Cập nhật chẩn đoán và điều trị tiền đái tháo đường

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Tác giả: Hải Thủy Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại: 641.56314 Cooking

Thông tin xuất bản: Nội tiết và Đái tháo đường, 2021

Mô tả vật lý: 45560

Bộ sưu tập: Metadata

ID: 494753

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Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. Prediabetes is a state characterized by impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, Prediabetes remains a state of high risk for developing diabetes with yearly conversion rate of 5%- 10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early diabetic nephropathy, diabetic neuropathy, early diabetic retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. A better understanding of prediabetes could help with earlier identification, thereby allowing earlier intervention, potentially lowering the number of individuals who go on to develop diabetes and diabetic complications. Preventing progression from prediabetes to type 2 diabetes by the lifestyle intervention and pharmacologic agents (metformin, aglucosidase inhibitors, glucagonlike peptide 1 receptor agonists, thiazolidinediones). Use of drugs requires consideration of cost, side effects, and durable efficacy. Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention. Based on findings from the Diabetes Prevention Program (DPP), Metformin should be recommended as an option for high-risk individuals (e.g., those with a history of Gestational Diabetes Mellitus, <
60 years olds, BMI ≥25 kg/m2 for Asian people, one of risk factors (HbA1c >
6%, IFG plus IGT, high blood pressure, HDL.C <
0,9 mmol/L, TG >
2,52 mmol and First-degree relative with diabetes).Tiền đái tháo đường (ĐTĐ) là tình trạng tăng glucose máu mức trung gian với các chỉ số glucose máu trên mức bình thường nhưng dưới ngưỡng chẩn đoán ĐTĐ. Tiền ĐTĐ là trạng thái đặc trưng bởi rối loạn đường huyết lúc đói (IFG) và/hoặc rối loạn dung nạp glucose (IGT). Mặc dù tiêu chuẩn chẩn đoán tiền ĐTĐ chưa thống nhất giữa các tổ chức Y học quốc tế nhưng tiền ĐTĐ vẫn là trạng thái có nguy cơ cao phát triển bệnh ĐTĐ với tỷ lệ hàng năm thay đổi từ 5% -10%. Các bằng chứng quan sát cho thấy mối liên quan giữa tiền ĐTĐ và các biến chứng của bệnh ĐTĐ như bệnh thận ĐTĐ giai sớm, bệnh thần kinh ĐTĐ, bệnh võng mạc ĐTĐ sớm, nguy cơ bệnh mạch máu lớn và gần đây ghi nhận bệnh não ĐTĐ thông qua suy giảm thần kinh nhận thức. Bên cạnh đó một số nghiên cứu cũng đã ghi nhận hiệu quả của các biện pháp can thiệp lối sống và xử dụng thuốc liên quan đến phòng ngừa bệnh ĐTĐ với mức giảm nguy cơ từ 40% -70% ở đối tượng người lớn mắc tiền ĐTĐ. Sự hiểu biết về tiền ĐTĐ có thể giúp xác định bệnh được sớm hơn, cho phép can thiệp sớm hơn, có khả năng làm giảm số lượng người bệnh tiền ĐTĐ sẽ phát triển bệnh ĐTĐ và các biến chứng ĐTĐ. Ngăn ngừa sự tiến triển từ tiền ĐTĐ thành bệnh ĐTĐ típ 2 bằng can thiệp lối sống và các nhóm thuốc (Metformin, Ức chế a-glucosidase, đồng vận thụ thể GLP1 glucagon like peptide 1), Thiazolidinediones). Việc sử dụng thuốc cần cân nhắc giữa chi phí, tác dụng phụ và hiệu quả lâu dài. Metformin có cơ sở bằng chứng mạnh mẽ nhất và chứng minh tính an toàn lâu dài như một liệu pháp dược lý để phòng ngừa bệnh ĐTĐ. Dựa trên các kết quả từ Chương trình Phòng chống Đái tháo đường (DPP), Metformin nên được khuyến nghị như một lựa chọn cho những người tiền ĐTĐ có nguy cơ cao (ví dụ: người có tiền sử ĐTĐ thai kỳ, <
60 tuổi, BMI ≥25 kg/m2 đối với người Châu Á , có một trong các yếu tố nguy cơ (HbA1c >
6%, IFG cộng với IGT, huyết áp cao, nồng độ HDL.C <
0,9 mmol /L, TG >
2,52 mmol/l và có người thân trực hệ bị ĐTĐ)

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