Guidelines 2011

2011:
OGTT
,

,
(>140 mg/dl)
(IFG)

 2011:

HbA1C %

< 7.5 %

(mg/dl)

90 145

(mg/dl)

90 - 180

(mg/dl)

120 - 180

HbA1C %

7,0%

(mg/dl)

80 - 130

(mg/dl)

80 - 140

(mg/dl)

120 - 150

 2011:

,
,

:
: 8080-130 mg/dl
:
: < 140 mg/dl
HbA1C < 7%
7%

> 250mg/dl,
250mg/dl, HbA1C > 9%,

,
,
/
/,
,

/
/

HbA1C 2 -3

:
: 8080-130 mg/dl
:
: < 140 mg/dl
HbA1C < 7%
7%

:
: 8080-130 mg/dl
:
: < 140 mg/dl
HbA1C < 7%
7%

/
/,
,

HbA1C 2 -3

:
: 8080-130 mg/dl
:
: < 140 mg/dl
HbA1C < 7%
7%

HbA1C 2 -3

/
/,
,
,
,

HbA1C 2 -3
/
/,
,
,
,

 2011:

> 45

102 cm () 88 cm ()

30 Kg/m2

, ,

>4 Kg


Position statement ADA 2011
1)

,
()
screening
()
,

screening ()
selfmonitoring (SMBG)
()
SMBG
,
(C)
SMBG
. , ,
, (C)
Diab. Care 2011;34:1419-23

 2011.

, ( 2
), .
3-6 HbA1C
(
):
o ,
o : , , HDL, LDL.
o , , ,
o (GFR) Cockroft-Gault
o (AST, ALT), , GT, CPK
o
o (
).
o

 2011:

(,
, , , ,
, )


()

()


Gram (+) , ()
,
(
)

 2011:

( )


(
)

 2011:

()

, ,
) ()

()

(

) ()

 2011:

 2011:

()





()

 2011:

, 1 3

, 3 6

 2011:

,
, ,

-
( & ,
, ,
,
)
)

( ,
, ,
,
& ,
,
)
)

( ,
, ,
,
)
)

 2011:



10 ,


2-3


2-3

 2011:

( )

( 10gr)

( 128
Hz)

 2011:


> 100

. 330mmHg
(Neuropad test)

 2011:



()


.

 2011:



( ,
, Duloxetin 60 120 gr ,
, Pregabalin - Gabapentin
300 360 mg/
mg/))
0,025 0,075%, 3 4

( )
)

( ,
, ,
, )
)

(,
, ,
, )
)

5
(,
, ,
, )
)
-
-
-

 2011:
()
95%, 95%
> 0.90

0.90 0.71

0,70 0,41

0,40

(
)

> 1,30

Monckeberg

 2011:

U/S Triplex
( )

(Toe Systolic Pressure Index TSPI)
2 (TCPO2)
( )
(DSA), MRI,
)

 2011:

50 (. 5)
,

> 10 ,

 2011:

(3 . ( 12%, 4/)

(, , , )


(
, , by pass)

( )

 .
2011

. . < 130 mmHg (C)

. . <80 mmHg (B)

3 5 gr.
, Lifestyle ,

140 mmHg 90 mmHg, /

130 139 mmHg, . ( L.S.
) ()
1 (C)

/
GFR>30
( ) GFR< 30 (C)
(B)

 :

2011

trans
,
,
()
) .
.
()

LDL 100mg%

()
< 40 ,
,
/
/ ()

LDL < 100mg%

:
:
> 40 CVD .
.
< 40 ()
LDL 30%
()
LDL , HDL TE
,
, -3 ()

2011

:
LDL< 100mg% (A)
:
LDL< 70mg% ()
LDL ,
LDL 30% - 40% ()
LDL :
TG < 150 mg% HDL > 40 mg% ()
HDL > 50 mg% ()
non HDL Apo B
- LDL < 100mg%, non HDL < 130 mg%
Apo B < 90 mg% (E)
- LDL < 70mg%, non HDL < 100 mg%
Apo B < 80 mg% (E)

 2011.

, ( 2
), .
3-6 HbA1C
(
):
o ,
o : , , HDL, LDL.
o , , ,
o (GFR) Cockroft-Gault
o (AST, ALT), , GT, CPK
o
o (
).
o

 2011:

()
/

, ,
12 (
, .. ,
) , 10%.

.
20-50%

 2011 :


()

-
-
-
-
-

 2011:

( )

( 10 .)

( )

( 128 HZ )

-
( )

 2011:

2

, ..

,


()

()
()

 2011:
-
(

)
,


,
/

 2011:
(1)



:
-
-
-

 2011:
(2)

:

-
- ()

 2011:

(US Triplex)

Monckeberg,
,


(Toe Systolic Pressure Index TSPI)

(Tcpo2 )

(DSA),
,
, DSA,

 -2011
..





.
,

.

 -2011
..
. 2
,

:

,
.

 -2011
..
. 1


.
:

,

,


.

 -2011

2
( )
2 :

5%

<30%

<10%

( 25-35 g )

 -2011

:



,
.
(
6g/)

 -2011

5005001000 Kcal /
/ .
.
( )

,
,

C

24
24
C

 -2011

45-60%

C

, ,
1 2

,
.
C

 -2011

10-20%
( )

1 2


C

1
(0.8 g/ Kg /)

 -2011

35% .
.

C
trans - 10%
.
.

,
, ,
,
1010-20% .

10%
10%
C

2-3 ( ) .
.

300 mg/
mg/

 -2011

. ( )
40g /
. ( )
, 3
4

( C)

50g/
1 2
. ( )
10%
. ( C)

 -2011

,
.
,
.
, ,

, ,


6g
/.

 -2011

( 10g /
/ 20 g/
g/
)

, .
.

,
,
C

,
C

.
.

, ,
,
, ,
, ,
, ,
,
.
.

,
, ,
, ,
, ,
,
( )
)

.
.

 -2011

2
, HDL
LDL, LDL
1 2 ,



. LDL < 100mg/dl, HDL
>50mg/dl <150mg/dl

 -2011

LDL
LDL :

: LDL <100mg/dl

: LDL <70mg/dl

LDL 30-40%

LDL
HDL ( >40mg/dl
> 50mg/dl
) (<150mg/dl ) C

LDL <100mg/dl non

HDL<130 mg/dl Apo-B <90 mg/dl
E

 -2011
(1)
LDL
:
trans

LDL >100 mg/dl
,
<40 ,


LDL <100 mg/dl

 -2011
(2)
, :

,
, > 40

,
, < 40 ,
,

LDL ,
,
LDL 3030-40%

30% LDL

LDL HDL
,
, -3
.
.

(
) .
. C

>400 mg/dl
LDL .
. ,
,
.
.
LDL C

 -2011

Hba1c < 6.5%,

.
(
) .
:

(GFR <40 ml/min )

 -2011

60-100 mg/dl
1 100-130 mg/dl


Hba1c <6.0%


:
35-45% ( ), 20-25%,
30-40%


< 1800

 -2011

Lispro Aspart

Detemir Glargine


:

.
6-7 ( 1 )
.

 -2011

80-110 mg/dl. :


1-2

,
,

.

 -2011

.
:
, ,
, ,
, 2
.

 -2011



Hba1c.
> 126 mg/dl
.
>92 mg/dl < 126 mg/dl ,
.
< 92 mg/dl,
24
28 .

 -2011

8 .
.
75gr 60
60 120
.
.
,
, :
:

60
60
120
120

92mg/dl
180 mg/dl
153 mg/dl

7070-95 mg/dl
1 9090-130 mg/dl
2 8080-120 mg/dl

3535-45% (
( ),
), 2020-25%, 3030-40%



< 1800

 -2011


Hba1c

2
6 4 (
3 )





.

EHJ 2011;32:1769-1818

EHJ 2011;32:1769-1818

Score chart: (high risk)

(score risk > 10%)

-
-

-

-
EHJ 2011;32:1769-1818

2011

&
+

( )
)
+

1

()
)

+

(
)
)

HbA1c 2- 3

()
)

+
+

()
)

HbA1c
2- 3

2

+

(
)
)

HbA1c 2- 3

3

+

3

HbA1c 2- 3

+ 2

+

HbA1c
2- 3

 2011:
( )*

- Humulin
Regular
- Actrapid

- (Lispro),
Humanlog
-
(Aspart)Novorapid
- (Glulisine),
Apidra

()
)

30-45 min

1 3

5 7

30 min

1 3

6 8

0-15 min

3 4

10 min

1 3

3 5

10 20 min

- 1

3 4

2 8

2 8

1.5

4 12

4 12

()
)
- Humulin NPH
- Protaphane

* (SPC)

 2011:
( )*

()
)

- (Glargine)
Lantus
- (Determir)
Levemir

-30/70 (30% 70%

), Mixtard30
-30/70 (30% 70%
), Humulin M3
-40/60 (40% 60%
), Mixtard40
-50/50 (50% 50%
), Mixtard50

- Aspart
30/70, Novomix 30
- Lispro
25/75, Humanlog mix 25
- Lispro
50/50, Humanlog mix 50

1 4

24

1 4

24

30min

2 8

24

30- 40 min

1 8

14 15

30min

2 8

24

30min

2 8

24

10 min

1 - 8

24

0- 15 min

14 -16

0 15 min

14 -16

* (SPC)

 2011:
( )*

- Humulin
Regular
- Actrapid

- (Lispro),
Humalog
-Aspart)
Novorapid
-(Glulisine),
Apidra

()
)

30-45 min

1 3

5 7

30 min

1 3

6 8

0-15 min

3 4

10 min

1 3

3 5

10 20 min

- 1

3 4

2 8

2 8

1.5

4 12

4 12

()
)
- Humulin NPH
- Protaphane

* (SPC)

 2011:
( )*

()
)

- (Glargine)
Lantus
- (Determir)
Levemir

-30/70 (30% 70%

), Mixtard30
-30/70 (30% 70%
), Humulin M3
-40/60 (40% 60%
), Mixtard40
-50/50 (50% 50%
), Mixtard50

- Aspart
30/70, Novomix 30
- Lispro
25/75, Humanlog mix 25
- Lispro
50/50, Humanlog mix 50

1 4

24

1 4

24

30min

2 8

24

30- 40 min

1 8

14 15

30min

2 8

24

30min

2 8

24

10 min

1 - 8

24

0- 15 min

14 -16

0 15 min

14 -16

* (SPC)

10

50 70%
*

>70%

* :
:
= 220 .
.
= 205 (0.5 )
)

2011

 :
(, )

2011

2 3


2
HbA1c 8.5%

&
+

HbA1c
2- 3

HbA1c <8.5%

HbA1c > 8.5%

(
)
)

&
+

+2

HbA1c
2- 3
&
+

+2

+
3

2011

HbA1c
2- 3

HbA1c >9
>9%
( )
)

&
+

HbA1c >8.5%

&
+

 2011
HbA1C %

&

&

1.0 2.0

1.0 2.0

(GFR <
30ml/min)

0.5 -0.8

(GFR <
25ml/min)

1.
1.
2.
2. R
3.
3.

1.0 2.0

(>>
MR)

(GFR<30ml/min)

1
2

0.5 1.5

(>)

(GFR<15ml/min)

0.5 - 1.4

. .
. .
.
,
(GFR<5ml/min)

DPPDPP-4
1
2
3

0.5 0.8

(GFR<50ml/min)

GLP -1
1
2

0.5 1.0

. .
.

(GFR<50ml/min)

(GFR<60ml/min)

 2011

mg/
mg/

/
/mg/
mg/

850/1000

500500-3000

150150-300

5
30

2.52.5-20
3030-120

12 24

1/2/3/4

1-6

0.5/1/2
60/120/180

1 -16
120120-540

1
2. MR
3.

1
2

50/100

15/30/45

1515-45

DPPDPP-4
1
2
3
GLP -1
1
2

100
50
5

5/10mg
5/10mg
0.6/1.2/1.8mg

100
100
5

1010-20mg
0.60.6-1.8mg

45 -60min
60min 2

6 .
.

:
:

:
:

,
, ,
,
,
, DPPDPP-4,
GLPGLP-1, ,
,

,
,
,
, ,
,
DPPDPP-4, GLPGLP-1,

,
,
DPPDPP-4, GLPGLP-1,

DPPDPP-4, GLPGLP-1,

( )
)

,
,
,
,