc mut net, throng huyet tia OH: )(lc dinh vi nit tri nguyen nhan; N4u khdng CO N do nt, ring, 1. lieu 2 -4 clan vt h.:4c 10-20%

Neu khong dat car muc Neu, can nhac thay dOi the

d6 insulin

4

Thea dal ki4rn soat glucose huyet myc tieu

5. Theo deii kiem soat dtrirng huyet

Do It.reeng HbA1C

BN dat muc tieu diet' trj VA ngireti cci glucose

huygt dircrc kiem so5t On rill-1h:

Xet nghiem HbAlc it nh5t 215n trong 1 n5m

6. Quin nguy co'va 4nh tim mach

BN ducfc that' doi lieu phap dieu tri hoc khong

clap Crag MUG tieu ve glucose huygt:

Xet nghiem HbA1c 3 thing mOt I5n.

Quin ly nguy ccrya 4nh tim mach

Kiem soat huyet ap: do huyet Quin IY lipid mau: do chi s6 ap ci rr6i lean kham dinh ky lipid mau it nhet hang nem

Sit dyng thti5c thong Kham phat hien

Ite't tap ieu c'au Benh tim mach %/anti

Neu huye't ap tam thu 2 130mmHg hay huyet ap tam tru'ong ao mmHg can phal

kiem tra la HA vao ngay khac

Chin doin tang huyet Sp: Kru kiem tra lai co huyet Sp

tam thu 2140 mmHg yalhoic huyet ap tam twang 290

mmHg.

Dieu trj tang huyet ap (Xem hudrng din dieu trj UTE), THA)

Dieu trj roi loan ma mau (Xem htfOng din dieu trj DID vacgc huting din lien quan)

(Xem Wang din dieu trj DTD ye cac huang din lien quan)

• Khong khuyen cao kham dinh IcY dOi yeti benh mach tranh.

• Kharn benh dtjng mach yanh (xcr yin Ong math) khi co bit kY trieu chlYng cUa benh

(Xem Phy lyc 03)

Dieu tri (Xem htthng dart dieu b.! OTD va

car hirerng din I4n quart)

7. Klein soat bien chting reach nniu nho va chart] soc bAn chin

Kiem soat bien tilling mach mau nh6 va cham sóc ban than

Binh thin dal than kham it nhat mOi

nam 01 l'an

Benh Wing mac do OTD: BN DTD tip 2 can &roc khan; mat toandiin, do thj Ric tai thai diem dltqc ch'a'n doan DTD

1

Bien chting than kinh do OTO: BN DTD tip 2 can duct clanh gia binh than kinh ngoai bien tai th6i diem char; doan

Cham soc ban than

Neu co 1.) ,"nh yang mac do DTD

Khium vdng mac it nhit King nam.

• Binh wan mec elang bin tne'n/dedcla thl rut: khairn mat thvitng hon.

Dinh gia albumin niiu va mdt lot cau than

(6 tat BN DTD tip 1 z 5 nom, 8N OTD tip Z 8N co tang huyit

by phi ht' )

Khan co bang chirng cia birth

iang met do DTD mot hok nhleu Ian

kham mat hang nam viz dttemg hstyk

&roc kicm soat tat:

Xem xet khan,. met 2 nam mpt ten

Barth gia bOh than kinh ngoai bien: it nhat m6i

nam mot ran.

Thvc hiin cianh gia ban than toan diin it nhat moi

nam mOt fan de xac dinh cac yeu to nguy co gay loet

va cat cut chi.

1

Kham ban than vao mai Ian kham benh cho tat ca

cat BN DTD

Chin &Lin, dieu trj

(xem Huang din chin &im, (lieu trj 011) va cac htrang din lien quan)

2.

Phy luc 0I :

Tieu chain de lam xet nghiem char' down dai thao dung hoc tien dai thao diriyng it ngtriri trtnimg thanh khong co tri0 chirng dai thao dierng

(Bat/ hanle kern the° Quye't clinh so /QD-BYT 'way Mang mine 2017 cua BO fretting BO Y te)

I. Ngueri ken CO BMI > 23 kg/m2, hoac can nang Ian horn 120% can Ong 1)7r Wang vg, CO mOt hoac nhieu ham mOt trong cac yeu to nguy co sau: It van dOng the Ikrc

- Gia dinh co ngu6i bi dai thao duirng 0 the N can ke .mc, anh chj em ruOt)

- Tang huyet dp (huyet ap tam thu > 140. mmHg vWhoac huyet ap tam throng > 90 mmHg, hay dang dieu trj thuOc ha huyet al))

Nang dO HDL cholesterol < 35 mg/ (0,9 mmol/L) va/hoac nong dO triglyceride > 250 mg/d1, (2.82 mmol/L)

\Jong bung to: 6 nam > 90 cm, 0 nit > 80 cm

Phy nix bi bung trimg da nang

Phy nit da mac dai thao dtr6ng thai kY

HbAlc > 5,7% (39 mmol/mol), r foi loan glucose huyet dai hay rOi loan dung nap glucose 0 lan xet nghiem tnra'c dO.

CO cac dau hieu de khang insulin tren lam sang (ninr beo phi, dau gai den...).

Tien sir co benh tim mach do xa vita dOng mach. 0 benh nhan khong CO cac dau hieu/tri'eu chimg tren, bit dau thvc hien xet nghiem phat hien sam dai did() &rang a ngu0i > 45 tu6i,

Neu ket qua 'cot nghiem binh thuang, nen lap lai xet nghiem sau in6i 1- 3 nam.,CO,the thtrc hien xet nghiem sant hcm thy thuOc vao ket qua xet nghiem trtrOc dO vg, yeu to nguy ca. Doi vii ngtr6i ti'en dai thao throng: thi1rc hien xet nghiem hang nam.

7

Phu luc 02:

Tieu chuan chan doan tien dal than direrng va dai than duiing (Ban hiinh kern theo Quvet dinh so VD-BYT ngay thang nant 2017

cua Bp tnaing BQ Y tel

1. Tieu chitin chan Joan teen dai thin duteng: khi c6 in6t trong cac roi loan sau day:

a) Rai loan glucose huyet doi (impaired fasting glucose: IFU): Glucose huyet twang luc dai tit. 100 (5.6mmol/L) den 125 mg/dL (6.9 mmol/L), hoac

b) Rei loan dung nap glucose (impaired glucose tolerance: IGT): Glucose huyet tiamg cr

then diem 2 gib sau khi lam nghiem phap dung nap glucose bang &rang uong 75 g tir 140 (7.8 mmol/L)4kn 199 mg/dL (11 mmol/L), ho4c

c) HbA le tit' 5,7% (39 mmol/mol) den 6,4% (47 mmol/mol).

2. Tieu chuAn chan don't' dal thin duirng: dkra vao 1 trong 4 tieu chuan sau day:

a) Glucose huyet twang luc dOi (fasting plasma glucose: FPG) > 126 mg/dL (hay 7 mmol/L). 13.0h ,nhan phai nhin an (khong wing nuac ngot, co the uong nuac loc, nuac dun soi de ngu6i) it nhat 8 gib (thuang phai nhin doi qua dem nir 8 -14 gib). hoac

b) Glucose huyet tuang a theri diem sau 2 gib lam nghiem phap dung nap glucose dtrang u6ng 75g (oral glucose tolerance test: OGTT) 200 mg/dL (hay 11,1 mmol/L).

Npiem phap dung nap glucose &rang u6ng phai dukic thvc hien theo huang dan cila To chirc Y to the giai: Benh nhan nhin dOi tir ntia dem tnrac khi lam nghiem phap, dung mot luang glucose ttrang &rang veri 75g glucose, h6a tan trong 250-300 ml nuac, uong trong 5 phut; trong 3 ngay truerc dO berth nhan khau phan co khoang 150-200 gam carbohydrat moi ngay.

c) IIbAlc 6,5% (48 mmol/mol). Xet.nghiem nay phai dirge thirc hien a phong thi nghiem &rot chuan haa theo tieu chuan cluSc

d) C3 benh nhan co trieu chang kinh dien dm tang glucose huyet hoac mix glucose h.uyet wan o theri diem bat kS, > 200 mg/dL (hay 11,1 mmol/L).

Neu khong co trieu chUng k.inh dien cda tang glucose huyet (bao g6m tieu nhieu, tieing nhi'eu, an nhieu, skit can khorT r6 nguyen nhan), xet nghiem chan doan a, b, d o trencan dtrerethkrc hien lap lai.lan 2 de xac dinh. chan doan. Thai gian thirc hien xet nghiem lan 2 sau lan nhat co the tir 1 den 7 ngay.

Trong die'u kien thirc to tai Viet Nam, nen dung phirang phap don gian‘ va hieu qua de chan doan than dung la dinh luong glucose huyet tuang doi 2 lan > 126 inf,/dL (hay 7 mmol/L). Neu HbAlc dirge do tai phong xet nghiem dirge chuan hoa quoc te, co the do HbA 1 c 2 fan de chan doan DTD.

Phu luc 03: Kham phat hien bOh tim mach vanh

(Ban hanh kern theo Quvet clinh sa /QD-BYT ngay thcing nom 2017 cua BO trtrang Y tj)

• Khong khuyen coo kham dinh ky d6i vai benh tim mach vanh.

• Kham benh dOng mach vanh (xa vira del-1g mach) khi c6 bat ky trieu chimg sau day:

Cac trieu chimg khong dien hlnh caa tim mach: nhx kho the, khong rO nguyen nhan, tirc ngisc; Cac dau hieu ho4c trieu chimg lien quan den tim mach: bao g6m tieng thei 012 mach canh, con thieu mau cuc be thoang qua. det quy, di khap khiZng, hoac benh deng mach ngoai bien; Hoac bat thu*ng ve dien tam d6.

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Phu hie 04:

Cac nei dung danh gia toan dien benh Wan dai than du.trng (Ban himh kem theo Quyb clinh so ;Tay thing nam 2017

clia BO taring Bo Y tel

1. Benh sir - Lam sang:

Tuoi, dac diem laic khal phat DTD (nhiem ceton acid dai thao duting, ghat hien clai thao &rang bang xet nghiem nhung khong có trieu chirng).

Can Ong cac con lUc sink. (dai vai phu Cac lan mang thai. trams da dirge chart dotin dai thao easing kh .Ong? CO dtrqc chain dotin CO busing trirng da nang cY cac Ian kham san trtrac khong?.

each An Wong, tinh trang (firth (Juan& tien sir can -Ong, hanh vi ngit (thoi quen, thin gian)„ thOi quen luyen tap the ltrc, giao due dinh &Ong, tien sir va nhu ca.0 ho trq hanh vi.

- Tien sir sir dung thu6c la, u6ng raga va six dung thu6c gay nghien.

- Tim hieu benh nhan CO tha.m gia cac chtrang trinh giao due ve DTD, tar quan ly va tien sir, nhu eau trq.

RA soat lai cac phis da dieu tri trunk va dap img dieu tri (dtra vao cac so lieu HbA lc)

Sir dung cac thu6e b6 sung va thay the: Cac loai thqc pham shire nang, thu6c co truyen da sir dung. Cac loci thu6c dieu tri benh khac, thi du thutic dieu tri dau khop...

Cdc benh d6ng mac va benh ve rang mieng Bang mac.

Tam soat -tram cam, 10 au va r6i loan an .u6ne bang each sir dung cac do Itrimg da dugs hid u ch.inh va phi hop.

Tam soat ve cac van de tam cac rao can,khac d6i dieu va tar quan ddi than throng, nhun.guon tai chink ha che, hau can Va. cac ngutin ht") trq.

Tam scat ve n6i dau bu6n, canh kh6n ding khi bi DTD

Dinh gia cac hanh vi sir dung thu6c u6n.g, .thu6c tie-m va cac rao can dai v-ai sir tuan thu dieu tri.

Neu benh nhan có may thin glucose huyet tai nha hoc so theo dOi kham benh. kiem tra lei cac thong so theo clOi glucose huyet va xir tri cita benh nhan.

- Tien sir nhie'm ceton acid, tan suit, (10 train trong, nguyen .nhan.

- Tien sir cac can ha glucose huyet, kha nang nhan biet va each xir tri lac e0 con, tan suit, nguyen nhan..

Tien sir tang huyet ap, rOi loan lipid man

- Cac bien chimg mach mau nit& yang mac, than, than kinh

Cac .bien chang mach mau benh tim thieu mau cue be, nhOi mau ca tim, dOt qui, Nnh mach mau ngoai vi.

D61 vii phi nCr trong lira tu6i sinh san: hal ve ke hoach sinh con cita benh nhan. benh có dung phtrang phap nao de ngira thai.

2. Kham thtic th4: can di.c biet eh& trong:

Chieu cao, can ning va BMI: Qua trinh phat trien va day thi a tre em. thanh thieu nien.

Do huyet ap, neu can do huy& ap nim va dimg de tim ha huyet ap lir the.

Kham day mat.

Kham tuyen giap.

Kham da: tim diu gai den. cac thay dOi da do DTD kiem soat kem, kham cac vuno, tiem chich neu benh nhan dUng insulin).

Kham ban chin toan dien:

+ Nhin: xem diu kho da, cac vet ehai., bin clang ban chin

+ SO: mach mu chin va chay sau

+ CO hay mat phan xa gin ca Achilles

+ Khan) thin kinh nhanh: cam giac xtic giac. cam giac rung. cam n1-(an monofilament.

3. Dinh gib ye etin lint sing:

HbAlc, neu chua lam trong 3 thing vira qua

Neu chaa thac hien hoic khong co sari thong tin yang mot nam qua v'e cac nei dung sau, thi lam xet nghiem:

+ XN ve bO thong tin lipid mau: bao gOm Cholesterol town phan. LDL. HDL: va Triglycerides khi can thiet.

+ Xet nghiem eh& rang gan, AST ALT, xet nghiem khac nett can

+ Ti so Albumin/crcatinin nu& tie'u lay 1 Ian vao buoi sang

+ Creatinin huyet thanh va de loe ciu than

+ TSH o benh nhan DID tip I

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