Академический Документы
Профессиональный Документы
Культура Документы
MANAGING DIABETES
MELLITUS AND LIFESTYLE
CHANGING
Melisa Aziz
PERKI Banten
DIABETES MELLITUS
• A metabolic disorder characterized by chronic hyperglycemia resulting from
defect in insulin secretion or action, or a combination of both
• ≈ 95% comprised by Type 2 DM
• Important contributor to vascular damage, macro- and microvascular
complication
• More than half the mortality and vast amount of morbidity is related to CVD
CAD AND DIABETES MELLITUS
• Global burden
Increased in numbers of people diagnosed with CAD and DM
Indonesia: Riskesdas 2007 data showed 5,7% prevalence of DM in urban area
WHO predicted increased from 8,7 million in 2000 up to 2-3 fold in 2035
Estimated around 300mil individuals are at future risk of developing Type 2DM
• Multidiciplinary strategies
Comprehensive care of DM patients often requires collaboration between
cardiology, internist (diabetology), and primary care
DIAGNOSTIC CRITERIA
GLYCEMIC CONTINUUM AND
CARDIOVASCULAR DISEASE
CVD
Nephropathy
CAD
Cardiovascular autonomic
neuropathy
• Persistent sinus tachycardia
• Orthostatic hypotensionStraining
to void
• Sinus arrhythmia
• Decreased heart variability in
PAD
response to deep breathing
• Near syncope upon changing
positions from recumbent to
standing
Physically Active
• Gradual increase in daily lifestyle activities
• Exercise training:
≥ 150 min/week of moderate intensity aerobic physical activity and/or 90min/
week of vigorous aerobic exercise
Physical activity should be distributed at least 30 min on at least 5 days/week
LIFESTYLE CHANGES
• Dietary Interventions
Total fat intake should be < 35%, saturated fat < 10%, and ono saturated
fatty acids > 10% of total energy
Fiber intake > 40gr/day (or 20gr/1000 kcal/day)
• Weight control
Aim for weight stabilization in overweight or obese patients bases on
calorie balances and weight reduction8
• hyperglycaemia is a symptom of multiple causes, and therefore requires a multifactorial approach
and thus comprehensive lifestyle changes, especially in DMT2
• physical activity is key to increasing caloric expenditure, combatting insulin resistance, reducing
hospitalizations and improving the prognosis
• physical activity supported by sustainable dietary changes improves weight control and, more
importantly, induce weight loss
• strict glycaemic control reduces the risk of microvascular and macrovascular complications; so
does a systolic blood pressure ≤140 mmHg, whereas ≤ 130 mmHg even further lessens the risks for
stroke, retinopathy and albuminuria and should therefore be the target if tolerated
• if tight glycaemic and/or blood pressure control are/is not tolerated, temporarily consider relaxed
targets in the elderly, frail and / or those with long-term DM and /or cardiovascular disease;
however, reconsider stricter targets after timely reassessment
• statins are recommended in all DMT2 patients >40 years and selected younger patients at high risk
• in DMT2 with co-existing cardiovascular disease, a sodium-glucose co-transporter-2 (SGLT2) inhibitor
should be considered early since it improves prognosis without major adverse effects
• improved risk factor management reduces cardiovascular mortality in DMT2 – more needs to be
done to reach all patients in need, which includes initiation of prevention and/or rehabilitation
programmes in the patient’s vicinity
• risk factor management is a Class I Level A indication often superior to medical treatment.