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Diabetes Mellitus in Portugal

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  1. Diabetes Mellitusin Portugal Joana Isabel Silvestre Costa Pereira

  2. Diabetes MellituswascoinedbyAreteustheCappadocian, anAlexandrianphysician (II a.C.) whenconfrontedwith a patientexhibitingexcessiveurination. Diabetes comes fromtheGreekmeaning «which passes through» andthewordMellitushoweverisofLatinoriginandmeaning «honey». This comes fromthetimewhenthephysicianmadethediagnosisthroughtastingthe urine. Willis, in 1670, distinguishedbetweenpatientswith a sweet-tasting urine (Diabetes Mellitus) andthosewhose urine waswithouttaste (Diabetes Insipidus).

  3. Whatis Diabetes Mellitus? Diabetes Mellitusis a chronicmetabolicdiseaseincreasinglycommoninoursocietyaffectingbothsexesanditsprevalenceincreasessteadilywith age. DM ischaracterizedbyincreasedlevelsof sugar (glucose) inblood (hyperglycemia). Thishyperglycemiais, in some cases, due to insufficientproductionofinsulin (Langerhansisletdamagefromauto-immunedisease) and/or to insufficientactionofinsulin (dysfunctionofpancreaticinsulin-producingcells (β-cells). Peoplewith DM are likely to develop a series ofcomplicationsinvariousorgansofthebodythrough injuries ofthebloodvessels. Youcanreducetheirdamagethrough a strictcontroloftheconcentrationofglucoseinblood, bloodpressure, controloftheconcentrationoflipids (bloodfats) and a periodicmonitoringofthemostsensitiveorgans (retina, kidney, heart…). Thecriteria for diagnosisof DM wasestablishedby WHO.

  4. Pathogenesisofprimaryformsof DM:

  5. WHO criteria for DM (2006): Diagnosisof DM ismadewhenpatientshaveabnormallyhighlevelsof sugar intheblood. These are oftencheckedduring a routinephysicalexamination. Doctorsmaycheckblood sugar levelsinpeoplewhohavesymptomsof DM orinpeoplewhohavedisordersthatcanbecomplicationsof DM. A Oral GlucoseToleranceTestmaybedoneincertainsituationssuch as inroutinescreeningofpregnantwomen for Gestational Diabetes orinolderpeoplewhohavesymptomsof DM but normal glucoselevelswhenfasting.

  6. Typicalsymptomsin DM: Blurredvision Lethargy Stupor Smellofacetone Polyphagia Xerostomia Polydipsia WeightLoss Kussmaulbreathing (hyperventilation) Nausea Vomiting Abdominal Pain Polyuria Glycosuria More commoninType I DM

  7. Long-termcomplicationsof DM:

  8. Treatment: *Treatmentof DM involvesdiet, exercise, educationand for some patients, drugs. *Complications are lesslikely to developifthereis a strictcontrolofblood sugar levels. *Thegoalof DM treatmentis to maintainblood sugar levelswithinthe normal range as much as possible-» MONITORING!!! *Somepatientsmayalsoneeddrugs to helpcontrolthelevelofcholesterolintheblood. *Theyshouldalso stop smoking and consume onlymoderateamountsofalcohol (up to 1 drinkperday for women; up to 2 drinksperday for men) *Insulinreplacementtherapy (3 types: rapid-actinginsulin, intermediate-actinginsulinandlong-actinginsulin) – especiallyType I DM *Oralantihyperglycemicdrugs–Type II DM *Sometimes, combinationofboth *New experimental treatments are notyetroutinelydone, but some show promise

  9. In Portugal (in 2009): *The global costs (partakingmedication, hospitalizationandambulatorycare) are increasingandalreadyrepresentaround 900-1100 million euros (0,7% ofthe GDP) *11,7% ofthepopulation (approximately 905 000 people) between 20-79 Y *Ofthese, 6,6% havebeendiagnosedwith DM and 5,1% haveyet to bediagnosed *Thereis a correlationbetween age andprevalenceof DM *Morethan ¼ ofthepopulation ages 60-79Y has DM *Itisprevalent for themalepopulationyoungerthan 60Y *Thesenumbersgobeyondtheprevisions for 2025 (8%). *Itisestimatedthat 500-700 new cases of DM are diagnosedeveryyearper 100000 inhabitants _population (2009): approximately 10 637 713 inhabitants

  10. ImpactinHospitalization: *DM has a significant role in COD and, unlikeotherpathologies, itsimpactisnotdecreasing. Despitethis , itisnoted a decreaseinthe intra-hospital mortalityinhospitalizedpatientswith diabetes. *numberofoutgoingpatients/admissionsinhospitalsinwhich DM isassumed as the principal orassociateddiagnosishasincreasedsignificantlyoverthepastyears (from 2000 to 2008, itincreased 85%) *principal causes ofhospitalizationofpatientswith DM in 2008 were: cardiovascular diseases (≈26%), endocrine, nutritionalandmetabolicdiseases (≈15%) andrespiratorydiseases (≈13%). _Totalofhospitalizations: 114 383 *thenumberofpatientsadmittedwithophtalmicmanifestations /complicationsdoubledfrom 2000 (≈11%) to 2008 (≈24%) *thehospitalizationperiodhasdiminished

  11. Sales ofbloodglucoseteststripshasincreased; in 2008 itrepesented 36,6 million €

  12. Ifweprojectthesevalues for 2020 (andbasedonthereplication rates oftheaverageannualgrowthintheperiod 2000-20089, itsvaluewillincreasenearly 500%!!! Bythen, itisestimatedthatitwillcost480 million € in Portugal!

  13. Conclusion: The figures presentedinthisdocument show a troublingrealityandpoint to theenormousimportanceof: *preventionandearlydiagnosisof diabetes *strictcontrolof DM withsystematicscreeningofcomplicationsand *therapeuticaleducation as a way to offerthe DM communityanimprovedqualityoflife, butalsoreducingtheimpactofcomplicationsin DM patients. Therefore, thesolutionis to prevent, educateandcontrol DM.

  14. Sources: Associação Protectora dos Diabéticos de Portugal (APDP) www.apdp.pt Sociedade Portuguesa de Diabetologiawww.spb.pt Merck Manual HomeEditionwww.merck.com/mmhe/sec13/ch165/ch165a.html WorldHealthOrganizationwww.who.int/topics/diabetes_mellitus/en/ Portugal- Diabetes: Factos e Números 2009; Relatório Anual do Observatório Nacional da Diabetes