Texto

HOSPITAL JUREZ DE MXICO

UNIDAD DE ENSEANZA
JORNADAS DE MEDICOS INTERNOS

Diabetes Mellitus 2
Dr Pavel Gonzlez Guzmn
Mdico residente de 3er ao

Caso clnico
Masculino*35*aos*con*Diabetes*mellitus*3po*2*
Sin*alteraciones*micro*o*macrovasculares*
AHF:*madre*y*hermano*con*DM2*
IMC*37*
TA:125/85*mmHg*
Crea*1.0*mg/dL*
LDH*88*mg/dL*HDL*45*mg/dL*TG*130*mg/dL*

Me#ormina*

Glizipida*

Simvasta4na*

Lisinopril*

Glycemic Management of Type 2 Diabetes Mellitus,,Faramarz Ismail-Beigi, M.D., Ph.D. ,NEJM,2012

Quienes estn
expuestos a
desarrollar DM2?

Dnde esta el
interno?

Existen
complicaci
ones?

Cmo se desarrolla
la DM 2?

Existe solo un
tipo de paciente
con DM2?

Cmo se diagnostica ?
Por qu yo?

Cul es el manejo?

Objetivos
1.-Factores de riesgo
2.-Fisiopatologa de la Diabetes
mellitus tipo 2
3.-Clasificacin y diagnostico
4.-Tratamiento inicial
antidiabeticos vs Insulina
5.-Consideraciones especiales

Factores de riesgo/tamizaje
IMC>25 kg/m2

Familiares de 1er
grado

Inactividad fsica

Latino

Madres de productos
macrosomicos o diabetes
gestacional

Hipertensin

HDL< 35 mg/dL

Trigliceridos > 250

mg/dL

Sndrome de ovario
poliquistico

Intolerancia a la
glucosa

Glucosa alterada en
ayuno

A1C> 5.7%

Datos de resistencia a Historia de eventos

la insulina
cardiovasculares

MIP

Diabetes Care Volume 38, Supplement 1, January 2015

Factores de riesgo/tamizaje
TH E J O U R N A L O F C L I N I CA L A N D A P P L I E D R E S EA RC H A N D E D U CATI O N

VOLUME 38 | SUPPLEMENT 1

WWW.DIABETES.ORG/DIABETESCARE

SU

LEME

Si los resultados son

normales repetir al
menos cada 3 aos

A M E R I C A N D I A B E T E S A S S O C I AT I O N

PP

Otros pacientes
(particularmente los
obesos) a partir de los
45 aos

JANUARY 2015

STANDARDS OF
MEDICAL CARE
IN DIABETES2015

Diabetes Care Volume 38, Supplement 1, January 2015

ISSN 0149-5992

POSITION STATEMENT

Diabetes
Diabetes Care 2015;38(Suppl. 1):S8S16 | DOI: 10.2337/dc15-S005
CLASSIFICATION

Diabetes can be classied into the following general categories:

1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin
deciency)
2. Type 2 diabetes (due to a progressive insulin secretory defect on the background
of insulin resistance)
3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third
trimester of pregnancy that is not clearly overt diabetes)
4. Specic types of diabetes due to other causes, e.g., monogenic diabetes syndromes
(such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic brosis), and drug- or chemical-induced
diabetes (such as in the treatment of HIV/AIDS or after organ transplantation)
This section reviews most common forms of diabetes but is not comprehensive.
For additional information, see the American Diabetes Association (ADA) position
statement Diagnosis and Classication of Diabetes Mellitus (1).
Assigning a type of diabetes to an individual often depends on the circumstances
present at the time of diagnosis, with individuals not necessarily tting clearly into a
single category. For example, some patients cannot be clearly classied as having
Diabetes Care Volume 38, Supplement 1, January 2015
type 1 or type 2 diabetes. Clinical presentation and disease progression may vary
considerably in both types of diabetes.

Fisiopatologa
BANTING LECTURE

Resistencia perifrica del Hgado

y el msculo

Secrecin de insulina disminuida

Insuficiencia de las clulas Beta

DETERMINANTE
Primeros planteamientos: El
triunvirato, DeFronzo (1987)

Hiperglicemia

Aumento
de la
produccin
de glucosa

Disminucin
del consumo
de glucosa

FIG. 1. Pathogenesis of type 2 diabetes: the triumvirate. Insulin

resistance in muscle and liver and impaired insulin secretion represent
the core defects in type 2 diabetes (1). See text for a more detailed
explanation.

further change in insulin sensitivity (Fig. 2). This characFrom the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus,Ralph A. DeFronzo,Diabetes care Vol 58,2009
teristic rise in insulin response to insulin resistance and

Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24.

edicin

nmetabolizeable glucose analog (232) (Fig. 12).

hese observations have important clinical implica-

cated in the pathogenesis of type 2 diabetes is the b

which, along with his seven companions, forms the

13. The ominous octet. See text for a more detailed explanation.

OCTETO OMINOSO

DIABETES, VOL. 58, APRI

From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus,Ralph A. DeFronzo,Diabetes care Vol 58,2009

Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24. edicin

Cecil y Goldman. Tratado de medicina interna ngIf: BrowseBookCtrl.parent_info.itemedition , 24. edicin

Diagnostico
Criterios ADA se revisan
cada ao
Glucosa en ayuno
Curva de tolerancia a la
glucosa
Hemoglobina glicosilada
Glucosa aleatoria
Diabetes Care Volume 38, Supplement 1, January 2015

Texto

NORMAL

Intolerancia a la glucosa
Glucosa alterada en ayuno
Prediabetes

DIABETES

Diabetes Care Volume 38, Supplement 1, January 2015

Tratamiento

care.diabetesjournals.org

Table 6.2Summary of glycemic recommendations for nonpregnant adults with

diabetes
A1C
,7.0%*
Preprandial capillary plasma glucose

80130 mg/dL* (4.47.2 mmol/L)

Peak postprandial capillary plasma glucose

,180 mg/dL* (,10.0 mmol/L)

*More or less stringent glycemic goals may be appropriate for individual patients. Goals should

targeting postp
pared with tho
dial glucose (4
reasonable for
to be recomme
who have pre

e considered
argets. The
argets, but
idualized to
nt and their
ssible, such
de with the
preferences,
e 6.1 is not
dly but used
uide clinical
h in type 1

c targets for
are shown
mendations
els that apievement of
of prepranMBG targets
d postchaltolerance
been associdiovascular
plasma gluical studies.
s, surrogate
hology, such

Figure 6.1Depicted are patient and disease factors used to determine

optimal
targets. 1, January 2015
Diabetes Care
VolumeA1C
38, Supplement
Characteristics and predicaments toward the left justify more stringent efforts to lower A1C;
those toward the right suggest less stringent efforts. Adapted with permission from Inzucchi

COMPLICACIONES
Microvasculares:
Enfermedades oculares
Retinopata (no proliferativa y proliferativa)
Edema de la mcula
Neuropatas
Sensitivas y motoras (mono neuropatas y poli neuropatas)

Vegetativas
Nefropatas

Macrovasculares:
Artropata coronaria
Enfermedad vascular perifrica
Enfermedad vascular cerebral
Otras
Del tubo digestivo (gastroparesia,diarrea)
Genitourinarias (uropatas y disfuncin sexual)
Dermatolgicas
Infecciosas
Oftalmologicas:Cataratas,glaucoma
Enfermedad periodontal
Hipoacusia