C:\documents and settings\administrator\桌面\35 ndiabetes mellitus

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<ul><li>1.Diabetes Mellitus Dr. CAI Mengyin Department of Endocrinology 3 rdAffiliated Hospital Sun Yat-sen University</li></ul> <p>2. </p> <ul><li>Populous country with westernized lifestyle </li></ul> <ul><li>Limited resources for healthcare expenditure </li></ul> <ul><li>Increasing prevalence of obesity </li></ul> <p>The official mascotsof the Beijing 2008 Olympic Games Populous country with obesity pandemic Asia countries are facing challenge from Diabetes 3. Economy taking-off like a rocketwith dramatic lifestyle change State on Bicycle Traffic jam in Beijing Coupon for food in Guangzhou One weeks food for a family in Beijing Exercise less Eat More 4. Prevalence rate of Diabetes Throughout the world: 150 millions ? 2% USA: 15 millions China:9.7 % --N Engl J Med 2010;362:1090-101. China: 1980 0.609% in 304537 Canton: 1980 0.411% in 42788 5. What is Diabetes Mellitus? Definition: Syndrome Metabolic disorder of multiple etiology (causes) characterized by hyperglycemia with carbohydrates, fat, and protein metabolic alterations, which result in defects in the secretionor action of insulin, or both. 6. Hyperglycemia X or Metabolic Syndrome Metabolic abnormalities and by long-termcomplications involvingeyes, kidneys, nerves, and blood vessels Acute complications: diabetic ketoacidosis, hyperosmolar nonketotic diabetic coma. homogenous Heterogeneous 7. Genetic factors Environmental factors Chinesepopulation 9% Monogenic Polygenic Aging Lifestyle Infections Diabetes Type I 90% Etiology and Development 8. Defect of Cell in Insulin Secretion &amp; Action 9. Non - diabetes Pre - diabetes Diabetes IGT/IFG Fasting plasmaglucose Insulinrequirement Insulinproduction 7.0 mmol/L 10. Derangements are due to relative or absolute insulin deficiency and glucagon excessiveness. Normally, it is a rise in the molar ratio of glucagon to insulin which leads to diabetic decompensation .Why does metabolic derangementhappen? 11. 12. Spectrum of Diabetes Mellitus Insulin receptor gene mutations (7.0 mmol/L after an overnight (at least 8-hour) fast. </p> <ul><li>Two-hour plasma glucose &gt; 11.1 mmol/L during a standard 75 g oral glucose tolerance test. </li></ul> <ul><li>Impaired fasting glucose (IFG): plasma glucose after an overnight fast that is &gt;6.1 mmol/L but less than 7.0 mmol/L. </li></ul> <p>43. Treatment of Diabetes Mellitus Management Goals </p> <ul><li>Obtain optimal glycemic control </li></ul> <ul><li>Prevent and retard microvascular complications </li></ul> <ul><li>Reduce macrovascular complications </li></ul> <ul><li>Avoid acute diabetic complications </li></ul> <ul><li>Better quality and lengthen span of life </li></ul> <ul><li>Strategies </li></ul> <ul><li>Earlier diagnosis and treatment </li></ul> <ul><li>Acting on results of SMBG and GHbA 1c </li></ul> <ul><li>Combination therapy </li></ul> <ul><li>Education for healthy life style and self management </li></ul> <p>44. LDL-c mmol/L 4.5 According to UKPDS data . Targets for Diabetic Control Good Moderate Poor FPG mmol/L 4.4-6.1 7.0 &gt;7.0 PBS mmol/L 4.4-8.0 10.0 &gt;10.0 HbA1c % 8.0 BMI Kg/m 2 M</p>