1. Diabetes Sandra Milena Acevedo Rueda MD Residente Medicina Interna UNAB

2. Diabetes Clasificacin Tipo 1 Tipo 2 Otros tipos especficos Gestacional Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 3. Diabetes Diagnstico Durante dcadas Glucosa en ayunas Prueba de tolerancia oral a 75 gr de glucosa Desde 2009 HBA1c Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 4. Diabetes Criterios diagnsticos HBA1c > 6.5% Glucemia en ayunas >126mg/dL Glucemia post carga >200mg/dL Sntomas clsicos de hiperglucemia y glucemia al azar >200mg/dL Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 5. Diabetes Pacientes en riesgo de Diabetes Glucemia en ayunas de 100 125mg/dL Glucemia post carga 140 199mg/dL HBA1C 5,5-6 Riesgo a 5 aos de 9 25% HBA1C 6-6,5 Riesgo a 5 aos de 2550% Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 6. Diabetes Pacientes en riesgo de Diabetes (Prediabetes) HBA1C 5,7-6,4% Alto riesgo de Diabetes y Enfermedad cardiovascular Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 7. Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 8. Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 9. Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 10. Diabetes Screening en paciente asintomtico IMC >25k/m2 y 1 ms de los siguientes FR Inactividad fsica Familiares 1er GC Diabetes Raza Mujeres que tuvieron hijo >9L DG Hipertensin tratamiento HDL y triglicridos ACOS HBA1c, Glucosa ayunas , Glucosa poscarga Condiciones asociadas a Resistencia Insulina Historia de enfermedad cardiovascular Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 En ausencia de los anteriores, iniciar los estudios a partir de los 45 aos 11. Diabetes Screening en paciente Asintomtico Al tercer ao Si normal, cada 3 o 5 aos Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 12. Diabetes Diabetes Gestacional Screening DM2 primera consulta prenatal -B Semana 24 a 28 con carga de glucosa 75 gr ** -B Diabetes persistente 6-12 sem posparto -E Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 13. Diabetes Diabetes Gestacional Uno de los siguientes criterios Glucosa en ayuno 92 mg/dL 1 h -- 180 mg/dL 2 h -- 153 mg/dL Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 14. Control glucmico en mujeres con GDM (glucometra) Control glucmico en mujeres DMT1 y DMT2 embarazadas (glucometra) Diabetes Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 15. Diabetes Prevenir o retrasar la DM Reduccin peso 7% Actividad fsica moderada 150min/sem Puede considerarse Metformina (preD, 60, aDG, IMC>35) -A Monitoreo anual E Glucosa antes del ejercicio - Riesgo de HipoG Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 16. Diabetes Tratamiento en DM 2 Cada nueva clase de agente no insulinico disminuye de 0,9 a 1,1% la HBA1c Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 17. Diabetes Dieta Baja en caloras, CH, grasa Dieta mediterrnea Efectiva: 2 aos -A Dietas bajas en CH ! -E Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 18. Diabetes Dieta 14 gramos de fibra -B Bebidas libres de azcar B Reduccin HBA1C 0,25-2,9% Reduccin LDL 15-25mg/dL Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 19. Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 20. HBA1c Realizar el test al menos dos veces por ao en pacientes que hayan cumplido las metas de tto, o quienes tienen un estable nivel de glucemia (E). Realizarla trimestralmente en pacientes en los que la terapia ha sido cambiada, o no cumplen los objetivos glucemicos (E). Permitir plantear cambios de tratamiento a tiempo (E). Diabetes Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 21. HBA1c Limitaciones: Bsicamente condiciones que afectan el vmen de los GR (hemlisis y prdida de sangre) y variaciones en la Hb, en especial cuando no existe correlacin entre los niveles y la clnica. Diabetes Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 22. A1C-Derived Average Glucose (ADAG) Correlation (r 5 0.92) No diferencias entre poblaciones (etnicidad) Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 23. Standards of Medical Care in Diabetes 2012. Position Statement. Diabetes Care, Volume 35, Supplement 1, January 2012 24. Objetivos Glucmicos (Adultos) A1c