Diabetes MellitusZhao-xiaojuanIntroduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.IntroductionThe chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.SymptomsPolyuriaPolydipsia (thirst)Weight lossWeaknessPolyphagiaBlurred visionRecurrent infectionImpairment of growthCriteria for diagnosis of diabetes (WHO1999)Symptoms of diabetes + Casual plasma glucose 1.1mmol/l(200mg/dl)Or FPG 7.0mmol/l (126mg/dl)Or 2-hPG 11.1mmol/lDiagnostic CriteriaWHO1999IGT-FPG7.0 10.0 HbA1c(%)8.0Blood pressure(mmHg)130/80- 160/95BMI (kg/m2)Male female1.11.1-0.94.4ManagementEssentials of managementMonitoring of glucose levelsFood planningPhysical activityTreatment of hyperglycemia2.Monitoring of Glucose LevelsBlood glucose levels- before each meal- at bedtime Urine glucose testingUrine ketone tests (should be performed during illness or when blood glucose is 20mmol/L ) 3.Food PlanningWeight control.50-60%of the total dietary energy should come from complex carbohydrates.20-25% form fats and oils.15-20% from protein.Restrict alcohol intake.Restrict salt intake to below 7g/d. 4.Physical ActivityPhysical activity play an important role in the management of diabetes particularly in T2DM. Physical activity improves insulin sensitivity, thus improving glycemic control, and may help with weight reduction Do sparingly avoid sedentary activitiesDo regularly participate in leisure activities and recreational sportsDo every day adopt healthy lifestyle habits5.Drug TreatmentIf the patient is very symptomatic or has a very high blood glucose level, diet and lifestyle changes are unlikely to achieve target values. In this instance, pharmacological therapy should be started without delay.TreatmentSulphonylureasBiguanides-Glucosidase inhibitorsThiazolidinedionesGlinidesInsulinCombination therapy1.SulphonylureasChlorpropamideTolbutamideGlibenclamideGlipizideGliclazideGliguidone Glimepiride2.BiguanidesMetforminPhenformin Buformin 3.-Glucosidase inhibitorsAcarboseVogliboseMiglitol4.ThiazolidinedionesRosiglitazonePioglitazoneCiglitazone 5.GlinidesNategliniderepaglinide6.InsulinInsulin is the most efficacious pharmacologic treatment for patients with diabetes6.InsulinIndication PreparationTherapy Adverse reactionManagement Algorithm for Overweight and Obese T2DMDiet Exercise and weight control Failure Add biguanide, TZD or -glucosidase inhibitors Failure Failure Combine two of these or add sulphonylurea or glinideAdd insulin or change to insulinCheck adherance at each stepManagement Algorithm for Non-Obese T2DMFailure FailureFailureAdd sulphonylurea, biguanide, - glucosidase inhibitors or glinideCombine sulphonylurea or glinide with biguande and/or -glucosidase inhibitors and/or add TZDAdd insulin or change to insulinCheck adherance at each step