21

.
-
&

www.lepouras.gr

I GENERAL

,
.

2
.

NIDDK, National Diabetes Statistics 2007.

www.diabetes.niddk.nih.gov/dm/pubs/statistics

 -
1

(IFG):

- : 100-125mg/dl

(IGT):

- 2- OGTT: 140-199 mg/dl

(bA1c): 5.7-6.4% *
(DA, WHO)

* 2

 OGTT
,


(>140 mg/dl)
(IFG)

 HbA1c
..;

HBA1c, ,

Shingon , Dong XL
,
900 (Shingon),
OGTT, HBA1c
(, ,
BMI).

HBA1c
,

HBA1c - OGTT



2

.

(Exp Clin Endocrinol Diabetes 2010 Nov 19)


HbA1c,
,
,
,


,
HbA1c

( ),
.

.


.

2
,


( , ),
.

 (DECODE)
-2
- :
- IGT -2: X 5
- IFG -2: 4,7
- IFG + IGT -2: 12

* GT (- ) -2: 0.7%

CV
- IGT : X 1.7

- IFG : 1,2

-IGT: 7.9%

-2/

,

Diabetes Care, "Older Subjects With Diabet

es and Prediabetes Are Frequently Unaware
of Having Distal Sensorimotor Polyneuropat
hy: The KORA F4 Study"
Last
Updated: May 22, 2013 DIABETES CARE
.

RESEARCH DESIGN AND METHODS

Glucose tolerance status was determined in 61- to 82year-old participants of the population-based KORA F4
Study (20062008) (n = 1,100).

DSPN ( )
154 (14%) , 140
. 23,9% (95%
CI 12,6 38,8),

DSPN.
, 10 11 (91%)
DSPN.

DSPN 22,0% (16,2 - 28,9)], 30 39 (77%)
DSPN .


, 18 25 (72%)
DSPN

CVD
CHD

Stroke
All causes

1.5

Hazard ratio

* *

*
* *

0.5
0
IFG

DM
( 7.0
)

IGT

DM
( )

Known
DM

From DECODE Study Group. AIM 2001;161:397-405

IGT
Austrian study: 238 .

30
25
20

IFG
IGT
.
.. 2

15
10
5
0
Matz K et al.: Diabetes Care 2006; 29: 792-7.


&
(Prediabetes Signals CAD Risk)
ByEd Susman, Contributing Writer, MedPage Today
Published: May 03, 2013 AACE

In the study, about 36% of patients with impaired fasting glucose

had coronary artery disease compared with 42% of patients with

diabetes and 21% of patients with normal blood glucose said Harith
Al-Shuwaykh, MD, a resident in internal medicine at Crittenton
Hospital Medical Center, Wayne State University, Detroit.
Those findings, which were based on a review of 86 patients who
underwent elective percutaneous coronary intervention, were
presented at the annual meeting of the American Association of
Clinical Endocrinologists.
Likewise 37% of patients with impaired fasting glucose had
hyperlipidemia compared with 38% of patients with diabetes and
24% of patients with normal blood glucose.

Eriksson et al. Prevention of Type 2 DM by

diet and physical exercise:
The 6-y Malm study.
Diabetologia 1991, 34:891-898
41 2, 161 IGT

2: 28% ., 26% IGT, 46% 2

IGT: 69% ., 21% IGT, 10% 2

-
10
2


(RR0.69, 95%CI 0.58-0.83)

Jeon CY . Diabetes Care

2008;30:44

DPS, DPP, DPPO *

5-10%
30/

-2 58%
CVD

Diabetes Prevention Program

An example of effectiveness
Modest Weight Loss and Lifestyle Changes
Can Have a Positive Health Impact
Placebo

Metformin

58%

Lifestyle

5% /year instead of
10% / year by lifestyle intervention
DPP Research Group. N Engl J Med 2002;346:393-403

And if Achieve Normal Glucose

Tolerance
--Markedly Delay Future Overt
Diabetes
~50% reduction
in risk;
BUT IF REACH
NML GLUCOSE,
Only ~18% risk
6 years after study
ie: only
3%/yr incidence

Diabetes Prevention Program 15 Years

Later

2,
.
15
, 27%
, 17%
,


15 .

.
50% 3.000
.


N = 3.234

N = 266

N = 3.304

N = 9.297

N = 3.234

N = 1.429

N = 9.193

IGT 2

DPP study
TRIPOD study

- 55 %

XENTROS study

- 34 %

Ramipril

DPP study

LIFE study

- 31 %

- 25 %

- 25 %

Troglitazone

Orlistat

- 37 %

HOPE study

STOP-NIDMM study

Lifestyle

- 58 %

Metformin

Acarbose
Losartan


-2

(DPP)*:

31%

(SP-NIDDM):

25%

(XENDOS):

37%

(DREAM):

62%

(CT-NOW) *

72%

(NAVIGATOR):

14%

(NAVIGATOR)

* , *

ACT NOW

Study Results: Time to Occurrence of Diabetes (Kaplan-Meier analysis)

Cumulative Hazard

0.30

Placebo

HR = 0.19
(95%, CI) = 0.09, 0.39
P<0.00001

0.25
0.20

6.8%
per year

80% reduction
in progression to DM

0.15
0.10

Pioglitazone

0.05

1.5%
per year

0
0

10

NNT = 3.5 patients with IGT for 1 year to prevent

the development of 1 case of T2DM

20

30

40

Months

DeFronzo RA. ADA Scientific Sessions, Late-Breaking Clinical Studies, June 9, 2008.

50

Prevention Increased with Use of

Incretin

9 m,
105 pts

15 :
12,4% , 13%
, 11,3%
.
, 28%

,

.

"We have a reduction in diabetes and a reduced prevalence of

complications in those who didn't develop diabetes, but we don't have a
treatment effect to prevent diabetes complications at this point." ,
David Nathan, MD, of Massachusetts General Hospital in Boston


,

( NGR) .
2.775
(DPPO).
, .
Framingham
.
T Framingham
(16,2 15,2)
14.3 )
28 %
.

.
American Diabetes Association 2014 Scientific Sessions; June 16,
2014.



(DPPO 15 years later)

,
,
, .
, ,
calcification score ,

.
,

Fitness, Fatness, and Survival in Adults With

Prediabetes

Paul A. McAuley, Enrique G. Artero, Xuemei Sui, Carl J.

Lavie, M. Joao Almeida, Steven N. Blair
Disclosures Diabetes Care.2014;37(2):529-536.

(CRF)
(
).

CRF ,
(CVD) 17.044
(89% ) (IFD,
100 mg / dL <126 mg / dL),
, CVD, .


CRF

.

BIOTIKO E

2 , .
,
( USDA ),
.
,
( NHANES ) ,
2.400
2 .



35 .
Database, at-Home .


,
,
.
.
,

.

.

 2

$ 1,50

10 ,
20 (mg / dL), 13%

, 162 mg / dL.
14

9 mg / dL
, 6% .

1.

5-10%
, 30
( 180 min
)
2.
( LDL < 100mg/dl, HDL >4OMG/Dl
>50mg/dl, < 200mg/dl,
<135mm/Hg <80mm/Hg).

:
ADA 2013-14

, 7%
& 150

/ ( )
-

As is the case for all children, children with diabetes or prediabetes should be
encouraged to engage in at least 60 min of physical activity each day. (B)

:
ADA 2013

:
-
:
- < 60
- 35

metformin
. (A)

 ADA 2014


In those identified with prediabetes, identify and, if appropriate, treat other
cardiovascular disease (CVD) risk factors. (B)

,


Perreault L, Pan Q, Mather KJ, Watson KE,
Hamman RF, Kahn SE; Diabetes Prevention
Program Research Group, Lancet. 2012;379:22432251

 2015
Lifestyle ( ,

, ..)

.

(, )
, ,
, ,
IGT IGT IFG.

(ADA 2015).

, .

The major complications of diabetes

Stroke
(cerebrovascular disease)

Visual impairment:
diabetic retinopathy,
cataract and glaucoma

Heart disease
(cardiovascular disease)
Bacterial and fungal
infections of the skin
Severe hardening of
the arteries (atherosclerosis)
Sexual dysfunction

Kidney disease
(diabetic nephropathy)
Autonomic neuropathy
(including slow emptying
of the stomach and diarrhoea)

Poor blood supply to lower limbs

(peripheral vascular disease)
Necrobiosis lipidoica

Gangrene
IDF publications: Time to Act Diabetes and cardiovascular disease. 2006.

Sensory impairment
(peripheral neuropathy)
neuropathy
Ulceration