8/18/2019 1 Andoni Prevalența Bolii Cardiovasculare Ro-En

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THE EPIDEMIC OF TYPE 2 DIABETES: A GLOBAL PROBLEM

FOR THE 21ST

 CENTURY 

MD DSc FICP FACP FRCP Prof. Boulton JM Andrew1

1. University of Mancester! Consultant Psysician at Mancester Royal In"r#ary!

$isitin% Professor at University of Mia#i! President of te &orldwide Initiative for

Dia'etes (ducation

For te "rst ti#e in te istory of #an)ind! non*co##unica'le diseases

ave 'eco#e te leadin% cause of %lo'al #ortality and #or'idity.

A#on%st tese! we are facin% a worldwide e+ide#ic of ty+e , dia'etes.

 -ere are li)ely #ore tan /0 #illion +eo+le worldwide wit dia'etes!

wit te lar%est +ro+ortion 'ein% found in Asia and te Middle (ast.owever! it is not only ty+e , dia'etes 'ut recent re+orts ave su%%ested

increases in ty+e 1 dia'etes in Finland and te United States. Across te

world! dia'etes accounts for 2*1/3 of national ealtcare 'ud%ets and it is

te late co#+lications +articularly tose a4ectin% te lower li#' and te

)idney! tat drive costs. -ere is overwel#in% evidence for te i#+act of 

+reventative #easures in tose wit 5+re*dia'etes6 or I7-. Bot te

Dia'etes Prevention Pro%ra##e fro# te United States and te Dia'etes

Prevention Study fro# Finland ave sown tat diet and lifestyle can%es

in tis +ase can lead to a /23 reduction in te incidence of ty+e ,

dia'etes. Moreover! tese , studies and studies fro# Cina re+ort a5le%acy e4ect6 and tat is tat lifestyle ad8ust#ent for a few years as a

lon%*lastin% e4ect in +rotection fro# develo+#ent of ty+e , dia'etes. For

te #ana%e#ent of ty+e , dia'etes! a +atient*centred a++roac is

advocated as +ro+osed 'y te revised (ASD9ADA %uidelines +u'lised in

,01/. &ereas strict control of dia'etes in youn% +eo+le wit ty+e ,

dia'etes wit few co#+lications is indicated! one #ust re#e#'er te ris)s

of y+o%lycae#ia in te elderly +o+ulation! es+ecially tose wit co*

#or'idities! in wo# a less a%%ressive a++roac is indicated. -e "rst line

a%ent after diet and lifestyle ad8ust#ent for te #ana%e#ent of ty+e ,

dia'etes re#ains #etfor#in. Second line dru%s include te DPP

ini'itors! 7:P*1 analo%ues! S7:-*, ini'itors! +io%lita;one and te

sul+onylureas. It #ust 'e re#e#'ered tat te natural istory of ty+e ,

dia'etes is one of +ro%ressive loss of 'eta*cell function and #ost +atients

in te lon%*ter# #ay well re