Diabetes is a serious threat to human health has, has a major impact on the social development of the disease, mainly in the following areas:
First, the prevalence
Diabetes is a worldwide epidemic, which increasingly higher prevalence, according to WHO estimates, the world has 175 million patients with diabetes about to reach 300 million by 2025. The prevalence of diabetes in China has sharply increased in the past that diabetes is a disease in the elderly. Recently discovered, both in the West or China, with an increase in obesity in children and adolescents, and children and adolescents with diabetes, particularly type 2 diabetes is also rapidly increasing number of people, early in life has become a major health problem.
High incidence of diabetic complications, resulting in tissue and organ damage, with maiming and killing of serious harm
(A) acute complications
1, diabetic ketoacidosis this disease is the most common acute complications of diabetes, common in type 1 diabetes, occurs in poor metabolic control, associated with infection, severe stress, insulin treatment is interrupted and eating disorders and other conditions. Type 2 diabetes, such as poor metabolic control, it can also occur when accompanied by severe stress. Delay in diagnosis or treatment can cause death. In young or old, higher mortality in patients with coma or hypotension. Experienced medical centers in the United States the fatality rate <5%, but in our primary hospital mortality can be as high as 10%.
2, diabetic nonketotic hyperosmolar syndrome
The syndrome is more common in older patients. Due to severe hyperglycemia and water and electrolyte balance disorders caused coma, shock and multiple organ failure. This syndrome high mortality rate, even at high levels of hospital mortality rate is still as high as 15%.
3, lactic acidosis
Diabetic patients with lactic acidosis incidence is not high, but the high mortality rate. Mostly in associated with liver and kidney dysfunction, or with chronic heart and lung dysfunction in patients with hypoxic diseases, especially those who while taking phenformin. Mainly due to anaerobic glycolysis in vivo glucose metabolism products - a lot of lactic acid accumulation lead to lactic acidosis, body fluids PH appears further reduced, leading to lactic acidosis.
(B) chronic complications
1, vascular complications
Cardiovascular disease is diabetes disability, death, and the main cause of economic loss. Diabetes and death due to cardiovascular disease, the coronary heart disease accounts for about half. After the 1980s, due to the achievement of the etiology and pathogenesis of coronary sclerosis disease awareness and prevention trials in the general population in Western countries, coronary heart disease incidence and mortality showed a clear downward trend. Diabetic population is not, morbidity and mortality of cardiovascular disease but increasing. The annual incidence of cardiovascular disease in diabetic populations of 2 to 3 times higher than the same age and gender non-diabetic population. US Framingham for 51 to 59 year-old male seven years of follow-up primary prevention research community, as well as coronary heart disease events and deaths in Finland study (1059 cases and 1373 cases of type 2 diabetes, non-diabetic), show that the incidence of diabetes in patients with cardiovascular events and mortality significantly higher than non-diabetic patients. The third report by the US National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPⅢ) noted that non-diabetic patients without previous myocardial infarction in patients with diabetes 10 years the risk of cardiovascular events with previous myocardial infarction suffered similar, so that the diabetes is coronary heart disease risk equivalent. Type 2 diabetes is an independent risk factor for coronary heart disease. Diabetes artery endothelial dysfunction, arterial endothelial injury, followed by vascular injury response premature and accelerated atherosclerosis is increased coronary events and death of the important reasons. Meanwhile diabetic cardiomyopathy, left ventricular diastolic dysfunction, prone to congestive heart failure and cardiac arrhythmias caused by autonomic neuropathy is also an important reason for increased cardiovascular mortality. Endothelial dysfunction and damage the foundation and atherosclerosis are multiple risk factors for diabetes and its accompanying insulin resistance, such as obesity, high blood pressure, high blood sugar, small, dense LDL-C increased hypertriglyceridemia disease, low HDL-C, PAI-1 increases, high homocysteine (ie, metabolic syndrome), as well as smoking. As multiple risk factors for cardiovascular disease not only in diabetes on the metabolic syndrome, and in pre-diabetes, impaired glucose tolerance phase as already exist. Therefore, when dealing with diabetes, and effective prevention and treatment of early intervention in order to minimize the incidence and mortality of cardiovascular disease.
2, diabetes and cerebrovascular disease
Diabetes, cerebrovascular disease atherosclerosis in cerebral ischemic encephalopathy caused by the most common, such as transient ischemic attack (transient ischemic attack, TIA), lacunar infarction, multiple cerebral infarction, cerebral thrombosis, etc. Diabetic angiopathy of cerebral thrombosis occurred in the middle cerebral artery, and lacunar infarction is more common in the brain's blood supply deep perforating branches, such as the putamen, internal capsule, thalamus and pons substrate and so on. Due to the high rates of diabetes, hypertension (20% to 60%), bleeding can also occur encephalopathy. Stroke incidence of diabetes is high compared with Western countries, while the north and is generally higher than the south. 2002 urban residents of cerebrovascular disease first two cause of death in rural areas are at the top. Diabetes, cerebrovascular disease incidence was significantly higher than non-diabetic women is even worse. Framingham study 45 to 74 years the incidence of diabetes than non-diabetic cerebral infarction were 2.5 times in men, women 3.7 times higher. Moreover, the occurrence of diabetes of all ages ischemic stroke were higher than non-diabetics.
Risk factors for diabetes cerebrovascular disease including high blood sugar, high blood pressure, dyslipidemia, blood abnormalities, smoking and chronic inflammation status. Where hypertension is particularly important for diabetic ischemic encephalopathy independent risk factor. In patients with ischemic stroke, 77% of the blood pressure is not controlled, antihypertensive therapy to reduce the incidence of stroke is very important. It also UKPDS and other antihypertensive therapy in clinical trials, such as HOPE, HOT, LIFE confirmed by other tests. It is also a risk factor for myocardial infarction in elderly stroke. Study abroad 121,432 cases over the age of 65 hospitalized patients with acute myocardial infarction, stroke occurred after discharge than those without the risk of myocardial infarction by 2.5 times.
3, diabetic eye disease
Each part can occur in patients with diabetic eye disease, such as abnormal cornea, iris neovascularization, optic neuropathy, etc., glaucoma prevalence of diabetes and non-diabetic patients with cataract at the same ages. Diabetic retinopathy is a leading cause of blindness in patients with diabetes, the prevalence of retinopathy of each type of diabetes prevalence over time and increased with age. 99% of type 1 diabetes and 60 percent of type 2 diabetes, duration of more than 20 years, almost all have different degrees of retinopathy. 10 children under the age of diabetic retinopathy rarely occurs after puberty increased risk of diabetic retinopathy.
4,
diabetic nephropathy
About 20% to 30% of type 1 or type 2 diabetes patients with diabetic nephropathy. Part of progression to ESRD. If not for special intervention in have persistent microalbuminuria in patients with type 1 diabetes for about 80 percent of people 10 to 15 years in the development of clinical nephropathy, hypertension may occur at this time. Once clinical nephropathy, as without effective intervention, within a few years decreased glomerular filtration rate, 50 percent after 10 years, 20 years more than 75% of patients will develop end-stage renal disease. After the diagnosis of diabetes type 2 diabetes, many people immediately microalbuminuria, even overt nephropathy, as no special intervention, in which patients with advanced 20% to 40% of clinical nephropathy, about 20 percent 20 years later progressed to the final ESRD. Due to the large number of patients with type 2 diabetes, so far carried out in Western countries in kidney patients on dialysis for more than half of patients with diabetes. Type 1 or type 2 diabetes and microalbuminuria appears, not only marks the presence of early kidney disease, but also greatly increase the prevalence of cardiovascular disease and risk of death, and therefore should be highly valued.
5, diabetic foot
Diabetic foot is diabetic lower extremity vascular disease, neuropathy and infection result of joint action, can cause severe foot ulcers and even amputation. United States each year from 1989 to 1992 due to amputation because of diabetes on average 1605 cases of foot ulcers is a major factor amputation. 40 percent of adults in the foot and lower limb amputations due to diabetes. A British study of 469 cases followed up without previous foot ulcers in diabetic patients, found 10.2 percent for four consecutive years of foot ulcer patients. Amputation rate in diabetic men and women of the same sex than non-diabetic population, respectively, 10.3 times and 13.8 times. Epidemiological information on the diabetic foot in our country is still lacking.
6, diabetic osteoarthritis
The incidence of diabetes, bone and joint disease is about 0.1% to 0.4%, mainly due to neuropathy, infection can aggravate the injury. Benbingfasheng rate is not very high, but it can cause dislocation, deformity, seriously affecting the joint function, reduce the quality of life of patients.
7, diabetes and oral diseases
The body's resistance to infection in diabetic patients with bacterial decline, oral and maxillofacial tissues and gingival and periodontal tissues in the oral cavity prone to infection, which can cause alveolar overflow pus, alveolar bone, loose teeth. Occurred in maxillofacial soft tissue infections, acute onset, rapid expansion of inflammation, the early stages can make the general condition suddenly deteriorated, not treated can cause death.
(Iii) with incidence and infection
1, hypoglycemia
Diabetes is often accompanied by obesity postprandial hyperinsulinemia, and therefore there may be late postprandial hypoglycemia, but to a lesser extent. The most common and more severe hypoglycemia and diabetes-related drugs overdose. Among insulin and sulfonylurea oral hypoglycemic agents most common. The latter again glibenclamide (glyburide) is staggering. Severe hypoglycemia harm the elderly and children particularly great.
2, the metabolic syndrome
Central obesity, hypertension, dyslipidemia, cholelithiasis, hyperuricemia and polycystic ovary syndrome, often associated with diabetes clustering occurs (ie metabolic syndrome), but also increased the risk of diabetes, cardiovascular disease.
3, erectile dysfunction
Very common, about half of patients with type 2 diabetes are the main due to diabetic autonomic neuropathy.
4, acute and chronic infections
Cellular and humoral immunity in patients with diabetes, reduced immune function often easily associated with urinary tract, biliary tract infection, fungal or bacterial skin infections, as well as pneumonia and tuberculosis.
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