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............................................................5 ....................................................................................................6 .............................................................................................................8 .............................................................................................................8 A. .................................................................................8 A.1. : .........8 A.2. (ICD 10): E.10-14.........................................................8 A.3. :.......................................................8 A.4. :..................................................................8 A.5. : .................................................9 A.6. : ...............................................9 A.7. , .............................................................9 A.8. , ...........10 A.9. ....................................................................11 . , ....................................13 .1. , .......................13 .1.1. ............13 .1.2. ( ) .....................................................................................14 .2. , ............................................15 .2.1. , ................15 .2.2. 10- ..............................................................16 .2.3. 10- ..............................................................17 .2.4. ...........................17 2
.3. - 1. .................................19 .4. - 2...................................19 . , ...................................................................21 .1. .........................................................21 .2. .................................22 .2.1. .........................................22 .2.2. .....................23 .3. ...................................................................................23 .4. .......................................24 .4.1. ................................................24 .4.2. .............................25 .4.2.1. ...................................................................25 .4.2.2. ...................................................................25 .4.2.3. ...........................................26 .4.3. .................................................................27 .4.4. ..............................................................................28 .4.4.1. ......................................................28 .4.4.2. ............................................................31 .4.5. ...............................................38 .5. ...........................................................................40 .6. .............................................................................42 .6.1. ...................................................................42 .6.2. ..................................................................43 .6.3. ...................................................................44 .6.4. , , .........................................................................................................45 3
.7. ........................................47 .7.1. ...........................47 .7.2. ................................47 .7.3. ...........................................47 .7.4. ...........................................48 .7.5. ..............48 .7.6. , .......................48 .7.7. ..............49 .7.7.1 ....................................................................49 .7.7.2. ..................................49 .7.7.3. ................................................50 .8. .....................................................50 :..................................................................................................52 .............................................................................................54 1. 2- .....54 2. , .........................................................................69 3. /- - .....................................................................................................70 4. ...........................................71 5. ...........................73
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2 -4 / HbA1C -2 ---4 /
5
()- ()- , EPOS Health Management . - , , , , , , , , . 2010 285 90 2 . 2009 () 6,5%, 9,5% . , 2- . ( < 25 k/) ( > 30 k/) 2- 10-20 . 2- 2-4 , 2-3 . () - . , - - . 35- , . , , .
6
- , , , 5 , , , . , . . 2- , . , , . , . , . , -4 . 2- , , , . 2- . - (, , ) . - 60-80% . , , , . , . , . , . , , - . HbA1c 1% 21%, , 37%, 14%- .
7
A. A.1. : , . 2 . : 1. , 2, , 2. , 2, ,
A.2. (ICD 10): E.10-14E.10.9 1 () E.11.9 2 () E.12.9 () E.13.9 () E.14.9 () R.73.0
A.3. : , , - - - ,
A.4. :1. - 8
2. 2- - , 3. - 4. - 5. -
A.5. :2010
A.6. :2014
A.7. , 1. . 2. 3. 4. 5. 6. 7. 8. 9. 10 . 11 . 12 . 13 . 14 . . . . . . . . . - , - EPOS Health Management, , , , EPOS Health Management EPOS Health management - , - - , 9
15 . 16 . 17 . 18 . 19 .
. .
A. . .
- , , - -
, 2- - 2- (2010 8- 26) (2010 9- 13) - (2010 10- 15- 10/09) - (2010 10- 20- 10/6) , . - - . - - . - .
- .
A.8. , : , . 1: . 10
2: . : . : . : (8- ) : 2 : (22-23 ) : 4.0-6.0 /, 3.3-5.5 / (): 6.1- 6.9 /, 5.6 - 6.0 / (): 2 7.8 - 11.0 / (): . : . (): , , .
A.9. 2010 285 20-60 . 90 2 . 2 2-4 , 2-3 11
. () - . 1950 , 1990 2- . . 1999 , 4 35- 2996 3.1%, 9.2% . () . 2005 - 8.2%, 12.2%, 20.1% . 2009 - 6,5%, 9,5% . 60000-80000 , 2009 7000 , . 10 . .
12
. , .1. , .1.1. ( , )
< 5.6 / ( 200 /)
( )
13
.1.2. ( ) ()
( )
< 6.1 / (< 110 /)
6.1-6.9 / (110-125 /) ()
7.0 / ( 126 /)
()
< 7.8 / (< 140 /) -
7.8-11.0 / (140-200 /) ()
11.1 / (> 200 /)
14
.2. , .2.1. ,
: , , , ,
, ,
15
.2.2. 10- - 2 / + 3-6
- 1
HbA1c > 6.5 : :
,
HbA1c > 6.5
HbA1c > 6.5
,
:
HbA1c > 6.5
16
.2.3. 10- - >10 - 2 - 2 / + / + 3-6 3-6
: : HbA1c 7-7.5 HbA1c 7-7.5 : : HbA1c > 6.5
HbA1c > 7%
HbA1c > 6.5 ,
.2.4. 17
, ,
HbA1c > 6.5
,
:
HbA1c 7.58
18
.3. - 1.,
(/)10 >10
.2. .2.1. - ( 25 k/) / ()
, 2- . ( < 25 k/) ( > 30 k/) 2- 10-20 . - . , , , - . , , , , 22
- - .
.2.2. , , - - . . - (, 2001) - (, 2002)- 3 , 58%- . , , - . - : 5%- 2- , . 30- 2- . , , , . (1000 15, ), ( 30%), ( < 10%) , 1-2 . - . -: . .
.3. - - . 23
. 2- , .
- . : - 40 o ( >25 m, >90c, >80c) o - (, , , ) o - 9 - - ( , , ) - - (24-28 ) . : 40 - 9- 3 . - , 40- - . - 2 .
.4. .4.1. - . . 4. - - / (/) 7.0 (126) 11.1 (200) 24
-
7.8-11.0 (140-200) 6.1-6.9 (110-125)
.4.2. , , , .
.4.2.1. () () - (40 ) ( 25 k/) ( ) ( ) (>140/90...) (4- , , ) ( , ) ( . )
.4.2.2. , , () = ()- 2 (2)- 18.5-24.9 24
1-2 1-3 1 1
0.5/1/2 1.5-16 15/30/45 100 15-45 100
B.4.4.2.2. . ( ) , , , . (, , ) , . 2- 1-2 . . 8-12 . 2 (, ) . 14.
36
1- : , , , 2- : , / 3- : , ( 0.1-0.2 ) , , . 4- : 2-4 10-20%- . : : : , 30-60 4-6 . 15 , 3 . : : , 1-2 10-14 . : : , 2-4 18-20 . : . : 30/70, 50/50 ( 30, 30/70)
15. 2 1 2 1 3 2 3 1 2 1
37
13
2
2
2
2
, 1
2
: : : o (8-12 ) + o (8-12 ) + o 2-3 2-4 . : : o , - o - (12 ), (8 ) - , - (6 )
.4.5. : 1. : , , , , : ( , HbA1c, , ,) ( , . , ) ( , , , ); : , , : , , 2. : , , , , , , , , 38
, , : , , , 16. ( ) 7 2-10 HbA1c 3-6 ( , 1 , , , , , , , , K, Na, Ca) 1 , 1 2 (>40 ) , 1 1 1 : , , ( , )
17- . , . 17. HbA1C 25.0 / (220 /) ( ). : 43
2 . 1-2 , . < 130/80 ... , : . , . , 5-8 / .
.6.3. , , . , . , , . () () . . , . , . (5.07/10 - ) . (a.dorsalis pedis, a.posterior tibialis) . , , , . 44
, , , , . , . , , . : 1. , . , . 2. ( ) . 3. . 4. .
.6.4. , , ( , ) : 2-4 , , . 2 . . 45
()- 100- .
140/90 .-