2013糖尿病诊疗接项目解读.ppt

糖尿病诊疗项目新近解读 Hospital of Integrated Chinese and Western Furen 辅仁中西结合医院 2013年杨保忠 本文主要是糖尿病管理中涉及的诊疗问题讲课材料，使用的国内外资料为文献资料，一并致谢。仅供学习参考。 糖尿病诊断新标准 糖尿病诊断标准：仍采用WHO1999年标准 糖尿病分型 临床阶段 正常血糖—正常糖耐量阶段 高血糖阶段 糖调节受损 糖尿病 病因分型 1型糖尿病：两个亚型 2型糖尿病 其他特殊类型糖尿病：八个亚型 妊娠期糖尿病 肝病性 特殊类型糖尿病： 1.β细胞功能的遗传缺陷：常染色体或线粒体基因突变致胰岛β细胞功能缺陷使胰岛素分泌不足 ????? ?2.胰岛素作用的遗传缺陷：严重胰岛素抵抗、高胰岛素血症伴黑棘皮病为特征 ????? ?3.胰腺外分泌病变：胰腺炎、创伤/胰腺切除术后、胰腺肿瘤、胰腺囊性纤维化、 ????? ??????????????????血色病、纤维钙化性胰腺病及其他 ????? ?4.内分泌腺病：肢端肥大症、柯兴综合征、胰升糖素瘤、嗜铬细胞瘤、甲状腺功能 ????? ??????????????亢进症、生长抑素瘤及其他 ????? ?5.药物或化学物诱导：Vacor（杀鼠剂）、戊脘眯、烟酸、糖皮质激素、甲状腺激素、 ????? ????????????????????二氮嗪、b-肾上腺素能激动剂、噻嗪类利尿剂、苯妥英钠、 ????? ????????????????????a-干扰素及其他 ????? ?6.感染：先天性风疹、巨细胞病毒感染及其他 ???????????? ?7.免疫介导的罕见类型：“僵人”综合征、抗胰岛素受体抗体及其他 ????? ?8.伴糖尿病的其他遗传综合征:Down综合征、Turner综合征、 Klinefeter综合 ????? ???????????????????????????征Wolfram综合征、Friedrich共济失调、Huntington ????? ???????????????????????????舞蹈病、Laurence-Moon-Beidel综合征、强直性肌 ????? ???????????????????????????营养不良、卟啉病、Prader-Willi综合征及其他 Type 1 diabetes is characterized by a loss of pancreatic β-cells and therefore an absolute insulin deficiency. The mainstay of therapy, therefore, is insulin treatment. Because the disease does not affect insulin sensitivity, patients typically require small doses of insulin to maintain glucose control. type 2 diabetes is characterized by preexisting insulin resistance followed by a relative insulin deficiency. As a result of insulin resistance and progressive insulin deficiency, patients with type 2 diabetes typically require higher doses of insulin with gradual upward titration of doses. Chronic liver disease (CLD) The presence of CLD is associated with significant impairment in glucose homeostasis. Glucose intolerance is seen in up to 80% of patients with CLD, and frank diabetes is present in 30–60%.9,10 Depending on its etiology, CLD has a significant impact on hepatic glucose metabolism. One of the common causes of CLD is chronic hepatitis C. Chronic hepatitis C is accompanied by insulin resistance,