Documente Academic
Documente Profesional
Documente Cultură
O chemare la actiune
Dr Mirela Culman
Institutul national de
Diabet,Nutritie si Boli metabolice
,,Nicolae Paulescu
Cardiovascular deaths
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
Statusul
protrombotic
Microalbuminuria
proinflamator
Obezitatea abdominal
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
EGIRb
NCEPc
Insulin resistance
&/or FPG
Insulin resistance
(hyperinsulinaemia)
FPG
Blood pressure
Blood pressure
Blood pressure
TG, HDL-C
TG, HDL-Cd
TG
Microalbuminuria
Central obesity
a
HDL-C
Central obesity
Central obesity
Definiie OMS
Definiie EGIR
72%
Year
International Diabetes Federation
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
% Surviving
100
80
No diabetes, no MI
Diabetes, no MI
60
Years of follow-up
Haffner SM et al. NEJM 1998;339:229-34
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
% Patients
Overweight patients
Type 2 diabetes
Matched controls
12 14
10 11
89
67
45
Goodkin
1975
Panzram &
Zabel-Langhennig
1981
16
11
10
6
5
78
56
34
3
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
CHD
MI
Stroke
Hypertension
Diabetic
CHD deaths/
1000 patient-years
Non-diabetic
Obesity
Serum cholesterol
(mmol/L)
SBP (mmHg)
BMI (kg/m2)
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