Langvinnir fylgikvillar sykurski Flokkun l l Augu l

Langvinnir fylgikvillar sykursýki: Flokkun l l Augu l Nýru l Fætur l Áhættuþættir CVD l Stóræðasjúkdómar 4 IHD 4 PVD 4 Ischaemic stroke Smáæðasjúkdómar 4 Retinopathy 4 Neuropathy 4 Nephropathy Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Tíðni augnskemmda any DR proliferative Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Meinmyndun Erfðir Endurteknar bráðar breytingar á efnaskiptum frumna Hyperglycaemia Vefjaskemmd Kúmúlatívar langtíma breytingar á makrómólikúlum Sjálfstæðir hraðandi þættir (BÞ, blóðfita. . . ) Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Retinopathy l l l Background 4 Microaneurysms 4 Hard exudates 4 Haemorrhages 4 IRMA 4 Soft exudates (cotton wool spots) Proliferative 4 Neovascularisation 4 Haemorrhage 4 Retinal detachment Macular oedema Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Nephropathy Eðlilegt albumin: kreatinin hlutfall í morgunþvagi < 3, 5 mg/mmol MAU Míkróalbúminúría albumin: kreatinin 3, 5 - 25 mg/mmol Albúmínúría albumin: kreatinin > 25 mg/mmol AU ESRD Nýrnabilun Dauði Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Neuropathy l l Vaxandi óafturkræf taugatruflun 4 Symmetrísk peripheral sensorimotor 4 Autonomic Bráð afturkræf taugatruflun 4 Diabetic amyotrophy 4 Mononeuritis Taugatruflun vegna þrýstings 4 Carpal tunnel 4 ulnar 4 lateral popliteal Taugatruflun tengd meðferð 4 Insulin neuritis Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Er hægt að koma í veg fyrir einhverja eða alla með góðri blóðsykurstjórn ? l Tegund 1 Sykursýki 4 Diabetes Control and Complications Trial (DCCT) NEJM 1993; 329: 977 l Tegund 2 Sykursýki 4 United Kingdom Prospective Diabetes Study (UKPDS) Aðalniðurstöður Lancet og BMJ 12. september 1998 Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: DCCT l Karlar og konur 13 - 39 ára l n = 1441 l Primary og secondary prevention tegund 1 DM l Samanburður 4 Usual care Hb. A 1 c 9, 2% 4 BS 12, 8 ± 3, 1 mmol/l Intensive care Hb. A 1 c 7, 2% BS 8, 6 ± 1, 7 mmol/l Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: DCCT Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: DCCT Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: Hvað er UKPDS ? l Hönnuð uppúr 1970. 23 UK sjúkrahús l Nýgreind Type 2 Diabetes Mellitus 4 fastandi plasma glúkósa > 6, 0 í tvígang 4 ekki ketosis l n = 5102. karlar og konur 25 - 65 ára. FU 10ár l Útilokanir 4 MI, s-kreatinin >175, angina, CHF, retinopathy, illkynja háþrýstingur ofl Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS markmið l Leiðir góð blóðsykurstjórn af sér færri microeða macrovascular fylgikvilla í gerð 2 af sykursýki ? l Er meðhöndlun blóðþrýstings gagnleg ? l Er einhver ein lyfja-meðferð betri eða verri en önnur ? Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS slembiröðun 5102 newly diagnosed Type 2 diabetic patients Diet therapy fpg < 6 asymptomatic 17% fpg 6. 1 - 15. 0 asymptomatic 68% fpg > 15 or symptomatic 15% Main Randomisation 82% Diet Failure 15% 14% Diet Alone 3% Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS slembiröðun Main Randomisation n=4209 (82%) 342 allocated to metformin 3867 Conventional Policy 30% (n=1138) Intensive Policy 70% (n=2729) attained Hb. A 1 c 7, 9% attained Hb. A 1 c 7, 0% Sulphonylurea n=1573 Insulin n=1156 Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS sykurstjórn The intensive glucose control policy maintained a lower Hb. A 1 c by 0. 9 % over a median follow up of 10 years from diagnosis of type 2 diabetes with reduction in risk of: 12% 25% for any diabetes related endpoint for microvascular endpoints p = 0. 029 p = 0. 0099 16% 24% for myocardial infarction for cataract extraction p = 0. 052 p = 0. 046 21% 33% for retinopathy at twelee years for albuminuria at twelve years p = 0. 015 p = 0. 000054 Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS metformin overweight patients RR (95% CI) M v Int A n y d iabete s rela ted end p oint p= 0. 0034 Metf o rm in Inte n sive D ia bete s rela ted deat h s p= 0. 11 Metf o rm in Inte n sive A ll cau se mo rta lity p = 0. 021 Metf o rm in Inte n sive M yoca rdial infa rct ion p= 0. 12 Metf o rm in Inte n sive RR p 0. 6 8 0. 9 3 0. 0 0 23 0. 4 6 0. 5 8 0 0. 0 1 7 0. 1 9 0. 6 4 0. 9 2 0. 0 1 1 0. 4 9 0. 6 1 0. 7 9 0. 0 1 0. 1 1 favours metformin or intensive favours conventional Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS blóðþrýstingur 1148 hypertensive patients on antihypertensive therapy n = 421 not on antihypertensive therapy n = 727 randomisation less tight blood pressure control aim : BP < 180/105 mm. Hg aim : BP < 150 / 85 mm. Hg avoid ACE inhibitor : Beta blocker n = 390 34% ACE inhibitor n = 400 35% Beta blocker n = 358 31% Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS blóðþrýstingur in 1148 Type 2 diabetic patients a tight blood pressure control policy which achieved blood pressure of 144 / 82 mm. Hg gave reduced risk for any diabetes-related endpoint 24% p=0. 0046 diabetes-related deaths 32% p=0. 019 stroke 44% p=0. 013 microvascular disease 37% p=0. 0092 heart failure 56% p=0. 0043 retinopathy progression 34% p=0. 0038 deterioration of vision 47% p=0. 0036 Dr. Rafn Benediktsson Saturday, June 5, 2021

Langvinnir fylgikvillar sykursýki: UKPDS Niðurstaða • intensive management of blood pressure and blood glucose, using existing therapies, markedly reduces the risk of diabetic complications • aim for blood pressure 140/80 mm Hg or less and any therapies can be used (e. g. beta blocker, ACE inhibitor, low dose thiazide or loop diuretic) • reduce Hb. A 1 c to 7. 0% or less and any therapies can be used (e. g. metformin, sulphonylurea, insulin, acarbose) Dr. Rafn Benediktsson Saturday, June 5, 2021