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4th ng

Kinh Tha Quy Giao S, Bac si;Kinh Tha Quy ai Biu.

Hi Ni tit va ai thao ng Vit Nam rt hn hanh chao mng Quy Thy C, Quy vi ai biu n tham d Hi nghi Khoa hc Ni tit va Chuyn hoa ln th VII c t chc tai Ha Ni.

Hi nghi chuyn nganh v Ni tit va Chuyn hoa ca Hi Ni tit va ai thao ng Vit Nam c t chc hai nm mt ln la ni quy t cac chuyn gia v Ni tit Chuyn hoa trong nc va quc t. S lng ln cac ai biu tham gia, bao cao vin, bai bao cao tham d co cht lng cao cng s phong ph a dang ca cac tai anh du s phat trin ngay cang ln manh ca Hi Ni tit va ai thao ng Vit Nam. Mc tiu chinh ca Hi nghi la anh gia lai cac hoat ng nghin cu khoa hc, cng tac iu tri chuyn khoa trong nc va xac inh nhng nhim v ca chuyn nganh trong giai oan ti ng thi ng vin cac nha khoa hc n lc hn na v s nghip d phng, chm soc, iu tri va theo di nhng bnh nhn thuc chuyn nganh Ni tit, ai thao ng va bnh ly Chuyn hoa trn toan t nc Vit Nam.

Ngoai Hi nghi chung toan quc, cac Hi ia phng tai ba min Bc - Trung - Nam u sinh hoat khoa hc inh k mi 3-6 thang mi nm hoc 2 nm mt ln. iu o chng t hoat ng khoa hc lin tc ca cac bac si chuyn nganh Ni tit Chuyn hoa - ai thao ng trn toan quc ngay cang ln manh. Mt s cac thanh vin ca Hi nm trong ban soan tho Cm nang hng dn iu tri cac bnh Ni tit va Chuyn hoa ca B Y T. Hi cng xut bn c Hng dn iu tri bnh ai thao ng typ 2, Tap chi Ni tit va Chuyn hoa xut bn 3 thang /s.

Hi nghi ln th VII tng kt 5 nm hoat ng ca Ban chp hanh Hi Ni tit va ai thao ng Vit Nam nhim k 2009-2014. Trong 5 nm va qua, ngoai nhng hoat ng anh gia s ln manh ca Hi v chuyn mn va nhn lc tai Vit Nam, Hi tng bc hi nhp v phng din khoa hc vi cac Hi Ni tit Chuyn hoa trong khu vc va trn th gii. Hin nay, Hi Ni tit va ai thao ng Vit Nam la thanh vin ca Hi Ni tit cac nc thuc khi ASEAN, Hi Ni tit Quc T (ISE), Lin oan ai Thao ng Quc T (IDF). Trong nhim k va qua, Hi t chc thanh cng Hi ngh Ni tit cc nc khi ASEAN AFES 2011, y la hi nghi quy t hn 1400 ai biu trong va ngoai nc tham d va c anh gia la mt trong cac Hi Ngh AFES co ni dung khoa hc phong ph va cht lng nht. Cac bao cao vin Vit Nam cng c mi tham d bao cao va lam giam kho tai cac Hi nghi Quc t trong khu vc. Mt s chuyn gia Ni tit Vit Nam co Abstract c chp nhn va cng b tai cac Hi nghi Ni tit Bc M va Chu u, mt s co cng trnh khoa hc c ng ti trn cac bao Ni tit Chuyn hoa Quc t nh JAFES, Diabetes Research and Clinical Practice, Lancet. c s chp thun ca B Y t, Hi cng phi hp cng Hi ai thao ng M va Trung tm nghin cu ai thao ng Steno, an Mach t chc cac lp cp nht kin thc v ai thao ng tai Vit Nam danh cho cac bac si chuyn khoa va a khoa. Thay mt ban chp hanh Hi Ni tit va ai thao ng Vit Nam, Ti xin biu dng va cm ta nhng hoat ng khoa hc ca cac ng nghip chuyn nganh trn mi min t nc. S oan kt ca cac thanh vin trong Hi, nhng hoat ng khoa hc khng ngng ngh la yu t chinh gop phn cho s phat trin ln manh ca Hi va s thanh cng ca Hi nghi ln th VII nay.

Kinh chc Quy ai biu sc khe, thu thp c nhiu thng tin cp nht trong hi nghi. Chc cho Hi Ni tit va ai thao ng Vit Nam lun duy tr c tnh oan kt va nim say m khoa hc.

PGS. TS. Nguyn Thy KhuCh tch Hi Ni tit v i tho ng Vit Nam, nhim k 2009-2014

5NOVO NORDISK PHARMAOPERATIONS A/S

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CC N V TI TR CHNH

TI TR BCH KIM

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TI TR BC

NG TI TR

Hi Ni tit & i tho ng Vit Nam xin trn trng cm n Qu Cng ty v T chc

tham gia ti tr cho Hi ngh Khoa hc v Ni tit v Chuyn ha ton quc ln th VII

MSD MERCK SERONO

MEGA

LILLY

6CC N V THAM GIA GIAN HNG

Hi Ni tit & i tho ng Vit Nam xin trn trng cm n Qu Cng ty v T chc

tham gia Hi ngh Khoa hc v Ni tit v Chuyn ha ton quc ln th VII

VPDD WOERWANG PHARMA HQ PHARMA DKSH

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CTY TNHH BAYER VIT NAM TAI TP.HCM HONG C - MY O NG HUYT

BECTON DICKINSON (BD) UNITED PHARMA

7BAN T CHC : GS.TS. Thi Hng Quang (Trng ban t chc) PGS.TS. Nguyn Thy Khu PGS.TS. Trung Qun (Ph trng ban) PGS.TS. Hong Trung Vinh PGS.TS. Nguyn Khoa Diu Vn TS.BS. Nguyn Vinh Quang TS.BS. Phm Th Hng Hoa ThS.BS. V Ch Dng ThS.BS. Nguyn Quang By Ths.BS. Lm Vn Hong

THNg TrC BAN T CHC: GS.TS. Thi Hng Quang PGS.TS. Trung Qun TS.BS. Nguyn Vinh Quang PGS.TS. Nguyn Khoa Diu Vn ThS.BS. V Ch Dng ThS.BS. Nguyn Quang By ThS.BS. Lm Vn Hoang

BAN TH K: ThS.BS. Nguyn Quang By (Trng ban) TS.BS. H Kim Thanh ThS. Chu Thy Ng (CTHV) ThS.BS. Lm vn Hong ThS.BS. Trnh Ngc Anh TS.BS. Bi Phng Tho (VN)

HI Ng KHOA HC: PGS.TS. Nguyn Thy Khu (Ch tch Hi, Ch tch Hi ng) GS.TS. Thi Hng Quang (Ph ch tch) CC y vIN: GS.TS. Nguyn Hi Thy GS.TS. Trn Hu Dng PGS.TS. Trung Qun PGS.TS. Hong Trung Vinh PGS.TS. Nguyn Th Hon PGS.TS. Nguyn Khoa Diu Vn PGS.TS. Nguyn Kim Lng PGS.TS. Nguyn Th Bch o PGS.TS. Nguyn Vn Qunh PGS.TS. T Vn Bnh TS.BS. Nguyn Vinh Quang TS.BS. Phm Th Hng Hoa ThS .BS Nguyn Quang By

BAN T CHC I HINI TIT - I THO Ng TON QUC 2014

8 THNg TrC HI Ng KHOA HC: PGS.TS. Nguyn Thy Khu GS.TS. Thi Hng Quang (Trng ban) GS.TS. Nguyn Hi Thy GS.TS. Trn Hu Dng PGS.TS. Trung Qun PGS.TS. Hong Trung Vinh

TH K HI Ng KHOA HC: TS.BS. Nguyn Quang Nam TS.BS. Nguyn Vinh Quang ThS.BS. Nguyn Quang By

BAN vN Ng TI Tr CHO I HI : PGS.TS. Nguyn Thy Khu GS.TS. Thi hng Quang GS.TS. Nguyn Hi Thy GS.TS. Trn Hu Dng PGS.TS. Trung Qun PGS.TS. Nguyn Khoa Diu Vn ThS.BS. Kim Thnh (BVNTTW)

BAN KINH T : PGS.TS. Nguyn Khoa Diu Vn (Trng ban) PGS.TS. Nguyn Th Bch o TS.BS. Phm Th Hng Hoa PGS.TS. Nguyn Th Hon TS.BS. H Th Kim Thanh TS.BS. Nguyn Vinh Quang ThS.BS. Kim Thnh (BVNTTW)

BAN HU CN: PGS.TS. Nguyn Th Nga (Trng ban) PGS.TS. Nguyn Th Hon TS.BS. Phm Th Hng Hoa TS.BS. Minh Thn ThS.BS. Quch Hu Trung (198) TS.BS. Nguyn Th Nga (103) BS. V Mai Hng (BVTN) BS. Phm Tun Dng (198) TS.BS. Nguyn Th Kim Ha (BVNTTW)

BAN T CHC I HI NI TIT - I THO Ng TON QUC 2014

9BAN I NgOI: PGS.TS. Nguyn Thy Khu (Trng ban) PGS.TS. Trung Qun (ngTrng ban) GS.TS. Thi Hng Quang GS.TS. Trn Hu Dng TS.BS. Nguyn Vinh Quang PGS.TS. Nguyn Vn Qunh PGS.TS. Nguyn Th Hon TS.BS. Nguyn Phng Tho (Vin nhi T) TS.BS. Nguyn Quc Khnh (Th k)

BAN BIN DCH: PGS.TS. Trung Qun (Trng ban) PGS.TS. Nguyn Thy Khu (ng Trng ban) ThS.BS. Trnh Ngc Anh (NTBM) ThS.BS. L Quang Ton (BVNTTW) ThS.BS. V Ch Dng (VNTW) TS.BS. Trn Quang Nam TS.BS. Trn Quc Khnh ThS.BS. Thu H (NTBM) ThS.BS. Nguyn nh Tng (VT) ThS.BS. Anh (NTTW)

BAN TUyN TrUyN : TS.BS. Nguyn Vinh Quang (Trng ban) PGS.TS. Nguyn Th Hon ThS.BS. Nguyn Quang By TS.BS. Nguyn Quc Khnh TS.BS. Trn Quang Nam

BAN BIN Tp : GS.TS. Thi Hng Quang (Trng ban) ThS.BS. Nguyn Quang By TS.BS. Trn Quang Nam TS.BS. Trn Quc Khnh

BAN T CHC I HINI TIT - I THO Ng TON QUC 2014

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1. GS. TS.2. GS. TS.3. GS. TS.4. GS. TS.5. PGS. TS.6. TS. BS.7. GS.TS8. GS.TS.9. GS.TS.10. GS.TS.11. GS.TS.12. GS.TS.13. GS.TS.14. GS.TS.15. PGS.TS.16. PGS.TS.17. PGS.TS.18. PGS.TS.19. PGS.TS.20. PGS.TS.21. PGS.TS.22. PGS.TS.23. PGS.TS.24. PGS.TS.25. PGS.TS.26. PGS.TS.27. PGS.TS.28. PGS.TS.29. PGS.TS.30. PGS.TS.31. PGS.TS.32. PGS.TS.33. PGS.TS.34. PGS.TS.35. TS.BS36. TS.BS.37. TS.BS.38. TS.BS.39. TS.BS.40. TS.BS.41. TS.BS.42. TS.BS.43. TS.BS.44. ThS.BS.45. ThS.BS.

CH TA ON

Malcolm NattrassJean Claude MbanyaChaicharn DeerochanawongLee Kok OnnMaria CraigJJ MukherjeeTrn c ThMai Th TrchNguyn Thu Nhn Phm Gia Khi Thi Hng QuangNguyn Hi ThyTrn Hu Dng Trn Qun AnhNguyn Khoa Diu Vn Trung QunNguyn Th Bch oNguyn Thy Khu Th Tnh Nguyn Kim LngNguyn Ph tNguyn Th HonNguyn Th Ngc LanNguyn Vn QunhPhm ng Mch inh Thu Hng Hong Trung Vinh L Anh Th Nguyn c Tin Nguyn Quang Tun Nguyn Th NhnTrn Ngc LngTrn Vn Huy V Bch NgaTrn Quang Nam L Tuyt HoaPhm Th Hng Hoa Phan Huy Anh VNguyn Th ThnhNguyn Vinh Quang Bi Phng ThoTrn Quang Khnh V Th Thanh HuynV Ch DngDip Thanh Bnh

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1. Dr.2. PGS.TS.3. TS.BS4. TS.BS.5. TS.BS.6. TS.BS.7. TS.BS.8. TS.BS.9. TS.BS.10. TS.BS.11. TS.BS.12. ThS.BS13. ThS.BS.14. ThS.BS.15. ThS.BS.16. ThS.BS.17. ThS.BS.18. ThS.BS.19. ThS.BS.20. ThS.BS.21. ThS.BS.22. ThS.BS.23. ThS.BS.24. ThS.BS.25. ThS.BS.26. ThS.BS.27. ThS.BS.

BO CO vIN

28. ThS.BS.29. ThS.BS.30. ThS.BS.31. ThS.BS.32. ThS.BS.33. ThS.BS.34. ThS.BS.35. ThS.BS.36. ThS.BS.37. ThS.BS.38. BS.CKII.39. BS.CKII.40. BS.CKII.41. BS.42. BS.43. BS.44. BS.45. BS.46. BS.47. BS.48. BS.49. BS.50. BS.51. BS.52. BS.53. BS.54. BS.

Bee Yong Mong Nguyn Tn Cng Trn Th Thanh HaChu L Hi VnHong i KinH Hunh Quang TrNguyn Anh QunNguyn Ngc Quang Nguyn Th Nht Chu Nguyn Th Thu ThoNguyn Xun CnhTrn Th Hoa ViCn Th Bch NgcHunh Hu NmHa Thnh NhnL Th Phng HuNg DngNg Minh oNguyn Vn Vy HuTrn Minh TritLm Th M Hnh nh Tng Li Th Phng QunhLm Vn HongL B NgcL Quang TonNg c K

Nguyn Ngc CngNguyn Phng Khanh Nguyn Quc VitNguyn Th Thu NgaNguyn Trn KinPhan Hong HipPhan Hu HnQuch Hu TrungThi Th Thanh ThyV Chi MaiTrn Thanh Sang Th M HnhNguyn Th Ngc Th o Thnh Xuynng nh DngNguyn nh DngNguyn Ngc KhnhNguyn Th Th HngPhm Th nh HuyTrn Th Thu HngTrnh Hoi NamNguyn Th Dim ChiNguyn Th Thu MaiNguyn Trn Ngc HiuNguyn Vn HonPhm Thu HTrn Th Bch Huyn

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TM TT CC CNg TrNH NgHIN CU KHOA HC

S DNg HBA1C TrONg CHN ON BNH I THO NgPGS. TS. Nguyn Thy Khu

HYDTPHCM

TM TTTim nng s dng HbA1c trong vic chm sc bnh nhn i tho ng ln u c cp n vo nm 1985 trong mt bo co ca T chc Sc khe Th gii. Nm 2005, T chc Sc khe Th gii phi hp cng Lin on i tho ng Th gii triu tp mt y ban tham vn xem xt li v cp nht cc tiu ch chn on i tho ng. Sau khi cn nhc cc d kin thng tin v bng chng sn c vo thi im trn, y ban cc chuyn gia thng nht cha nn chp thun s dng HbA1c nh mt tiu ch chn on i tho ng do tnh chun xc trong k thut xt nghim cn cha c chun ha. Vo thng 03 nm 2009, T chc Sc khe Th gii tham kho kin ca y ban cc chuyn gia cp nht cc bo co nm 1999 v 2005 v t li vai tr ca HbA1c trong chn on bnh i tho ng da trn cc bng chng sn c.

vAI Tr HbA1C TrONg CHN ON I THO Ng: - Nm 1970, ln u tin ngi ta ghi nhn hemoglobin glycat ha (gi tt l HbA1c) nh mt hemo-globin bt thung trn bnh nhn i tho ng. Sau khi c pht hin, c nhiu nghin cu nh chng minh c s lin quan gia nng HbA1c v nng glucose mu. iu ny gi c th s dng HbA1c nh mt thong s nh gi tnh trng kim sot ng huyt ca bnh nhn i tho ng. Nghin cu ADAG (A1c-Derived Average Glucose) trn 643 bnh nhn i tho ng cng nhn mi tng quan gia HbA1c v mc ng huyt trung bnh trn nhiu i tng bnh nhn i tho ng thuc cc tp khc nhau. HbA1c bt u c a vo thc t lm sng t thp nin 1980 v ngy nay tr thnh mt tiu ch ti quan trng trong qun l bnh nhn i tho ng. - Nng HbA1c phn nh mc dao ng ng huyt trung bnh trong vng 8-12 tun trc. C th thc hin xt nghim vo bt c thi im no trong ngy v khng cn nhn i. S thun tin ny khin cho HbA1c tr thnh mt xt nghim c a chung nh gi s kim sot ng huyt ca bnh nhn i tho ng. Gn y, HbA1c thu ht c nhiu s quan tm ca gii chuyn mn nh mt cng c chn on v xa hn na l cng c tm sot i tho ng trong nhm i tng c nguy c cao mc bnh i tho ng. - Do nhng bt tin trong vic xt nghim ng huyt i (bnh nhn phi nhn i t nht 8 gi qua m) cng nh s phc tp trong vic tin hnh nghim php dung np glucose nn t lu ngi ta c gng tm mt xt nghim khc chn on i tho ng. Nm 2009, HbA1c c y ban cc chuyn gia v Hip hi i tho ng Hoa k khuyn co s dng nh mt tiu ch chn on i tho ng. Mc d nhy v chuyn ca xt nghim HbA1c l tng ng vi xt nghim ng huyt i v ng huyt 2 gi sau nghim php dung np glucose nh mt yu t tin on dng bnh l vng mc, khng phi xt nghim ny c ph bin mt cch rng ri mi ni trn th gii. Hn na c mt s bnh nhn s c chn on i tho ng bng tiu ch HbA1c nhng cc xt nghim ng huyt li bnh thng v ngc li mt s bnh nhn s c chn on i tho ng bng cc tiu ch ng huyt nhng nng HbA1c li trong gii hn bnh thng. - S dng HbA1c s gip trnh c s dao ng ca xt nghim ng huyt v quan trng nht l ngi c xt nghim s khng phi nhn i hoc phi chun b y nhng iu kin nghim ngt nh khi phi tin hnh nghim php dung np glucose chn on i tho ng. Tuy vy, nng HbA1c li chu tc ng ca mt s yu t nh di truyn, huyt hc v cc yu t lin quan vi bnh l i km. Nhng yu t c xem l quan trng nht nh hng n kt qu xt nghim HbA1c trn ton cu bao gm bnh l huyt sc t (ph thuc vo k thut xt nghim), cc bnh l gy tnh trng thiu mu v cc bnh l rt ngn i sng hng cu nh st rt. T chc Sc khe Th gii cng khuyn co cn cn nhc v tnh tin li v

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hu dng ca xt nghim HbA1c so vi cc xt nghim ng huyt trong chn on bnh i tho ng do nhiu quc gia trn th gii vn cha trin khai y xt nghim ny. Bn cnh , vic chun ha k thut xt nghim HbA1c cng gii hn kh nng s dng HbA1c trn thc t lm sng. - Sau nghin cu DCCT, Chng trnh Chun ha Glycohemoglobin Quc gia (NGSP: National Gly-cohaemoglobin Standardization Program) c thit lp ti Hoa K v trong mt thi gian di chng trnh ny c xem l nn tng chun ha xt nghim HbA1c. Gn y, Hip hi cc nh Ha sinh Lm sng Quc t (IFCC: International Federation of Clinical Chemists) thnh lp mt nhm chuyn vin nhm nghin cu mt chng trnh chun ha rng ri xt nghim HbA1c ton cu. C NGSP v IFCC ng s cng tc tm ra mt k thut xt nghim HbA1c tham chiu nhm hi ha cc k thut xt nghim HbA1c ca cc hng sn xut trn ton th gii.

TIU CH CHN ON I THO Ng ADA/WHO 2011-2012: - Tiu ch chn on i tho ng ca tin Hip hi i tho ng Hoa k s dng xt nghim HbA1c ln u c ngh vo nm 2009. n nm 2012, tiu ch ny c ngh nh sau:

A1c 6,5%. Xt nghim phi c tin hnh trong mt c s xt nghim s dng phng php xt nghim c NGSP cp giy chng nhn v chun ha theo k thut xt nghim dng trong nghin

cu DCCT *HAy

ng huyt tng tnh mch nhn i qua m 126 mg% (7,0 mmol/l) *. Nhn i t nht 8 giHAy

ng huyt 2 gi sau nghim php dung np glucose (OGTT: Oral Glucose Tolerance Test) 200 mg% (11,1 mmol/l). Nghim php phi c tin hnh v tun th cht ch cc iu kin ca T chc Sc khe Th gii yu cu, s dng ti glucose tng ng 75 g glucose khan c ha tan trong nc *

HAyng huyt tng tnh mch bt k 200 mg% (11,1 mmol/l) trn bnh nhn c triu chng in hnh

ca tnh trng tng ng huyt mn tnh hay cn tng ng huyt cp tnh* Trong trng hp khng c triu chng lm sng ca tnh trng tng ng huyt, cn phi lp li

cc tiu ch chn on t 1 n 3 xc nh chn on

- Hip hi i tho ng Hoa k cng a ra cc tiu ch chn on cc i tng c nguy c cao mc bnh i tho ng nh sau:

ng huyt i t 100 mg% (5,6 mmol/l) n 125 mg% (6,9 mmol/l): Ri lon ng huyt ing huyt 2 gi sau nghim php dung np 75 g glucose t 140 mg% (7,8 mmol/l) n 199 mg% (11,0 mmol/l): Ri lon dung np glucose HbA1c t 5,7% n 6,4%

- y ban cc chuyn gia ca T chc Sc khe Th gii cng thng nht vi cc tiu ch chn on i tho ng c Hip hi i tho ng Hoa k cp nht vo nm 2012. Tuy nhin vi cc khi nim trung gian tin i tho ng, y ban cng ngh nhng gi tr HbA1c t 6,0% n

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xt nghim ng huyt mc chm sc sc khe cng ng trc khi ngh n chuyn trin khai HbA1c trong chn on bnh i tho ng. Cc chuyn gia cng kt lun rng cha c bng chng a ra bt k mt khuyn co chnh thc no v cc gi tr HbA1c di 6,5%. y ban cc chuyn gia ca T chc Sc khe Th gii cng ngh cn c thm nhiu nghin cu tin cu dc xc nh mt cch chun xc hn ngng ng huyt v HbA1c tin on cc bin chng mch mu ln v mch mu nh do i tho ng trn tng chng tc ring bit; ng thi cng cn thnh lp mt nhm chuyn gia xem xt li v chun ha tt c cc k thut xt nghim lin quan n HbA1c v ng huyt.

Bng 1: Cc yu t nh hng n kt qu HbA1c

1. Cc yu t nh hng n sn xut hng cu: Tng HbA1c: thiu st, thiu vitamin B12, gim sinh hng cu Gim HbA1c: s dng erythropoietin, st, vitamin B12, bnh gan mn tnh, tng hng cu li2. Thay i v hemoglobin: Cc bnh v huyt sc t, HbF, methemoglobin, thay i hemoglobin do di truyn hay ha cht,... c th lm tng hay gim HbA1c3. phn ng glycat ha: Tng HbA1c: nghin ru, suy thn mn, gim pH trong hng cu Gim HbA1c: dng aspirin, vitamin C, vitamin E, bnh huyt sc t, tng pH trong hng cu Bin th HbA1c: do di truyn4. ph hy hng cu: Tng HbA1c: tng i sng hng cu: sau ct lch Gim HbA1c: gim i sng hng cu: lch to, bnh huyt sc t, vim khp dng thp, s dng thuc chng virus, ribavirin, dapsone5. K thut xt nghim: Tng HbA1c: tng bilirubin, carbamyl hemoglobin, nghin ru, dng aspirin liu cao, dng thuc phin ko di Gim HbA1c: tng triglycerid mu Bin th HbA1c: do di truyn

Bng 2: So snh thun li v bt li gia xt nghim ng huyt v HbA1c

ng huyt HbA1c

Chn b bnh nhn trc khi xt nghim

Nhn i qua m t nht 8 gi (H i) hay cc iu kin nghim ngt ca NPDN glucose

Khng cn

iu kin bo qun mu xt nghim

Quay ly tm tch huyt tng hay huyt thanh v gi 4 C

Gi nhit > 23 C nu xt nghim trong vng 12 gi k t khi ly mu. Nu gi nhit 4 C s n nh trong 1 tun

Mc d ph bin Rng ri Cn khim khuyt nhiu niChn ha Chun ha theo k thut xt nghim

tham chiuChun ha theo k thut xt nghim tham chiu

Kim tra nh k y y Cc bnh nh hng Bnh nng v cp tnh c th nh hng

n ng huytBnh nng c th lm gim i sng hng cu

Bnh huyt sc t t nh hng C th nh hng n kt qu ty theo k thut xt nghim

Chi ph R tin t tin

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KT LUNKhng nn chn on i tho ng trn mt i tng khng c triu chng, ch n thun da vo mt gi tr ng huyt hay HbA1c bt thng. Cn lp li mt ln xt nghim b sung v chn on c xc lp nu c t nht hai kt qu t tiu ch chn on i tho ng. Cc xt nghim ng huyt hoc HbA1c s dng mu mao mch khng c khuyn co dng chn on bnh i tho ng; tr phi l phng tin duy nht sn c. Cng c th s dng hai xt nghim cng mt lc (v d ng huyt i v HbA1c) v nu c hai xt nghim u t tiu ch chn on th xem nh bnh nhn c chn on i tho ng. Nu ch c mt trong hai xt nghim l bt thng, cn lp li xt nghim bt thng vi cng mt k thut xt nghim trc khi xc nh chn on.

-- ~o0o~ --

KT QU HOT Ng IU TrA Lp BN DCH T HC BNH I THO Ng TON QUC NM 2012 v Xy DNg B CNg C NH gI MC NgUy C MC

BNH I THO Ng DNH CHO NgI vIT NAMBnh vin Ni tit Trung ng

TM TT1. t vn . Trong hon cnh gia tng s lng ngi mc T v HCCH nh nhng bnh dch nguy him do thay i v li sng, s hiu bit ca cng ng v bnh cn thp D n quc gia phng chng T trin khai hot ng lp bn dch t hc i tho ng ti 06 vng sinh thi trong Ton quc vi mc tiu:Xc nh t l mc bnh i tho ng ti 06 vng sinh thi Vit Nam nm 2012.. Xc nh mt s yu t nguy c vi bnh i tho ng ti Vit Nam. 2.phng php. iu tra s dng phng php iu tra dch t hc m t ct ngang. iu tra tin hnh trn 11.191 ngi trong tui t 30 69 tui. 3. Kt qu. T l mc T ti cc vng l Min ni pha Bc, ng bng sng Hng, Duyn hi min Trung, Ty Nguyn, ng Nam B, Ty Nam B ln lt l: 4,82%, 5,81%, 6,37%, 3,82%, 5,95%, 7,18 % v Ton Quc l 5,42% (95%CI: 4,88% - 6,02%). T l mc RLDNG mu ti cc vng Min ni pha Bc, ng bng sng Hng, Duyn hi min Trung, Ty Nguyn, ng Nam B, Ty Nam B ln lt l: 10,7%, 11,25%, 13,06%, 10,7%, 17,53%, 13,58% v ton Quc l 13,68%. Nhng ngi trn 45 tui c nguy c mc T cao hn nhng ngi di 45 tui l 4,42; nhng ngi c THA c nguy c mc T cao hn nhng ngi khng mc THA l 3,45 ln; nhng ngi c vng eo ln c nguy c mc T cao hn nhng ngi c vng eo bnh thng l 2,60 ln; nhng ngi c huyt p tng c nguy c mc T cao hn nhng ngi khng mc tng huyt p l 3,45 ln; tng ng vi vic c vng eo ln, nhng ngi c ch s khi c th BMI 23 c nguy c mc T cao hn nhng ngi c ch s BMI < 23 l 2,01 ln; nhng ngi trong gia nh c tin s ngi mc T th c nguy c mc T tp 2 cao hn nhng ngi m khng c ai trong gia nh b mc T l 2,09 ln. Phn ln ngi dn c mc hiu bit v bnh l rt thp, 82,5% s i tng c kin thc rt thp, 15,9% c kin thc thp, 1,3% c kin thc trung bnh kh. Ch c 0,3% c kin thc tt. 4. Bn lun. t l mc bnh T hai cuc iu tra 2002 v 2012 sau 10 nm t l bnh T tng t 2,7% ln 5,42% tng khong 201 %, y l t l bo ng v gia tng t l bnh T ti Vit Nam. iu tra cng ch ra mt thc trng ng quan tm nc ta khi t l ngi bnh mc T trong cng ng khng c pht hin cao l 63,6% so vi nm 2002. yu t nguy c theo y vn nh tui, huyt p, tin s c ri lon chuyn ha lipid, vng eo nguy c, ch s khi c th, tin s gia nh c ngi mc bnh T vi t l T v RLDNG thng qua gi tr p, OR nhn thy cc YTNC u c lin quan cht ch vi mc T vi OR 2 ln, p

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T L I TNg TIN I THO NgTI KHOA KHM CHA BNH THEO yU CU Bv BCH MAI

PGS. TS. Trung Qun - i hc Y H Ni

TM TTMc tiu: Nhn xt t l i tng tin i tho ng ti khoa KCBTYC Bnh vin Bch mai i tng nghin cu: i tng nghin cu l nhng ngi Vit Nam kho mnh, tui t 30 - 69 n khm sc kho ti khoa KCBTYC Bnh vin Bch mai t thng 2/2012 n thng 10/2012.phng php nghin cu: M t ct ngang. Kt qu v kt lun: T l tin i tho ng l 38%, trong ch yu l n gii chim n 68,5%. T l tin i tho ng tng dn theo tui, thp nht l nhm tui 30 39 v cao nht nhm tui 60 69.

SUMMAryprEvALENCE OF prEDIABETES IN OUTpATIENT DEpArTMENT OF BACH MAI HOSpITAL

Objective: To estimate the prevalence of prediabetes in outpatient department of Bach mai hospital.research subjects: Healthy Vietnamese people from 30 to 69 years of age had their health check up in out-patient department from 2/2012 to 10/2012Method: descritive cross-sectional studyresults and conclusion: The prevalence of prediabetes was 38% (68,5% in female). This was increased with age, lowest in aged 30 39 and highest in aged 60 69.

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IU TrA yU T NgUy C, BIN CHNg CA BNH NHNI THO Ng Typ 2 IU Tr BNH vIN vIT TIp HI pHNg NM 2006

BSCK II Trn Th Mai, ThS. Nguyn Th Thy NgnKhoa Ni Tit-Bnh Vin Vit Tip Hi Phng

TM TTNghin cu m t ct ngang trn 179 bnh nhn c chn on i tho ng tp 2 iu tr ti khoa ni 3-Bnh vin vit Tip nm 2006, chng ti thy: Nhm tui chim t l cao nht l 50-59 tui (34,1%), t l n /nam 2/1. Cc yu t nguy c thng gp theo th t gim dn l: THA chim 45,8%; Thi quen n nhiu cht ngt, bo chim 26,9%; ung ru, ht thuc l chim 18,4%; tin s gia nh l 17,9%; bo ph l 16,8%; t hot ng th lc l 13,4%; tin s sinh con > 4kg, ri lon dung np glucose gp 1,1%. V mt lm sng: nhm triu chng n nhiu, ung nhiu, tiu nhiu v gy, st cn chim t l cao nht chim 48,9% v 50,6%. V cn lm sng: Ure, Glucose v Triglycerid cao hn so vi tr s bnh thng ( p < 0,01 v p < 0,001). Cc bin chng gp nhiu l: bin chng mt chim 41,9%, bin chng thn 39,7%; bin chng rng ming 36.9%, tn thng thn kinh ngoi vi 24,6%.

ABSTrACTTILE: EvALUATION OF rISK FACTOrS AND COMpLICATIONS OF TypE 2 DIABETIC pA-

TIENTS TrEATED IN vIET TIEp HOSpITAL- HAI pHONg IN 2006.Authors: Dr Tran Thi Mai, Dr Nguyen Thi Thuy Ngan.

Department of Endocrinology Viet Tiep Hospital Hai Phong Viet Nam

Background: Diabetes mellitus is a metabolic disease characterized by hyperglycemia due to insulin resist-ance and deficit of insulin secretion from beta cells. The prevalence of type 2 diabetes is tremendously increas-

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ing in the 21st century, especially in developing country. The prevalence of type 2 diabetes in Vietnam is also increasing particularly in big cities with rapid westernization. Therefore, we did a survey to evaluate the risk factors and complications in type 2 diabetic patients treated in Viet Tiep Hospital, Haiphong. Methods: This was a cross-sectional study including 179 patients hospitalized for diabetes in endocrinology department in 2006. results: Hypertension was diagnosed in 45,8% of patients. Other risk factors such as high proportion of car-bohydrate and fat in the diet (26,9%), alcohol consumption and cigarette smoking (18,4%), family history of diabetes (17,9%), obesity (16,8%), physical inactivity (13,4%), macrosomia and impaired glucose tolerance (1,1%) were also recognized. Clinical symptoms such as polyphagia, polydipsia polyuria, weight loss were reported by approximately half (48,9%) of the patients.. Serum urea, plasma glucose and triglycerides were higher than normal value (p < 0.01). The most common complications were retinopathy (41.9%), nephropathy (39.7%), buccal and dental complications (36.9%), and peripheral polyneuropathy (24.6%).

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NH gI HIU QU KIM SOT gLUCOSE MU SAU N HAI gI CATHUC gLUCOBAy THNg QUA CH S HBA1C BNH NHN T Typ2

IU Tr NgOI Tr TI BNH vIN NI TIT TTS. BS. Trn Th Thanh Ha - Bnh vin Ni tit T

TM TTMc tiu: nh gi hiu qu kim sot glucose mu sau n hai gi ca thuc Glucobay thng qua ch s Hba1C bnh nhn Ttyp2 iu tr ngoi tr ti Bnh Vin Ni Tit v tc dng khng mong mun ca thuc Glucobay. phng php: Nghin cu tin cu c so snh. Bnh nhn tui t 30 n 69, c chn on T type2 theo WHO nm 1998 ang iu tr cc nhm thuc vin h glucose mu, nhng bnh nhn ny c nh lung Glucose mu lc i, glucose mu hai gi sau n cho mi ln khm v nh lng Hba1c trc khi nhn vo nghin cu v kt thc sau 16 tun iu tr ngoi tr ti Bnh Vin Ni Tit. Chng ti chn cc bnh nhn T, nhng bnh nhn ny lm xt nghim Glucose mu hai gi sau n 8,0 mmol/l ( theo tiu chun ca IDF). Nhm chng chn 30 bnh nhn tui t 30 n 69 chn on Ttyp2 iu tr cc nhm thuc vin h glucose huyt, cc bnh nhn ny c nh lung Glucose mu lc i, glucose mu hai gi sau n v Hba1c trc khi nhn vo nghin cu v kt thc sau 16 tun v nhm bnh nhn ny khng s dng thuc glucobay so snh vi nhm bnh nhn c phi hp thuc Glucobay iu tr ngoi tr ti Bnh Vin Ni Tit.Kt lun: T l gim ng huyt sau n trc iu tr v ng huyt sau n sau 16 tun iu tr gim c 23% (3,84mmol/l) c ngha thng k. Nhm bnh ch s HbA1c trung bnh trc iu tr l 8,62% 1,12% sau iu tr ch s HbA1c l 7,96% 1,18%, gim c 0,66%. Nhm chng ch s HbA1c trung bnh trc iu tr v sau iu tr khng gim m li tng ln 0,1%. Triu chng y hi gp 28 bnh nhn chim t l 25,2%,tiu chy gp 12 bnh nhn chim 10%, khng c bnh nhn no phi rt khi nhm nghin cu.

ABSTrACT

Aims: this is a self-hand-pocket study to evaluate the efficacies of Glucobay at 2 hours after meals through HbA1C in T2DM out-patients in Endocrinology institute; Define the adversed events of Glucobay on local out-patients. Method: A prospective study comparing group of 111 T2DM out-patients of Endocrinology institute to other group of 30 T2DM patients, using other kinds of ODA_ Following their treatment during 16 weeks, measuring Fasting Plasma Glucose test and HbA1C regularly, focused on the special period of before and after treatment. Results: There were the significant decline of PPG (on comparing mean PPG before and after 16 weeks of treatment) (23% _ 3.84 mmol/L), the mean HbA1C declined clearly in Glucobay group (0.66%) comparing to

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group of other ODA patients. Besides, the side effects were defined as bloating, gas (25.2%), diarrhea (10%), headache (7.2%), but no patient was withdrawn from this study due to side effects.

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NgHIN CU TNH TrNg KHNg INSULIN BNH NHN T Typ2TI BNH vIN A KHOA TW THI NgUyN

Phm Th NhunBVKT Thi Nguyn

TM TT Khng insulin (KI) ng vai tr quan trng trong c ch bnh sinh ca bnh i tho ng (T). N ng hnh vi bo ph v mt s nguy c tim mch khc. C nhiu phng php nh gi s KI, ch s HOMA-IR ( HomaOstasis Model Assessent Insulin Resistance) l mt trong nhng ch s thng c s dng nh gi tnh trng KI bnh nhn T typ2.Mc tiu nghin cu: nh gi tnh trng KI bnh nhn T typ2i tng v phng php nghin cu:- 185 i tng nghin cu, gm: + Nhm chng: 40 ngi kho mnh, + Nhm bnh nhn T typ2:145 ngi.-Tt c u c khm lm sng v ly mu xt nghim.-Ch s HOMA-IR c tnh theo cng thc: HOMA- IR = I0(u/ml) x G0(mmol/l) / 22,5.-X l s liu theo chng trnh SPSS 13.0Kt qu:-T l KI bnh nhn T typ2 trong nhm nghin cu l 73,8%,-Hm lng insulin v ch s KI (HOMA-IR) bnh nhn T typ2cao hn so vi nhm chng,vi p < 0,05.-Hm lng insulin, ri lon chuyn ho lipid, t l tng huyt p, s o vng bng / vng mng nhm bnh nhn T typ2 c KI cao hn so vi nhm T typ2 khng KI, vi p < 0,05.

SUMMAry

Background: Insulin resistance (IR) plays an important role in the pathophysiology of type 2 diabetes mel-litus. It is well correlated with obesity and others cardiovascular risk factors. There are many methods for evaluating IR in type 2 diabetic patients, and the index of Homeostasis model assessent Insulin resistance (HOMA- IR) is the most common method. Aim of the study: to evaluate the IR in type 2 diabetic patients by HOMA-IR. Subject and methods: In this case control study, we evaluated the insulin resistance in 145 type 2 diabetic patients using the HOMA-IR formula and compared with 40 healthy subjects. results: The prevenlence of IR in type 2 diabetic patients was 73,8%, statistically higher than in the control group (p < 0,05). Other components of the metabolic syndrome such as insulinemia, lipidemia, waist-to-hip ratio and the prevalence of hypertension were much higher in diabetic patients with IR than in diabetic patients without IR (p < 0.05).

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NNg INSULIN, CH S KHNg INSULIN, NHy INSULIN v CHC NNg T BO BTA XC NH THEO M HNH HOMA 2 BNH NHN I THO Ng Typ 2

TrN 60 TUI CHN ON LN UBSCK II. Nguyn Ha Hip - BVK Thng nht - ng Nai

PGS. TS. Hong Trung Vinh - Hc vin Qun yTS. Bi Vn Mnh - Hc vin Qun y

TM TTKho st nng insulin, ch s khng insulin (HOMA 2-IR), nhy insulin (HOMA 2.%S), v chc nng tit insulin ca t bo bta (HOMA 2.%B) xc nh bng m hnh HOMA 2 62 bnh nhn (BN) i tho ng typ 2 (T typ 2) tui trn 60 chn on ln u c so snh vi nhm chng khe mnh v nhm chng bnh. Kt qu nhn thy: Gi tr trung bnh nng insulin, HOMA 2-IR tng; HOMA 2-%S, HOMA 2-%B gim so vi c hai nhm chng. S BN c tng nng n insulin, gim HOMA 2-%B chim t l cao, s BN c tng HOMA 2-IR, gim HOMA 2-%S tng ng so vi nhm chng bnh. Gi tr trung bnh HOMA 2-IR tng, HOMA 2-%S gim bnh nhn d cn, bo, tng huyt p (THA), ri lon lipid mu (RLLP) so vi nhng bnh nhn c cc ch s trn mc bnh thng song lin quan khng c ngha vi hi chng chuyn ha (HCCH) T kha: i tho ng typ 2, i tho ng typ 2 ngi cao tui, khng insulin, nhy insulin, chc nng t bo bta.

SUMMAryEvALUATION OF INSULIN CONCENTrATION, INSULIN rESISTANCE, INSULIN SENSITIv-ITy AND INSULIN SECrETION By HOMA 2 MODEL IN DIABETIC pATIENTS FIrST DIAg-

NOSED AT THE AgE OF 60.

Aims of the study: (1) to investigate insulin level, insulin resistance, insulin sensitivity and insulin secretion by HOMA 2 model in 62 diabetic patients first diagnosed at the age of 60 and (2) to compare these variables with the control healthy group and with diabetic patients less than 60 years old. results: the mean value of insulin level and the HOMA 2-IR were higher, HOM2-%S and HOM 2-%B were lower in the diabetic group first diagnosed at the age of 60 than in the two control groups.The rate of patients with high insulin level, low HOMA 2-%B were higher and the rate of patients with high HOMA 2-IR, low HOMA 2-%S were similar compared with diabetic patients less than 60 years old group. The mean value of HOMA 2-IR was increased, HOMA 2-%S was decreased in patients with overweight, high circumference, hypertension, dyslipidemia but have no significant relation with metabolic syndrome.

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C IM LM SNg, CN LM SNg v MT S BIN CHNg BNH NHN I THO Ng Typ 2 TrN 60 TUI CHN ON LN U

BSCK II. Nguyn Ha Hip - BVK Thng nht - ng NaiPGS. TS. Hong Trung Vinh - Hc vin Qun y

TS. Bi Vn Mnh - Hc vin Qun y

TM TTSo snh triu chng lm sng, cn lm sng, bnh kt hp v mt s bin chng c quan ch 62 bnh nhn (BN) i tho ng typ 2 (T typ 2) trn 60 tui c chn on ln u vi 42 BN T typ 2 di 60 tui cng chn on ln u.

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Ti liu thng tin cho cn b y t

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THNG TIN K TOA

TI LIU THAM KHO:1. Blonde L. et al. Diabetes, Obesity and Metabolism 2009;11:623631; 2. Hermansen K. et al. Diabetes Care 2006;29:12691274; 3. Thng tin k toa Levemir c ph duyt bi cc Qun l dc Vit Nam; 4. Philis-Tsimikas A. et al. Clin Ther 2006; 28:15691581; 5. Rosenstock J. et al. Diabetologia 2008;51:408416.

THUN TIN VI BT TIM FLEXPEN

KIM SOT HbA1c HIU QU1,2

THUN TIN VI BT TIM FLEXPEN

KIM SOT HbA1c HIU QU

LIU TIM 1 LN/NGY

Mu sc ca bt timd nhn bit

Thit k s dng vikim tim NovoFine

S giy tip nhn h s ng k ti liu thng tin thuc ca Cc QLD-B Y T: 0085/14/QLD-TT,Ngy 17 thng 04 nm 2014 - Ngy in ti liu: Ngy 08 thng 05 nm 2014

Insulin nncho bnh nhn i tho ng3FlexPen (insulin detemir)

Thng tin chi tit, xin lin h: Lu 2, Ta nh E-Town 2 364 Cng Ha, Q. Tn Bnh, TP.HCM T: +84 3812 5848 Fax: +84 38125842

VPD Novo Nordisk Pharma Operations A/S

Tng 19, phng 1908, to nh SunWah 115 Nguyn Hu, Qun 1, Thnh ph H Ch Minh T: +84 8 3915 3636Fax: +84 8 3915 3636

Cng ty phn phi:

Vimedimex Bnh Dng18L 1-2 VSIP II, ng S 3,KCN Vit Nam - Singapore 2,Th Du Mt, Bnh Dng FlexPen (insulin detemir)

Levemir FlexPen Rx thuc bn theo nInsulin detemir 100 U/ml, dung dch tim cha trong bt tim bm sn thuc. THNH PHN NH TNH V NH LNG: 1 ml dung dch cha 100 n v (U) insulin detemir* (tng ng vi 14,2 mg). 1 bt tim bm sn thuc cha 3 ml tng ng vi 300 n v. * Insulin detemir c sn xut bng k thut DNA ti t hp trong t bo Saccharomyces cerevisiae. 1 n v (U) insulin detemir tng ng vi 1 n v quc t (IU) insulin ngi. DNG BO CH: Dung dch tim trong sut, khng mu, trung tnh cha trong bt tim FlexPen bm sn thuc. CH NH IU TR: iu tr bnh i tho ng ngi ln, thiu nin v tr em t 2 tui tr ln. LIU LNG V CCH DNG: Levemir FlexPen l cht tng t insulin nn, ha tan c thi gian tc dng ko di (n 24 gi). So vi cc insulin khc, ch iu tr insulin nn-bolus vi Levemir FlexPen khng km theo tng cn. Nguy c h ng huyt v ban m thp hn so vi insulin NPH (Neutral Protamine Hagedorn) cho php chun liu tng cao hn nhm t c mc glucose huyt mc tiu trong ch iu tr insulin nn-bolus. Levemir FlexPen em li s kim sot ng huyt tt hn khi o glucose huyt tng lc i (FPG) so vi iu tr bng insulin NPH. Levemir FlexPen c th dng n c di dng insulin nn hoc kt hp vi insulin bolus. Levemir FlexPen cng c th dng kt hp vi cc thuc iu tr i tho ng dng ung hoc di dng liu php b tr cho iu tr bng liraglutid. Liu lng: Khi kt hp vi cc thuc iu tr i tho ng dng ung hoc b tr cho liraglutid, khuyn co dng Levemir FlexPen 1 ln/ngy, liu khi u l 10 U hoc 0,1-0,2 U/kg. Liu Levemir FlexPen nn c chun da trn nhu cu ca tng bnh nhn. Da trn cc kt qu nghin cu, c th s dng hng dn chun liu sau y:

* Self Monitored Plasma Glucose: Glucose huyt tng t theo di. Khi Levemir FlexPen c s dng nh mt phn ca ch iu tr insulin nn-bolus, nn dng Levemir FlexPen mt hoc hai ln mi ngy ty theo nhu cu ca bnh nhn. Liu Levemir FlexPen nn c iu chnh theo tng bnh nhn. i vi nhng bnh nhn cn dng liu hai ln mi ngy kim sot ti u glucose huyt, liu bui ti c th s dng vo bui ti hoc lc i ng. Vic iu chnh liu c th cn thit nu bnh nhn tng hot ng th lc, thay i ch n thng thng hoc ang c bnh km theo. Nhm bnh nhn c bit: Cng nh vi tt c cc sn phm insulin, nhng bnh nhn cao tui v nhng bnh nhn suy thn hoc suy gan, nn tng cng theo di glucose v liu Levemir FlexPen nn c iu chnh theo tng bnh nhn. Hiu qu v an ton ca Levemir FlexPen c chng minh thiu nin v tr em t 2 tui tr ln trong cc nghin cu n 12 thng. Chuyn sang t nhng sn phm insulin khc: C th cn phi iu chnh liu v thi gian tim thuc khi chuyn t cc sn phm insulin tc dng trung gian hoc insulin tc dng ko di sang Levemir FlexPen. Cch dng: ng dng: Tim di da. Levemir FlexPen ch dng tim di da. Levemir FlexPen khng c tim tnh mch v c th gy h ng huyt trm trng. Tim bp cng nn trnh. Levemir FlexPen khng c s dng trong bm truyn insulin. Levemir FlexPen c dng tim di da vng thnh bng, i, phn trn cnh tay, vng c delta hoc vng mng. Nn lun thay i v tr tim trong cng mt vng tim gim nguy c lon dng m. Cng nh vi tt c cc sn phm insulin, thi gian tc dng s thay i ty theo liu dng, v tr tim, lu lng mu, nhit v mc hot ng th lc. CHNG CH NH: Qu mn vi hot cht hay bt k t dc no ca thuc. Cnh bo v thn trng c bit khi s dng: c k hng dn s dng trc khi dng. Nu cn thm thng tin, xin hi kin bc s. Thuc ny ch dng theo n ca bc s. Trc khi i du lch n ni c s khc bit v mi gi, bnh nhn nn tham kho kin bc s, v iu ny c ngha l bnh nhn phi tim insulin v dng ba n vo nhng thi im khc. Tng ng huyt: Vic iu tr insulin khng liu hoc khng lin tc, c bit trong i tho ng type 1, c th dn n tng ng huyt v nhim toan ceton do i tho ng. Thng thng, cc triu chng u tin ca tng ng huyt xut hin t t, ko di trong vi gi hoc vi ngy. Nhng triu chng ny bao gm kht, tiu nhiu ln, bun nn, nn, bun ng, da kh , kh ming, mt s ngon ming v hi th c mi aceton. Trong i tho ng type

1, cc trng hp tng ng huyt khng c iu tr cui cng s dn n nhim toan ceton do i tho ng, c kh nng gy t vong. H ng huyt: B mt ba n hay luyn tp th lc gng sc, khng c k hoch c th dn n h ng huyt. H ng huyt c th xy ra nu liu insulin qu cao so vi nhu cu insulin. Nhng bnh nhn c s kim sot glucose huyt c ci thin r, v d do liu php insulin tch cc, c th c thay i v nhng triu chng bo trc thng gp ca h ng huyt v nn c bc s thng bo trc. Nhng triu chng bo hiu thng thy c th mt i nhng bnh nhn b bnh i tho ng lu. Cc bnh i km, c bit tnh trng nhim trng v st, thng lm tng nhu cu insulin ca bnh nhn. Cc bnh i km thn, gan hoc bnh nh hng n tuyn thng thn, tuyn yn hoc tuyn gip c th i hi thay i liu insulin. Chuyn sang t cc sn phm insulin khc: Khi chuyn bnh nhn sang s dng loi insulin hay nhn hiu insulin khc cn thc hin di s gim st y t cht ch. Phn ng ti ch tim: Cng nh bt k liu php insulin no khc, c th c phn ng ti ch tim, bao gm au, , ni m ay, vim, thm tm, sng v nga. Thay i lin tc ch tim trong vng tim c th gip lm gim hoc phng trnh cc phn ng ny. Nhng phn ng trn thng qua i trong vi ngy n vi tun. Trong mt s trng hp him gp, phn ng ti ch tim c th i hi phi ngng s dng Levemir FlexPen. Kt hp thiazolidinedione v cc thuc insulin: c bo co v cc trng hp suy tim sung huyt khi dng thiazolidinedione kt hp vi insulin, c bit nhng bnh nhn c cc yu t nguy c v pht trin suy tim sung huyt. Cn phi nh iu ny nu xem xt iu tr kt hp thiazolidinedione vi cc thuc insulin. Nu s dng kt hp, phi theo di bnh nhn v cc du hiu v triu chng ca suy tim sung huyt, tng cn v ph. Phi ngng s dng thiazolidinedione nu xy ra bt k triu chng no v tim xu i. TNG TC VI CC THUC KHC V CC DNG TNG TC KHC: Mt s thuc c bit l c tng tc vi chuyn ha glucose. Nhng cht sau y c th lm gim nhu cu insulin ca bnh nhn: Cc thuc chng i tho ng dng ung, cht c ch monoamine oxidase (MAOI), thuc chn beta, cht c ch enzyme chuyn angiotensin (ACE), salicylat, cc steroid ng ha v sulphonamid. Nhng cht sau y c th lm tng nhu cu insulin ca bnh nhn: Cc thuc trnh thai dng ung, thiazid, glucocorticoid, hormone tuyn gip, cht ging giao cm, hormone tng trng v danazol. Cc thuc chn beta c th che lp cc triu chng h ng huyt. Octreotid/lanreotid c th lm tng hay gim nhu cu insulin. Ru c th lm tng hoc lm gim tc dng h ng huyt ca insulin. PH N C THAI V CHO CON B: C th xem xt iu tr bng Levemir FlexPen trong thi k mang thai nu li ch bin minh c cho nguy c c th xy ra. Mt th nghim lm sng ngu nhin c i chng ph n mang thai b i tho ng type 1 so snh Levemir FlexPen (n=152) vi insulin NPH (n=158), c hai kt hp vi insulin aspart. Kt qu cho thy insulin detemir v insulin NPH c hiu qu tng t v mt d liu an ton tng th tng t trong thi k mang thai, kt qu ca mang thai cng nh i vi thai nhi v tr s sinh. Cc d liu hu mi t khong 300 kt qu b sung ph n mang thai s dng Levemir FlexPen cho thy insulin determir khng c tc dng bt li n qu trnh mang thai v khng c c tnh gy d tt hoc hoc c tnh i vi thai nhi/tr s sinh. Cc d liu trn ng vt khng cho thy c tnh i vi sinh sn. Ph n cho con b: Cha r c phi insulin detemir c bi tit vo sa m hay khng. C th cn phi iu chnh liu insulin ph n cho con b. TC NG TRN KH NNG LI XE V S DNG MY MC: Kh nng tp trung v phn ng ca bnh nhn c th b suy gim do hu qu ca h ng huyt. TC DNG KHNG MONG MUN: Tm tt v cc d liu an ton: Cc phn ng ph quan st thy bnh nhn s dng Levemir FlexPen ch yu l do tc dng dc l ca insulin. c tnh tng t l phn trm bnh nhn iu tr d kin s gp cc phn ng ph ca thuc l 12%. Bng danh mc cc phn ng ph: Rt thng gp ( 1/10): Ri lon chuyn ha v dinh dng - h ng huyt. Thng gp ( 1/100 n

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TI LIU THAM KHO:1. Blonde L. et al. Diabetes, Obesity and Metabolism 2009;11:623631; 2. Hermansen K. et al. Diabetes Care 2006;29:12691274; 3. Thng tin k toa Levemir c ph duyt bi cc Qun l dc Vit Nam; 4. Philis-Tsimikas A. et al. Clin Ther 2006; 28:15691581; 5. Rosenstock J. et al. Diabetologia 2008;51:408416.

THUN TIN VI BT TIM FLEXPEN

KIM SOT HbA1c HIU QU1,2

THUN TIN VI BT TIM FLEXPEN

KIM SOT HbA1c HIU QU

LIU TIM 1 LN/NGY

Mu sc ca bt timd nhn bit

Thit k s dng vikim tim NovoFine

S giy tip nhn h s ng k ti liu thng tin thuc ca Cc QLD-B Y T: 0085/14/QLD-TT,Ngy 17 thng 04 nm 2014 - Ngy in ti liu: Ngy 08 thng 05 nm 2014

Insulin nncho bnh nhn i tho ng3FlexPen (insulin detemir)

Thng tin chi tit, xin lin h: Lu 2, Ta nh E-Town 2 364 Cng Ha, Q. Tn Bnh, TP.HCM T: +84 3812 5848 Fax: +84 38125842

VPD Novo Nordisk Pharma Operations A/S

Tng 19, phng 1908, to nh SunWah 115 Nguyn Hu, Qun 1, Thnh ph H Ch Minh T: +84 8 3915 3636Fax: +84 8 3915 3636

Cng ty phn phi:

Vimedimex Bnh Dng18L 1-2 VSIP II, ng S 3,KCN Vit Nam - Singapore 2,Th Du Mt, Bnh Dng FlexPen (insulin detemir)

Levemir FlexPen Rx thuc bn theo nInsulin detemir 100 U/ml, dung dch tim cha trong bt tim bm sn thuc. THNH PHN NH TNH V NH LNG: 1 ml dung dch cha 100 n v (U) insulin detemir* (tng ng vi 14,2 mg). 1 bt tim bm sn thuc cha 3 ml tng ng vi 300 n v. * Insulin detemir c sn xut bng k thut DNA ti t hp trong t bo Saccharomyces cerevisiae. 1 n v (U) insulin detemir tng ng vi 1 n v quc t (IU) insulin ngi. DNG BO CH: Dung dch tim trong sut, khng mu, trung tnh cha trong bt tim FlexPen bm sn thuc. CH NH IU TR: iu tr bnh i tho ng ngi ln, thiu nin v tr em t 2 tui tr ln. LIU LNG V CCH DNG: Levemir FlexPen l cht tng t insulin nn, ha tan c thi gian tc dng ko di (n 24 gi). So vi cc insulin khc, ch iu tr insulin nn-bolus vi Levemir FlexPen khng km theo tng cn. Nguy c h ng huyt v ban m thp hn so vi insulin NPH (Neutral Protamine Hagedorn) cho php chun liu tng cao hn nhm t c mc glucose huyt mc tiu trong ch iu tr insulin nn-bolus. Levemir FlexPen em li s kim sot ng huyt tt hn khi o glucose huyt tng lc i (FPG) so vi iu tr bng insulin NPH. Levemir FlexPen c th dng n c di dng insulin nn hoc kt hp vi insulin bolus. Levemir FlexPen cng c th dng kt hp vi cc thuc iu tr i tho ng dng ung hoc di dng liu php b tr cho iu tr bng liraglutid. Liu lng: Khi kt hp vi cc thuc iu tr i tho ng dng ung hoc b tr cho liraglutid, khuyn co dng Levemir FlexPen 1 ln/ngy, liu khi u l 10 U hoc 0,1-0,2 U/kg. Liu Levemir FlexPen nn c chun da trn nhu cu ca tng bnh nhn. Da trn cc kt qu nghin cu, c th s dng hng dn chun liu sau y:

* Self Monitored Plasma Glucose: Glucose huyt tng t theo di. Khi Levemir FlexPen c s dng nh mt phn ca ch iu tr insulin nn-bolus, nn dng Levemir FlexPen mt hoc hai ln mi ngy ty theo nhu cu ca bnh nhn. Liu Levemir FlexPen nn c iu chnh theo tng bnh nhn. i vi nhng bnh nhn cn dng liu hai ln mi ngy kim sot ti u glucose huyt, liu bui ti c th s dng vo bui ti hoc lc i ng. Vic iu chnh liu c th cn thit nu bnh nhn tng hot ng th lc, thay i ch n thng thng hoc ang c bnh km theo. Nhm bnh nhn c bit: Cng nh vi tt c cc sn phm insulin, nhng bnh nhn cao tui v nhng bnh nhn suy thn hoc suy gan, nn tng cng theo di glucose v liu Levemir FlexPen nn c iu chnh theo tng bnh nhn. Hiu qu v an ton ca Levemir FlexPen c chng minh thiu nin v tr em t 2 tui tr ln trong cc nghin cu n 12 thng. Chuyn sang t nhng sn phm insulin khc: C th cn phi iu chnh liu v thi gian tim thuc khi chuyn t cc sn phm insulin tc dng trung gian hoc insulin tc dng ko di sang Levemir FlexPen. Cch dng: ng dng: Tim di da. Levemir FlexPen ch dng tim di da. Levemir FlexPen khng c tim tnh mch v c th gy h ng huyt trm trng. Tim bp cng nn trnh. Levemir FlexPen khng c s dng trong bm truyn insulin. Levemir FlexPen c dng tim di da vng thnh bng, i, phn trn cnh tay, vng c delta hoc vng mng. Nn lun thay i v tr tim trong cng mt vng tim gim nguy c lon dng m. Cng nh vi tt c cc sn phm insulin, thi gian tc dng s thay i ty theo liu dng, v tr tim, lu lng mu, nhit v mc hot ng th lc. CHNG CH NH: Qu mn vi hot cht hay bt k t dc no ca thuc. Cnh bo v thn trng c bit khi s dng: c k hng dn s dng trc khi dng. Nu cn thm thng tin, xin hi kin bc s. Thuc ny ch dng theo n ca bc s. Trc khi i du lch n ni c s khc bit v mi gi, bnh nhn nn tham kho kin bc s, v iu ny c ngha l bnh nhn phi tim insulin v dng ba n vo nhng thi im khc. Tng ng huyt: Vic iu tr insulin khng liu hoc khng lin tc, c bit trong i tho ng type 1, c th dn n tng ng huyt v nhim toan ceton do i tho ng. Thng thng, cc triu chng u tin ca tng ng huyt xut hin t t, ko di trong vi gi hoc vi ngy. Nhng triu chng ny bao gm kht, tiu nhiu ln, bun nn, nn, bun ng, da kh , kh ming, mt s ngon ming v hi th c mi aceton. Trong i tho ng type

1, cc trng hp tng ng huyt khng c iu tr cui cng s dn n nhim toan ceton do i tho ng, c kh nng gy t vong. H ng huyt: B mt ba n hay luyn tp th lc gng sc, khng c k hoch c th dn n h ng huyt. H ng huyt c th xy ra nu liu insulin qu cao so vi nhu cu insulin. Nhng bnh nhn c s kim sot glucose huyt c ci thin r, v d do liu php insulin tch cc, c th c thay i v nhng triu chng bo trc thng gp ca h ng huyt v nn c bc s thng bo trc. Nhng triu chng bo hiu thng thy c th mt i nhng bnh nhn b bnh i tho ng lu. Cc bnh i km, c bit tnh trng nhim trng v st, thng lm tng nhu cu insulin ca bnh nhn. Cc bnh i km thn, gan hoc bnh nh hng n tuyn thng thn, tuyn yn hoc tuyn gip c th i hi thay i liu insulin. Chuyn sang t cc sn phm insulin khc: Khi chuyn bnh nhn sang s dng loi insulin hay nhn hiu insulin khc cn thc hin di s gim st y t cht ch. Phn ng ti ch tim: Cng nh bt k liu php insulin no khc, c th c phn ng ti ch tim, bao gm au, , ni m ay, vim, thm tm, sng v nga. Thay i lin tc ch tim trong vng tim c th gip lm gim hoc phng trnh cc phn ng ny. Nhng phn ng trn thng qua i trong vi ngy n vi tun. Trong mt s trng hp him gp, phn ng ti ch tim c th i hi phi ngng s dng Levemir FlexPen. Kt hp thiazolidinedione v cc thuc insulin: c bo co v cc trng hp suy tim sung huyt khi dng thiazolidinedione kt hp vi insulin, c bit nhng bnh nhn c cc yu t nguy c v pht trin suy tim sung huyt. Cn phi nh iu ny nu xem xt iu tr kt hp thiazolidinedione vi cc thuc insulin. Nu s dng kt hp, phi theo di bnh nhn v cc du hiu v triu chng ca suy tim sung huyt, tng cn v ph. Phi ngng s dng thiazolidinedione nu xy ra bt k triu chng no v tim xu i. TNG TC VI CC THUC KHC V CC DNG TNG TC KHC: Mt s thuc c bit l c tng tc vi chuyn ha glucose. Nhng cht sau y c th lm gim nhu cu insulin ca bnh nhn: Cc thuc chng i tho ng dng ung, cht c ch monoamine oxidase (MAOI), thuc chn beta, cht c ch enzyme chuyn angiotensin (ACE), salicylat, cc steroid ng ha v sulphonamid. Nhng cht sau y c th lm tng nhu cu insulin ca bnh nhn: Cc thuc trnh thai dng ung, thiazid, glucocorticoid, hormone tuyn gip, cht ging giao cm, hormone tng trng v danazol. Cc thuc chn beta c th che lp cc triu chng h ng huyt. Octreotid/lanreotid c th lm tng hay gim nhu cu insulin. Ru c th lm tng hoc lm gim tc dng h ng huyt ca insulin. PH N C THAI V CHO CON B: C th xem xt iu tr bng Levemir FlexPen trong thi k mang thai nu li ch bin minh c cho nguy c c th xy ra. Mt th nghim lm sng ngu nhin c i chng ph n mang thai b i tho ng type 1 so snh Levemir FlexPen (n=152) vi insulin NPH (n=158), c hai kt hp vi insulin aspart. Kt qu cho thy insulin detemir v insulin NPH c hiu qu tng t v mt d liu an ton tng th tng t trong thi k mang thai, kt qu ca mang thai cng nh i vi thai nhi v tr s sinh. Cc d liu hu mi t khong 300 kt qu b sung ph n mang thai s dng Levemir FlexPen cho thy insulin determir khng c tc dng bt li n qu trnh mang thai v khng c c tnh gy d tt hoc hoc c tnh i vi thai nhi/tr s sinh. Cc d liu trn ng vt khng cho thy c tnh i vi sinh sn. Ph n cho con b: Cha r c phi insulin detemir c bi tit vo sa m hay khng. C th cn phi iu chnh liu insulin ph n cho con b. TC NG TRN KH NNG LI XE V S DNG MY MC: Kh nng tp trung v phn ng ca bnh nhn c th b suy gim do hu qu ca h ng huyt. TC DNG KHNG MONG MUN: Tm tt v cc d liu an ton: Cc phn ng ph quan st thy bnh nhn s dng Levemir FlexPen ch yu l do tc dng dc l ca insulin. c tnh tng t l phn trm bnh nhn iu tr d kin s gp cc phn ng ph ca thuc l 12%. Bng danh mc cc phn ng ph: Rt thng gp ( 1/10): Ri lon chuyn ha v dinh dng - h ng huyt. Thng gp ( 1/100 n

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Kt qu nhn thy: T l tng chu vi vng bng, t s vng bng/vng mng cao hn. 64,5% trng hp khng c triu chng lm sng kinh in. n km, mt ng ko di l 2 triu chng c t l cao hn. S BN c tng acid uric, cholesterol, triglycerid, GGT; gim protein, albumin, HDL.c, hng cu, Hb, EF < 50%, tng ch s khi lng c tht tri (LVMI), ST chnh bnh l, dng pS, bloc nh - tht trn in tim u c t l cao hn.T kha: i tho ng typ 2, i tho ng typ 2 ngi cao tui.

SUMMAryCLINICAL, pArACLINICAL CHArACTErISTICS AND COMpLICATIONS IN DIABETIC pA-

TIENTS FIrST DIAgNOSED AT THE AgE OF SIXTy.

The aims of this study are investigation about clinical, paraclinical characteristics and some complications in 62 first time diagnosed patients over 60 years of type 2 diabetes mellitus compared to 42 first time diagnosed patients below 60 years of type 2 diabetes mellitus included in control group. results showed that: Patients with increased waist circumference, and ratio of waist circumference/hip high-er. 64.5% patients without classical clinical symptoms. Two signs have high percentage are poor appetite, lose sleep. Patients with high concentration of uric acid, cholesterol, triglyceride, GGT, decreasing concentration of protein, albumin, HDL-c, red blood cell, hemoglobin, EF

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ASSESSMENT OF THE rOLE OF THE HbA1C CONTrOL IN TUBErCULOSIS TrEATMENT FOr TB pATIENTS WITH TypE II DIABETES

Dr. Nguyen Anh QuanTechnical University of Medicine and Pharmacy-Da Nang

Background: The results of HbA1C tests indicate glycemic control. The correlation study was carried out between the effective control of type II Diabetes with TB treatment outcomes; there are two objectives: 1. Clinical and subclinical studies for tuberculosis patients having type II Diabetes. 2. Evaluating the TB treatment outcomes based on glycemic control with HbA1c value.Study population: Tuberculosis patients with type II diabetes include 89 patients, 57 male; 32 women primar-ily over age 55 (74.1%)Methods: The combination of retrospective, descriptive and prospective study; subscribe to vertical; conveni-ent sample. Group 1: HbA1c

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SUMMAry ENDOSCOpIC STUDy OF HELICOBACTEr pyLOrI INFECTION

IN TypE 2 DIABETIC pATIENTS

Studied on 120 type 2 diabetic patients in Department of Endocrinology Hospital 103. Aim of the study: To identify the prevalence of clinical symptoms, endoscopic features, and the prevalence of helicobacter pylori infection in type 2 diabetic patients. Method: cross-sectional study including 120 type 2 diabetic inpatients in the Department of Endocrinology of The 103 Hospital. results: abdominal pain in 62.5%, belching in 56.7%, nausea in 45.8%, heartburn in 43.3%, constipation in 26.7%, diarrhea in 15.0%.- Gastroscopic images: erythemateous edema gastritis (42,5%), flat erosion, in 11,7%, raised erosion in 22.5%, and atrophic gastritis in 32,5%, gastric ulcer in 11.7% and no gastric cancer. - The rate of helicobacter pylori infection was 38.3% (in which 4.2% severe infection, 8.3% moderate infec-tion and 25.8% mild infection).- There are significant differences between the proportion of endoscopic inflammations in the stomach and HbA1c levels control, BMI, duration of diabetes (p

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SUMMArygLyCEMIC CONTrOL AND ITS rISK FACTOrS OF OUTpATIENTS pArTICIpATINg

IN DIABETES MANAgEMENT prOgrAM AT OUTpATIENT DEpArTMENTAT BACH MAI HOSpITAL

Vu Thuy Thanh, Nguyen Trang Nhung, Nguyen Thi Hong Van, Vien Van DoanOutpatient Deparment, Bach Mai hospital

Background: The program for management of outpatients with diabetes plays an important role in improving the glycemic control. Aims: To describe the situation of controlling glycemic and its risk factors in patients participating in diabetes management program at Bach Mai Hospital. Material and methods: a cross sectional study in 1160 diabetes outpatients aged 19-92 at Bach Mai hospital from 1/2014 to 5/2014.results: The results indicate that 61% patients had achieved target blood glucose control. The longer duration of disease was, the worse glycemic control level. 86.3% patients had hypertension, however 76.2% patients with good blood pressure control. 76.6% patients had dyslipidemia, the rate of elevated triglycerid was highest 61,8%. Only 9.36% patients had renal impairment levels. All patients were received consultancy about diet and exercise, 80% patients performed better diet and regular exercises, the remaining elderly patients, limited movement due to complications. 100% patients took medicine regularly. About 50.1% of patients treated only pills to control glucose, 22.9% insulin injections, 27,0% of patients had boths insulin and pills.Conclusions: The first step shows relatively clinical effectiveness of the management better outpatients treat-ment for people with diabetes.Key word: Diabetes management program, glycemic control.

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MT S yU T LIN QUAN N KIM SOT gLUCOSE MU BNH NHN I THO Ng TI KHOA NI TIT - BNH vIN vIT TIp HI pHNg NM 2011

ThS. BS. Nguyn Th Thy Ngn, PGS. TS. Th TnhKhoa Ni tit - Bnh Vin Vit Tip Hi Phng

TM TTNghin cu 138 bnh nhn i tho ng ti khoa ni 3 - Bnh vin vit Tip t 03-08/2011 bng phng php m t ct ngang chng ti thy: Tui trung bnh ca i tng nghin cu l 61,1 12,1; phn ln BN c tui trn 50 v nhm tui 70 c t l cao nht 31,9%. T l nam v n l ngang nhau. BN khng thc hin ch n v tp c nguy c kim sot GML v HbA1c khng t cao gp 3,94 v 2,89 ln (p

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Background: Good control of blood glucose and of other relevant factors will improve and extend the qual-ity of life of diabetics, limiting complications in target organs. However, in practice there are many factors that make blood glucose control more difficult. In Hai Phong city, have not been many studies evaluating the factors that affect blood sugar condition. Therefore, we carried out subject to the commented influence of several factors (diet and exercise, blood glucose monitoring, using of antihyperglycemic, etc.) to the control of blood glucose in patients with diabetes hospitalized in Department of endocrinology of Viet- Czech Friendship Hospital in 2011. Methods: In a cross-sectional study was conducted in 2011, 138 patients hospitalized for diabetes in 2011.results: Patients who did not adhere to eating and exercise plan recommended are 3.94 and 2.89 times more at risk of having poor control of fasting glucose and A1c than patients who complied with that plan (p 0.05. City cholesterol, triglycerides, LDL-c decrease, the average value increases HDL -c has no statistical

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significance. The percentage of good control of blood glucose, HbA1c, BP, Cholesterol TP increases, the rate of poor control indices declining significantly. The rate -controlled BMI, triglycerides, LDL-c increased, the proportion of poor controls have not reduced significantly. The percentage of patients with good treatment observance is 57.4 %, the rate of treatment observance of 42.6 % is not good. Group Executive therapeutical average value indices of glucose, HbA1c, systolic blood pressure, BMI, cholesterol TP, lower triglycerides significantly (p

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NHN XT C IM TNg gLUCOSE MU SAU N BNH NHN I THO Ng Typ 2 IU Tr NI Tr TI BNH vIN NI TIT NgH AN

L Th Cm, H Vn Hiu, Nguyn Th Qunh Thm v cng sBnh vin Ni tit Ngh An

TM TTKim sot cht ch glucose sau n s lm gim c ngha bin chng mn tnh v kim sot bng phng php no l vn cn t ra cho cc bc s lm sng. Nghin cu c im tng glucose mu sau n ca 200 bnh nhn i tho ng typ 2 iu tr ni tr ti Bv Ni tit Ngh An, kt qu nh sau: Glucose mu i trung bnh ca nhm bnh nhn nghin cu l 6.1 0.7 mmol/l. C s lin quan gia HbA1c vi tng glucose mu sau n. Nhm glucose mu sau n t 10 20 mmol/l chim t l cao nht (76%), nhm glucose mu sau n < 10 mmol/l ch chim 9.5%, c ngha thng k vi p < 0.05. Glucose mu sau n t 10 20 mmol/l nhm bnh nhn c bin chng mch mu ln, bin chng thn kinh ngoi vi chim t l cao nht, vi p < 0.05. Glucose mu sau n t 10 20 mmol/l nhm bnh nhn nhn s dng cc phc insulin n thun, phc 2 mi phi hp thuc vin, phc 1 mi phi hp thuc vin v thuc vin n thun chim t l cao chim t l cao nht vi p > 0.05. Nhm s dng glucovance u c glucose mu sau n t < 10mmol/l chim t l cao hn so vi cc nhm cn li.

ABSTrACT

Strict control postprandial glucose significantly reduces chronic complications and control of the method is to put the matter to the clinician. Study on postprandial hyperglycaemia of 200 patients with type 2 diabetes inpatient treatment in Nghe An Endocrine Bv , results as follows: fasting glucose average patient study group was 6.1 0.7 mmol/l . There is an association between HbA1c with postprandial hyperglycaemia . Postpran-dial blood glucose group from 10-20 mmol / l accounts for the highest percentage (76 %) , the postprandial blood glucose < 10 mmol/l accounts for only 9.5 %, which was statistically significant with p < 0.05 level. Postprandial blood glucose of 10-20 mmol/l in the group of patients had major vascular complications , pe-ripheral neuropathy highest proportion , with p < 0.05. Postprandial blood glucose of 10-20 mmol/l in patients who use insulin regimens alone, coordination nose regimen 2 tablets, 1 dose regimens coordination and tablets pills merely proportion high proportion of highest p>0.05. Groups are used glucovance achieve postprandial blood glucose < 10mmol/l higher rate than other groups.

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NgHIN CU I THO Ng Tp LADA TrONg156 TrNg Hp I THO Ng KHNg THA CN, BO pH TUI 35

BS. Nguyn Th Thu Mai GS. TS. Trn Hu Dng (HYD HU)

ABSTrACT

The prevalence of individuals with latent autoimmune diabetes in adults (LADA) among non overweight diabetic patients is unknown. Hence, the aim of this study was to determine the prevalence of LADA in non overweight diabetic patients. Study design and methods: A cross-sectional study including 156 non overweight and obesity population of diabetic patients. Clinical data were obtained and a blood sample was taken to measure glutamic acid decar-boxylase antibody (GADAb). results: The prevalence of LADA in non overweight diabetic patients was 14,10%.

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NH gI vA X Ng MCH NgOI BIN QUA SNg LC 2055 TrNg HpTrn Th Thu Hng, Quch Hu Trung, Phm Tun Dng. Bnh Vin 19-8

T: 0912449975. Email: bacsi.thuhuong@gmail.com

TM TTt vn : bnh ng mch chi di mn tnh thng l kt qu ca ca qu trnh hp dn dn ca cc ng mch chi di do nguyn nhn va x ng mch. Triu chng thng gp ca l chng khp khing cch hi, tuy nhin triu chng ny ging nh phn ni ca tng bng v ch c mt s t ngi bnh ng mch chi di b khp khing cch hi, s cn li khng c triu chng. Vi bn cht ca tnh trng va x h thng, bnh nhn bnh ng mch chi di mn tnh l i tng c nguy c cao v nhi mu c tim, t qu v t vong tim mch. Cc ch s ABI, PP, BaPWV c khuyn co trong tm sot cc yu t nguy c tim mch.Mc tiu: nh gi tnh trng va x ng mch ngoi bin qua sng lc qun th ng thi tm mi lin quan gia cc ch s nh gi va x ng mach vi mt s thng s lm sng.i tng v phng php: nghin cu trn 2055 ngi t 21 n 90 tui (375 n, 1710 nam) khm ti Bnh vin 19-8 t thng 01/2012 n thng 07/2014. Phng php nghin cu m t ct ngang. lu thng ng mch chi di c nh gi bng ch s c chn cnh tay (ABI), p lc mch (PP) v huyt p trung bnh (MAP). cng ng mch c nh gi bng tc lan truyn sng mch c chn cnh tay (baPWV). Cc i tng u c o vng bng, chiu cao, cn nng v cc ch s nh gi va x ng mch bng my VP-1000Plus (Omron). S liu x l bng SPSS 16.0.Kt qu: tc lan truyn sng mch trung bnh 1527,38 319,58cm/s, c 53,3% trng hp c tng tc lan truyn sng mch (BaPWV 1450cm/s). Ch s c chn cnh tay ABI trung bnh 1,11 0,08, c 1,3% trng hp ch s c chn cnh tay bnh l (ABI 0,9). p lc mch trung bnh 51,07 9,35mmHg, c 16,8% trng hp tng p lc mch (PP 60mmHg). N gii c tng cc ch s nh gi va x ng mch so vi nam gii [OR=2,13; (1,62 2,80); p

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ng mch - arterial stiffness (tc lan truyn sng mch, p lc mch) l mt yu t nguy c tim mch cn c nh gi theo cc hng dn chuyn ngnh. Cc nghin cu cho thy tng cng ng mch gp trn bnh nhn tng huyt p, i tho ng, bo ph v c lin quan ti cc bin c tim mch (nhi mu c tim, t qu no, t vong do tim mch).Mc tiu: nh gi cng ng mch trn bnh nhn T tp2 ng thi tm mi lin quan gia cng ng mch vi cc thng s lm sng, cn lm sng.i tng v phng php: nghin cu trn 231 ngi t 45 n 65 tui (116 ngi T tp2 v 115 ngi nhm chng) khm ti Bnh vin 19-8 thng 5/ 2014. Phng php nghin cu m t ct ngang. cng ng mch c nh gi bng tc lan truyn sng mch c chn cnh tay (baPWV), p lc mch (PP), huyt p trung bnh (MAP) v ch s c chn cnh tay (ABI). Cc i tng u c khm lm sng, xt nghim cn lm sng v o cc ch s nh gi cng ng mch bng my VP-1000Plus (Omron). S liu nghin cu c x l bng phn mm SPSS 16.0.Kt qu: cng ng mch ca bnh nhn T tp2 tng c ngha so vi nhm chng (baPWV 1517,79 250,55cm/s so vi 1236,95 99,48cm/s vi p

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lm sng v o cc ch s nh gi cng ng mch bng my VP-1000Plus (Omron). S liu x l bng SPSS 16.0.Kt qu: bnh nhn RLLP gim c ngha p lc mch (PP) chn so vi nhm chng (67,98 12,50 mmHg so vi 70,78 12,04 vi p

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MAC was evaluated by 2D mode ultrasound. results: artery calcification in 54 patients (70,13%), 49 of them (63,64%) was MAC. In 49 patients with MAC, there were 18 patients (36,73%) with mild severity and 31 patients (62,27%) with severe severity. Age, diabetes duration, HbA1c and GFR were some influential factors of MAC. Some unrelated factors were fast-ing glucose, BMI, serum lipids and serum calcium. There were a statistically significant associated between albuminuria, ABI, systolic blood presure, LVMI, QTc with MAC severity. Conclusion: MAC in type 2 diabetes patients is a common phenomenon. It relates to some diabetic compli-cations including hypertension, left ventricular hypertrophy, nephropathy and cardiac autonomic neuropathy

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KHO ST CH S HUyT Ng TI Ng MCH rNv NHU M THN BNH NHN I THO Ng Typ 2

BSCK II. L Vn Lng - BVK Thng nht - ng NaiPGS. TS. Hong Trung Vinh - Hc vin Qun y

TS. Bi Vn Mnh - Hc vin Qun y

TM TTKho st cc ch s huyt ng (CSH) ca ng mch (M) ti rn v nhu m thn 102 bnh nhn (BN) i tho ng typ 2 (T typ 2) so snh vi ch s tng ng 32 ngi khe mnh thuc nhm chng. Cc CSH bao gm: vn tc nh tm thu (Vs), vn tc cui tm trng (Vd), vn tc trung bnh (Vm); ch s p (PI) ch s tr khng (RI) xc nh bng phng php siu m Doppler. Kt qu cho thy: gim gi tr Vs, Vd, Vm; tng PI, RI ti c rn v nhu m thn trong ti rn thn cao hn so vi ti nhu m thn. T l BN gim Vs, Vd, Vm; tng RI, PI cao hn so vi BN c ch s tng ng mc bnh thng. Cc ch s vn tc tng quan nghch; PI, RI tng quan thun vi tui ca BN. PI, RI tng quan thun vi thi gian pht hin bnh. RI tng BN km THA. Kt lun: BN T typ 2 cc CSH bin i theo xu hng gim vn tc dng chy, tng ch s p v tr khng. RI tng quan thun vi tui, thi gian pht hin bnh, tng BN c THA km theo.T kha: i tho ng typ 2 ch s huyt ng ti ng mch thn.

SUMMAry

Investigate hemodynamic parameters in renal arteries at hilar and parenchyma in type 2 diabetic patients.This study was to investigate hemodynamic parameters in renal arteries at hilar and parenchyma by Duplex Doppler sonography in 102 type 2 diabetic patients and 32 control healthy subjects. Hemodynamic param-eters were examined including peak systolic velocity (Vs), end diastolic velocity (Vd), mean velocity (Vm), resistive index (RI), pulsitility index (PI). Results showed decreases in Vs, Vd, Vm; increases in RI, PI in renal artery at hilar and parenchyma. Vs, Vd, Vm, RI, PI at hilar were significantly higher than those at parenchyma. Proportion of patients with decreases in Vs, Vd, Vm, and increases in PI, RI were higher than that of patients who had normal parameters. The flow velocities had negative correlation. RI, PI positively correlated with age of patients. RI, PI have positive correlation with duration of type 2 diabetes mellitus. RI was increased in patients with hypertension. Conclusion: in type 2 diabetic patients, there were decreases in Vs, Vd, Vm and increases in RI, RI. RI had positive correlation with age and duration of type 2 diabetes mellitus. There was an increase in RI in patients with hypertension.Key words: Type 2 diabetes mellitus, hemodynamic in renal arteries.

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MI LIN QUAN gIA CC CH S HUyT Ng TI Ng MCH THN vI TN THNg THN BNH NHN I THO Ng Typ 2

BSCK II. L Vn Lng - BVK Thng nht - ng NaiPGS. TS. Hong Trung Vinh - Hc vin Qun y

TS. Bi Vn Mnh - Hc vin Qun y

TM TTKho st mi lin quan gia cc ch s huyt ng ti ng mch rn v nhu m thn bao gm: Vn tc nh tm thu (Vs), vn tc cui tm trng (Vd), vn tc trung bnh (Vm), ch s p (PI), v ch s tr khng (RI) 102 bnh nhn (BN) i tho ng typ 2 (T typ 2) vi cc mc microalbumin niu (MAU), macroalbumin niu (MAC) v suy thn mn tnh (STMT). Kt qu nhn thy: Cc ch s vn tc dng chy gim dn, PI v RI tng dn theo mc tn thng thn. Cc ch s vn tc dng chy tng quan thun, PI v RI tng quan nghch c ngha vi mc lc cu thn. T kha: i tho ng typ 2, ch s huyt ng ti ng mch thn.

SUMMAry

The relationship between hemodynamic indexes of renal artery and profiles of kidney damage in patients of type 2 diabetes mellitus.This study was to investigate relationship between hemodynamic indexes in renal arteries at hilar and paren-chyma by Duplex Doppler sonography including Vs, Vd, Vm, RI, PI with microalbuminuria (MAU), macroal-buminuria (MAC) and chronic renal failure in 102 type 2 diabetic patient. Results showed that with advancing stage of kidney damage the flow velocities were gradually decreased, and RI and PI gradually increased. The indexes of flow velocities had significant positive correlation with GFR (glomerular filtration rate) and RI, PI had negative correlation with GFR.Key words: type 2 diabetes mellitus, hemodynamic index at renal artery.

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KHO ST HNH THI v HUyT Ng Ng MCH THN BNH NHN I THO Ng Typ 2 SUy THN gIAI ON SM IU Tr TI BNH vIN NI TIT NgH AN

Nguyn Th Cm Nhung, Nguyn Thanh Hi, Thi Th Thu Hin v cng s Bnh vin Ni Tit Ngh An

TM TTMc tiu: Kho st hnh thi v huyt ng ng mch thn bnh nhn i tho ng typ 2 c MicroAl-bumin niu v mi lin quan vi mt s yu t nguy c.i tng v phng php nghin cu: Nghin cu phn tch bnh chng vi 45 bnh nhn T typ 2 c MicroAlbumin niu dng tnh v 45 bnh nhn T typ 2 c MicroAlbumin niu m tnh. Tt c u c siu m thn 2D nh gi kch thc, hnh thi v siu m Doppler ng mch thn nh gi ch s huyt ng.Kt qu: 1. c im hnh thi v huyt ng ng mch thn:* 6,7% bnh nhn c kch thc thn ln hn bnh thng (chiu di thn >12cm). * Ch s sc cn RI trung bnh ca hai thn l 0,670,05 v 0,660,05 u cao hn so vi gi tr bnh thng l < 0,65. 2. Lin quan gia s bin i hnh thi v huyt ng ng mch thn vi mt s yu t nguy c: * Vi tnh trng tng huyt p: Nhm THA c t l RI ng mch thn > 0,65 cao hn so vi nhm khng THA (73,9% so vi 63,6% bn thn phi v 65,2% so vi 63,6% bn tri). * Lin quan gia s thay i sc cn RI ng mch thn nhu m vi s xut hin MAU niu: T l

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i tng nghin cu c ch s tr khng RI ca M thn nhu m >0,65 nhm c MAU (+) cao hn so vi nhm c MAU (-). S khc bit ny c ngha thng k vi p12cm).* The medium RI index of right and left kidney: 0,67 0,05 v 0,66 0,05, were higer than normal index. 2. The relationship with some rick factors: * The high prevalence of RI index above 0.65 increased accoding to hypertension. * The rate of patients with RI index above 0.65 and Microalbuminure were higer than the group with-out Microalbuminure (p

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diastolic blood pressure overload were not correlated with BMI.Key words: hypertension, type 2 diabetes mellitus, twenty four hour ambulatory blood pressure monitoring.

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C IM BIN THIN HUyT p 24 gI BNH NHN TNg HUyT p C I THO Ng Tp 2

BSCK II. inh c Ha - BVK Thng Nht - ng Nai.PGS. TS. Hong Trung Vinh - Hc Vin Qun y

TS. Bi Vn Mnh - Hc vin Qun y

TM TT102 bnh nhn (BN) tng huyt p (THA) chia lm 2 nhm: 41 BN THA n thun thuc nhm chng v 61 BN THA km i tho ng typ 2 (T typ 2) thuc nhm nghin cu. Tt c bnh nhn u c o huyt p (HA) lin tc 24 gi mang trong ngi (ABPM). Kt qu nhn thy: BN THA km T typ 2 c biu hin THA tm thu n c, ch THA ban m chim t l cao hn (11,5% v 13,1% so vi 4,9% v 4,9%), khng cn bin thin HA theo nhp sinh hc ngy - m. T l v gi tr trung bnh qu p lc tm thu (QTALTT), qu ti p lc tm trng (QTALTTr) ban m cao hn so vi ban ngy, cao hn so vi nhm chng bnh. T l nondipper, HA o ngc cng cao hn. Kt lun: THA km T typ 2 lm gia tng bin thin huyt p.T kha: Tng huyt p, i tho ng typ 2, o huyt p lin tc 24 gi mang theo ngi.

SUMMAry

Characteristics of twenty four hour ambulatory blood pressure variability in hypertensive patients with type 2 diabetes mellitus. 102 hypertensive patients were divided into two groups: 41 patient with only hypertension (control group) and 61 patients with hypertensionand type 2 diabetes mellitus (study group). All patients had blood pressure by 24-hour (ABPB) measured. results showed that: The proportion of isolated systolic hypertension and only night time hypertention was higher (11,5% and 13,1% versus 4,9% and 4,9%) in hypertensive patients with type 2 Diabetes compared with control group. There was no circadian variation of blood pressure in patients with hypertension and type 2 diabetes. Mean systolic and diastolic blood pressure were significantly higher in night time than that in day time and higher compared with control group. Proportion of patients with nondipper and reverse hypertension was higher in patients with hypertension and type 2 Diabetes.Key words: Hypertension, type 2 diabetes mellitus, twenty four hour ambulatory blood pressure monitoring (ABPM)

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NgHIN CU v NH gI B Dy Lp NI TrUNg MCNg MCH CNH (NTM M CNH) NgI TIN T

TM TTNghin cu v nh gi b dy lp ni trung mc ng mch cnh (NTM M cnh) ngi tin T c tin hnh trn 100 i tng trong tui t 30-69 ti khoa Khm bnh theo yu cu ca Bnh vin Bch Mai t thng 01/2013 n thng 10/2013.Kt qu nghin cu cho thy b dy NTM M cnh tng theo nhm tui, tng Triglycerides (TG), s yu t nguy c (YTNC) n. Tuy nhin khng c s khc bit b dy NTM M cnh theo gii tnh, loi tin i tho ng (T), mc BMI < 23 v 23, mc HA bnh thng v tng, vng eo (VE) bnh thng v tng,

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t s eo/hng (WHR) bnh thng v tng, c v khng ht thuc l, Cholesterol (CT) bnh thng v tng, LDL-C bnh thng v tng, HDL-C bnh thng v gim, s YTNC nam. Khuyn ngh chnh ca nghin cu l c th s dng ch s b dy ni trung mc ng mch cnh gp phn nh gi mc x va ng mch ca ngi tin i tho ng, c thm cng c iu tr v tin lng bnh nhn.

SUMMAry

We aimed to assess the carotid artery intima-media thickness in 100 peole with pre-diabetes, aged from 30-69 at Outpatient Under Request Department of Bach Mai hospital from 2013, January to October.The results showed that the carotid artery intima-media thickness inscreased with age group, increased TG and the number of risk factors in female. However, there is no significant difference between the carotid ar-tery intima-media thickness with gender, type of pre-diabetes, BMI (under and over 23), blood presure level (normal and increase), VE (normal and increase), WHR (normal and increase), smoking, CT (normal and in-crease), LDL-C (normal and increase), HDL-C (normal and decrease) and the number of risk factors in male.

In conclusion, carotid intima media thickness can be used as an additional measurement to diagnose athero-sclerosis in prediabetes patient.

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KHO ST TN THNg Ng MCH LN CHI DI BNg SIU M DOppLEr BNH NHN I THO Ng Typ 2 IU Tr TI BNH vIN NI TIT NgH AN

Nguyn Th Cm Nhung, Thi Th Thu Hin, Nguyn Trng ThBnh vin Ni Tit Ngh An

TM TTMc tiu: Kho st tn thng ng mch ln chi di v mi lin quan vi mt s c im lm sng v cn lm sng bnh nhn i tho ng typ 2. i tng v phng php nghin cu: 30 BN T2 iu tr ni tr bnh vin Ni tit Ngh An thi gian t thng 1 6/2012 c kho st cc M ln chi di v tnh trng x va, bin chng hp tc mch ca mng x va, kt hp vi thm khm lm sng v xt nghim. Kt qu: 1. V tn thng XVM: 63,3% BN c XVM, v tr hay gp nht l M i chung. 2. Lin quan vi lm sng: * 21,1% BN giai on I theo phn loi ca Leriche v Fontaine (cha c triu chng c nng) nhng c tn thng XVM. * 46,7% BN n vi giai on lm sng IV c ri lon dinh dng trn da v/hoc hoi t u chi, chim t l cao nht. * BN ht thuc l v THA c t l XVM cao hn so vi BN khng ht thuc v khng THA. 3. Lin quan vi ch s Lipid mu: BN tng Triglicerid v gim HDL-C c t l tn thng XVM cao hn nhm c ch s Triglicerid v HDL-C bnh thng.

ABSTrACTASSESS LESIONS OF LArgE ArTErIES OF LOWEr EXTrEMITIES By DOppLEr

ULTrASOUND IN TypE 2 DIABETIC pATIENTS TrEATEDIN NgHE AN ENDOCrINOLOgy HOSpITAL

Objectives: to assess the lesions of large arteries of lower extremities and the relationship with clinical and paraclinical characteristics in type 2 diabetic patients. Subjects and Methods: 30 patients with type 2 diabetes treated in Nghe An Endocrinology Hospital from January 2012 to June 2012 were assessed arteries of lower

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extremities for atherosclerosis, complication of atherosclerosis plaque such as stenosis, embolism by using the carotid Doppler ultrasound and examined clinical symptoms. results: 1. Atherosclerosis: 63.3%, highest at femoral artery. 2. Relationship with clinical: * 21.1% was at stage I, according to Leriche and Fontaine clinical atherosclerosis classification (without symptoms). * 46.7% was at stage IV. * The prevalence of large arterial lesion in diabetic group with smoking and hypertension was higher than diabetic group without smoking and hypertension. 3. Relationship with lipidemia index: the prevalence of atherosclerosis in diabetic group with increased trigliceride and decreased HDL-C was higher than diabetic group with normal trigliceride and HDL-C.

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KHO ST v HNH THI v CU TrC Ng MCH CNH ON NgOI S BNH NHN I THO Ng Typ 2 BNg SIU M DOppLEr

TI BNH vIN NI TIT NgH ANNguyn Th Cm Nhung, Thi Th Thu Hin, Nguyn Trng Th

Bnh vin Ni Tit Ngh An

TM TTMc tiu: Kho st tn thng ng mch cnh on ngoi s v mi tng quan vi mt s yu t nguy c x va ng mch bng siu m Doppler bnh nhn i tho ng typ 2. i tng v phng php nghin cu: 72 bnh nhn T2 c kho st v b dy lp ni trung mc, tnh trng x va ca ng mch cnh ngoi bng siu m Doppler u d 7.5MHz kt hp thm khm triu chng lm sng v mt s yu t nguy c. Kt qu: 1. IMT ca MCa: * IMT trung bnh dy nht v tr chia i MCa: (P) 1,15 0,39 mm, (T) 1,07 0,29 mm. * 80,6 % bnh nhn dy IMT 1mm. 2. Tn thng x va: * T l BN c mng XV: 62,5% c hai bn, v tr hay gp nht l ch chia i MCa 55,6% vi b dy mng XV (P) 3,13mm v (T) 2,97mm. * c im v bin chng mng XV: 15,3% XV hn hp v 2,8% c lot trong mng. Tt c BN c mng XV u gy hp lng mch cc mc khc nhau trong 52,8% gy hp di 50%. 3. Mi tng quan vi giai on lm sng v mt s yu t nguy c: * Tn thng MCa tng ln theo giai on lm sng, siu m pht hin c c nhng tn thng MCa giai on 0. * T l c tn thng MCa tng ln theo tui, BMI, THA v thi quen ht thuc l.

ABSTrACTSTUDy OF MOrpHOLOgy AND STrUCTUrE OF EXTErNAL CArOTID ArTEry

By DOppLEr ULTrASOUND IN TypE 2 DIABETIC pATIENTS IN NgHE AN ENDOCrINOLOgy HOSpITAL

Objectives: to study the lesions of external carotid artery and the relationship with atherosclerosis rick fac-tors by Doppler ultrasound in patients with type 2 diabetes. Subjects and Methods: A cross sectional study, from 1/2012 to 6/2012, 72 patients with type 2 diabetes were assessed carotid intima media thickness, carotid artherosclerosis by using the carotid Doppler ultrasound and examined clinical symptoms and rick factors.

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results: 1. The carotid intima media thickness: * The intima media thicknest was at bifurcation of carotid (BIF): Right 1.15 0.39 mm, Left 1.07 0.29 mm. * IMT 1mm: 80.6 %. 2. The prevalence of carotid artherosclerosis was 62.5%, highest in BIF 55.6% with the thickness of right and left artherosclerosis plaque was 3.3mm and 2.97mm, respectively. *The character and complications of artherosclerosis plaque: mixed structure: 12.3%, ulcer in artherosclerosis plaque: 2.8%. * Stenosis: all of artherosclerosis plaque with different level, and 52.8% has stenosis less than 50%. 3. The relationship with clinical stage and artherosclerosic rick factors: * The lesions of carotid increased with higher Robert Courbiers classification. Especially, Doppler ultrasound could reveal atherosclerosis in patient without symptom of cerebral vascular disease (stade 0 of Robert Courbier Marseilles clinical classification). * The high prevalence of carotid artery increased with age, BMI, hypertension and smoking.

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NgHIN CU LM SNg, CN LM SNg v BNH L TIM MCH BNH NHN I THO Ng Typ 2 C CHN ON LN U TI BNH vIN vIT TIp HI pHNg

Th Tnh, Nguyn Ngc nhi hc Y Hi Phng

TM TTMc tiu: M t c im lm sng, cn lm sng, xc nh t l cc bnh l tim mch v lin quan vi mt s yu t nguy c ca bnh nhn i tho ng typ 2 c chn on ln u ti bnh vin Vit Tip Hi Phng 2012-2013i tng v phng php nghin cu: Nghin cu m t ct ngang- 139 bnh nhn i tho ng typ 2 c chn on ln u.Kt qu: L do vo vin hay gp l biu hin ca tai bin mch no nh au u chng mt, yu na ngi, ni kh 41,01%; au ngc, kh th 34,53%; cc l do khc t gp hn. yu t nguy c : THA 61,15%, RLLP mu 48,20%, ht thuc l 43,16%, bo ph 31,65%, tin s gia nh c ngi mc T 25,89%, nghin ru 19,42%. Biu hin bnh tim mch l 67,66%, tai bin mch mu no 34,53%, tn thng mt 11,51%, tn thng thn 23,02%. Bnh nhn i tho ng typ 2 b ri lon lipid mu c nguy c b bnh tim gp 3,77 ln ,b tng huyt p gp 2,55 ln, b bnh mch vnh gp 4,52 ln, b tai bin mch no gp 5,67 ln so vi nhng bnh nhn khng c ri lon lipid mu. Bnh nhn i tho ng typ 2 bo ph tha cn c nguy c b bnh mch vnh gp 2,88 ln b tai bin mch no gp 3,92 ln so vi nhng bnh nhn c BMI bnh thng.Kt lun:Bin chng tim mch hay gp ngi i tho ng c chn on ln u l tai bin mch mu no v bnh mch vnh. Bnh nhn i tho ng typ 2 c chn on ln u c ri lon lipid mu, bo ph c nguy c b bnh tim mch cao hn so vi nhng bnh nhn khng ri lon lipid mu v khng bo ph.

SUMMAryCLINICAL, LABOrATOry CHArACTErISTICS AND CArDIOvASCULAr DISEASE IN pA-

TIENTS WITH NEWLy DIAgNOSED TypE 2 DIABETES ADMITTEDTO vIET TIEp HAI pHONg HOSpITAL

Objectives: To describe clinical and laboratory characteristics and prevalence of cardiovascular disease and related risk factors of patients with newly diagnosed type 2 diabetes admitted to Viet Tiep Hai Phong Hospital

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2012-2013.patients and methods: Descriptive cross sectional study - 139 patients with with newly diagnosed type 2.results: Common reason for hospitalization was manifestations of cerebral vascular accident such as head-ache, dizziness, hemiparesis, speech impairment 41.01%; chest pain, dyspnea 34.53%. Risk factors: hyperten-sion 6.15%, dyslipidemia 48.20 %, smoking 43.16 % , obesity 31.65%, family history 25.89 %, alcohol 19.42 %. Symptoms of cardiovascular disease 67.66 %, cerebral vascular accident 34.53 % , retinopathy 11.51%, nephropathy 23.02 %. Patients has dyslipidemia were increased risk for heart disease (HR: 3.77) , blood pressure (HR: 2.55), coronary artery disease (HR: 4.52), cerebral vascular accident (HR:5.67) compared to patients without dyslipidemia. Patients with overweight andobesity were increased risk for coronary artery disease (HR:2.88), cerebral vascular accident (HR:3.92 ) compared with patients with normal BMI .Conclusion: Common cardiovascular complications were stroke and coronary artery disease. In patients with newly diagnosed type 2 diabetes admitted to hospital, dyslipidemia and obesity were risk factors for cardio-vascular disease.

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NgHIN CU TIN I THO Ng v I THO Ng Typ 2THEO TNg NgUy C TIM MCH BNH NHN HUyT p

Phan Nhn LongBVKV Bng Sn Bnh nh

TM TTMc tiu: Kho st t l tin i tho ng (TT) v i tho ng typ 2 (T2). Tm hiu mt s mi lin quan gia TT v T vi tui, ch s huyt p, lipid mu ton phn theo cc phn tng nguy c tim mch (PT-NCTM).i tng v phng php: Mt nghin cu m t ct ngang gm 462 bnh nhn tng huyt p (THA), t tui 45, c PT-NCTM thp, trung bnh, cao v rt cao. c khm bao gm huyt p (HA), xt nghim glucose mu i v lipid mu ton phn.Kt qu: T l TT chim 14,28% v T chim 13,42%.-T l TT: Tng thp 0,43%, tng TB 4,11%, tng cao 2,81% v tng rt cao 6,92%.-T l T2: Tng thp 0%, tng TB 5,19%, tng cao 2,81% v tng rt cao 5,41%.Mt s c im:-Tng thp: TT 100% gii n nhm tui 50-59, 100% HA 140/80-90mmHg v khng c ri lon lipid mu (RLLPM).-Tng trung bnh: TT nhm tui ch yu: 70-79, 80-89 chim 52,64% v T nhm tui ch yu 60-69, 70-79 chim 65%. TT ch yu nam chim 68,42% v T n ch yu chim 54,17%. TT HA ch yu 160/80mmHg v T ch yu 140/80mmHg. TT RLLPM ch yu: HDL-C (52,26%) v CT (45,83%). T ri lon ch yu TG (45,83%).-Tng cao: TT nhm tui ch yu: 70-79, 80-89 chim 69,23% v T nhm tui ch yu 60-69 chim 30,7%. TT v T ch yu n chim 76,42% v 84,62%. TT v T HA ch yu: 160/80mmHg. TT RLLPM ch yu: HDL-C (53,84%) v CT (53,84%) v LDL-C (53,84%). T ri lon ch yu LDL-C (76,92%).-Tng rt cao: TT v T nhm tui ch yu: 70-79 chim 37,5% v 28%.TT v T ch yu n chim 65,63% v 80%. TT v T HA ch yu: 180/90-100mmHg. TT RLLPM ch yu: CT (90,62%) v LDL-C (81,25%). T cng RLLPM ch yu CT (76%) v LDL-C (84%).

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SUMMAryprEvALENCE OF prEDIABETES AND TypE 2 DIABETES IN HypErTENSIvE pATIENT,

STrATIFIED By CADIOvASCULAr rISK.

Objective: To evaluate the prevalance of prediabetes and type 2 diabetes in hypertensive patient, stratified to low, average, high and very high cardiovascular risk and to assess the relationship between prediabetes and type 2 diabetes with age, sex, blood pressure and dyslipidmia stratified by cardiovascular risk.Subjects and methods: A cross-sectional study of 462 hypertensive patients, age 45 years old, stratified to low, average, high and very high cardiovascular risk. They were examined including blood pressure, fasting plasma glucose and plasma total cholesterolemia.results: The prevalance of prediabetes was 14.28%, type 2 diabetes was 13.42%.-The prevalance of prediabetes stratified by cardiovascular risk: low risk: 0.43% , average 4.11%, high 2.81% and very high risk 6.92%. -The prevalance of diabetes in low risk: 0%, average 5.19%, high 2.81% and very high risk: 5.41%.Some characteristics of risk stratifications: -Low risk: Mean age of prediabetes: 50-59 (100%). The main sex of prediabetes: female (100%). The main blood pressure of prediabetes: 140/80-90mmHg and non dyslipidmia.-Average risk stratification: The main age groups of prediabetes: 70-79, 80-89 (52.64%) and diabetes: 60-69, 70-79 (65%). The main sex of prediabetes: male (68.42%) and diabetes: female (54.17%). The main blood pressure of prediabetes: 160/80mmHg and diabetes: 140/80mmHg. The main dyslipidmia of prediabetes: HDL-C (52.26%), CT (45.83%) and diabetes: TG (45.83%).-High risk stratification: The main age groups of prediabetes: 70-79, 80-89 (69.23%) and diabetes: 60-69 (30.7%). The main sex of prediabetes and diabetes: female (76.42% and 84.62%). The main blood pres-sure of prediabetes and diabetes: 160-80mmHg. The main dyslipidmia of prediabetes: HDL-C (53.84%), CT (53.84%), LDL-C (53.84%) and diabetes: LDL-C (76.92%).-Very high risk group: Age of prediabetes: 70-79 (37.5%) and diabetes: 70-79 (28%), most of them are femThe main sex of prediabetes and diabetes: female (65.63% and 80%). The main blood pressure of prediabetes and diabetes: 180/90-100mmHg. The main dyslipidmia of prediabetes: CT (90.62%), LDL-C (81.25%) and diabe-tes: CT (76%), LDL-C (84%).Conclusions: Higher prevalance of prediabetes, diabetes and dyslipidemia was seen in hypertensive patients with more cardiovascular risks. These patients shoud be treated early.

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vAI Tr CA THN TrONg KIM SOT gLUCOSE MU BNH NHN I THO NgGS. TS. Trn Hu Dng, ng Anh o

i hc Y Dc Hu

TM TTi tho ng ngy cng ph bin trn ton th gii cng nh ti Vit Nam. Trong i tho ng tp 2 chim a s trn 90%. Theo bo co ca Lin on i tho ng th gii (IDF) 2012, ton th gii c khong 371 triu ngi b i tho ng. Cn ti Vit Nam, theo cc s liu bo co nm 2013 t l i tho ng chim khong 5,8 % dn s. Bnh thn i tho ng l bin chng thng gp bnh nhn i tho ng, c th gp ngay ti thi im chn on i tho ng tp 2, l nguyn nhn ca bnh thn mn trn ton th gii v l nguyn nhn hng u dn n suy thn mn giai on cui Hoa K cng nh cc nc chu u, chim khong 40%. Bnh thn i tho ng lm tng nguy c bnh tt, t vong bnh nhn i tho ng. Suy gim chc nng thn l ro cn cho vic kim sot tt glucose mu, v thn l c quan chuyn ha v thi tr hu ht cc tc nhn h glucose mu, do nh hng trc tip hay gin tip n dc hc v ng hc ca tt c cc thuc iu tr i tho ng tp 2. Nguy c h glucose mu cao khi chc nng thn b suy gim.

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Mc d thn c bit n vi chc nng ch yu l c quan bi tit, tuy vy n cng ng vai tr quan trng trong vic cn bng hng nh ni mi glucose thng qua s tn sinh glucose v s hp thu glucose ng thn thng qua SGLT (Sodium glucose co-transporter ) duy tr nng glucose tun hon.

THE rOLE OF THE KIDNEy IN gLyCEMIC CONTrOL IN DIABETIC pATIENTSSUMMAry

Patients with diabetes are at risk of early renal function decline. Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. Diabetes is the most common cause of kidney failure. Even when diabetes is controlled, the disease can lead to chronic kidney disease (CKD) and kidney failure. Once the glomerular filtration rate (GFR) is less than 60 ml/min, the pharmacokinetics of antidiabetic drugs may be altered. There-fore, kidney function needs to be monitored at least once a year.Numerous drugs with different mechanisms of action and different pharmacologic profiles are being used with the aim of improving glycemic control in patients with type 2 diabetes. Therapeutic options for patients with type 2 diabetes and CKD are limited because a reduced glomerular filtration rate results in the accumulation of certain drugs and/or their metabolites.Conventional oral hypoglycemic agents, such as sulfonylurea (SU), are not suitable due to the risk of pro-longed hypoglycemia; furthermore, metformin is contraindicated for moderate to advanced CKD. Therefore, in order to achieve good glycemic control, insulin injection therapy remains the mainstay of treatment in diabetic patients with moderate to advanced CKD, particularly in those receiving dialysis therapy. However, some agents can still be used in patients with CKD. Repaglinide and mitiglinide are rapid- and short-acting in-sulinotropic SU receptor ligands. They are rarely accompanied by hypoglycemia, and are attractive therapeu-tic options even in the dialysis population. In addition, alpha-glucosidase inhibitors are rarely accompanied by hypoglycemia and are administered without dose adjustments in dialysis patients. However, the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommended that alpha-glucosi-dase inhibitors should be avoided in patients with advanced CKD stages and on dialysis. Moreover, dipeptidyl peptidase-4 inhibitors and incretin mimetics are new antihyperglycemic agents which may be used more fre-quently in the future in patients with type 2 diabetes and CKD. Recommended oral antidiabetic agents differ between countries. The kidney plays an important role in glucose homeostasis and has become a target for the treatment of hy-perglycemia in type 2 diabetes. The kidney contributes to the maintenance of blood glucose l