monitorizarea continua a glicemiei
TRANSCRIPT
![Page 1: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/1.jpg)
ABORDAREA CLINICA A DIABETULUI ZAHARAT
1. Diagnostic - Evaluare
2. Managentul clinic in Diabetul zaharat PROGRAMUL TEME
Terapie Educatie Monitorizare Evaluare
COMPLEX COMPLET INTENSIV
![Page 2: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/2.jpg)
STUDII PRIVIND CONTROLUL GLICEMIC
1993 - DCCT (Diabetes Control and Complications Trial)
2002 - DCCT-EDIC (DCCT - Epidemiology of Diabetes Interventions and Complications Study)
1993 - SDIS (Stockholm Diabetes Intervention Study)
1998 - UKPDS (United Kingdom Prospective Diabetes Study)
2000 - Kumamoto Study 1995 - VACSDM
(Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus)
2001 - VADT (Veterans Affairs Diabetes Trial)
Diabet zaharat tip 1
Diabet zaharat tip 2
![Page 3: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/3.jpg)
CONTROLUL GLICEMIC - loc central in managementul diabetului 1,2,3
- influenteaza evolutia diabetului si aparitia complicatiilor cronice 1,2,3
CONTROLUL GLICEMIC STRICT- dificil de obtinut - necesita tratament intensiv 1,2,3
1UKPDS STUDY GROUP (UKPDS 33). The Lancet 1998, 352, 837-8532UKPDS STUDY GROUP (UKPDS 34). The Lancet 1998, 352, 854-8653THE DCCT RESEARCH GROUP. NEJM 1993, 329/14, 977-986
CONTROLUL GLICEMIC
![Page 4: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/4.jpg)
EVALUAREA STATUSULUI GLICEMIC
MONITORIZAREA INTERMITENTA /AUTOMONITORIZARE
Glicemia bazalaGlicemia bazala
Profil glicemic in 7 puncteProfil glicemic in 7 puncte
!!
A1c
Alte Alte modalitatimodalitati
MONITORIZAREA MONITORIZAREA CONTINUA A CONTINUA A GLUCOZEI (MCG)GLUCOZEI (MCG)
![Page 5: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/5.jpg)
MONITORMONITOR- Conexiune cu fir sau prin unde radio - Afisarea nivelului glucozei retrospectiv sau in timp real- Alerta in caz de hipo- sau hiperglicemie (pentru masurarea in timp real)
DISPOZITIV DE DESCARCARE A DATELOR PE COMPUTERDISPOZITIV DE DESCARCARE A DATELOR PE COMPUTER
SENZORUL DE GLUCOZA- Cateter – implantat subcutanat abdominal- substrat: glucoz-oxidaza
CGMS Guardian RT
SISTEMUL DE MONTORIZARE CONTINUA A GLUCOZEI (CGMS)
![Page 6: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/6.jpg)
AUC (aria de sub curba)
amplitudine glicemica x timp de expunere
EXPUNERE GLICEMICAEXPUNERE GLICEMICA
Media glicemiilor AMPLITUDINE GLICEMICAAMPLITUDINE GLICEMICA
MAGE (amplitudinea medie a excursiilor glucozei)
VARIABILITATE GLICEMICAVARIABILITATE GLICEMICA- Corelat cu - 8-iso PGF-2α urinar
- stresul oxidativ
MONITORIZAREA CONTINUA A GLUCOZEIEVALUAREA COMPLEXA A STATUSULUI GLICEMIC
![Page 7: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/7.jpg)
• Nivelul glicemiei1
• Distributia valorilor glucozei pe domenii glicemice1
• AUC (expunerea glicemica)1
• Variabilitatea Variabilitatea glucozeiglucozei22
• Amplitudinea medie Amplitudinea medie a a excursiilor glucozei excursiilor glucozei (MAGE)(MAGE)22
influ
ente
aza • Riscul
cardiovascular • Evolutia pe termen lung a complicatiilor diabetului3,4,5
• Disfunctie endoteliala2
• Evolutia pe termen lung a complicatiilor diabetului3,4,5
dete
rmin
a
1BODE BW et al. Diabetes Care 2005, 28, 2361-2366.2MONNIER L et al. JAMA 2006, 295, 1681-16873UKPDS STUDY GROUP (UKPDS 33). The Lancet 1998, 352, 837-8534UKPDS STUDY GROUP (UKPDS 34). The Lancet 1998, 352, 854-8655THE DCCT RESEARCH GROUP. NEJM 1993, 329/14, 977-986
MONITORIZAREA CONTINUA A GLUCOZEIEVALUAREA COMPLEXA A STATUSULUI GLICEMIC
![Page 8: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/8.jpg)
Glucose Sensor Profile
-50
0
50
100
150
200
250
300
350
400
12:00 AM 4:00 AM 8:00 AM 12:00 PM 4:00 PM 8:00 PM 12:00 AM
Time
Glu
co
se
Co
nc
en
tra
tio
n (
mg
/dL
)
MAGE – evidentiaza variatiile glicemiei
cu potential risc cardiovascular
![Page 9: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/9.jpg)
AUC – evidentiaza magnitudinea expunerii la hipo- sau hiperglicemie
![Page 10: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/10.jpg)
AUC PP
AUC diurnAUC nocturn0
10
20
30
40
50
60
70
80
90
100
%
Distributia AUC Intensitatea excursiilor glicemice
Glucoza - CGM
Glicemie nocturnaGlicemie diurna
Glicemie P P
0
10
20
30
40
50
60
70
80
90
100
%
Distributia nivelelor glucozeiAmplitudinea glicemica
STATUSUL GLICEMIC
![Page 11: Monitorizarea Continua a Glicemiei](https://reader036.vdocuments.mx/reader036/viewer/2022082413/5571f83c49795991698cf556/html5/thumbnails/11.jpg)
CONCLUZII
CGMS permite analiza globala si detaliata a excursiilor glucozei privind
HipoglicemiaHiperglicemiaValori glicemice optime
Variabilitatea glicemica Controlul glicemic pe termen lung
(A1c) poate fi imbunatatit prin aplicarea metodei de evaluare prin monitorizare continua si optimizarea consecutiva a terapiei