Professional Documents
Culture Documents
Undiagnosed Diagnosed
30
25 Type 2
diabetes
20
15 Micro-
Undiagnosed vascular
10
diabetes disease
5 IGT
Normal
0
Macro-
vascular
Up to 10 years disease
9% neuropathy
20% retinopathy
Diagnosed DM = 1,5% 8% nephropathy
50% heart & blood
Undiagnosed DM = 4,2% vessel
Total DM = 5,7%
IGT = 10,2 %
Early detection and diagnosis
Prediabetes Type-2 DM
Early Early
Plasma glucose (mmol/L)
30
detection of detection
25 Risk Factors of newly Type 2
Healthy & newly DM DM (?) diabetes
20
lifestyle
15 promotion Undiagnosed
Micro-
vascular
10
diabetes disease
5 IGT
Normal
0
Macro-
vascular
disease
Up to 10 years
TREAT AS NEEDED
Group with
Screening
Do:
Diagnosis - DM
- OGTT
Criteria - Pre DM
- HbA1 measurement
ADA: Risk Test for T2DM
http://www.diabetes.org/diabetes-basics/prevention/diabetes-risk-test/
Screening
2007 2010
%
Toddlers 12.2 14.0
6-12 years old female 6.4 7.7
6-12 years old male 9.5 10.7
15-18 years old female 23.8 26.9
15-18 years old male 13.9 16.3
9.1%
7.3%
Prevalence of DM
4.4%
3.7%
RBG > 200 < 200 > 200 140-199 < 140
RBG > 200 < 200 > 200 140-199 < 140
FBG (Fasting Blood Glucose) IGT (Impaired Glucose Tolerance) PERKENI Consensus Guidelines, 2011.
RBG (Random Blood Glucose) IFG (Impaired Fasting Glucose)
Diagnostic Criteria for Prediabetes
Pre-Diabetes Diabetes
100 < FBG < 126 > 126
140 < PPG < 200 > 200
5.7 < A1C < 6.5%* > 6.5%*
Periodic
Blood
Early Life Style Pharmacology Glucose
Detection Changes Therapy and Risk
Factor
Monitoring
Nonmodifiable Modifiable
Age Overweight
Race/Ethnicity Abnormal lipid
metabolism
Gender
Inflammation,
Family history hypercoagulation
Hypertension
Smoking
Physical inactivity
Unhealthy diet
Insulin resistance
Management
Lifestyle Modification
Dietary intervention
Reduce intake by 5001000 kcal/day from total
daily intake
Purnamasari D et al. Identification, Evaluation and treatment of overweight and obesity in adults: Clinical
Practice Guidelines of the Obesity Clinic, Wellness Cluster Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Risk Management:
Weight Loss Recommendations
Purnamasari D et al. Identification, Evaluation and treatment of overweight and obesity in adults: Clinical
Practice Guidelines of the Obesity Clinic, Wellness Cluster Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Medical Nutrition Therapy (MNT)
Daly A, Power MA. Medical Nutrition Therapy. Diabetes Mellitus and Related Disorders; Medical Management of Type
2 Diabetes, 7th Edition. American Diabetes Association, 2012.
Exercise in the
Prevention of T2DM
Characteristics &
Study Intervention Results
Duration
577 people 67.7% cumulative
>25 years incidence in the
Da Quing control group
Study Diet +
(China) Random selection 43.8% (reduction of 31%)
Exercise
2007 from clinics 41.1% (reduction of 46%)
46% (reduction of 42%)
6 years follow-up
522 people,
Finnish 40-64 years
Diabetes
BMI> 25 58% decreased
Prevention Diet +
incidence in the
Study Random selection Exercise
diet + exercise group
(Finland) by people
2001
3.2 years follow-up
Pan, Li, Hu et al., 1997
Tuomilehto, Lindstrom, Eriksson, et al., 2001
Exercise in the
Prevention of T2DM (contd)
Characteristics &
Study Intervention Results
Duration
31% decreased
3234 persons= >25 years
incidence of diabetes
Diabetes Placebo
in the metformin
Prevention BMI= >22 (Asian people),
group
Programme >24 (other groups) Metformin
(USA)
2002 58% decreased
Random selection 2.8 Diet + Exercise
incidence in the diet
years follow-up
+ exercise group
30
Metformin
of Diabetes (%)
20 Lifestyle
10
0
0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0
Years
Exercise
Da Qing 1997w22 0.53 (0.34 to 0.82)
Tao 2004w21 0.30 (0.10 to 0.93)
Anti-obesity drug
Heymsfield 2000w28 Orlistat 0.39 ()0.19 to 0.78
XENDOS 2004w37 Orlistat 0.48 (0.26 to 0.88)
Herbal
Fan 2004w20 Jiangtang bushen recipe 0.32 (0.03 to 3.07)
0 1 2 3 Gillies GL et al.
Favours Favours Downloaded from bmj.com
intervention control on 31 October
Treatment based on HbA1c Level
<7% 7-8% 8-9% >9% 9-10% >10%
Lifestyle Lifestyle
Modification Modification
+ Lifestyle
Modification
Monotherapy
+ Lifestyle
Met, SU, AGI,
Glinid, TZD, Modification
2 OADs
DPP-IV Combination +
Met, SU, AGI,
Glinid, TZD, 3 OADs Lifestyle
DPP-IV Combination Modification
Met, SU, AGI,
+
Glinid, TZD,
DPP-IV 2 OADs
Combination
Notes : Met, SU, AGI,
Fail : not achieving A1c target Glinid, TZD
Lifestyle
<7% after 2-3 months of + Modification
treatment.
(A1c = average blood glucose Basal Insulin +
conversion, ADA 2010) Intensive
Insulin
T2DM Antihyperglycemic Therapy: General Recommendations
Healthy eating, weight control, increased physical activity
Costs Low
Costs Low
Two Drug Two drug combinations Sulfonylurea Thiazolidine-dione DPP-4 Inhibitor GLP-1 receptor Insulin (usually
agonist basal)
Combinations
Efficacy (HbA1c) High High Intermediate HIgh Highest
Hypoglycemia Moderate risk Low risk Low risk Low risk High risk
Costs Low
Two drug combinations Sulfonylurea Thiazolidine- DPP-4 Inhibitor GLP-1 Insulin (usually
dione receptor basal)
Two Drug agonist
Hypoglycemia Moderate risk Low risk Low risk Low risk High risk
Or Insulin Or Insulin
If combination therapy that includes basal insulin has failed to achieve HbA1c target after 3-6 months,
proceed to a more complex insulin strategy, usually in combination with 1-2 non-insulin agents
More complex
insulin strategies Insulin (multiple daily doses)
Diabetes Care. Diabetologia 19 June 2012
Summary
or
2-h plasma glucose at glucose tolerance test
200 mg/dL
o Glucose tolerance test (WHO standard)
using 75 g anhydrous glucose diluted in
100 cc water.