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DIABETUL ZAHARAT TIP2

O chemare la actiune
Dr Mirela Culman
Institutul national de
Diabet,Nutritie si Boli metabolice
,,Nicolae Paulescu

Bolile cardiovasculare cauz major de


deces
deces (%)

Geiss LS et al. Diabetes in America.2nd ed.Bethesda, MD:NIH;1995

Mortalitate cardiovascular crescut la


pacienii cu Sindrom metabolic
CHD deaths

Cardiovascular deaths

Cumulative hazard (%)

10

10

Relative risk
3.77 (1.74, 8.17)

Relative risk
3.55 (1.96, 6.43)

DMS

5
DMS

No DMS

0
0

No DMS

0
12

12

Years of follow-up
Lakka HM et al. JAMA 2002;288:2709-16

Conglomerat de factori de risc pentru boala


cardio vascular

Statusul
protrombotic

Microalbuminuria

proinflamator

Obezitatea abdominal

Riscul de boal cardiovascular se multiplic


n funcie de factorii de risc asociai

HIPERTENSIUNE
TAS 15o mmHg
X 1,5

X 3,8
X 6,2

X 2,6
DIABET

DISLIPIDEMIE
Colesterol 260 mg/dl
X
2,3
X4

X 1,8

Risc bazal 15/1000 (1,5%) n 8 ani


KannelWB.Importanceof hypertensionas amajor risk factorin cardiovascular disease ,in Hypertension:
Physiopathology and treatament. New York NY:MacGraw-Hill BookCo;1977:888-910

Sindromul metabolic - Quartetul


uciga
WHOa

EGIRb

NCEPc

Insulin resistance
&/or FPG

Insulin resistance
(hyperinsulinaemia)

FPG

Plus 2 or more of:

Plus 2 or more of:

Plus 2 or more of:

Blood pressure

Blood pressure

Blood pressure

TG, HDL-C

TG, HDL-Cd

TG

Microalbuminuria
Central obesity
a

HDL-C
Central obesity

Central obesity

World Health Organisation; bEuropean Group for the study

of Insulin resistance; cNational Cholesterol Education Program;


d

and/or treatment for dyslipidaemia

Eschwege E. Diabetes Metab 2003;29:6S19-27

Prevalena sindromului metabolic n Europa

Definiie OMS

Definiie EGIR

Balkau B et al. Diabetes Metab 2002;28:364-76


Eschwege E. Diabetes Metab 2003;29:6S19-27

Prevalena sindromului metabolic n USA

National Cholesterol Education


Program definition

World Health Organisation


definition

Ford ES, Giles WH. Diabetes Care 2003;26:575-81


Eschwege E. Diabetes Metab 2003;29:6S19-27

Cel mai tipic exemplu de sindrom


metabolic
Diabetul tip 2

La fiecare 21 secunde apare un caz nou de diabet !

Number of people with


diabetes world wide (millions)

Epidemie global de diabet

72%

Year
International Diabetes Federation

Diabetul determin risc crescut pentru


evenimente cardiovasculare
Risc de 3 ori mai mare
De infarct de miocard

Risc de 25 ori mai mare de


moarte de cauz crdiovascular
Cu diabet

No Diabetes
diabetes
RR: relative risk
1

CV deaths/100,000
person-years (age adjusted)

Incidence (%)

Fr diabet

RR 2.6

120

RR 4.1

80
40

RR 4.8
RR 5.1

0
1
2
3
Number of cardiovascular risk factors

Haffner SM et al. NEJM 1998;339:229-34; 2Stamler J et al. Diabetes Care 1993;16:434-44

Pacientul cu DZ 2 are prognostic asemntor cu cel


nediabetic care a suferit un IM

% Surviving

100

80
No diabetes, no MI
Diabetes, no MI

60

No diabetes, with prior MI


Diabetes, with prior MI
40
0

Years of follow-up
Haffner SM et al. NEJM 1998;339:229-34

Toate atingerile de organ date de diabet


sunt de natur angiopat Micro/Macro
Liebl A. et al. Dtsch. Med. Wochenschr. 126,585,2001

AVC

La fiecare 12 minute

Orbire

La fiecare 90 minute

IM

La fiecare 19 minute

Dializ
Amputaie

La fiecare 90 minute
La fiecare 19 minute

n Statele Unite
n fiecare 24 de ore
Peste 65 orbesc
656 dezvolt insuficen renal i ncep
dializa renal
Peste 500 mor datorit complicaiilor
2200 persoane sunt diagnosticate cu
diabet
153 sufer o amputaie de m inferior

Prevalena complicaiilor dibetului

% Patients

Data from a UK primary care audit (10,709 diabetic patients)

CHD: coronary heart disease


CVD: cerebrovascular disease
Morgan CL. Diabet Med 2000;17:146-51

Raportul dintre costul global i costul complicaiilor


Non - overweight patients
Mean cost/patient (1000)

Mean cost/patient (1000)

Overweight patients

Cost of managing complications

Overall costs (standard practice)

UKPDS 41. BMJ 2000;329:1375-8; UKPDS 51. Diabetologia 2000;44:298-304

Costurile diabetului nainte i dup diagnostic


Costs after diagnosis

Total treatment cost


(US $ x 1000)

Costs before diagnosis

Years before diagnosis

Years after diagnosis

Type 2 diabetes
Matched controls

Brown JB et al. Diabetes Care 1999;22:1116-24;


Nichols GA et al. Diabetes Care 2000;23:1654-9

Diabetul tip 2 reduce sperana de via


Years of life expectancy lost according to age
at diagnosis of diabetes
Age at
Marks & Krall
diagnosis
1971
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 +

12 14
10 11
89
67
45

Goodkin
1975

Panzram &
Zabel-Langhennig
1981

16
11
10
6
5

78
56
34
3

Panzram G. Diabetologia 1987;30:123-31

Diabetul tip 2 amplific efectele adverse ale


sindromului metabolic
Diabet tip2

Fr diabet
30

20
RR 1.7
p=0.04
RR 1.2
p=0.62

10

RR 1.3
p=0.59

Prevalence (%)

Prevalence (%)

30

RR 2.2
p<0.001

20

RR 2.3
p=0.007

10

RR 1.8
p=0.013

CHD

MI

Stroke

Dysmetabolic syndrome present


RR: relative risk

CHD

MI

Stroke

Dysmetabolic syndrome absent


Isomaa B et al. Diabetes Care 2001;24:683-9

Componentele sindromului metabolic


amplific riscul cardiovascular la diabetici
Dyslipidaemia

Hypertension
Diabetic

CHD deaths/
1000 patient-years

Non-diabetic

Obesity

Serum cholesterol
(mmol/L)

SBP (mmHg)

BMI (kg/m2)

Adlerberth AM et al. Diabetes Care 1998;21:539-45;


Eschwege E. Diabetes Metab 2003;29:6S19-27

% patients with complications

Complicaiile cronice ale diabetului apar mai


frecvent la pacienii care asociaz sindrom
metabolic

PVD: peripheral vascular disease


CAD: coronary artery disease
DSN: Distal sensory neuropathy

Costa LA et al. Diabet Med 2004;21:252-5

% with each risk factor

Riscul de complicaii cronice crete proporional cu


severitatea sindromului metabolic
No. of risk
factors:

PVD: peripheral vascular disease


CAD: coronary artery disease
DSN: Distal sensory neuropathy

Costa LA et al. Diabet Med 2004;21:252-5

Managementul
intensiv si multifacorial
Control glicemic bun

Tratament

Complicaii
microvasculare i
macrovasculare
Sindromul metaboloic
Rezistena la insulin, obezitate,
hiperinsulinemia, hipertensiune,
dislipidemia, ateroscleroz, status
procoagulant, proinflamator