Beograd 24.07.2013.

Osnove prevencije dijabetesa

Profesor dr Neboj ša M. Lalić

Medicinski fakultet Univerziteta u Beogradu, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, KCS, Beograd

PREVALENCE ESTIMATES OF DIABETES, 2007

SOURCE:

DIABETES ATLAS

THIRD EDITION © INTERNATIONAL DIABETES FEDERATION, 2006

PREVALENCE ESTIMATES OF DIABETES, 2025

SOURCE:

DIABETES ATLAS

THIRD EDITION © INTERNATIONAL DIABETES FEDERATION, 2006

Prevencija tipa 2 dijabetesa



nemedikamentna



medikamentna

Nemedikamentna prevencija tipa 2 dijabetesa



dijeta



fizička aktivnost

Finnish Diabetes Prevention Study

23%

Risk of diabetes reduced by

58%

after 4 years

25% 20% 15% 10% 11%

(6–15 CI) (17– 29 CI)

5% 0% Intervention Control % with Diabetes Tuomilehto J et al. N Engl J Med 2001;344:1343-1350.

Slide Source

Lipids Online Slide Library www.lipidsonline.org

Finnish Diabetes Prevention Study

Goals Weight reduction >5% Fat intake <30% energy Sat fat <10% energy Fiber >15 g/1000 kcal Exercise >4 hr/wk Intervention Controls % of subjects 43 47 26 25 86 13 26 11 12 71 Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.

P value 0.001

0.001

0.001

0.001

0.001

Slide Source

Lipids Online Slide Library www.lipidsonline.org

Novembar 2006 god

Nacionalni program zdravstvene zaštite od dijabetesa u Srbiji

• • • • • • • • •

Standardi:

Standard 1:  Prevencija tipa 2 dijabetesa Standard 2:  Detekcija osoba sa dijabetesom Standard 3:  Osposobljavanje pacijenata sa dijabetesom Standard 4:  Terapija i praćenje odraslih osoba sa dijabetesom Standardi 5 i 6:  Terapija i praćenje dece i adolescenata sa dijabetesom Standard 7:  Tretman akutnih komplikacija dijabetesa Standard 8:  Tretman pacijenata sa dijabetesom u hospitalnim uslovima Standard 9:  Tretman dijabetesa u trudnoći Standardi 10, 11 i 12:  Detekcija i lečenje kasnih komplikacija dijabetesa

• •

Ministarstvo zdravlja Republike Srbije Programski okvir UNAPREĐENJE ZDRAVLJA STANOVNIŠTVA ZA BOLESTI OD POSEBNOG SOCIJALNO MEDICINSKOG ZNAČAJA

Program

•

RANA DETEKCIJA I PREVENCIJA TIPA 2 DIJABETESA NA PRIMARNOM NIVOU ZDRAVSTVENE ZAŠTITE U SRBIJI

Nosilac Programa:

Republička stručna komisija za šećernu bolest Ministarstva zdravlja Republike Srbije

Rukovodilac Programa:

Prof dr Nebojša M. Lalić Vlada Republike Srbije usvojila Nacionalni program u martu 2009. godine

Detekcija rizika i prevencija tipa 2 dijabetesa

< 7 Upitnik procene rizika za tip 2 dijabetesa; zbir bodova: 7-14 ≥ 15 Bez mera prevencije Savet o izmeni na čina života Poseban pristup (gojaznost, IM, gestacijski dijabetes, hipertenzija, HLP, pretodno IFG / IGT)

OGTT

Dijabetes Normoglikemija IFG IGT Terapija hiperglikemija i faktora rizika Intervencija Evaluacija Praćenje

National Guidelines Prevention of type 2 diabetes, 2005

Program prevencije tipa 2 dijabetesa u Republici Srbiji Plan intervencije Primarni nivo zdravstvene zaštite Identifikacija osoba sa visokim rizikom Prva poseta Prev. centru 6 sedmica Druga poseta Prev. centru Pregled • merenja: telesne težine, visine, ITM, obima struka, arterijskog pritiska, EKG • anamneza prethodnih bolesti, upitnici o navikama u ishrani i fizičkoj aktivnosti • laboratorijske analize i OGTT

Globalna procena rizika za T2D i KVB

Individualna intervencija Intervencija u grupi

Primena dijete i fizičke aktivnosti

Kontrolni pregled (6 meseci) Dalji redovni pregledi i evaluacija faktora rizika (6 meseci do 1 god)

Prevention Manager Training (I)

• The IMAGE Curriculum for the Prevention Manager Training Course translated and adapted in the second half of 2010.

• The national course for prevention managers certified by the National CME Accreditation Board in May 2010 • The national courses for prevention managers were held in Belgrade, 2011 - 2013

Prevention Manager Training (II)

• The national courses were attended by 102 participants (35 physicians, 48 nurses and 19 nutritionists) from 62 primary care centers in Serbia • The faculty consisted of diabetologists, medical psycologists, public health specialists and diabetes nurse educators. We acknowledge the participation of Prof P. Kronsbein from Germany, Prof C. Graves and Dr A. Stathi from UK.

• The structure of the course consisted of 8 modules which comprised lectures and interactive workshops. The particants were provided with CDs with all the course materials.

• The evaluation showed high average mark of the course by the attendees

Nacionalni program rane detekcije i prevencije tipa 2 dijabetesa u Srbiji Detekcija osoba sa povi šenim rizikom za tip 2 dijabetesa Preliminarni rezultati Broj testiranih osoba: 3024

%

100 90 80 70 60 50 40 30 20 10 0 11.3

88.7

Skor rizika ≥ 15 Skor rizika <15

Nacionalni program rane detekcije i prevencije tipa 2 dijabetesa u Srbiji Detekcija osoba sa povi šenim rizikom za tip 2 dijabetesa Preliminarni rezultati Da li je neko u vašoj porodici imao ili sada ima dijabetes ?

%

90 80 70 60 50 40 30 20 10 0 24.3

75.7

83.9

16.1

NE DA Skor rizika ≥ 15 Skor rizika <15

Nacionalni program rane detekcije i prevencije tipa 2 dijabetesa u Srbiji Detekcija osoba sa povi šenim rizikom za tip 2 dijabetesa Preliminarni rezultati

%

90 80 Da li uobičajeno tokom dana imate fizičku aktivnost najmanje 30 min ?

81.1

NE DA 70 62.2

60 50 40 30 20 10 0 18.9

37.8

Skor rizika ≥ 15 Skor rizika <15

Nacionalni program rane detekcije i prevencije tipa 2 dijabetesa u Srbiji Detekcija osoba sa povi šenim rizikom za tip 2 dijabetesa Preliminarni rezultati

%

80 70 Koliko često jedete voće i povrće ?

NE svaki dan Svaki dan 60 54 50 46 40 28.2

30 20 10 0 Skor rizika ≥ 15 71.8

Skor rizika <15

Nacionalni program rane detekcije i prevencije tipa 2 dijabetesa u Srbiji Detekcija osoba sa povi šenim rizikom za tip 2 dijabetesa Preliminarni rezultati

%

90 80 70 60 50 40 30 20 10 0 Da li koristite lekove za povišen arterijski pritisak ?

81.9

32.4

67.6

18.1

NE DA Skor rizika ≥ 15 Skor rizika <15

Nacionalni program rane detekcije i prevencije tipa 2 dijabetesa u Srbiji Detekcija osoba sa povi šenim rizikom za tip 2 dijabetesa Preliminarni rezultati Skor rizika ≥ 15 Skor rizika < 15

Starost (god)

53.1+/-1.3

47.2 +/-0.5 *

ITM (kg/m 2 ) Obim struka (cm) Glikemija našte (mmol/l)

29.7+/-0.9

93.2+/-1.8

25.5+/-0.2 * 85.9+/-0.4 *

Holesterol Trigliceridi (mmol/l) (mmol/l) Broj cigareta / dan

5.8+/-0.4

5.8+/-0.3

2.5+/-0.3

23+/-3 5.3+/-0.1 * 5.2+/-0.1

2.1+/-0.1

18+/-1

Podaci su prikazani kao srednja vrednost +/-SEM * p < 0.01

Desetogodi šnji rizik za razvoj tip 2 dijabetesa kod učesnika XXIX Konferencije opšte medicine Srbije Kopaonik, 26-30. 09. 2008. godine 60 50 40 Nizak rizik (skor < 7) Lako povisen rizik (skor 7-11) Umeren rizik (skor 12-14) Visok rizik (skor 15-20) Vrlo visok rizik (skor >20) 30 12,7% 20 10 0

Upitnik popunilo 620 učesnika Konferencije Svaki 7. lekar ima povišen rizik za razvoj tipa 2 dijabetesa!

National Programme of Early Detection and Prevention of Type 2 Diabetes in Serbia

Experiences (I) The main positive trends

a) b) c) satisfactory and progressively increasing response (20-30%) of the subjects invited for the screening high compliance in responding to the questionnaires satisfactory acceptance of the high-risk individuals to participate in the prevention part of the Program (40-50%)

National Programme of Early Detection and Prevention of Type 2 Diabetes in Serbia

Experiences (II) Challenges

a) b) c) inadequate or unsustainable logistics for the implementation of the screening in 7/25 primary centers lack of the resources for practical education for prevention in high-risk individuals and lack of the resources for the evaluation of the program especially for the electronic database and follow-up.

National Programme of Early Detection and Prevention of Type 2 Diabetes in Serbia

Experiences (III) Barriers

• • • • • • Lack of sustainable modalities for financing detection of increased risk and prevention of type 2 diabetes as a part of the national health care system Problems with integration of preventive activities in the existing health care system on the planning as well as on the implementation level Problems with integration of preventive activities in the organization of local communities, especially regarding the lack of the facilities for structured exercise Problems with coordination between the workplace and the preventive interventions implemented in local community Lack of adequately trained personnel, especially the prevention managers Lack of the facilities within the health care centres for practical education of the participants in the Programme.

National Programme of Early Detection and Prevention of Type 2 Diabetes in Serbia

What are the plans for the future activities?

• • • • • • • • Development of national curriculum for education of educators for prevention of type 2 diabetes; Development of the comprehensive system of education of educators for prevention of type 2 diabetes; Development of the comprehensive system of education of health care professionals from primary health care for prevention of type 2 diabetes; Development of the comprehensive system of implementation of the screening for the subjects with high risk for type 2 diabetes; Development of the comprehensive system of detection of newly diagnosed patients with type 2 diabetes and their treatment through the health care system; Development of algorithm for follow up implementation of preventive treatment for the subjects with high risk for type 2 diabetes; Introduction of the regular evaluation system of the changes in the number of newly diagnosed patients with type 2 diabetes and subjects with high risk for type 2 diabetes; Introduction of the regular evaluation system of the efficiency of the preventive treatment in the subjects with high risk for type 2 diabetes.