Diabetes - WK
Transcript of Diabetes - WK
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(3rd NHMS) showed that the prevalence of the T2DM
for adults aged 30 years old and above now stood at
a staggering 14.9% T2DM,
upped by almost 79.5% in the space of 10 yearsfrom 1996 to 2006.
The prevalence of T2DM is the highest among Indian
ethnic at 19.9% for those aged 30 years and above.
Fourty eight percent (48%) of patients above theage of 30 years old are not aware that they have
diabetes
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Symptommatic (tiredness, lethargy, polyuria,polydipsia, polyphagia, weight loss, pruritis vulvae,balanitis)
Asymptommatic Overweight (BMI) >23 kg/m2 or waist circumference (WC) 80
cm for women & 90 cm for men
Dyslipidaemia either high density lipoprotein (HDL)cholesterol 1.7 mmol/L
History of cardiovascular disease (CVD)
Hypertension (140/90 mmHg or on therapy for hypertension)
Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose
(IFG) First-degree relative with diabetes
Other clinical conditions associated with insulin resistance(e.g. severe obesity and acanthosis nigricans)
Physical inactivity
Women with polycystic ovarian syndrome (PCOS)
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Pregnant women should be screened if they have
any of the following risk factors:
BMI >27kg/m2 Previous macrosomic baby weighing 4kg or above
Previous gestational diabetes mellitus (GDM)
First-degree relative with diabetes
Bad obstetric history Glycosuria at the first prenatal visit
Current obstetric problems (essential hypertension,
pregnancy induced hypertension, polyhydramnios and
current use of steroids)
Age above 25
Women with history of GDM
age 30 years
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Anually
In children and adolescents, screen every
two years starting at the age of 10 years old
or at onset of puberty if puberty occurs at ayounger age.
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In the symptomatic individual, one abnormal
glucose value is diagnostic.
In the asymptomatic individual, 2 abnormal
glucose values are required.
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Patient is the central member - must
understand the condition, its effect on
health and the practicalities of management.
Primary Care PractitionerDietitian
Physician/Endocrinologist/Diabetologist
Ophthalmologist/optometrist
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Diet
Exercise - 150 min/week of moderate-
intensity aerobic physical activity and/or at
least 90min/week of vigorous aerobic.
If glycaemic targets are not achieved (HbA1c
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a-glucosidase inhibitors
Biguanides (Metformin)
Thiazolidinediones (TZDs)
Insulin Secretatogues Sus
Insulin Secretagogues Non-SUs orMeglitinides
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Orally administered glucose has a greater insulinstimulating effect than intravenously administeredglucose.
Incretins
The incretin effect is markedly decreased in T2DM,resulting in delayed and reduced insulin release aswell as lack of suppression of glucagon release aftera meal.
This led to the possibility that certain substancessecreted by the gastrointestinal mucosa stimulatedinsulin secretion. Glucagon, glucagon derivatives,secretin, cholecystokinin and gastrin inhibitorypeptide, all have such an action.
Recently, attention has been focused on glucagon-
like polypeptide 1 (GLP-1), an additional gut factorthat stimulates insulin secretion.
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GLP-1 is synthesized within L cells located predominantly inthe ileum and colon, and a lesser number in the duodenumand jejunum.
GLP-1 stimulates insulin secretion, suppresses glucagonsecretion, slows gastric emptying, reduces food intake,
increases cell mass, maintains cell function, improvesinsulin sensitivity and enhances glucose disposal.
The glucose lowering effects of GLP-1 are preserved in type 2diabetics.
However, native GLP-1 is rapidly degraded by dipeptidylpeptidase- IV(DPP-IV) after parenteral administration.
GLP-1 receptor (GLP-1R) agonists and DPP-IV inhibitors haveshown promising results in clinical trials for the treatment of
type 2 diabetes.
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2 classes of drugs have recently been
developed: DPP-4 inhibitor (incretin
enhancer) and GLP-1 analogue or GLP-1
receptor agonist (incretin mimetic).
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Dipeptidyl peptidase-4 (DPP-4) Inhibitor
(Sitagliptin)
It lowers HbA1c by 0.5 0.8%
GLP-1 Analogue (Exenatide)
It is given parenterally, just before breakfast
and dinner.
It reduces HbA1c by 0.5 1.0%
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act at the gut epithelium, to reduce the rate ofdigestion of polysaccharides in the proximal small
intestine by inhibiting a-glucosidase enzymes.
They should be taken with main meals
primarily lower postprandial glucose without causinghypoglycaemia
Reducing HbA1c by 0.50.8%
commonest side effects are bloating, abdominal
discomfort, diarrhea and flatulence.
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Stimulate pancreas to secrete insulin Glyburide (Diabeta) [Prototype Pro p 393] Glucotrol (Glipizide)
Diabenese (chlorpropamide)
Adverse reactions Hypoglycemia
Water retention/edema
Photosensitivity
May need to add insulin in times of stress
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Decreases liver production of glucose
Decreases intestinal absorption of glucose
Improves cell sensitivity to insulin
Example: Metformin
Metformin monotherapy will lower HbA1c by about1.5%. GI upset, flatulence
C/I: serum creatinine >150 mol/l or creatinineclearance
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Increase cellular sensitivity to insulin
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Client should have liver enzymes
checked periodically
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Blood glucose monitoring
Body weight monitoring
Foot-care
Personal hygiene
Healthy lifestyle/diet and physical activity
Identify targets for control
Stop smokingAlcohol intake