: 2014

, 5 2014

ADA 2014 - 2013

-

,

The Diabetes Epidemic: Global

Projections, 20102030

IDF. Diabetes Atlas 5th Ed. 2011

 ADAEASD 2012

Diabetes Care 2012;35:13641379

Diabetologia 2012;55:15771596


(www.ede.gr)

STANDARDS OF MEDICAL CARE

IN DIABETES2014

Diabetes Care, Volume 37,Supp 1, Jan 2014

Criteria for the Diagnosis of

Diabetes
A1C 6.5%
OR

Fasting plasma glucose (FPG)

126 mg/dL (7.0 mmol/L)
OR

2-h plasma glucose 200 mg/dL

(11.1 mmol/L) during an OGTT
OR

A random plasma glucose 200 mg/dL (11.1 mmol/L)

ADA. I. Classification and Diagnosis. Diabetes Care 2014;37(suppl 1):S15; Table 2

 ( 2013) 2

( ,
)
200 mg/dl

126 mg/dl
( 8 )

2 OGTT 75 gr 200
mg/dl

( OGTT).

 2 ( 2013)
- HbA1c

HbA1c ,

DCCT

(NGSP)
HbA1c 6.5 % ( B)
HbA1c 5.7-6.4 %
()
HbA1c ,
, ,
. ,
bA1c
,
.

 HbA1c

HbA1c

C, E

HbA1c





o


( HbA1c )

, HbA1c 2
. ()

, HbA1c 4 . ()
HbA1c
. ()
ADA 2014
2013 : 3-6

, HbA1c

Correlation of A1C with Average Glucose

These estimates are based on ADAG data of ~2,700 glucose measurements over 3 months per A1C
measurement in 507 adults with type 1, type 2, and no diabetes. The correlation between A1C and
average glucose was 0.92. A calculator for converting A1C results into estimated average glucose
(eAG), in either mg/dL or mmol/L, is available at http://professional.diabetes.org/eAG.

Mean plasma glucose

A1C (%)

mg/dL

mmol/L

126

7.0

154

8.6

183

10.2

212

11.8

10

240

13.4

11

269

14.9

12

298

16.5

ADA. V. Diabetes Care. Diabetes Care 2014;37(suppl 1):S23; Table 8

5%,
( 7%- ADA 2014)

30
,

<30%
(
<10%)

IGT , BMI>35 kg/m
<65 .
(SPC)

( 2013).
ADA 2014:
2 IGT(A), IFG(E),
HbA1c 5,7-6,4 % (E),
BMI>35 kg/m, <60
().

2
(mg/dl)
< 180
< 130

HbA1c (%)

< 7,0

ADA

< 180

70-130

< 7,0

IDF

< 160

< 115

< 7,0

, ,
HbA1c 7,0-7,5 % ( )
,
, HbA1c 6,5 %

Impact of Intensive Therapy for Diabetes: Summary of Major

Clinical Trials
Study

Microvasc

UKPDS

DCCT / EDIC*

CVD

Mortality

ACCORD

ADVANCE

VADT

Kendall DM, Bergenstal RM. International Diabetes Center 2009

UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:854.
Holman RR et al. N Engl J Med. 2008;359:1577. DCCT Research Group. N Engl J Med 1993;329;977.
Nathan DM et al. N Engl J Med. 2005;353:2643. Gerstein HC et al. N Engl J Med. 2008;358:2545.
Patel A et al. N Engl J Med 2008;358:2560. Duckworth W et al. N Engl J Med 2009;360:129. (erratum:
Moritz T. N Engl J Med 2009;361:1024)

Initial Trial
Long Term
Follow-up
* in T1DM

 2
( 2013)

 2
( 2013)

()

AMP-

12

KATP

PPAR-g

TGs, HDL-C

Ca

()

DPP-4

DPP-4
GLP-1, GIP

A1c
?

GLP-1

GLP-1 R
,

HbA1c

? Ca

Main Pathophysiological Defects in T2DM

pancreatic
insulin
secretion

incretin
effect

gut
carbohydrate
delivery &
absorption

pancreatic
glucagon
secretion

HYPERGLYCEMIA

+
hepatic
glucose
production

peripheral
glucose
uptake
Adapted from: Inzucchi SE, Sherwin RS in: Cecil Medicine 2011

Approach to Management of
Hyperglycemia

ADA. V. Diabetes Care. Diabetes Care 2014;37(suppl 1):S25. Figure 1

T2DM Antihyperglycemic Therapy: General Recommendations

Diabetes Care, Diabetologia. 19 April 2012
[Epub ahead of print]

E
;

2
,
,
10-15 , .

,
3-6
. ( 2013)
,
,
2 .() (ADA 2014)
2013, 6
Diabetes Care, Volume 37,Supp 1, Jan 2014

T2DM Antihyperglycemic Therapy: General Recommendations

Diabetes Care, Diabetologia. 19 April 2012
[Epub ahead of print]



SU

TZD

DPP-IV

GLP-1

,
,
,Ca
(;)

( (
;, )
;,Ca
)

. -
DPP-4

GLP-1

Glu (mg/dl) HbA1c (%)

60-70

0,9-1,4

60-70
40-70
40-70
30-40
30-40
60-70
>100

1,3-1,8
0,3-2,0
0,9
0,6-0,9
0,6-0,8
0,8-1,5
1,0-3,6
Ann Intern Med 2011;154;602-613

-
- , SU,
-



- -
-
- GLP-1
-

-
DPP-IV
GLP-1

A
:

( > )

GLP-1

DPP-IV

Recommendations: Bariatric Surgery

Consider bariatric surgery for adults with BMI 35 kg/m

and type 2 diabetes B
After surgery, life-long lifestyle support and medical

monitoring is necessary B
Insufficient evidence to recommend surgery in patients
with BMI <35 kg/m2 outside of a research protocol E
Well-designed, RCTs comparing optimal medical/lifestyle
therapy needed to determine long-term benefits, costeffectiveness, risks E
ADA. V. Diabetes Care. Diabetes Care 2014;37(suppl 1):S34

SPC:
: GFR < 30-45 ml/min
< 60 ml/min

,
DPP-IV

GLP-1
GFR < 30-60 ml / min

(HbA1c<
7,5-8%)


: ( UKPDS)

? SU preconditioning
? &
?

K
:

TZDs
?

T2DM Antihyperglycemic Therapy: General Recommendations

Diabetes Care, Diabetologia. 19 April 2012
[Epub ahead of print]

T2DM Antihyperglycemic Therapy: General Recommendations

Diabetes Care, Diabetologia. 19 April 2012
[Epub ahead of print]

Met

SU

TZD

(SU+Met,
TZD+Met)

+
(SU+Met)

+
+

(SU+Met)

(SU+Met,
TZD+Met)

+
(SU+Met,
TZD+Met)

Diabetes Care, Diabetologia.

19 April 2012 [Epub ahead of print]

ADA-EASD Position Statement: Management of

Hyperglycemia in T2DM

ANTI-HYPERGLYCEMIC THERAPY

Therapeutic options: Insulin

Insulin level

Rapid (Lispro, Aspart, Glulisine)

Short (Regular)

Intermediate (NPH)
Long (Detemir)

Long (Glargine)
0

Hours

10 12 14 16 18 20 22 24
Hours after injection

 2
+
+ +1

+

2 3
:
HbA1c, , , , ,

Basal plus:
,

Basal bolus: ,
,
,
:
( ),
,

,
,
,

DPP-4 GLP-1


2013

140 mmHg

80 mmHg /

130/80 mmHg

ADA 2014

140 mmHg

80 mmHg /

<130 mmHg

2013, 15
Diabetes Care, Volume 37,Supp 1, Jan 2014


LDL

< 100 mg/dl

< 70 mg/dl
( )

HDL

> 40 mg/dl ()
> 50 mg/dl ()
< 150 mg/dl

TG

2013, 14
Diabetes Care, Volume 37,Supp 1, Jan 2014

(75-162 mg)
1 2
(10 >10%) >50
>60
( , ,
, , ).(C)

, < 50 < 60
.(C)
,
.(E)
X (75-162 mg)
.()
,
. ()

. ()
Diabetes Care, Volume 37,Supp 1, Jan 2014

100 mg
> 50 > 60
( ,
, , , )

).(C)
< 50 < 60
,
. (E)
< 30 .(C)
100 mg /
.()
,
. ()

. ()
2013, 18-19

 : screening

,
screening ,
.
. ()
, - (C ) , ()
().
, blockers, 2 . ()
,
TZDs. (C)
,
.
.()
2013, 19
Diabetes Care, Volume 37,Supp 1, Jan 2014

 2013:

()





()

,
2
,

, 1-2

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,