dijabetes tip 2

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  • 7/25/2019 Dijabetes Tip 2

    1/17

    114- (" ", . 38/91, 46/93, 55/95, 10/04, 84/05, 111/05, 65/06, 5/07,

    77/08, 67/09 88/10),

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  • 7/25/2019 Dijabetes Tip 2

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    , . , - .

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  • 7/25/2019 Dijabetes Tip 2

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    o HbA1c HbA1c

    o 6.5%

    - - 2 -. .

    , :o o o -o o o o o

  • 7/25/2019 Dijabetes Tip 2

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    . 4

    ; . , , / , , . .

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    = 5-10% :o o

    2.

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    . 5

    (HbA1c), /.

    HbA1c

    HbA1c 6.5%

    , , .

    HbA1c

    (

    ) HbA1c.

    HbA1c , - (8.5mmol/l), .

    6

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    HbA1c .

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    HbA1c 6.5% HbA1c < 6.5%

    +

    ,,

    4

    ,:

    3,

    ,

    HbA1c 6.5%

    HbA1c 7.5% HbA1c < 7.5%

    -

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    DPP-4

    8

    9,

    ( ) .

    DPP-4()

    9

    ( , , , ). GLP-1

    6

    ( )

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    HbA1c 6.5%

    HbA1c < 6.5%

    DPP-4 8

    9,

    4+ DPP-4

    5,8

    5,9

    HbA1c < 7.5%

    HbA1c 7.5% HbA1c < 7.5%

    + DPP-4 ,

    5,9

    + + ,

    2+

    4+

    5,9,

    2

    + 4

    + GLP-1 6

    HbA1c 7.5%

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    () .

    > 130 mol/l (GFR) < 45 ml/min/1.73 m2

    > 150 mol/l GFR < 30ml/min/1.73 m2

    , GFR < 45 ml/min/1.73 m2

    , .

    ( )

    . , .

    DPP-4

    DPP-4 HbA1c 0.5 6 .

    DPP-4 , DPP-4 :

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    GLP-1 ( )

    GLP-1 HbA1c 1 3% 6 .

    GLP-1 .

    .

    HbA1c < 7.5% ( ), .

    ( ).

    .

    , - - ( , ), :- -

    ,

    - ,

    -

    , - .

    () ( HbA1c 9 0%)

  • 7/25/2019 Dijabetes Tip 2

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    ( - [ , ])

    - .

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    ( ) , / , .

    , .

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  • 7/25/2019 Dijabetes Tip 2

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    . 11

    ()

    ,

    ( HDL-C TG) .

    TG, ( HDL-C TG).

    :

    ( 20%/10

    TG > 4.5mmol/l (

    ),

    ( ,

    )

    http://www.dtu.ox.ac.uk/http://www.dtu.ox.ac.uk/http://www.dtu.ox.ac.uk/
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    . 12

    , -, -3

    TG=2.3-4.5 mmol/l ,

    1-3

    ( 40 mg)

    ,

    < 4.0mmol/l (HDL-C 1.4 mmol/l) LDL-C < 2.0 mmol/l. :

    80 mg

    (HDL-C 1.4 mmol/l

    .

    -3 ( ).

    50 < 145/90 mmHg

    50

    - (75mg) , ,

    2

    1 (NICE

    technology appraisal guidance 94) ( )

    (NICE technology appraisal guidance 132)

    2

    (NICE technology appraisal guidance 90)

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    , , < 130/80 mmHg

    , < 140/80 mmHg

    .

    4-6 ( ).

    . > , :1 > 150/90 mmHg2 > 140/80 mmHg

    2 > 130/80 mmHg ,

    .

    (www.nice.org.uk/CG34) , CCB.

    ( ),

    II

    ( )

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    . 14

    , :

    ACR ( , )

    GFR.

    ACR1e (

    /):

    3-4

    1.

    / ACR :

    ,

    ,

    (ACR > 100 mg/mmol),

    ACR

    , ,

    GFR ,

    ,

    ( ).

    II .

    < 130/80mmHg

    ACR( )

    R .

    ,

    .

    ACR = albumin:creatinine ratio ( :); AER = albumin excretion rate ( ); = 1ACR = ACR > 2.5 mg/mmol > 3.5 mg/mmol

  • 7/25/2019 Dijabetes Tip 2

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    . 15

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    rubeosis iridis

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    o o o o , o .

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    2 cotton wool , - , cotton wool

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    : : - (NICE clinical guideline 96), www.nice.org.uk/guidance/CG96 www.endocrinology.org.mk

    ,

    :

    http://www.nice.org.uk/guidance/CG96http://www.nice.org.uk/guidance/CG96http://www.nice.org.uk/guidance/CG96http://www.nice.org.uk/guidance/CG96
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    . 17

    :

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    2: (NICE clinical guideline 10),www.endocrinology.org.mk

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    : (NICE clinical guideline23).www.endocrinology.org.mk