tratamentul în diabetul zaharat

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Tratamentul în diabetul zaharat. Scopuri majore ale tratamentului diabetului. Diabetul de tip 1 Atingerea ţintelor glicemice cu un plan de lucru individualizat şi flexibil Evitarea hipoglicemiei severe, a hiperglicemiei simptomatice şi a cetoacidozei - PowerPoint PPT Presentation

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  • Tratamentul n diabetul zaharat

  • Scopuri majore ale tratamentului diabetului Diabetul de tip 1 Atingerea intelor glicemice cu un plan de lucru individualizat i flexibilEvitarea hipoglicemiei severe, a hiperglicemiei simptomatice i a cetoacidozei Asigurarea strii de bine i creterii normale fizice i psihice a copilului

  • Scopuri majore ale tratamentului diabetului Diabetul zaharat de tip 2Prevenirea complicaiilor Evitarea efectelor adverse ale medicaiei i mai ales a hipoglicemiilor

  • Scopuri specifice Eliminarea simptomatologiei Optimizarea controlului glicemic Atingerea i meninerea unei greuti rezonabile Atingerea i meninerea intelor pentru TA i profilul lipidic Identificarea, prevenirea i tratarea complicaiilor micro- i macro- vasculare

  • Tratamentul cuprinde: Educaia medical continu Terapia nutriional Activitatea fizic Intervenia farmacologic

  • Educaia medical continu Scop:S-i ofere pacientului cunotine, abiliti i motivaie pentru a cuprinde automonitorizarea n viaa de zi cu zi Este un proces planificat i pentru a fi eficace trebuie individualizat

  • Terapia nutriional Carbohidrai : 45-65%Nu se recomand diet cu
  • Activitatea fizic Se recomand pentru: mbuntirea controlului glicemicScderea i meninerea greutii Scderea riscului cardiovascular 150 min/ spt, exerciii moderate de aerobicn absena contraindicaiilor, exerciii de rezisten

  • Tratament farmacologic Rezistenta la insulinaTiazolidindione1Kobayashi M. Diabetes Obes Metab 1999; 1 (Suppl. 1):S32S40.2Nattrass M & Bailey CJ. Baillieres Best Pract Res Clin Endocrinol Metab 1999; 13:309329.

  • Optiuni terapeutice pentru tipul 2 de DZSulfoniluree1 generatie: clorpropamid, tolbutamid2 generatie: glibenclamid, gliclazid, glipizid, gliquidone3 generatie: glimepirideGlinide/MeglitinideNon-sulfoniluree: repaglinideAmino acid derivat: nateglinideBiguanideMetforminBuforminThiazolidinedionerosiglitazona, pioglitazona Inhibitor de -glucosidase- acarbozaInsulinaregularintermediara/cu durata lungapre-mixataanalogiRapizicu durata lunga

    Antidiabetice orale combinatie fixaglibenclamid/metformin, glipizid/metformin,rosiglitazona/metformin

  • Comparatie ADO in functie de modul de actiune

  • Sulfoniluree II

  • -glucosidase inhibitors (e.g. acarbose) delay digestion and absorption of carbohydrates in the gastrointestinal tract.1,2 Sulfonylureas and meglitinides stimulate insulin secretion from the pancreas.1,2 Biguanides (e.g. metformin) suppress liver glucose output, enhance insulin sensitivity in the liver and stimulate insulin-mediated glucose disposal. They do not stimulate insulin secretion.1,2 Thiazolidinediones decrease insulin resistance in fat, muscle and liver. In addition, they have a beneficial effect on -cell function.1,2 When selecting agents for combination therapy, combining agents from different classes will give the best effects due to their complementary mechanisms of action.1Kobayashi M. Diabetes Obes Metab 1999; 1 (Suppl. 1):S32S40.2Nattrass M & Bailey CJ. Baillieres Best Pract Res Clin Endocrinol Metab 1999; 13:309329.There are currently a wide range of treatment options available for the management of type 2 diabetes.Over time, the choice of agents has evolved significantly, with introduction of new generations of sulfonylureas as well as novel classes of agents, such as the thiazolidinediones and meglitinides.There is also increasing choice in the types of insulin available.With growing interest in the earlier introduction of combination therapy, combining agents from different antidiabetic classes may be of benefit because of their complementary mechanisms of action. In addition, the increasing availability of fixed-dose oral antidiabetic combinations may increase convenience for both physician and patient.