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การประเมินผล การดูแลผู้ป่วยโรคเบาหวานชนิดที่ 2 และความดันโลหิตสูง ของโรงพยาบาลในสังกัดกระทรวงสาธารณสุข และโรงพยาบาลในสังกัดกรุงเทพมหานคร ปี 2554-2555. www.crcn.in.th. วัตถุประสงค์ของโครงการ.

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Www crcn in th

2 2554-2555

www.crcn.in.th


Www crcn in th

  • 2

  • 2 ..

  • 2 2553


Www crcn in th

()

  • 2 TCEN(Toward Clinical Excellence Network) CPG

  • .

WWW.CRCN.IN.TH


Www crcn in th

2

(Prevalence)(Incidence)

  • Fasting blood sugar 70130 mg/dl

  • HbA1c

  • HbA1c< 7%

  • Lipid profile

  • LDL < 100 mg/dl

  • 130/80 mmHg

  • Microalbuminuria

  • ACE inhibitor ARB Microalbuminuria


Www crcn in th

2

  • ,

  • 1

  • Diabetic retinopathy

  • Diabetic nephropathy

  • Myocardial infarction

  • Cerebral infarction

  • Impaired fasting glucose (IFG)

  • / / (..)


Www crcn in th

  • < 140/90 mmHg

  • (follow up)

WWW.CRCN.IN.TH


Www crcn in th

  • (CRF version14 dated 5 March 2555)

  • 15 . 15 ..2555

WWW.CRCN.IN.TH


Www crcn in th

  • ()

  • .

  • WWW.CRCN.IN.TH


    Www crcn in th

    (2)

    WWW.CRCN.IN.TH


    Www crcn in th

    OPD

    • 15 15 ..2555

    • Admit IPD*

    • .

    WWW.CRCN.IN.TH


    Www crcn in th

    • . 12 (1 )

    • OPD

    • () OPD & ,OPD ,OPD ,OPD /

    WWW.CRCN.IN.TH


    Www crcn in th

    • (CRF)

    • 2

      ()OPD

    WWW.CRCN.IN.TH


    Www crcn in th

      • (OPD card)

      • (OPD Online)

      • (Log book online)

      • ()

    WWW.CRCN.IN.TH


    Www crcn in th

    • 2 1 2555

    WWW.CRCN.IN.TH


    Www crcn in th

    1. (CRF) CRCN

    2.

    3.

    4. .

    WWW.CRCN.IN.TH


    Www crcn in th

    .CRCN

    WWW.CRCN.IN.TH


    Www crcn in th

    OPD

    WWW.CRCN.IN.TH


    Www crcn in th

      • /

      • Patient Log

    WWW.CRCN.IN.TH


    Www crcn in th

    1

    • (.. 2555 .. )

    • ( )

    • ( = 12 )

    • ()

    WWW.CRCN.IN.TH


    Waist circumference

    (Waist Circumference)

    • (L4-L5)

    • (L2-L3)

    • (L1)

    • /

    WWW.CRCN.IN.TH


    Waist circumference1

    WaistCircumference

    WWW.CRCN.IN.TH


    Waist circumference2

    Waist Circumference

    WWW.CRCN.IN.TH


    C ase r ecord f orm crf 2 2 dm type ii

    CASE RECORD Form (CRF) 2 2 (DM type II)


    Www crcn in th

    2

    10.

    .

    • 12

    (remind)

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • 11. .. .

      • ..

      • 5 ..

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • 12. .

      • OPD

        • PCU

      • PCU .. HN:.

        • 12 12

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    13.

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    14. Fasting Plasma Glucose (FPG) 12 ( 8 .. DTX)

    • vein Capillary tube

    • 1 FPG

    • 2 FPG FPG 1 12

    • FPG

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    15. Dipstick (DTx) 12 DTx( follow up)

    16.(Postprandial Blood Glucose) 12

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    17.1-17.11 12

    • 17.1) Hb A1C

    • 17.2) Hemoglobin

    • 17.3) Serum BUN

    • 17.4) Serum Creatinine


    Www crcn in th

    2

    () 12

    • 17.5) Serum Potassium

    • 17.6) Serum Uric Acid

    • 17.7) Total Cholesterol

    • 17.8) Triglyceride

    • 17.9) HDL Cholesterol

    • 17.10) LDL Cholesterol

    • 17.11)Estimated GFR


    Www crcn in th

    2

    • 12

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    17.7-17.10 Lipid profile 12

    • LDL

      • Measured-LDL/Direct-LDL LDL

      • Calculated-LDL

      • LDL Measured-LDL/Direct-LDL

    • LDL

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • Triglyceride (TG) 360 LDL-cholesterol

    • TG LDL-cholesterol LDL

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    Tips GFR 17.11 12

    • ml/min/1.73 m3

    • GFR ( 3/11)

    • GFR =

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    18. 2

    • 12 OPD

    • 1 BP

    • 2 BP 12


    Www crcn in th

    2

    19. Aspirin Clopidogrel ( Plavix, Pidogen, Apolets)

    • 1


    Www crcn in th

    2

    20. 12

    1.

    2. ( 1 )

    • 2.1 (Hypoglycemia)

    • 2.2 Diabetic ketoacidosis; DKA

    • 2.3 Hyperosmolar Non-ketotic Hyperglycemic Syndrome, HNHS

    • 2.4 (Hyperglycemia)


    Www crcn in th

    2

    Hypoglycemia, DKA , HNHS

    • Hypoglycemia; plasma glucose < 70 mg/dL, ,

    • Diabetic ketoacidosis; DKA 250 mg/dL metabolic acidosis High anion gap pH < 7.35 serum ketone(1 : 2 dilution)

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • Hyperosmolar non-ketotic hyperglycemic syndrome; HNHS 500 mg/dLserum osmolality > 350 mOsm/H2Oserum ketone 0 1+

    • Hyperglycemia

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • 12 1

      (Admit) Admit

    • 1 20

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    21. Albumin/ Protein 12

    • 1

    • DN

    • . 4

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    21. Albumin/ Protein 12

    • 1 Urine Dipstick / UA Urine Dipstick

      • Albumin/ Protein Albumin/Creatinine Ratio Albuminuria Albumin/Creatinin Ratio

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • Trace albumin 10 mg/100ml 150 mg/24 hrs normal urine Microalbuminuria 1

    • Macroproteinuria

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    2 Microalbuminuria Dipstick

    • Microalbuminuria 20 mg/L Trace 2( 1 Urine Dipstick dipstick )

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    • 3Morning urine Albumin/Creatinine ratio

    • < 30 300 mg/g (

    • mg/g)

      • 30-299mg/g Microalbuminuria

      • 300mg/g Macroproteinuria


    Www crcn in th

    2

    4

    • 2

    • ()

      • Albuminuria

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    22. DiabeticNephropathy; DN ()

    • 12

    • ( > 12 )

    • DN

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    23. ACEI ARB 12

    • ACEI; Captopril,Enalapril,Fosinopril,Cilazepril,Perindopril,Quinapril,Ramipril,Lisinopril

    • ARB; Candesartan,Irbesartan,Losartan,Telmisartan,Valsartan

  • WWW.CRCN.IN.TH


    Www crcn in th

    2

    24. 12 (Visual Acuity, VA)

    VA: SANLLEN Chart E chart

    6/6 () 20/20 ()

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    24. Snellen VA

    () VA without correction 6/6,6/9..6/60

    • FC (Counting finger)

    • HM (hand movement)

    • PJ (Projection of light)

    • PL (Perception of light)

    • No PL (no light perception total blindness)

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    25. 12

    • (eye ground)

    • Fundus camera

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    25. 12

      • Visual field Visual acuity

      • consult

      • 12 2

    • 12

      1

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    25. DR 12

    • DR /. Fundus camera DR

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    26. Diabetic retinopathy (DR; ) 12

    25

    • Non-proliferative diabetic retinopathy (NPDR);

    • Proliferative diabetic retinopathy (PDR)

    • Diabetic Macular edema

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    27. 12

      • ;

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    27. 12

    • refer . 2

    • 1

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    28. 12

    • /

    • /

    • /

    • ( ABI )

  • WWW.CRCN.IN.TH


    Www crcn in th

    2

    28. 12

    • (dry gangrene)

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    29. 12

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    30. , 12 ( )

    • (amputation)

    • drygangrene (autoamputation)

    • dry gangrene 12

    • 32

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    31. 12

    • autoamputation dry gangrene

    • 26 2

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    32. 12

    • ( ) (

    • )

    • 34

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    33.

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    34.

    12

    • 1) BiguanidesMetformin(Glucophage,Siamformet), Buformin Phenformin

    • 2) Sulfonylurea Glipizide(Minidiab), Glibenclamide(Daonil, Euglucon), Gliclazide(Diamicron), Gliquidone(Glurinor), Glimepiride(Amaryl) Glyclopyramide

    WWW.CRCN.IN.TH


    Www crcn in th

    34. 12

    • 3) Non- Sulfonylurea Repaglinide(Novonorm), Nateglinide Mitiglinide

    • 4) Thiazolidinedione Rosiglitazone(Avandia), Pioglitazone(Actos), Rivoglitazone Troglitazone

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    34. 12

    • 5) Alpha glucosidase Inhibitor (-Gl) Acarbose(Glucobay), Miglitol Voglibose(Basen)

    • 6) DPP-4 inhibitor Alogliptin,Linagliptin, Saxagliptin(Onglyza), Sitagliptin (Januvia) Vildagliptin(Galvus)

    WWW.CRCN.IN.TH


    34 12

    34. 12

    • 7) GLP-1 Analog Exenatide, Liraglutide, Taspoglutide, Albiglutide Lixisenatide

    • 8) Insulin Insulin

    • 12 9 ( )

    WWW.CRCN.IN.TH


    Www crcn in th

    2

    35.

    • 1 12

      12

    • 2 12

      12

    WWW.CRCN.IN.TH


    Www crcn in th

    35.

    • 3

      1 2

      • 12 1

    WWW.CRCN.IN.TH


    Www crcn in th

    35

    • 35.1-35.13

    • 12

    • 12

    • 35.14- 35.17()

    WWW.CRCN.IN.TH


    C ase r ecord f orm crf 3 ht 9 11

    CASE RECORD Form (CRF) 3 (HT)9 -11


    Www crcn in th

    3

    • 37. .. .

      • ..

      • 5 ..

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    • 38. .

      • OPD

        • PCU

    WWW.CRCN.IN.TH


    Www crcn in th

    3 ( 38 )

    • PCU ..

      • 12 12

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    39.

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    40.

    • 12 OPD

    • 1 BP OPD

    • 2 BP 12

    • BP

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    40.

    • 1

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    41. 12

    • 43

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    42.

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    43. FPG 12

    • vein vein Dipstick

    • FPG

    • FPG

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    44. 12

    • 9 (_43)

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    44. 12

    44.1 Serum creatinine

    44.2 Serum uric acid

    44.3 Serum potassium

    44.4-7 Total Cholesterol, Triglyceride, HDL, LDL

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    44. 12

    44.8 Estimated creatinine clearance GFR

    44.9-10 Hemoglobin Hematocrit

    44.11 Urinalysis

    44.12 Electrocardiogram

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    44.7 Lipid profile 12

    • LDL

      • Measured-LDL/Direct-LDL LDL

      • Calculated-LDL

      • LDL Measured-LDL/Direct-LDL

    • Triglyceride (TG) 360 LDL-cholesterol

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    36.8 GFR 12

    • ml/min/1.73 m3

    • GFR ( 9/10)

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    44.11 Urine analysis 12

    • UA

      • (Manual)

      • urine dipstick (Manual)

    • UA urine dipstick

    • UA

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    44.11 Urine analysis 12

    • RBC

    • WBC

    • Cast cast

    • Protein ()

    • 36.12

  • 1

  • WWW.CRCN.IN.TH


    Www crcn in th

    3

    44.12 ECG 12

    • ECG ECG

    • ECG

    • /

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    45.

    1 12

    12

    2 12

    12

    3

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    45.15 (Renal insufficiency)

    • 1) Acute renal failure; ARF

    • 2) Chronic renal insufficiency; CRI

    • 3) Chronic kidney disease; CKD Chronic renal failure; CRF

    • 4) End-stage renal disease; ESRD

    • Renal insufficiency

    WWW.CRCN.IN.TH


    Www crcn in th

    3

    45.

    1 2

    • 12 1

    WWW.CRCN.IN.TH


    Www crcn in th

    • -

        • Patchara Aukaramahasan

    WWW.CRCN.IN.TH


    Www crcn in th

    WWW.CRCN.IN.TH


    C linical r esearch c ollaboration n etwork www crcn in th crcn 02 951 0352 310

    clinical research collaboration networkwww.crcn.in.th(CRCN) 02-951-0352 310

    Thank you for your attention


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