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按一下以編輯母片標題樣式,*,按一下以編輯母片,第二層,第三層,第四層,第五層,糖尿病,糖尿病 (,Diabetes Mellitus),尿糖症 (,Glycosuria,),尿崩症 (,Diabetes,Insipidus,),醣寶寶 (,Glycosidosis,),The global burden of diabetes (2000-2025),16.7,24.5,39.3,18.2,38.4,30.7,21.8,9.1,57.2,22.8,37.5,18.6,0.4,0.7,2000,2025,* In million subjects,47%,116%,25%,140%,150%,102%,64%,World,Developed,Developing,2000,154,m,55,m,99,m,2025,300,m,72,m,228,m,糖尿病流行病學,十大死因第四位,全台流行率約,5%,中年人以上,約,7-9%,95%,以上為第二型,DM,發生率約為千分之九,女性多於男性,仍在增加中,預估,2025,年,最高流行率在亞洲,增加一倍,Worldwide Prevalence of Type 2 Diabetes,World Health Organization.,The World Health Report 1997.,Prevalence,(millions),0,10,20,30,40,50,60,70,80,Africa,NorthAmerica,Southeast,Europe,Europe,Southeast,Asia,West,Pacific,2000,2025 (estimated),1995,糖尿病診斷,症狀+任何時間血漿糖,200,mg/d,空腹血漿糖, 126,mg/d,口服葡萄糖試驗兩小時血漿糖, 200,mg/d,血糖與疾病,FPG,mg/d,2-hPG,mg/d,正常,60-100,140,低血糖,40-50,空腹高血糖,100-125,耐糖異常,140-199,糖尿病,126,200,或症狀任何時間血糖,200,糖尿病分類,第一型 /,IDDM,第二型 /,NIDDM,其他型,妊娠型 /,GDM,第二型糖尿病之致病風險因子,年齡,45,歲,體重過重,BMI25,家族史,(,父母或兄弟姊妹,),習慣性身體缺少活動,種族,:,非、西、土及亞裔美人 太平洋群島土著,妊娠糖尿病史,或曾生產巨嬰,(9,磅,),高血壓,(,成人,140/90,),高,密度膽固醇,35,及,/,或三甘油酯,250,卵巢多囊症,血管病史,糖尿病血糖高的機制,胰島素,缺乏 (絕對 / 相對),胰島素抗阻,肝糖產量高,糖尿病併發症急性,三多症及體重減輕、疲勞等,昏迷,(1)酮酸中毒,(2)高糖高滲透壓,(3)乳酸中毒,(4)低血糖,糖尿病併發症慢性,神經症,眼底症,腎臟症,足病症,大血管症,微血管症,High Risk of Cardiovascular Events in Type 2 Diabetes,ref. :,Haffner SM et al.,N Engl J Med,1998;339:229-234,7-year,incidence of cardiovascular events (%),- MI = No prior myocardial infarction,+ MI = Prior myocardial infarction,Cardiovascular deaths,0,5,10,15,20,25,30,35,40,45,50,Myocardial infarction,Stroke,-MI +MI,Nondiabetic subjects,Subjects with type 2 diabetes,-MI +MI,-MI +MI,-MI +MI,-MI +MI,-MI +MI,MAU is considered a “window to the arteries,Devereux and Alderman, Circulation, 1993,LVH,IMT,MA,LVH: Left Ventricular Hypertrophy,IMT: Intima-media thickening,糖與老化及併發症,多醇途徑,醣化蛋白,過氧化離子根,缺氧,呼吸鏈異常,能量失調,糖尿病的治療理想,以儘,可能近似生理方式將血糖控制於正常範圍,治療併發症,預防勝於治療,糖尿病治療I,衛教,營養 / 飲食,運動 / 生活形態,口服藥物,(1)醣解抑制劑,(2)胰島素敏感劑,(3)胰島素刺激劑,a.,長效,b.,短效,(4)混合機制劑,糖尿病治療II,胰島素,:,(1),注射,:a,.,長效、中效、短效、超短效,b.,幫浦引流,:,閉鎖式,/,開放式,(2),口服,/,噴鼻,移植,:,(1),胰臟,/,胰小島,/,微膠囊,(2),幹細胞,胰島素治療(打針)的衝擊,心理 / 生活,家庭,學校 / 職場,社會 / 毒品 / 環保,糖尿病與社會,職,場 / 保險,婚姻 / 懷孕,併發症,胰島素的故事,己得四個諾貝爾獎,糖尿病仍未解決,
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