Diabetes Mellitus 2 MIPS 2015 PDF

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    HOSPITAL JUREZ DE MXICOUNIDAD DE ENSEANZA

    JORNADAS DE MEDICOS INTERNOS

    Diabetes Mellitus 2

    Dr Pavel Gonzlez Guzmn

    Mdico residente de 3er ao

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    Caso clnico

    !"#$%&'() +, "-)# $)( .'"/010# 20&&'1%# 34) 5

    6'( "&107"$')(0# 2'$7) ) 2"$7)8"#$%&"70#

    9:;< 2"=70 > ?072"() $)( .!5

    @!A +B

    C9

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    Quienes estnexpuestos a

    desarrollar DM2?

    Cmo se desarrollala DM 2?

    Cmo se diagnostica ?

    Cul es el manejo?

    Existencomplicaci

    ones?

    Existe solo untipo de paciente

    con DM2?

    Por qu yo?

    Dnde esta el

    interno?

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    Objetivos1.-Factores de riesgo

    2.-Fisiopatologa de la Diabetesmellitus tipo 2

    3.-Clasificacin y diagnostico

    4.-Tratamiento inicial

    antidiabeticos vs Insulina

    5.-Consideraciones especiales

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    Factores de riesgo/

    tamizaje

    IMC>25 kg/m2Familiares de 1er

    gradoInactividad fsica

    LatinoMadres de productos

    macrosomicos o diabetes

    gestacional

    Hipertensin

    HDL< 35 mg/dLTrigliceridos > 250

    mg/dLSndrome de ovario

    poliquistico

    Intolerancia a la

    glucosa

    Glucosa alterada en

    ayuno A1C> 5.7%

    Datos de resistencia ala insulina

    Historia de eventoscardiovasculares

    MIP

    Diabetes Care Volume 38, Supplement 1, January 2015

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    I

    |

    A M E R I C A N D I A B E T E S A S S O C I A T I O N

    STANDARDS OF

    MEDICAL CARE

    IN DIABETES2015

    SU

    PPLEMEN

    T

    1

    O t r o s p a c i e n t e s(particularmente los

    obesos) a partir de los45 aos

    Si los resultados son

    normales repetir almenos cada 3 aos

    Factores de riesgo/

    tamizaje

    Diabetes Care Volume 38, Supplement 1, January 2015

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    CLASSIFICATION

    Diabetes can be classied into the following general categories:

    1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin

    deciency)

    2. Type 2 diabetes (due to a progressive insulin secretory defect on the background

    of insulin resistance)

    3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or thirdtrimester of pregnancy that is not clearly overt diabetes)

    4. Specic types of diabetes due to other causes, e.g., monogenic diabetes syndromes

    (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), dis-

    eases of the exocrine pancreas (such as cysticbrosis), and drug- or chemical-induced

    diabetes (such as in the treatment of HIV/AIDS or after organ transplantation)

    Diabetes Care Volume 38, Supplement 1, January 2015

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    Fisiopatologa

    Resistencia perifrica del Hgadoy el msculo

    Insuficiencia de las clulas BetaDETERMINANTE

    Primeros planteamientos: Eltriunvirato, DeFronzo (1987)

    Secrecin de insulina disminuida

    Aumentode laproduccin

    de glucosa

    Hiperglicemia

    Disminucindel consumode glucosa

    From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus,Ralph A. DeFronzo,Diabetes care Vol 58,2009

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    Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24.edicin

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    From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus,Ralph A. DeFronzo,Diabetes care Vol 58,2009

    OCTETO OMINOSO

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    Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24. edicin

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    Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24. edicin

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    Diagnostico

    Criterios ADA se revisancada ao

    Glucosa en ayuno

    Curva de tolerancia a laglucosa

    Hemoglobina glicosilada

    Glucosa aleatoria

    Diabetes Care Volume 38, Supplement 1, January 2015

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    Texto

    Diabetes Care Volume 38, Supplement 1, January 2015

    NORMAL Intolerancia a la glucosa DIABETESGlucosa alterada en ayuno

    Prediabetes

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    Tratamiento

    Table 6.2Summary of glycemic recommendations for nonpregnant adults with

    diabetes

    A1C ,7.0%*

    Preprandial capillary plasma glucose 80130 mg/dL* (4.47.2 mmol/L)

    Peak postprandial capillary plasma glucose ,180 mg/dL* (,10.0 mmol/L)

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    Diabetes Care Volume 38, Supplement 1, January 2015

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    COMPLICACIONES

    Microvasculares:Enfermedades oculares

    Retinopata (no proliferativa y proliferativa) Edema de la mcula

    Neuropatas

    Sensitivas y motoras (mono neuropatas y poli neuropatas)

    Vegetativas

    Nefropatas

    Macrovasculares:Artropata coronaria Enfermedad vascular perifrica

    Enfermedad vascular cerebral

    Otras

    Del tubo digestivo (gastroparesia,diarrea)

    Genitourinarias (uropatas y disfuncin sexual)DermatolgicasInfecciosas

    Oftalmologicas:Cataratas,glaucoma Enfermedad periodontalHipoacusia