1. Langvinnir fylgikvillar sykursýki: Flokkun
Augu
Nýru
Fætur
Áhættuþættir CVD
Stóræðasjúkdómar
IHD
PVD
Ischaemic stroke
Smáæðasjúkdómar
Retinopathy
Neuropathy
Nephropathy 1

2. Langvinnir fylgikvillar sykursýki: Tíðni augnskemmda
any DR
proliferative 2

3. Langvinnir fylgikvillar sykursýki: Meinmyndun
Erfðir
Endurteknar bráðar breytingar á efnaskiptum frumna
Hyperglycaemia
Vefjaskemmd
Kúmúlatívar langtíma breytingar á makrómólikúlum
Sjálfstæðir hraðandi þættir (BÞ, blóðfita...) 3

4. Langvinnir fylgikvillar sykursýki: Retinopathy
Background
Microaneurysms
Hard exudates
Haemorrhages
IRMA
Soft exudates (cotton wool spots)
Proliferative
Neovascularisation
Haemorrhage
Retinal detachment
Macular oedema 4

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

6. Langvinnir fylgikvillar sykursýki: Neuropathy
Vaxandi óafturkræf taugatruflun
Symmetrísk peripheral sensorimotor
Autonomic
Bráð afturkræf taugatruflun
Diabetic amyotrophy
Mononeuritis
Taugatruflun vegna þrýstings
Carpal tunnel
ulnar
lateral popliteal
Taugatruflun tengd meðferð
Insulin neuritis 6

7. Langvinnir fylgikvillar sykursýki: Er hægt að koma í veg fyrir einhverja eða alla með góðri blóðsykurstjórn ?
Tegund 1 Sykursýki
Diabetes Control and Complications Trial (DCCT) NEJM 1993; 329:977
Tegund 2 Sykursýki
United Kingdom Prospective Diabetes Study (UKPDS) Aðalniðurstöður Lancet og BMJ 12. september 1998 7

8. Langvinnir fylgikvillar sykursýki: DCCT
Karlar og konur ára
n = 1441
Primary og secondary prevention tegund 1 DM
Samanburður
Usual care HbA1c 9,2% BS 12,8 ± 3,1 mmol/l
Intensive care HbA1c 7,2% BS 8,6 ± 1,7 mmol/l 8

9. Langvinnir fylgikvillar sykursýki: DCCT9

10. Langvinnir fylgikvillar sykursýki: DCCT10

11. Langvinnir fylgikvillar sykursýki: Hvað er UKPDS ?
Hönnuð uppúr UK sjúkrahús
Nýgreind Type 2 Diabetes Mellitus
fastandi plasma glúkósa > 6,0 í tvígang
ekki ketosis
n = karlar og konur ára. FU 10ár
Útilokanir
MI, s-kreatinin >175, angina, CHF, retinopathy, illkynja háþrýstingur ofl 11

12. Langvinnir fylgikvillar sykursýki: UKPDS markmið
Leiðir góð blóðsykurstjórn af sér færri micro- eða macrovascular fylgikvilla í gerð 2 af sykursýki ?
Er meðhöndlun blóðþrýstings gagnleg ?
Er einhver ein lyfja-meðferð betri eða verri en önnur ? 12

13. Langvinnir fylgikvillar sykursýki: UKPDS slembiröðun
5102 newly diagnosed Type 2 diabetic patients
Diet Alone 3%
fpg < 6
asymptomatic
17%
Main Randomisation
82%
fpg
68%
Diet Failure
15%
fpg > 15
or symptomatic
Diet therapy
14% 13

14. Langvinnir fylgikvillar sykursýki: UKPDS slembiröðun
Main Randomisation n=4209 (82%)
3867
342 allocated to metformin
Conventional Policy 30% (n=1138)
attained HbA1c 7,9%
Intensive Policy 70% (n=2729)
attained HbA1c 7,0%
Sulphonylurea n=1573
Insulin n=1156 14

15. Langvinnir fylgikvillar sykursýki: UKPDS sykurstjórn
The intensive glucose control policy maintained a lower HbA1c by 0.9 %
over a median follow up of 10 years from diagnosis of type 2 diabetes
with reduction in risk of:
12% for any diabetes related endpoint p = 0.029
25% for microvascular endpoints p =
16% for myocardial infarction p = 0.052
24% for cataract extraction p = 0.046
21% for retinopathy at twelee years p = 0.015
33% for albuminuria at twelve years p = 15

16. Langvinnir fylgikvillar sykursýki: UKPDS metformin
overweight patients
RR (95% CI) M v
Int RR p A n
y d i
abete s r
ela t ed
end
oint
Metf o rm
Inte ve =
0.0034
0.6 8
0.9 3
0.0 23
0.4 6 D a
bete
deat h
0.11
0.5
0.8 1 7
0.1 9 l c au e mo ta it y
0.021 4 2
oca d al
nfa ct on
0.12
0.7
favours metformin or intensive
favours conventional 16

17. Langvinnir fylgikvillar sykursýki: UKPDS blóðþrýstingur
1148 hypertensive patients
on antihypertensive
not on antihypertensive
therapy
n = 727
therapy
n = 421
randomisation
less tight blood
tight blood
pressure control
pressure control
aim : BP < 180/105 mmHg
aim : BP < 150 / 85 mmHg
avoid ACE inhibitor : Beta blocker
ACE inhibitor
Beta blocker
n = 390
n = 400
n = 358
34%
35%
31% 17

18. Langvinnir fylgikvillar sykursýki: UKPDS blóðþrýstingur
in 1148 Type 2 diabetic patients a tight blood pressure control policy which achieved blood pressure of 144 / 82 mmHg 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 18

19. 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 HbA1c to 7.0% or less and any therapies can be used (e.g. metformin, sulphonylurea, insulin, acarbose) 19