{"id":10499,"date":"2008-01-14T09:21:20","date_gmt":"2008-01-14T06:21:20","guid":{"rendered":"https:\/\/www.synevo.ro\/afectiuni\/profil-screening-diabet-zaharat\/"},"modified":"2020-07-10T12:31:12","modified_gmt":"2020-07-10T09:31:12","slug":"profil-screening-diabet-zaharat","status":"publish","type":"synevo_diseases","link":"https:\/\/old.synevo.md\/ru\/afectiuni\/profil-screening-diabet-zaharat\/","title":{"rendered":"Profil screening diabet zaharat"},"content":{"rendered":"<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Diabetul zaharat (DZ)<\/strong><\/span> este un grup de afec\u0163iuni metabolice caracterizate prin hiperglicemie, asociat\u0103 cu tulbur\u0103ri ale metabolismelor lipidelor \u015fi proteinelor, care se datoreaz\u0103 unei deficien\u0163e \u00een ac\u0163iunea insulinei la nivelul \u0163esuturilor \u0163int\u0103.<br \/>Marea majoritate a cazurilor de diabet se poate \u00eemp\u0103r\u0163i \u00een dou\u0103 mari categorii etiopatogenice:<!--more--><\/p>\n<hr \/>\n<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Diabetul zaharat de tip 1 <\/strong><\/span>cunoscut \u015fi ca diabetul insulino-dependent, diabetul cu debut juvenil este prezent la 5-10% din pacien\u0163ii diabetici. Mecanismul patogenic const\u0103 \u00een distruc\u0163ia autoimun\u0103 mediat\u0103 celular, a celulelor insulare beta-pancreatice \u015fi are ca rezultat de obicei deficien\u0163a absolut\u0103 a secre\u0163iei de insulin\u0103. Markerii distruc\u0163iei imune sunt: autoanticorpii anti-celule insulare pancreatice, autoanticorpii anti-insulin\u0103, autoanticorpi GAD65 (glutamic acid decarboxilaza) etc. Unul sau de obicei mai mul\u0163i dintre ace\u015fti autoanticorpi sunt prezen\u0163i la 85-90% din indivizi, c\u00e2nd hiperglicemia este pentru prima oar\u0103 detectat\u0103. Exist\u0103 \u015fi o susceptibilitate genetic\u0103 pentru aceast\u0103 afec\u0163iune, identificat\u0103 cel mai adesea prin prezen\u0163a unor muta\u0163ii \u00een structura mai multor gene, dintre care cele mai cunoscute sunt cele apar\u0163in\u00e2nd sistemului HLA, de care depinde reglarea r\u0103spunsului imun al organismului. Instalarea clinic\u0103 a bolii este zgomotoas\u0103 \u015fi are o evolu\u0163ie rapid\u0103, astfel \u00eenc\u00e2t sub v\u00e2rsta de 20 ani, 2\/3 din pacien\u0163i sunt diagnostica\u0163i \u00een cetoacidoz\u0103 inaugural\u0103, jum\u0103tate din ace\u015ftia fiind cetoacidoze diabetice severe.<br \/>Pacien\u0163ii cu DZ tip 1 sunt predispu\u015fi \u015fi pentru alte afec\u0163iuni autoimune: boala Graves, tiroidita Hashimoto, boala Addison, anemia pernicioas\u0103, hepatita autoimun\u0103 etc.<\/p>\n<hr \/>\n<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Diabetul zaharat de tip 2<\/strong><\/span> cunoscut \u015fi ca diabetul non-insulino-dependent, diabetul cu debut la v\u00e2rsta adult\u0103, este prezent la ~90-95% din pacien\u0163ii diabetici. Mecanismul patogenic const\u0103 \u00een prezen\u0163a rezisten\u0163ei periferice la insulin\u0103 \u015fi a deficien\u0163ei, de obicei relative, a secre\u0163iei de insulin\u0103. De\u015fi ereditatea este mai bine exprimat\u0103 \u00een tipul 2 de diabet, baza sa genetic\u0103 este mai pu\u0163in cunoscut\u0103 dec\u00e2t \u00een tipul 1 de diabet. Riscul dezvolt\u0103rii acestei forme de diabet cre\u015fte cu v\u00e2rsta, prezen\u0163a obezit\u0103\u0163ii \u015fi lipsa activit\u0103\u0163ii fizice. El apare mai frecvent la femei cu diabet gesta\u0163ional \u00een antecedente \u015fi pacien\u0163i cunoscu\u0163i cu hipertensiune sau dislipidemie. Aceast\u0103 form\u0103 de diabet frecvent scap\u0103 nediagnosticat\u0103 c\u00e2\u0163iva ani, pentru c\u0103 hiperglicemia se dezvolt\u0103 gradual \u015fi \u00een stadii precoce, adesea nu este suficient de sever\u0103 pentru a determina apari\u0163ia simptomelor clasice de diabet. Totu\u015fi, ace\u015fti pacien\u0163i au un risc crescut de dezvoltare a complica\u0163iilor macrovasculare \u015fi microvasculare. De aceea este important screeningul pentru DZ la indivizii cu risc crescut pentru diabet zaharat \u015fi pre-diabet.<\/p>\n<hr \/>\n<p style=\"text-align: center;\"><span style=\"color: #00539f;\"><strong>Criteriile de testare pentru diabet la adul\u0163ii asimptomatici<\/strong><\/span><\/p>\n<hr \/>\n<p style=\"text-align: justify;\">1. Screeningul cuprinde to\u0163i adul\u0163ii \u2265 45ani, \u00een special cei supraponderali (BMI \u226525kg\/m2); dac\u0103 este normal se va repeta la interval de 3 ani;<br \/>2. Screeningul adul\u0163ilor &lt; 45ani, supraponderali (BMI \u226525kg\/m2), dac\u0103 au \u00eenc\u0103 factor de risc pentru diabet zaharat dintre urm\u0103torii:<\/p>\n<ul>\n<li style=\"text-align: justify;\">lipsa activit\u0103\u0163ii fizice;<\/li>\n<li style=\"text-align: justify;\">istoric familial \u2013 rud\u0103 de grd. I cu DZ;<\/li>\n<li style=\"text-align: justify;\">apartenen\u0163\u0103 la un grup etnic cu risc crescut de DZ;<\/li>\n<li style=\"text-align: justify;\">na\u015ftere de copil cu greutate &gt; 4kg sau istoric de DZ gesta\u0163ional;<\/li>\n<li style=\"text-align: justify;\">hipertensiune (\u2265140\/90 mmHg);<\/li>\n<li style=\"text-align: justify;\">HDL colesterol &lt; 35mg\/dl \u015fi\/sau trigliceride &gt; 250 mg\/dl;<\/li>\n<li style=\"text-align: justify;\">sindromul ovarelor polichistice (PCOS);<\/li>\n<li style=\"text-align: justify;\">testare anterioar\u0103, care a eviden\u0163iat sc\u0103derea toleran\u0163ei la glucoz\u0103\/glicemie bazal\u0103 modificat\u0103;<\/li>\n<li style=\"text-align: justify;\">alt\u0103 condi\u0163ie clinic\u0103 asociat\u0103 cu rezisten\u0163a la insulin\u0103 (acanthosis nigricans);<\/li>\n<li style=\"text-align: justify;\">istoric de boal\u0103 vascular\u0103.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><em><strong>Criteriile ADA (American Diabetes Association) pentru diagnosticul diabetului zaharat sunt:<\/strong><\/em><\/p>\n<ul>\n<li style=\"text-align: justify;\">Simptome sugestive (poliurie, polidipsie, sc\u0103dere ponderal\u0103 inexplicabil\u0103), la care se adaug\u0103 o valoare a glucozei \u201crandom\u201d \u2265 200 mg\/dL (\u2265 11.1 mmol\/L) sau<\/li>\n<li style=\"text-align: justify;\">Valoarea glicemiei bazale \u2265126 mg\/dL (\u2265 6.99 mmol\/L) sau<\/li>\n<li style=\"text-align: justify;\">Valoarea glicemiei \u2265 200 mg\/dL la 2h dup\u0103 administrarea a 75g glucoz\u0103 (\u00een cadrul testului de toleran\u0163\u0103 la glucoz\u0103).<sup>1,2,3<\/sup><\/li>\n<\/ul>\n<hr \/>\n<p style=\"text-align: justify;\"><strong>Complica\u0163iile pe termen lung ale diabetului includ:<\/strong> retinopatia, nefropatia, neuropatia periferic\u0103, afec\u0163iunile cardiovasculare arterosclerotice (prin tulbur\u0103rile metabolismului lipoproteinelor).<\/p>\n<p>\u00a0<\/p><div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\"><p>Testele disponibile \u00een laboratoarele Synevo, pentru screeningul (la indivizii asimptomatici) respectiv diagnosticul (la pacien\u0163ii cu semne sau simptome de boal\u0103) diabetului zaharat sunt:<\/p><\/div>\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\"><div class=\"synevo-shop-products\">\r\n    <div class=\"sysprod\">\r\n        \r\n        <div class=\"sysprod-products\">\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/glucoza-serica-glicemie\/\">Glucoz\u0103 seric\u0103 (glicemie)<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>80.00 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9246\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9246\"\r\n                                data-product_sku=\"CH41\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/test-de-toleranta-la-glucoza-per-os-75g\/\">Test de toleran\u021b\u0103 la glucoz\u0103 per os (75g)<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>140.00 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9307\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9307\"\r\n                                data-product_sku=\"CH55\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                    <\/div>\r\n        \r\n    <\/div>\r\n<\/div>\r\n\r\n<style>\r\n.synevo-shop-products {\r\n    padding: 24px 0;\r\n    margin: 24px 0;\r\n    border-radius: 10px;\r\n    background: #F6F7F9;\r\n}\r\n.synevo-shop-products .sysprod-product {\r\n    position: relative;\r\n    margin: 0 24px;\r\n    margin-bottom: 24px;\r\n    border-radius: 10px;\r\n    background: #fff;\r\n    display: flex;\r\n    flex-direction: row;\r\n    align-items: center;\r\n}\r\n.synevo-shop-products .sysprod-product:last-child {\r\n    margin-bottom: 0;\r\n}\r\n.synevo-shop-products .sysprod-product-title {\r\n    flex-grow: 1;\r\n    padding: 15px;\r\n    margin-left: 14px;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 16px;\r\n    color: #29263F;\r\n}\r\n.synevo-shop-products .sysprod-product-price {\r\n    flex-shrink: 0;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 18px;\r\n    color: #FDB813;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart {\r\n    flex-shrink: 0;\r\n    position: relative;\r\n    width: 38px;\r\n    height: 38px;\r\n    margin-left: 24px;\r\n    margin-right: 24px;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart .button {\r\n    top: unset;\r\n    right: unset;\r\n}\r\n<\/style><\/div><\/div><p><small><strong>Bibliografie:<\/strong><br>1. American Diabetes Association, Diagnosis and Classification of Diabetes Mellitus, Diabetes Care 28:S37-S42, 2005.<br>2. American Diabetes Association, Standards of Medical Care in Diabetes, Diabetes Care 28:S4-S36, 2005.<br>3. C-tin Ionescu Targoviste, Diabetul zaharat, \u00cen Medicina Interna, Bolile cardiovasculare \u015fi metabolice, Vol.2, 1996, 1167-1241.<\/small><\/p><hr class=\"wp-block-separator\"\/><p>Mai multe informa\u021bii despre testele disponibile: <\/p><ul class=\"wp-block-list\"><li><a href=\"\/shop\/glucoza-serica-glicemie\/\" class=\"rank-math-link\">Glucoza seric\u0103<\/a><\/li><li><a href=\"\/shop\/test-de-toleranta-la-glucoza-per-os-75g\/\" class=\"rank-math-link\">Test de toleran\u0163\u0103 la glucoz\u0103 per os (2h, 75g glucoz\u0103)<\/a><\/li><\/ul>","protected":false},"featured_media":0,"template":"","synevo_diseases_category":[898],"class_list":["post-10499","synevo_diseases","type-synevo_diseases","status-publish","hentry","synevo_diseases_category-medicina-de-familie"],"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases\/10499","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/synevo_diseases"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10499"}],"wp:term":[{"taxonomy":"synevo_diseases_category","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases_category?post=10499"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}