糖尿病基础知识-英文课件.ppt
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1、Dr.Rasha Salama PhD Public Health,Suez Canal University,Egypt Diabetes MSc,Cardiff University,United Kingdom?Diabetes mellitus(DM)is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production,insulin action,or both.?The term diabetes mellitus descr
2、ibes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate,fat and protein metabolism resulting from defects in insulin secretion,insulin action,or both.?The effects of diabetes mellitus include long term damage,dysfunction and failure o
3、f various organs.?Diabetes mellitus may present with characteristic symptoms such as thirst,polyuria,blurring of vision,and weight loss.?In its most severe forms,ketoacidosis or a non ketotic hyperosmolar state may develop and lead to stupor,coma and,in absence of effective treatment,death.?Often sy
4、mptoms are not severe,or may be absent,and consequently hyperglycaemia sufficient to cause pathological and functional changes may be present for a long time before the diagnosis is made.?The longterm effects of diabetes mellitus include progressive development of the specific complications of retin
5、opathy with potential blindness,nephropathy that may lead to renal failure,and/or neuropathy with risk of foot ulcers,amputation,Charcot joints,and features of autonomic dysfunction,including sexual dysfunction.?People with diabetes are at increased risk of cardiovascular,peripheral vascular and cer
6、ebrovascular disease.?The development of diabetes is projected to reach pandemic proportions over the next10-20 years.?International Diabetes Federation(IDF)data indicate that by the year 2025,the number of people affected will reach 333 million 90%of these people will have Type 2 diabetes.?In most
7、Western societies,the overall prevalence has reached 4-6%,and is as high as 10-12%among 60-70-year-old people.?The annual health costs caused by diabetes and its complications account for around 6-12%of all health-care expenditure.?Type 1 Diabetes Mellitus?Type 2 Diabetes Mellitus?Gestational Diabet
8、es?Other types:?LADA(?MODY(maturity-onset diabetes of youth)?Secondary Diabetes Mellitus?Was previously called insulin-dependent diabetes mellitus(IDDM)or juvenile-onset diabetes.?Type 1 diabetes develops when the bodys immune system destroys pancreatic beta cells,the only cells in the body that mak
9、e the hormone insulin that regulates blood glucose.?This form of diabetes usually strikes children and young adults,although disease onset can occur at any age.?Type 1 diabetes may account for 5%to 10%of all diagnosed cases of diabetes.?Risk factors for type 1 diabetes may include autoimmune,genetic
10、,and environmental factors.?Was previously called non-insulin-dependent diabetes mellitus(NIDDM)or adult-onset diabetes.?Type 2 diabetes may account for about 90%to 95%of all diagnosed cases of diabetes.?It usually begins as insulin resistance,a disorder in which the cells do not use insulin properl
11、y.As the need for insulin rises,the pancreas gradually loses its ability to produce insulin.?Type 2 diabetes is associated with older age,obesity,family history of diabetes,history of gestational diabetes,impaired glucose metabolism,physical inactivity,and race/ethnicity.?African Americans,Hispanic/
12、Latino Americans,American Indians,and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes.?Type 2 diabetes is increasingly being diagnosed in children and adolescents.?A form of glucose intolerance that is diagnosed in some women dur
13、ing pregnancy.?Gestational diabetes occurs more frequently among African Americans,Hispanic/Latino Americans,and American Indians.It is also more common among obese women and women with a family history of diabetes.?During pregnancy,gestational diabetes requires treatment to normalize maternal blood
14、 glucose levels to avoid complications in the infant.?After pregnancy,5%to 10%of women with gestational diabetes are found to have type 2 diabetes.?Women who have had gestational diabetes have a 20%to 50%chance of developing diabetes in the next 5-10 years.?Other specific types of diabetes result fr
15、om specific genetic conditions(such as maturity-onset diabetes of youth),surgery,drugs,malnutrition,infections,and other illnesses.?Such types of diabetes may account for 1%to 5%of all diagnosed cases of diabetes.?Latent Autoimmune Diabetes in Adults(LADA)is a form of autoimmuneautoimmune(type 1 dia
16、betestype 1 diabetes)which is diagnosed in individuals who are older than the usual age of onset of type 1 diabetes.?Alternate terms that have been used for LADA include Late-onset Autoimmune Diabetes of Adulthood,Slow Onset Type 1 diabetes,and sometimes also Type 1.5?Often,patients with LADA are mi
17、stakenly thought to have type 2 diabetestype 2 diabetes,based on their age at the time of diagnosis.?About 80%of adults apparently with recently diagnosed Type 2 diabetes but with GAD auto-antibodies(i.e.LADA)progress to insulin requirement within 6 years.?The potential value of identifying this gro
18、up at high risk of progression to insulin dependence includes:?the avoidance of using metformin treatment?the early introduction of insulin therapy?MODY Maturity Onset Diabetes of the Young?MODY is a monogenic form of diabetes with an autosomal dominant mode of inheritance:?Mutations in any one of s
19、everal transcription factors or in the enzyme glucokinase lead to insufficient insulin release from pancreatic?-cells,causing MODY.?Different subtypes of MODY are identified based on the mutated gene.?Originally,diagnosis of MODY was based on presence of non-ketotic hyperglycemia in adolescents or y
20、oung adults in conjunction with a family history of diabetes.?However,genetic testing has shown that MODY can occur at any age and that a family history of diabetes is not always obvious.?Within MODY,the different subtypes can essentially be divided into 2 distinct groups:glucokinase MODY and transc
21、ription factor MODY,distinguished by characteristic phenotypic features and pattern on oral glucose tolerance testing.?Glucokinase MODY requires no treatment,while transcription factor MODY(i.e.Hepatocyte nuclear factor-1alpha)requires low-dose sulfonylurea therapy and PNDM(caused by Kir6.2 mutation
22、)requires high-dose sulfonylurea therapy.Secondary causes of Diabetes mellitus include:?Acromegaly,?Cushing syndrome,?Thyrotoxicosis,?Pheochromocytoma?Chronic pancreatitis,?Cancer?Drug induced hyperglycemia:?Atypical Antipsychotics-Alter receptor binding characteristics,leading to increased insulin
23、resistance.?Beta-blockers-Inhibit insulin secretion.?Calcium Channel Blockers-Inhibits secretion of insulin by interfering with cytosolic calcium release.?Corticosteroids-Cause peripheral insulin resistance and gluconeogensis.?Fluoroquinolones-Inhibits insulin secretion by blocking ATP sensitive pot
24、assium channels.?Naicin-They cause increased insulin resistance due to increased free fatty acid mobilization.?Phenothiazines-Inhibit insulin secretion.?Protease Inhibitors-Inhibit the conversion of proinsulin to insulin.?Thiazide Diuretics-Inhibit insulin secretion due to hypokalemia.They also caus
25、e increased insulin resistance due to increased free fatty acid mobilization.?Prediabetes is a term used to distinguish people who are at increased risk of developing diabetes.People with prediabetes have impaired fasting glucose(IFG)or impaired glucose tolerance(IGT).Some people may have both IFG a
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