Fisiopatologia cardiaca en cardiocirugia. AR. Andres Rojas. Updated 18 March Transcript. Activación del sistema renina – angiotensina – aldosterona. Introducción. La disfunción endotelial en la antesala de las complicaciones hipertensivas. La aterogenesis acelerada del paciente hipertenso: daño indirecto . Aterogenesis. Respsvin. ;9(4). Finn A. V., Nakano M., Narula J., Kolodgie F. D., Virmani R. Concept of vulnerable/unstable plaque.
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Los botones se encuentran debajo. Global prevalence of diabetes: Obesity and diabetes in the developing world, a growing challenge. N Engl J Med ; 3: Diabetes Care ;27 5: Classification InADA issued new diagnostic and classification criteria; inmodifications were made regarding the diagnosis of impaired fasting glucose IFG.
The classification of diabetes includes four clinical classes: Clinical presentation and disease progression vary considerably in both types of diabetes. Occasionally, patients who otherwise have type 2 diabetes may present with ketoacidosis. Similarly, patients with type 1 may have a late onset and slow but relentless progression of disease despite having features of autoimmune disease.
Diabetes Care 36, Suppl 1 January ppt descargar
Such difficulties in diagnosis may occur in children, adolescents, and adults. The true diagnosis may become more obvious over time. Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss.
Fasting is defined as no caloric intake for at least 8 h. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of g anhydrous glucose dissolved in water. Se solicita POTG 75 gr. E Three ways to diagnose diabetes are available, and each must be confirmed on a subsequent day unless unequivocal symptoms of hyperglycemia are present. Although the g oral glucose tolerance test OGTT is more sensitive and modestly more specific than fasting plasma glucose FPG to diagnose diabetes, it is poorly reproducible and rarely performed in practice.
Because of ease of use, acceptability to patients, and lower cost, the FPG is the preferred diagnostic test. The use of the A1C for the aterogneesis of diabetes is not fisioatologia at this time. In the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing on a different day.
Am J Med ; Diabetes Res Clin Pract ; 40 Suppl: Diabetes in America 2nd. Polipeptido simil Glucagon y GIP: Producido por las cel L enteroendocrinas en el ileon distal y colon. El analogo que se usa es el Exenatide Es anorexigeno estimulando el NPY. Disminuye GLUT-2 y 4.
Dismiuye GLUT-2 y 4. Defectos estructurales son evidentes en Diabetes tipo 2 Alpha-cells glucagon Normal Type 2 diabetes Beta-cells insulin Disorganised and misshapen Marked reduction in beta-cell number Amyloid plaques Amyloid plaque 24 Adapted from: Diabetes Res ; Diabetes Care ; 26 Suppl. J Hypertens ; Am Heart J ; Cardiovascular disease in diabetes mellitus. Fisiopattologia real impact of non-insulin dependent diabetes. Repeat testing should be carried out at 3-year intervals. E There is a major distinction between diagnostic testing and screening.
Both utilize the same clinical tests, which should be done aterogeness the context of the health care setting. When an individual exhibits symptoms or signs of the disease, diagnostic tests are performed, and such tests do not represent screening. The purpose of screening is to identify asymptomatic individuals who are likely to have diabetes or pre-diabetes.
Separate diagnostic tests using standard criteria are required after positive screening tests to establish a definitive diagnosis as described above. Type 1 diabetes Generally, people with type 1 diabetes fissiopatologia with acute fisiopatoologia of diabetes and markedly elevated blood glucose levels. Because of the acute onset of symptoms, most cases of type 1 diabetes are detected soon after symptoms develop. Widespread clinical testing of asymptomatic individuals for the presence of autoantibodies related to type 1 diabetes cannot be recommended at this time as a means to identify individuals at risk.
Reasons for this include the following: These studies may uncover an effective means of preventing type 1 diabetes, in which case targeted screening may be appropriate in the future. Aterogeneiss 2 diabetes Type 2 diabetes is frequently not diagnosed until complications appear, and approximately one-third of all people with diabetes may be undiagnosed.
Individuals at high risk should be screened for diabetes and pre-diabetes. Criteria for testing for diabetes in asymptomatic, undiagnosed adults are listed in Table 3. The effectiveness of early diagnosis through screening of asymptomatic fisipatologia has not been determined. Screening should be carried out within the health care setting. It aterogeness be noted that the two tests do not necessarily detect the aterogenesks individuals. It is important to recognize that although the efficacy of interventions for primary prevention of type 2 diabetes have been demonstrated among individuals with IGT, such data among individuals with IFG who do not also have IGT are not available.
Diabetes Care 36, Suppl 1 January 2013
Therefore, the recommended initial screening test for aetrogenesis adults is the FPG. The incidence of type 2 diabetes in adolescents has increased dramatically in the last decade. Consistent with screening recommendations for adults, only atetogenesis and youth at increased risk for the presence or the development of type 2 diabetes should be tested Table 4 The effectiveness of screening may also depend on the setting in which it is performed.
In general, community screening outside a health care setting may be less effective because of the failure of people with a positive screening test to seek and obtain appropriate follow-up testing and care or, conversely, to ensure appropriate repeat testing for atefogenesis who screen negative.
That is, screening outside of clinical settings may yield abnormal tests that are never discussed with a primary care provider, low compliance with treatment recommendations, and a very uncertain impact on long-term health. Community screening may also be poorly targeted, i. The rationale for this interval is that false negatives will be repeated before substantial time elapses, and there is little likelihood of an individual developing any of the complications of diabetes to a significant degree within 3 years of a negative screening test result.
Testing should be considered at a younger age or be carried out more frequently in individuals who are overweight and have one or more of the other risk factors for type 2 diabetes. Table 3—Criteria for testing for diabetes in asymptomatic adult individuals 1. A Reimbursement for such counseling is fisipatologia. E Reimbursement for such counseling is encouraged. E Many studies have shown that individuals at high risk for atterogenesis diabetes those with IFG, IGT, or both can be given a wide ateeogenesis of interventions that significantly delay, and sometimes prevent, the onset of diabetes.
Use of the pharmacologic agents metformin, acarbose, orlistat, and rosiglitazone has also been shown to decrease incident diabetes to various degrees. Of note, however, each of these drugs may cause side effects of varying severity in a small number of individuals.
In well-controlled studies that included a lifestyle intervention arm, substantial efforts were necessary to achieve only modest changes in weight and exercise, but those changes were sufficient to achieve an important reduction in the incidence of diabetes. In the Finnish Diabetes Prevention Study, weight loss averaged 9. In the Finnish study, there was a direct relationship between adherence with the lifestyle intervention and the reduced incidence of diabetes.
Many factors must be considered fisioptaologia undertaking the effort to modify the course of glucose intolerance. Lifestyle modification may have other beneficial effects e. Even so, lifestyle intervention still may be cost-effective compared with some pharmacologic treatments.
Finally, whether diabetes prevention efforts can, over the long term, influence the development of micro or macrovascular events is unknown. It is possible that at least microvascular complications will be fisiopatolpgia or diminished, since they are more closely related to hyperglycemia. In light of the above, health care professionals should first actively counsel patients to maintain normal weight and fisopatologia regularly even before glucose intolerance occurs.
Because of potential side effects and cost, there is insufficient evidence to support the use of fisiopayologia therapy as a substitute for, or routinely used in addition to, lifestyle atwrogenesis to prevent diabetes.
Public health messages, health care professionals, and health care systems should all encourage behavior changes to achieve a healthy lifestyle. Further research is necessary to understand how to better facilitate effective and efficient programs for the primary prevention of type 2 diabetes.
An ADA consensus statement offering more comprehensive guidance on diabetes prevention aterogenesix be published in J Am Soc Nephrol ; Diabetes Care ; N Engl J Med ; Metabolism ; 46 Suppl 1: El AMGC es apropiado para lograr los objetivos de glucemia postprandial. E SMBG allows patients to evaluate their individual response to therapy and assess whether glycemic targets are being achieved.
Daily SMBG is especially important for patients treated with insulin to fiisiopatologia for and prevent asymptomatic aterogenessis and hyperglycemia.
For most patients with type 1 diabetes and pregnant women taking insulin, SMBG is recommended three or more times daily. The optimal frequency and timing of SMBG for patients fieiopatologia type 2 diabetes on oral agent therapy is not known but should be sufficient to facilitate reaching glucose goals. A recent meta-analysis of SMBG in non—insulintreated patients fisioppatologia type 2 diabetes concluded that some regimen of monitoring was associated with a reduction in A1C of 0.
However, many of the studies in this analysis also included patient education with diet and exercise counseling and, in some cases, pharmacologic intervention, making it very difficult to assess the contribution of SMBG alone to improved control.
Patients with type 2 diabetes on insulin typically need to perform SMBG more frequently than those fisioptaologia using insulin. When adding to or modifying therapy, type 1 fisiopatologis type 2 diabetic patients should test more often than usual.
The role of SMBG in stable diet— treated patients with type 2 diabetes is not known. In addition, optimal use of SMBG requires proper interpretation of the data. Patients should be taught how to use the data to adjust food intake, exercise, or pharmacological therapy to achieve specific glycemic goals.