دكتور  /  موسى العنزي <ul><li>استشاري طب اسرة </li></ul>
Definition, Classification and Diagnosis of Diabetes
<ul><li>Diabetes mellitus  is a  metabolic disorder characterized by the presence of hyperglycemia due to defective insuli...
Classification of diabetes Type 1 diabetes*  is diabetes that is primarily a result of pancreatic beta cell destruction an...
<ul><li>Type 1 diabetes </li></ul><ul><li>is a disease resulting from  absolute insulin deficiency , usually caused by aut...
The typical patient with  type 1 diabetes <ul><li>Is often diagnosed as a  child or young adult  (although it can occur at...
Type 2 diabetes <ul><li>is a disease resulting from a relative, rather than an absolute, insulin deficiency with an underl...
The typical patient with  type 2 diabetes <ul><li>Is more likely to be diagnosed as an  adult .  </li></ul><ul><li>Is over...
Criteria for the diagnosis of  diabetes <ul><li>The diagnostic criteria for diabetes and the plasma glucose thresholds for...
<ul><li>Normal   </li></ul><ul><li>Fasting plasma glucose  <100  mg/dl  o r  </li></ul><ul><li>Oral glucose tolerance test...
 
<ul><li>Revision of the section &quot; Diagnosis of Diabetes &quot; now includes the use of the A1c level for diabetes dia...
Criteria for testing for pre-diabetes and diabetes in asymptomatic adult <ul><li>1.  Testing should be considered in all a...
Monitoring Glycemic Control <ul><li>Glycated hemoglobin (A1C)  is a valuable indicator of treatment effectiveness, and sho...
<ul><li>A recent consensus statement by the  American Diabetes Association (ADA) and the European Association for the Stud...
SELF-MONITORING OF BLOOD GLUCOSE <ul><li>Awareness of all measures of glycemia, including  self monitoring of blood glucos...
<ul><li>SMBG  should only be used if the purpose for SMBG is defined and agreed between the  doctor, diabetes educator and...
Self-management education   <ul><li>The objectives of diabetes self-management education (SME) are to increase the  indivi...
<ul><li>Extensive revisions to the section &quot; Diabetes Self-Management Education &quot; are based on new evidence.  </...
<ul><li>The term “ SME ,” rather than “diabetes education,” emphasizes the importance of including a variety of  client-ce...
ELEMENTS OF SME <ul><li>The essential components of SME are hypothesized to include : </li></ul><ul><li>Interventions that...
Involvement of medical providers in providing the intervention . <ul><li>Education  should be offered in a timely and need...
RECOMMENDATIONS   <ul><li>R1. People with diabetes should be offered timely diabetes education that is tailored to enhance...
Self –management education Incorporate cognitive, behavioral and social interventions that include  Goal – setting Problem...
15/06/10 Riyadh PHC / HPTD
Upcoming SlideShare
Loading in...5
×

Classification &amp; Diagnosis Of Diabetes

1,258

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,258
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Classification &amp; Diagnosis Of Diabetes

  1. 1. دكتور / موسى العنزي <ul><li>استشاري طب اسرة </li></ul>
  2. 2. Definition, Classification and Diagnosis of Diabetes
  3. 3. <ul><li>Diabetes mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both . </li></ul><ul><li>The chronic hyperglycemia of diabetes is associated with significant long-term sequel, particularly damage, dysfunction and failure of various organs – especially the kidneys, eyes, nerves, heart and blood vessels. </li></ul>Definition
  4. 4. Classification of diabetes Type 1 diabetes* is diabetes that is primarily a result of pancreatic beta cell destruction and is prone to ketoacidosis. This form includes cases due to an auto- immune process and those for which the etiology of beta cell destruction is unknown. Type 2 diabetes may range from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance. Gestational diabetes mellitus refers to glucose intolerance with onset or first recognition during pregnancy. Other specific types include a wide variety of relatively uncommon conditions, primarily specific genetically defined forms of diabetes or diabetes associated with other diseases or drug use. * Includes latent autoimmune diabetes in adults (LADA), and includes the small number of people with apparent type 2 diabetes who appear to have immune-mediated loss of pancreatic beta cells
  5. 5. <ul><li>Type 1 diabetes </li></ul><ul><li>is a disease resulting from absolute insulin deficiency , usually caused by autoimmune destruction of pancreatic islet cells. </li></ul><ul><li>Other autoimmune disorders may also be present such as Addison’s disease, thyroiditis, and pernicious anemia. </li></ul>
  6. 6. The typical patient with type 1 diabetes <ul><li>Is often diagnosed as a child or young adult (although it can occur at any age). </li></ul><ul><li>Is lean (i.e., BMI less than 25 kg/m2 ). </li></ul><ul><li>Displays normal insulin sensitivity , i.e., insulin requirements do not exceed 0.7 units of insulin/kilogram body weight/24 hours. </li></ul>
  7. 7. Type 2 diabetes <ul><li>is a disease resulting from a relative, rather than an absolute, insulin deficiency with an underlying insulin resistance . </li></ul><ul><li>Types of diabetes </li></ul>
  8. 8. The typical patient with type 2 diabetes <ul><li>Is more likely to be diagnosed as an adult . </li></ul><ul><li>Is overweight or obese (i.e., BMI > 25 kg/m2 , and often far exceeding that BMI). </li></ul><ul><li>Is more likely to have a family history of diabetes (>90% of those with type 2 diabetes will have a first degree relative with the disease). </li></ul><ul><li>• If treated with insulin, is more likely to require very large doses to control the blood glucose (e.g., >0.7 units/kg/day) due to insulin resistance . </li></ul><ul><li>Such individuals frequently have characteristics associated with insulin resistance, including abdominal obesity, hypertension, lipid abnormalities, atherosclerosis, and hyperuricemia. </li></ul>
  9. 9. Criteria for the diagnosis of diabetes <ul><li>The diagnostic criteria for diabetes and the plasma glucose thresholds for other diagnostic categories are based on venous samples and laboratory methods . </li></ul>
  10. 10. <ul><li>Normal </li></ul><ul><li>Fasting plasma glucose <100 mg/dl o r </li></ul><ul><li>Oral glucose tolerance test (OGTT) 2-hr plasma glucose <140 mg/dl </li></ul><ul><li>Pre-diabetes </li></ul><ul><li>Impaired fasting glucose (IFG) = fasting plasma glucose of 100–125 mg/dl or </li></ul><ul><li>Impaired glucose tolerance (IGT) = OGTT 2-hr plasma glucose of 140–199 mg/dl </li></ul><ul><li>Diabetes </li></ul><ul><li>1. Symptoms of diabetes and a casual plasma glucose > 200 mg/dl. “ </li></ul><ul><li>Casual ” is defined as any time of day, without regard to the time since the last meal. + The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss. or </li></ul><ul><li>2. Fasting plasma glucose > 126 mg/dl. </li></ul><ul><li>Fasting is defined as no caloric intake for at least eight hours. </li></ul><ul><li>3. 2-h plasma glucose > 200 mg/dl during an oral glucose tolerance test . The test should be performed using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water . </li></ul>
  11. 12. <ul><li>Revision of the section &quot; Diagnosis of Diabetes &quot; now includes the use of the A1c level for diabetes diagnosis, with a cutoff point of 6.5%. </li></ul><ul><li>The section formerly named &quot; Diagnosis of Pre-diabetes &quot; is now named &quot; Categories of Increased Risk for Diabetes .&quot; Categories suggesting an increased risk for future diabetes now include an A1c range of 5.7% to 6.4%, as well as impaired fasting glucose and impaired glucose tolerance levels. </li></ul>ADA 2010
  12. 13. Criteria for testing for pre-diabetes and diabetes in asymptomatic adult <ul><li>1. Testing should be considered in all adults who are overweight (BMI _25 kg/m 2 *) and </li></ul><ul><li>have additional risk factors: </li></ul><ul><ul><li>physical inactivity </li></ul></ul><ul><li>first-degree relative with diabetes </li></ul><ul><li>members of a high-risk ethnic population. </li></ul><ul><li>women who delivered a baby weighing 9 lb or were diagnosed with GDM </li></ul><ul><li>hypertension (140/90 mmHg or on therapy for hypertension) </li></ul><ul><li>HDL cholesterol level -35 mg/dl (0.90 mmol/l) and/or a triglyceride level -250 </li></ul><ul><li>mg/dl (2.82 mmol/l) </li></ul><ul><li>women with polycystic ovarian syndrome (PCOS) </li></ul><ul><li>IGT or IFG on previous testing </li></ul><ul><li>other clinical conditions associated with insulin resistance (e.g., severe obesity, </li></ul><ul><li>acanthosis nigricans) </li></ul><ul><li>history of CVD </li></ul><ul><li>2. Age 45 years </li></ul><ul><li>If results are normal, testing should be repeated at least at 3-year intervals, with </li></ul><ul><li>consideration of more frequent testing depending on initial results and risk status </li></ul>
  13. 14. Monitoring Glycemic Control <ul><li>Glycated hemoglobin (A1C) is a valuable indicator of treatment effectiveness, and should be measured every 3 months . Diagnosis of diabetes </li></ul>
  14. 15. <ul><li>A recent consensus statement by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes states that “an A1C of > 7% should serve as a call to action to initiate or change therapy.” For most patients, the A1C should be decreased to <7%. </li></ul>
  15. 16. SELF-MONITORING OF BLOOD GLUCOSE <ul><li>Awareness of all measures of glycemia, including self monitoring of blood glucose (SMBG) results and A1C , provide the best information to assess glycemic control . </li></ul>
  16. 17. <ul><li>SMBG should only be used if the purpose for SMBG is defined and agreed between the doctor, diabetes educator and person with diabetes , including a defined plan on how the results are to be used </li></ul>
  17. 18. Self-management education <ul><li>The objectives of diabetes self-management education (SME) are to increase the individual’s involvement in, confidence with and motivation for control of their diabetes, its treatment and its effect on their lives </li></ul>
  18. 19. <ul><li>Extensive revisions to the section &quot; Diabetes Self-Management Education &quot; are based on new evidence. </li></ul><ul><li>Goals of diabetes self-management education are to improve adherence to standard of care, to educate patients regarding appropriate glycemic targets, and to increase the percentage of patients achieving target A1c levels . </li></ul>ADA 2010
  19. 20. <ul><li>The term “ SME ,” rather than “diabetes education,” emphasizes the importance of including a variety of client-centred strategies and interventions that address the physical, psychological and social management of living with a chronic illness. </li></ul>
  20. 21. ELEMENTS OF SME <ul><li>The essential components of SME are hypothesized to include : </li></ul><ul><li>Interventions that include face-to-face delivery, </li></ul><ul><li>Education tailored to individual needs and circumstances; </li></ul><ul><li>A group setting with others who share the same condition; </li></ul><ul><li>Feedback following an intervention. </li></ul><ul><li>psychological emphasis in the intervention; </li></ul>
  21. 22. Involvement of medical providers in providing the intervention . <ul><li>Education should be offered in a timely and needs-based manner. </li></ul><ul><li>SME program should include a problem-solving component; monitoring of relevant health parameters; healthy eating; physical activity; pharmacotherapy; hypo- and hyperglycemia prevention and management; and prevention and surveillance of complications and co-morbid conditions . </li></ul><ul><li>Skill training during SME should include self-monitoring of blood glucose (SMBG), making dietary choices, incorporating an exercise regimen , using medications as recommended and possible medication adjustment. Education for flexible insulin management and dietary freedom has been shown to improve quality of life as well as glycemic control. </li></ul>
  22. 23. RECOMMENDATIONS <ul><li>R1. People with diabetes should be offered timely diabetes education that is tailored to enhance self-care practices and behaviors </li></ul><ul><li>R2.All people with diabetes who are able should be taught how to self-manage their diabetes, including SMBG </li></ul><ul><li>R3. Self-management education that incorporates cognitive behavioral interventions such as problem-solving, goal setting and self-monitoring of health parameters should be implemented in addition to didactic education programming for all individuals with diabetes. </li></ul><ul><li>R4. Interventions that increase patients’ participation and collaboration in healthcare decision-making should be used by providers . </li></ul><ul><li>R5. SME interventions should be offered in small group and/or one-on-one settings, as both are effective for people with type 2 diabetes . </li></ul><ul><li>R6. Interventions that target families’ ability to cope with stress or diabetes-related conflict should be considered in education interventions when indicated . </li></ul>
  23. 24. Self –management education Incorporate cognitive, behavioral and social interventions that include Goal – setting Problem solving Other motivational strategies Psychological mediators Motivation (beliefs, attitudes) Coping skills Knowledge Psychomotor skills Healthy self –management behaviors Diet SMBG Medications Physical activity Smoking cessation. Long term outcomes Morbidity Mortality Quality of life. Short –term outcomes Glycemic , BP and lipid control Weight Quality of life Attendance at health care process of self management education for people with diabetes
  24. 25. 15/06/10 Riyadh PHC / HPTD

×