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=1:Bvisible*o3>+B#style.visibility<*l%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*l%(++0+l0 ++0+l0 ++0+l0 ++0+l0 ++0+ l0 +" 0L0 jbp(  p p HD?Rectangle 6`   r* c   , p  0e0e?Rectangle 1028h8   `Conclusions 2/4 Importante amlioration du risque vasculaire des personnes diabtiques de type 2, quel que soit l ge, en 6 ans" g   p  A ??Picture 1036w  p N?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!RQdrs/downrev.xmlDj0EB7ƍh;0b$N"vys9`zq$; &qeuǍmYco|v{3LoXFD !3)}ՒA?{ 1Fj7|LWiV-U`k7TCZozye^*u7,@^]⯼r%yJ' } Fݨ r PK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!RQdrs/downrev.xmlPKm u,$ 0 FMeilleure prvention cardiovasculaire (contrle TA et paramtres lipidiques) Intensification des traitements antithrombotiques (+ 12 points) et des revascularisations coronaires (+ 5 points)<N u Nauc  ? p N,?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!\?drs/downrev.xmlDJ@ab7Q,!v[?P&}1;MBawۦ>zy8-דđ-+H [&2)8b'б 9*Bs)}ӑA?#qv 1Vj7M4s|p}u0 r!^梬@8uŔR+OtbvrޠDUA~PK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!\?drs/downrev.xmlPK"f,$ 0 *Obsit plus frquente : 41 % (+ 7 points)0+0 )ac+   p Nl?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!drs/downrev.xmlDj@p ݈N `b\3$fF}.7_'r`:I@WV\+ؖ;ˤBۛ9fڞyC""Bg ϤUCı[g0j#t!IC=5TQP~磯Piu^Rw @C]_yEZc2K εz>SnTPK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!drs/downrev.xmlPK"U ,$ 0 ZMeilleur contrle glycmique : - 0,3 % d HbA1c Intensification du traitement par antidiabtiques oraux (et insuline) (biguanides : + 12 points ; associations : + 7 points) P/  /a}ca  H p 0޽h ? ̙33___PPT10..d-+fD' p= @B D' = @BA?%,( < +O%,( < +DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*p%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*p%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*p%(++0+p0 ++0+p0 ++0+p0 +" 0L0 tj(  t t H?Rectangle 6`   l*    u t  0e0e?Rectangle 1028}M   KConclusions 3/4 Lgre augmentation des complications du diabte de type 2"L LgK   t  ,'0e0e?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!"Ldrs/downrev.xmlDJ0E!qRNf>"*L͙^lNJvڿ7YL#9XVpH@V7\)x<_Ycga>>Zaw4>Gu}./k2':!FWIᦓII LJ{. 8fnmnR'5@S?go_z $]W 5z>SnTPK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!"Ldrs/downrev.xmlPKA,<$ 0  sComplications coronariennes : + 3 points Complications ohtalmologiques : + 3 points Risque podologique : + 4 points&t% 3tct   t  A??Picture 1036w : t N:?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!"+drs/downrev.xmlLMk@E:QІQj?hb"ty&̛03jwpQ˹j08eqZ|HAL aY`7t,B-"} LJ_5dЏmOuC)M'I2[ P/FA>C5:ֽ/K'o\|?NʵY2Kk} Fݨ r PK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!"+drs/downrev.xmlPK,$ 0 D : Dpistage et traitement plus frquent : coronaroplasties, laser, gradation du risque podologique Survie plus longue ? Age moyen inchang, car quilibre entre vieillissement des diabtiques et nouveaux diabtiques plus jeunes ? l$ 3 6 3cac  H t 0޽h ? ̙33  ___PPT10r ..d-+7D' = @B D' = @BA?%,( < +O%,( < +Ds' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t)%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t)T%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*tTt%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(+p+0+t0 ++0+t0 +".& 0L0 aYx(  x x HtT?Rectangle 6`   l*     x  PM0e0e?Rectangle 1028}M   \Conclusions 4/4 Comment amliorer davantage la prise en charge mdicale du diabte de type 2"] ]g\  F x  Z0e0e?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!ײdrs/downrev.xmlDN0EH5H) u+ޭMS>IJI)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!Pdrs/downrev.xmlDN0EH5Hl hC݊jHU~Oj<ۦ|= X^ݫsutHηLĥ- vx deRp&SmOcj!STЄЧR!~b{U 1Zj7M{i`O `laWY"ǵ޿_ʴa@Tk} Fݨ rPK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!Pdrs/downrev.xmlPK ,$ 0 bTraiter mieux pour prvenir ou ralentir les complications Intensifier la prise en charge dittique Passer de la mono la bi puis trithrapie par antidiabtiques oraux Intensifier le traitement normotenseur H;  ;ac   x Nz?Rectangle 1029"PK![Content_Types].xml|N0 HC+jS8 @:Q۸ ??\o<7p]V޷O(I'6E=, ){Ō4>I)q7UuDހǏ)}nL"Mᴸ&g0eSA)΄2';2 WYu7{ɯΒzŘqFrj9K*(]mOlPK!Z,[ _rels/.relslj0 ``t_Pƈ[>,dgzjǎ?I'f#®Pb-\/Ƿ0Z]nLnp__3.iJV KQBiDžrL,Vʌ/7р4`ANar+m;E/'3U Aںv83/PK!+)drs/downrev.xmlDN0EH5Hl*j (nEy,P~OxnXlsG,Vđ|hkMʙk f"Ddcp3бHjhb3)CՐ0u=qv[)ZCN*u/-饡j_+|jro[u^j}}5>?48hS8}l0D%&U?PK-![Content_Types].xmlPK-!Z,[ _rels/.relsPK-!+)drs/downrev.xmlPK\ a,$ 0 s *60 e  H x 0޽h ? ̙33ME___PPT10%..d-+NґDE' = @B D' = @BA?%,( < +O%,( < +DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*x%(D' =%(DM' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*xB%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*xB\%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*x\%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*x%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*x%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*x%(++0+x0 ++0+x0 ++0+x0 +"  0L0   0|o (  |  |  x|0e0e?Rectangle 3Pp   6  Rsum INVS tude ENTRED (1) La population diabtique, estime 2,4millions en mtropole et toujours en augmentation, est une population globalement ge (66ans pour la mdiane), conomiquement plus dsavantage que la population gnrale ge gal, et parmi laquelle 23% sont ns l tranger. Le diabte de type 2 est la forme la plus frquente (92%, soit 2,2millions de personnes en mtropole). Au moment de l tude, il est connu depuis 9 annes pour sa mdiane, ce qui expose un risque lev de complication. Chez les personnes diabtiques de type 2, une remarquable diminution du risque vasculaire est note entre 2001 et 2007. Alors que l obsit est devenue encore plus frquente (41%, + 7 points depuis 2001), le contrle glycmique s est amlior (HbA1c mdiane : 6,9%, -0,3%), et la pression artrielle (mdiane 130/80mmHg, - 10 mmHg pour la systolique) et le cholestrol (LDL mdian: 1,04g/l,-0,19g/l) ont baiss quel que soit l ge. Pourtant, les complications du diabte ont lgrement augment en frquence, ce qui s explique partiellement par un dpistage plus frquent de celles-ci, et peut tre galement par une esprance de vie plus longue chez les plus gs et un diabte plus frquent chez les plus jeunes. D Z Z Z - | ?TEspace rserv du numro de diapositive 2`   h*   H | 0޽h ? ̙33y___PPT10Y+D=' = @B +"  0L0   P (  6    x0e0e?Rectangle 3`   j Rsum INVS tude ENTRED (2) Les traitements antidiabtiques se sont intensifis et les choix thrapeutiques se sont modifis, correspondant mieux aux recommandations actuelles(*). Toutefois, le contrle glycmique est encore insuffisant (HbA1c >7%) pour 41% des personnes diabtiques de type 2, ce qui les expose au risque de complications sur le rein, les yeux, les nerfs. L escalade thrapeutique actuellement recommande*, conduisant ajouter un puis deux puis trois antidiabtiques oraux, puis l insuline si le contrle glycmique est insuffisant, est donc encore imparfaitement suivie. Les traitements prventifs des maladies cardiovasculaires et rnales se sont aussi beaucoup intensifis, ce qui a eu pour effet direct la baisse importante des niveaux de pression artrielle et de cholestrol entre 2001 et 2007. L encore, des amliorations restent possibles, en particulier en ce qui concerne le contrle de la pression artrielle, puisque 49 % des personnes diabtiques de type 2 ont une pression artrielle qui dpasse strictement le seuil recommand(*) de 130/80 mmHg. 4 Z# Z$2x 0 0,/-  ?TEspace rserv du numro de diapositive 2`   h*   H  0޽h ? ̙33y___PPT10Y+D=' = @B +"  0L0   `c (     x|0e0e?Rectangle 2`   *Rsum INVS tude ENTRED (3) D importantes amliorations de la qualit du suivi mdical sont observes, les actes ncessaires au dpistage et au suivi des complications du diabte(*) tant plus souvent pratiqus. Toutefois, le fond d Sil ncessaire au dpistage de la rtinopathie, et le dosage de l albumine dans les urines ncessaire au dpistage de l atteinte rnale prcoce, restent encore trop peu pratiqus et ont peu progress. L examen attentif des pieds, qui vise dpister la neuropathie et l atteinte vasculaire priphrique et traiter prcocement toute lsion, est trs insuffisamment pratiqu. C est essentiellement aux mdecins gnralistes que s adresse ce bilan de sant des personnes diabtiques de type 2, puisqu ils suivent seuls, c. Les mdecins gnralistes sont donc les acteurs essentiels des progrs raliss et de ceux restant faire, en tant que coordonateurs du parcours de soins, entre paramdicaux et spcialistes du diabte. 4 Z Z  0-  ?TEspace rserv du numro de diapositive 2`   h*   H  0޽h ? ̙33y___PPT10Y+D=' = @B +"  0L0 p(     x 0e0e?Rectangle 2`   LRsum INVS tude ENTRED (4) Le diabte de type 2 est la forme la plus frquente: 92% des personnes diabtiques li une association entre rsistance et carence en insuline, et trait par rgime, antidiabtiques oraux et/ou insuline), 5,6 % ont un diabte de type 1 (carence en insuline lie une destruction des cellules scrtrices du pancras qui ncessite un traitement par insuline) et 2,5 % ont d autres types de diabte (MODY, pancratite, mucoviscidose& ) ou ont transmis des informations insuffisantes pour effectuer ce classement. Avant 45 ans, plus de la moiti (54 %) ont un diabte de type 1. Ds 45 ans, le diabte de type 1 devient proportionnellement marginal (8 % entre 45 et 54 ans, 3 % entre 55 et 64 ans, puis moins de 1 %). 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X>;_ZH|lvZn0D_M?PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!qi)1*drs/shapexml.xmlPK-!ax6m drs/downrev.xmlPKu <; ph___PPT9JB  INSULINE = hormone VITALE = LA seule hormone HYPOGLYCEMIANTE fait diminuer la glycmie en: permettant le transport du glucose vers l intrieur des cellules (GLUT 4) hormone d pargne = favorise les voies de stockage d nergie stimule la synthse de glycogne stimule la synthse de triglycrides (lipognse) favorise synthse protique (= anabolisante) "  # !   - c c#ccc c J c  c  A c a l  HDq?Rectangle 3"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!̨O;drs/shapexml.xmlXMo6 x-H,E #΢ǀ5E $9R`Sl[9H#q8(mF:U3ir[(sOӳ1g>SmNzo_3L6~Rg|B=|l- J*{^ toUB~Pf玬f*2~9ג^C,lI#@63}xNJaƾ_a5y}XIQxZbr]i=%|` d-`cbU/͊6h˒aBr ,x<i<àGOL(r?JʸCyFfarX3v~)qڼ4 { 9d#W*HǴ @TL]P:ؠ6!ԑԉŎb.qG$b|q;;;eb Ma荎we source d nergie (ATP) N0 <  lac  nH  0޽h ? ̙33___PPT10i.GbQ+D=' = @B +" 0L0  F(  1  |?TEspace rserv du numro de diapositive 4`   l*    H  c A 8??8insulin-receptor-GLUT4_w500Picture 6insulin-receptor-GLUT4_w500    ZV;>?Text Box 19 fINSULINE 2   Q  f@3>?Text Box 20 Q  EUtilisation du GLUCOSE: Captation, source nergie Voies de stockage4F 2EG3G3 F   N?Text Box 29$ G  P 2    ZD3Ԕ?Text Box 31IY[ gGLUCOSE 23    ZHd$?Text Box 32C U.  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H%g4m:\NV(t)³&}kױihir|W$Ywj7- `r4M%Zfn:\4N)~yu] O[SC= gL#д[NR7G#|jrG=1ZW2Bk~lƸB;/bb.V+wg3me}iH^mH¾ϧlCzm/PK!YYdrs/downrev.xmlDJ@ﰌEF Vb(jfI4;i;x 7 U=x6p3@6\ؾ?_߃ b (lz~6#ߤJcꔺBX0|G,l$g xkmi B=T~nXO㗅*|e0hHϻ# ]cL H =PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!@A>*drs/shapexml.xmlPK-!YYdrs/downrev.xmlPK Z  T   2  z YG-8c,Flche vers le bas 14#"@PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!>B drs/shapexml.xmlVn1}Z%C&JZ>Dx+?cۻ@PU<$x\r})[Kc )\9(tV<ߟF90Q|+-yJl0ڤJ¹*iX쥮$^M >ͼUi%:pTVݾjP PVc-VdeBI#'4luUF:JF0 q!䦬¿ <2цD9ۤkg۔UwA"7 r 9 ;0"+XJ}:C(~;cs` .{i*Qԩ`geTAzWPwHSYvY^5G!qbPnD#<{eA7F(cb:d^A~m gӝ[MA:|NM2ϥpgoMB;ps/ O<Q%ns3ԳN@&8UuSvjoaψz)+<`5%,-QԜ dK?u}Jjf\fI$ K pNxB;px.JxVcbv|4sqзq]cջuMv]cH38 1C*$fc0@l*R(tb4LuzuJ9ЦXҤD= gKi<1KchB׎')KPŋ>Qֹ=?!AG]y\yՏھv^y*nX=`Ǯm+ BJP.V qCأ a뮵W7PB7K)7PK!~drs/downrev.xmlDAK1F!f*6-(UZ:L7n&Kz{>b5N bYA\yp`y3)(jyyoiإZd ؔRXYrg'ÔPK宓wE 6,-U_oa; As7"јχO;[A7!4f1QPrjF PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!>B *drs/shapexml.xmlPK-!~drs/downrev.xmlPK. 5  T     Jj?ZoneTexte 15!  g TISSUS CIBLES A  H  0޽h ? ̙33___PPT10i.GbQ+D=' = @B +"  0 w(  1  n?TEspace rserv du numro de diapositive 5`   l*    T   x(y0e0e?Rectangle 3   INSULINE hypoglycmiante synthse par les lots bta de Langerhans du pancras endocrine en miroir& GLUCAGON hyperglycmiante (favorise production hpatique de glucose) synthse par les lots alpha R " F  ZeaePDgPgpgPC   F8?Text Box 6 #   P 2    N`?Text Box 10,  ^  2  H  0޽h ? ̙33___PPT10i.GbQ+D=' = @B +"c 0L0 RJ  (  1  ?TEspace rserv du numro de diapositive 6`   l*    ~   ~t0e0e?Rectangle 1047 W  Prise d un repas (glucides) lvation de la glycmie dtection du signal glucose par le pancras scrtion d un PIC d insuline glucagon frein Entre les repas niveau de glycmie stable, Scrtion BASALE d insuline glucagon raugmente n P~ " P P " P PA " PcKcggg3gPg3cg$ggPg3   ^Hd?Text Box 1043C U.  Y  2    R ?Text Box 1044S :  P 2  2  f33?AutoShape 10488 R 3  ^  R?Text Box 1053 m   XVariation de la scrtion d insuline / 24h B- 2+g3G 3 - 2  f33?AutoShape 1054 GP  N     R?Text Box 1055 ~  SECRETION d insuline CONTINUE 24h/ 24 Glycmie rgule entre 0,7 et 1,4 g/lFL 2 E e7E L   f33?AutoShape 1056 _ ~   N   `  3 A &??fscrtion insulinePicture 12C:\Users\Florence\Pictures\scrtion insuline.jpeg*_     fT33?AutoShape 1056j_ ~  N   H  0޽h ? ̙33___PPT10i.GbQ+D=' = @B +"  0L0 @}(  E   x!0e0e?Rectangle 2T$   y1PHYSIOPATHOLOGIE Les diffrents type de diabtes 2 2A 2H  0޽h ? ̙33y___PPT10Y+D=' = @B +" 0 `n(  1   +?TEspace rserv du numro de diapositive 5`   l*    0   x(0e0e?Rectangle 2EW   dDIFFERENTS TYPE DE DIABETE C$    x50e0e?Rectangle 3" PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!kGdrs/shapexml.xmlZn6;YΏeH[XqZb5RiߡoGRd_McCCj8珣4a 8S|js&UMcunN8+PSdJQ?"gA1*™LE)˥XTt}+ײInR+~b4/f4Qϙ)^{#C0qHv[%"0 fZ|`*Yc+3mBLiAޖeUU%1I6}`~^wzt=1Z=2ܟAE !Ct{ro b ?v.g!(,q18tĞh6 8_/d52W- ϹВW1vz=Ac;q4G<P!V 5 zfi.Pi/.wsFMLldȥ%aa&:1"Ia'rKXl*Uz`O*08~m+d)AP€T"'Met+&qsK`e\)QhgUc i j4W!^ℝ䉽"Ga esn\hbE%jlVK̯}BO5v@5 ň;b܌tyH@4N?b'f?>ل,'Α`IɪFCecAj`SGLi?_ldHgYdX5J+lj_]IR /K)=2"s03{I%|JAimO煎Ypv-8=R/$NKeDcO:.si6Nж+GshOvV2š\ao[m%{SZʼ%h+ѫTӑA3kSƯ>MZ#QЌWd 4sW,VsՃ;h-9Ǻ}S#="ٞf7 7wk|ǨdQ@nU|%EZ%AUdLjV^[XRӶ,LCDU1do 7Jۢt.KN-%^eNW Ŭ>X[++QVu{#X}?f{+.?۔i$pgHO;nߎ(E YvwѦ|xf`,SFHJJ̀յ7a=uul\n W ĵJd#%J^M0Nh0FIN~ZIvW˪3{ U>%0jtsARRU !e2yH[IN/lK>8Ƅ0@ZmCm;N;.qyO|쾊eIiIܥ=~ĴiWLDB\\1b"y[0ۤĻ'BWS6M0#Ƒ[=PK!drs/downrev.xmlDj@EaxBwu%*QD[Z4]tTҺmfNuy]~ԅ+QZ(')kGDhMA.~PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!kG*drs/shapexml.xmlPK-! drs/downrev.xmlPK ;r  Diabte type 1 (insulinodpendant ) Diabte type 2 (non  insulinodpendant ) Diabte gestationnel: 6% des grossesses (..) 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QNG.t/(x4LmţQo=?E˝b#H?Oval 2Pp@  {DIABTE2 G .E.     jH(e(e?Text Box 3 s oDcs : 6 Cause  C  d  d(e(e?Text Box 4 =R DEsprance de vie : De 5 10 ansJ# C A #   j(e(e?Text Box 5 C O TMortalit cardio-vasculaire : 2 4 foisP+ C  C +    j;(e(e?Text Box 6| X   pNeuropathie priph C  >  d\=(e(e?Text Box 7 = *Amputation NT 1 cause 8500 amputations/an>+ CcC +    j>(e(e?Text Box 8  oCcit : 1 cause C    dhO(e(e?Text Box 9  SInsuffisance Rnale : 1 cause des nouveaux cas 2300 prises en charge en dialyse/an\0 $Z/Cc#cC T   bZ>?AutoShape 12J   bZ>?AutoShape 13X P  bZ>?AutoShape 14Rf _  bZ>?AutoShape 16 TV   \>?AutoShape 18@|   b>?AutoShape 19p @ bZ>?AutoShape 20 X    fbH\H\?Text Box 21R zComplications chroniques C(   @ bZ>?AutoShape 18    \>?AutoShape 18C =/  r?VEspace rserv du numro de diapositive 19`   h*   H  0޽h ?       ̙33y___PPT10Y+D=' = @B +"  0 A(  7  d~?TEspace rserv du numro de diapositive 5`   r* c   4   x0e0e?Rectangle 2r   hLES COMPLICATIONS chroniques c&    x0e0e?Rectangle 3;W  Sont communes tous les types de diabte, il n ya pas de petit diabte Consquences de l hyperglycmie chronique = fonction de la dure et du niveau de l exposition l hyperglycmie HbA1c = hmoglobine glyque ou glycosyle = reflet de la moyenne des glycmies des 2 3 mois prcdents 1 fois/ 3 mois Importance du maintient d un bon quilibre glycmique au long cours x ZE " Z Z+ Q D   Zcc-cc)ccccccc cecDcc H  0޽h ? ̙33___PPT10i.jkiu +D=' = @B +"' 0L0 rj(  v 6, C (Group 2"6,"   ~D!A jJ?AutoShape 36 BChaque rduction de 1% de l HBA1CP"gog"  D"   ~!A jJ?AutoShape 4H( Rduction du risque*4gc  92    xG#;H33f3d?AutoShape 5" z{V { 1%.ac(     L?Text Box 6W, o * p < 0,0001 c     d?Text Box 7} 8  Complications microvasculaires(2c  _    ~Yud?AutoShape 8" #H t  - 37%Pacac      dP?Text Box 9 Artriopathie des memb. inf.(2c  g  # YGX?ud?AutoShape 10" # tI - 43%Pacac     fh ?Text Box 11k @  yInfarctus du myocarde(2c  a   Yud?AutoShape 12" "u  - 14%Pacac     f#?Text Box 13 }Mortalit lie au diabte(2c  a   Y/ud?AutoShape 14" "tc - 21%Pacac      z30e0e?Rectangle 15G   RImpact du contrle du diabte sur les complications : diabte de diagnostic rcent2S6g g S,  b;pG1?Rectangle 16"@=:P *Stratton UKPDS 35, BMJ 2000: 321: 4015-412+ +c +   \HԔ?Rectangle 17 sAu bout de 10 annes  a  /  R?VEspace rserv du numro de diapositive 17`   h*   H  0޽h ? ̙33___PPT10i.7`:|L+D=' = @B +" 0 %(  7  \?TEspace rserv du numro de diapositive 5`   r* c   "   xZ0e0e?Rectangle 2r   V CONCLUSION  c&    xg0e0e?Rectangle 3h*   HAmpleur croissante de la pathologie, prise en charge enjeu majeur de sant publique Diffrents diabtes domins par le diabte de type 2 Relation linaire entre rduction HbA1c et amlioration complications chroniques 0 Zcc H  0޽h ? ̙33___PPT10i.jkiu +D=' = @B +". 0 5-(  7  ?TEspace rserv du numro de diapositive 5`   r* c   4   xt0e0e?Rectangle 3;   hMerci de votre attention" Zc   A*??jcahors-pont-valentrePicture 2C:\Users\Florence\Pictures\cahors-pont-valentre.jpegC!GH  0޽h ? ̙33___PPT10i.jkiu +D=' = @B +" 0 aY@(    c 0e0e?ZEspace rserv de l'image des diapositives 1   X  # 0e0e?DEspace rserv des commentaires 2 0   `&Des progrs importants restent faire ' 3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.9J 0 p$(    c 0e0e?ZEspace rserv de l'image des diapositives 1     # 0e0e?DEspace rserv des commentaires 2 0   ;88% de la population franaise = 56,5 millions de personnes< < < 3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.//c 0 3+(    c 0e0e?ZEspace rserv de l'image des diapositives 1   *  # 0e0e?DEspace rserv des commentaires 2 0   2  3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.9Л  0 6 .  (    c 0e0e?ZEspace rserv de l'image des diapositives 1       00e0e?DEspace rserv des commentaires 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!9 drs/shapexml.xmlVN1W;XV4 FlVJQDzmk{C}~7$BTeΏgofGF*}΄*tY:aUk{ٵ%~dgr?>vqۚ|[TP^F \qO=NPC~>,c\~#kX$\OgdD4mThcU՝:!T_ITp-n}j5dQ `\jUgH 3'9|zQhZXyDG\ :5\fлV3ŤlA'6328}7[8}uHuڼ=r͝xJ+S!خŒ0mF(:9>6 W5f9&Ni8 v5GgZBבoħx :,X((ƟJAڏ -UH]ZTM⴬1TLm[_ԎU`tr숸*lˌjԎj (\6!G0HP,pc؀VdXqemzhHz6^_+Ό~PK!Qzdrs/downrev.xmlDN0EHkQ$U[A% bѪɃ6MX,`yuYGӉ 9ZV0& K[ > k,+yX&7K̵xOCEQABKˆ cWYg0jn:9OTl9>4Ӧ|6 6>}9E |"eUh,@TO=@NAPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!9 *drs/shapexml.xmlPK-!Qzdrs/downrev.xmlPK 0   ~ 8 Z     @  (;fafa?TEspace rserv du numro de diapositive 3`  n*    CH  0޽h ? I}OPM80___PPT10.74b  0 \T(    c 0e0e?ZEspace rserv de l'image des diapositives 1   F  # ,H0e0e?DEspace rserv des commentaires 2 0   N   @  Rfafa?TEspace rserv du numro de diapositive 3`  n*    CH  0޽h ? I}OPM80___PPT10.74b  0 }u (    c 0e0e?ZEspace rserv de l'image des diapositives 1   t  # a0e0e?DEspace rserv des commentaires 2 0   |$chantillon alatoire de 10 000 patients diabtiques adultes et enfants diabtiques type 1 ou 2, qu ils soient suivi par MG ou mdecin sp libraux ou hhospitaliers Tirage au sort Cnam TS et RSI commerant et artisans/libraux idem DOM et enfants Suivi conso mdicale, hospit, questionnaire patient tlphonique, autoquestionnaire patient postal, questionnaire mdecin-soignant, enqute de mortalit,    3  Tl?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.(/tN! 0 %0(    c 0e0e?ZEspace rserv de l'image des diapositives 1     # 0e0e?DEspace rserv des commentaires 2 0   $La moyenne d ge Age moyen proche de 65 ans Taux de prvalence maximum pour les 75-79 ans (13,4%) 25% ont 75 ans ou plus 54% d hommes, plus jeunes que les femmes 80% en surpoids ou obses T Zd  G  3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.9պ* 0 P :(      c 0e0e?ZEspace rserv de l'image des diapositives 1        h0e0e?DEspace rserv des commentaires 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!(rƉ drs/shapexml.xmlWn6w x;IB" mQqzI"rQ/֏$;)P ٺ],J Ol+J՘3r]Tjw7'9TAR+.6 &M5hdɾҍP䀚ը1 aZo*gPfa<. rƖlC`g+gVr]^]lGlTCm b`a~dSw&~Q7TNifnL{w~c  J ||HtAq[\]O"+rA ի:2D֤VErIlromEؖv2O!J=gzYuԬnšˇmXesK qy}H j/uU?V189X@&cβ@,mSTqϘ ڪcl Kd hFVh]Z XRyc&X-/ %o͍sU֫PK R|) (rۮ0m/fwv=_|'ޱuxq˽ z(c>%d/6SLFe4}SU:<.'MxigB 2@N2ٚ[q}d I<^X9.`֬p n@YS ^Gi[mF۩3:AdXJgZޏOw P!0…lW+ʍdCUH ϵeÖ,S6f\[j%=4mvax4uj=+*Y3͸]<f+QAxU\N5{ =BrKPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!(rƉ *drs/shapexml.xmlPK-!cdrs/downrev.xmlPK 0   0L escalade thrapeutique actuellement recommande*, conduisant ajouter un puis deux puis trois antidiabtiques oraux, puis l insuline si le contrle glycmique est insuffisant, est donc encore imparfaitement suivie. 41 % ont une HbA1c au dessus de 7 % (15 % au dessus de 8 %) F =  = 3   ܖ?TEspace rserv du numro de diapositive 3_   h*    H   0޽h ? I}OPM80___PPT10.(/tN  0 qip(    c 0e0e?ZEspace rserv de l'image des diapositives 1   h  #  0e0e?DEspace rserv des commentaires 2 0   pMoyenne anciennet 11 ans type 1 et 17 ans type 2 81% France, 9% Magrheb, 10% autre, situation financire c est y arrive difficilement 53%   3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.+/D?" 0 !(    c 0e0e?ZEspace rserv de l'image des diapositives 1     # 0e0e?DEspace rserv des commentaires 2 0   V regarder avec rserve car autodclaration On ignore si le diabte est la seule cause W 3  `?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.9㋠+ 0 3+(    c 0e0e?ZEspace rserv de l'image des diapositives 1   *  # 0e0e?DEspace rserv des commentaires 2 0   2  3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.9~b $ 0 "  (    c 0e0e ?Rectangle 2     # 0e0e?Rectangle 3 A   6Mdecin gnraliste : pas de remboursement sur 12 mois de consultation avec un endocrino libral, ni de remboursement sur 2 ans d hospitalisation en service diabto/endocrino/nutrition Spcialiste hospitalier : au moins 1 remboursement sur 2 ans d hospitalisation en service diabto/endocrino/nutrition mais aucun remboursement sur 12 mois de consultation avec un endocrino libral Spcialiste hospitalier : au moins 1 remboursement sur 12 mois de consultation avec un endocrino libral mais aucun remboursement sur 2 ans d hospitalisation en service diabto/endocrino/nutrition Spcialiste hospitalier et libral : au moins 1 remboursement sur 2 ans d hospitalisation en service diabto/endocrino/nutrition et au moins 1 remboursement sur 12 mois de consultation avec un endocrino libral R"  H  0޽h ? I}OPM:@ 0   J(      c 0e0e?ZEspace rserv de l'image des diapositives 1      # 0e0e?DEspace rserv des commentaires 2 0|  d\___PPT9>6 @Remboursement moyen par personne et par an Adultes vivant en mtropole Type 1 ou Type 2 Soins rembourss, Soins pays, Part hors rgime obligatoire (part mutuelle et patient) LPP = liste des produits et prestations remboursables par l'Assurance Maladie " P *eeeeeXe  #  ' H* .  W P @   7fafa?TEspace rserv du numro de diapositive 3`  n*    CH   0޽h ? I}OPM80___PPT10.74bB 0 \T@$(  $ $ c 0e0e?ZEspace rserv de l'image des diapositives 1   F $ # `A0e0e?DEspace rserv des commentaires 2 0   N   @ $ (Qfafa?TEspace rserv du numro de diapositive 3`  n*    CH $ 0޽h ? I}OPM80___PPT10.74bGC 0 `(W(  ( ( c 0e0e?ZEspace rserv de l'image des diapositives 1    ( #  ,0e0e?DEspace rserv des commentaires 2 0   MLPP = liste des produits et prestations remboursables par l'Assurance Maladie*N "' N @ ( hfafa?TEspace rserv du numro de diapositive 3`  n*    CH ( 0޽h ? I}OPM80___PPT10.74bA 0 \T,(  , , c 0e0e?ZEspace rserv de l'image des diapositives 1   F , # Pv0e0e?DEspace rserv des commentaires 2 0   N   @ , fafa?TEspace rserv du numro de diapositive 3`  n*    CH , 0޽h ? I}OPM80___PPT10.74b* 0 tl0(  0 0 c 0e0e?ZEspace rserv de l'image des diapositives 1   ^ 0 # 0e0e?DEspace rserv des commentaires 2 0   f324 + 1683 =2007   @ 0 (fafa?TEspace rserv du numro de diapositive 3`  n*    CH 0 0޽h ? I}OPM80___PPT10.74b& 0 \T4(  4 4 c 0e0e?ZEspace rserv de l'image des diapositives 1   F 4 # 0e0e?DEspace rserv des commentaires 2 0   N   @ 4 \fafa?TEspace rserv du numro de diapositive 3`  n*    CH 4 0޽h ? I}OPM80___PPT10.74b' 0 \T8(  8 8 c 0e0e?ZEspace rserv de l'image des diapositives 1   F 8 # 0e0e?DEspace rserv des commentaires 2 0   N   @ 8 fafa?TEspace rserv du numro de diapositive 3`  n*    CH 8 0޽h ? I}OPM80___PPT10.74b( 0 \T<(  < < c 0e0e?ZEspace rserv de l'image des diapositives 1   F < # 0e0e?DEspace rserv des commentaires 2 0   N   @ < fafa?TEspace rserv du numro de diapositive 3`  n*    CH < 0޽h ? I}OPM80___PPT10.74b) 0 \T @(  @ @ c 0e0e?ZEspace rserv de l'image des diapositives 1   F @ # 0e0e?DEspace rserv des commentaires 2 0   N   @ @ fafa?TEspace rserv du numro de diapositive 3`  n*    CH @ 0޽h ? I}OPM80___PPT10.74b 0 3+@D(  D D c 0e0e?ZEspace rserv de l'image des diapositives 1   * D # 0e0e?DEspace rserv des commentaires 2 0   2  3 D l?TEspace rserv du numro de diapositive 3_   h*    H D 0޽h ? I}OPM80___PPT10.9(< 0 OGH(  H H c 0e0e?ZEspace rserv de l'image des diapositives 1   F H # \0e0e?DEspace rserv des commentaires 2 0   N   3 H ?TEspace rserv du numro de diapositive 3_   h*    H H 0޽h ? 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I}OPM80___PPT10.9 0 TL0\(  \ \ c 0e0e?ZEspace rserv de l'image des diapositives 1   K \ # |-0e0e?DEspace rserv des commentaires 2 0   SLe signal glc est dtect  3 \ ?TEspace rserv du numro de diapositive 3_   h*    H \ 0޽h ? I}OPM80___PPT10.4@"= 0 OGP`(  ` ` c 0e0e?ZEspace rserv de l'image des diapositives 1   F ` # P0e0e?DEspace rserv des commentaires 2 0   N   3 ` ?TEspace rserv du numro de diapositive 3_   h*    H ` 0޽h ? I}OPM80___PPT10./ !- 0  pd(  d d c 0e0e?ZEspace rserv de l'image des diapositives 1     d # 0e0e?DEspace rserv des commentaires 2 0   Diabte survenant pendant la grossesse, Disparat le plus souvent l accouchement, Risque ++ de diabte de type 2 ultrieur  utilisation d insuline n est pas un critre pour classer les formes de diabte8~ P~GPA  3 d ?TEspace rserv du numro de diapositive 3_   h*    H d 0޽h ? I}OPM80___PPT10.:Ws0 0 3+h(  h h Nl?Rectangle 7_   h*     h c H\H\ ?Rectangle 2    h # t0e0e?Rectangle 3 0   Il existe 3 grands types de diabte sucr. Le diabte de type 2 est 10 fois plus frquent que le diabte de type 1. A cot de ces 3 grands type de diabte sucr, il existe de nombreuses autres formes : diabte de type MODY li a un dficit en glucokinase, diabte secondaires une maladie pancratique ou une endocrinopathie, & La pancratite firbrocalcifiante fait partie de ces autres causes. Vous connaissez certainement mieux que moi cette forme de pancratite au moins en partie secondaire la consommation de manioc riche en glucides cyanognes toxiques pour le pancrasD D D H h 0޽h ? I}OPM 0 xl(  l l Nt?Rectangle 7_   h*     l c H\H\ ?Rectangle 2    l  ~8%0e0e?Rectangle 3" PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!_z*drs/shapexml.xmlZn6}/ Zڹ4qcAIT"Ur|}ϐ|fsqRـ0 o3sCRd3alU?؍PNsuۏ~p1JJ8-{dlG^c(K˴)CvJ#P;tT~{)x34frdJf#EL^DZ.TP'S[a`Jb0=&΍wSKop9VX su0J<ȠjSe 3r T?;=j"A m#vg8f)dvp}:'^稪hc$JA?rKrP#EP˄дJcnJF$* /ೡuuYGPT!bInNm[F`WkOt* <- '#$d 3VW%#Jj&K*rHD2%8K?PߚąȶeDJƺbfz̰]~-Kkr uy k%_~ }3x}k"̻$k PYn} m n݄XpM!ȅl-4,l"!Pɗm>rSn0 Aסf`4Z-%HrGn|0H1ꡂaqQZ5h<'"bϳ@ҫ 'w&e6h%$o".K{ԇR4o* ~v^"Ŕ P~kR+WCYDL0mMSZ+"zdu9N٢׭85ҪT_d0…=,惫eʞ͖OP1>#:.җ5k#۱:M!FWIẕwIJM5u<5B7<|:Lzx=엏 \c]W>RFmv/FSPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!_z**drs/shapexml.xmlPK-!ndrs/downrev.xmlPK  0   <Susceptibilit gntique HLA Virus Coxsackie Oreillons Rubole congnitale Rtrovirus CMV Composs chimiques Alloxan Streptoztocine Pyriminil (raticide) Pentamidine L-Asaparaginase, & Aliments Srum albumine bovine Nitrosamines Viandes fumes ou sales Gluten Stress?. ??? Rupture de la tolrance immunitaire Activation de lymphocytes T autoractifs vis vis des cellules b uCYZf  7C C d & f  H l 0޽h ? I}OPM80___PPT10.5pUs1 0 3+p(  p p Nx?Rectangle 7_   h*     p c H\H\ ?Rectangle 2    p # I0e0e?Rectangle 3 0   Il existe 3 grands types de diabte sucr. Le diabte de type 2 est 10 fois plus frquent que le diabte de type 1. A cot de ces 3 grands type de diabte sucr, il existe de nombreuses autres formes : diabte de type MODY li a un dficit en glucokinase, diabte secondaires une maladie pancratique ou une endocrinopathie, & La pancratite firbrocalcifiante fait partie de ces autres causes. Vous connaissez certainement mieux que moi cette forme de pancratite au moins en partie secondaire la consommation de manioc riche en glucides cyanognes toxiques pour le pancrasD D D H p 0޽h ? I}OPMK  0 t[(  t t NS?Rectangle 7_   h*     t c H\H\ ?Rectangle 2   @ t # g0e0e?Rectangle 3 0   tImpaired glucose tolerance (IGT) shows up first HbA1C & FPG are still normal at this stage1,2 Increased risk of CV complications begins in the non-diabetic range.3 Measurement of postprandial glucose allows early identification of at-risk individuals Importantly, risk begins to accumulate with impaired glucose tolerance, which is inevitably present for a significant period prior to the diagnosis of overt diabetes. So it really is worth controlling glycaemia as well, and as early, as possible. 1. Gerstein HC. Glucose: a continuous risk factor for cardiovascular disease. Diabet Med 1997; 14 (Suppl 3): S25 S31. J p P    p  H t 0޽h ? I}OPM80___PPT10. E 0 Y Q 0x(  x x NTo?Rectangle 7_   h*     x c 0e0e ?Rectangle 2h    x  dm0e0e8c?Rectangle 4 P   MESSAGES CLS L origine du dveloppement de l insulinorsistance semblerait tre due des facteurs gntiques ou facteurs acquis, induits par l environnement mtabolique ambiant, voire les 2 la fois, Les facteurs gntiques (atteintes polygniques) ou in utero (malnutrition ou retard de croissance) sont des phnomnes irrversibles. Les facteurs acquis et induits par l environnement ambiant au stade de l adolescence (sdendarit / obsit) ou adulte (tabac, ossit, sdentarit& ) sont rversibles, c est dire qu en changeant de comportement, on peut jouer positivement en rduisant l insulinorsistance. e-X  3 &&     H x 0޽h ? I}OPM> 0 OG`|(  | | c 0e0e?ZEspace rserv de l'image des diapositives 1   F | # ,0e0e?DEspace rserv des commentaires 2 0   N   3 | Ȣ?TEspace rserv du numro de diapositive 3_   h*    H | 0޽h ? I}OPM80___PPT10./ !8 0 3+(    c 0e0e?ZEspace rserv de l'image des diapositives 1   *  # L0e0e?DEspace rserv des commentaires 2 0   2  3  (?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.":Pr: 0 xp(    c 0e0e?ZEspace rserv de l'image des diapositives 1   o  # 0e0e?DEspace rserv des commentaires 2 0   w=Hyperglycmie chro active active diffrentes voies pathologie > 3  ?TEspace rserv du numro de diapositive 3_   h*    H  0޽h ? I}OPM80___PPT10.:@9 0 I(    N?Rectangle 7_   h*      c H\H\ ?Rectangle 2   .  # 40e0e?Rectangle 3 0   b Sont responsables de la morbimortalit, csqces lourdes Le retard diagnostic, le caractre progressif des anomalies, la frquence des facteurs de risque cardiovasculaire associs (tabac, HTA, & ) expliquent l importante morbidit et mortalit associe au diabte.   H  0޽h ? I}OPM3 0   W (    ND?Rectangle 7_   l*      c 0e0e ?Rectangle 2   8   # (0e0e?Rectangle 3 @   l Lessons from UKPDS: better control means fewer complications The UKPDS has proven beyond doubt that intensive glycaemic control is strongly associated with significant clinical benefits for patients with type 2 diabetes. In an epidemiological analysis of the UKPDS cohort, every 1% decrease in HbA1C was associated with clinically important reductions in the incidence of: l diabetes-related death ( 21%) l myocardial infarction (heart attacks) ( 14%) l microvascular complications ( 37%) l peripheral vascular disease ( 43%) There is no lower limit beyond which reductions in HbA1C cease to be of benefit. Taking diabetes-related death as an example, this means that: HbA1C of 2% delivers a 42% reduction in risk HbA1C of 3% delivers a 63% reduction in risk, and so on. Therefore, the greater the reduction in HbA1C, the greater the protection against complications. Stratton MI Adler AI, Neil AW, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405-12.^w" lG<J'=V'_5 ` VH  0޽h ? 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r U Y%k"- '\ϧ]'@d &G' 6q  ( B h v Џ Ι n b J   ( |: r  9 p s F |  - c L h #   ' w. = C H vM V "^ c Uh 9m 5r w { Ņ W  s O & < D  E E F AjOh+'0 `h  0DIABETE type 2 EPIDEMIOLOGIE PHYSIOPATHOLOGIEmod_locPHARMA134Microsoft PowerPoint@к3@0_ @&uIGg  K.  y--$xx--'@"Arial Black-. 2 7DIABETE."System-@"Arial Black-. 2 +# EPIDEMIOLOGIE .-@"Arial Black-. 2 7PHYSIOPATHOLOGIE.-@"Arial Black-. 2 EAADPHSO .-@"Arial Black-. 2 N4Septembre 2009.-@"Arial Black-. 2 W2SaintO.-@"Arial Black-.  2 WC-.-@"Arial Black-. 2 WE Jean de Luz.-@"Arial Black-. .2 iDr Florence Ayon CH Cahors.-՜.+,D՜.+,<    V Affichage l'cran89( ITimes New RomanArialCalibri Arial Black HelveticaTahomaVerdana WingdingsPalatino LinotypeComic Sans MS Arial NarrowSymbolMonotype Sorts MS PGothicModle par dfaut!Graphique Microsoft Office Excel+ DIABETE EPIDEMIOLOGIE PHYSIOPATHOLOGIE EPIDEMIOLOGIE Introduction Diapositive 4 Prvalence Prvalence Prvalence PrvalenceENTRED 2007-20101ENTRED-Mtropole 2007-2010 6 sources de donnes ENTRED-Mtropole 2007-2010 Diapositive 12 ENTRED-Mtropole 2007-2010 ENTRED-Mtropole 2007-2010 @- Diabte de type 2 (n=3 894) - (Complications auto-dclares)_- Diabte de type 2 (n=3894) - Types dantidiabtiques oraux rembourss au dernier trimestre>- Diabte de type 2 (n=3894) - Types dantidiabtiques oraux Diabte de type 2 - Evolution de 2001 (n=3324) 2007 (n=3377) des types dantidiabtiques rembourss au dernier trimestre Suivi mdical des personnes diabtiques sur 2 ans (daprs les donnes de lAssurance maladie : sous-estimation du recours au spcialiste hospitalier)- Diabte de type 2 - Evolution 2001 2007 de la qualit du suivi des actes recommands sur 1 an (dosages en libral : sous estimation) &ENTRED 2007-2010 Aspects conomiques Diapositive 22Diapositive 23&ENTRED 2007-2010 Aspects conomiques &ENTRED 2007-2010 Aspects conomiques FConclusions 1/4 Caractristiques des personnes diabtiques de type 2Conclusions 2/4 Importante amlioration du risque vasculaire des personnes diabtiques de type 2, quel que soit lge, en 6 ansLConclusions 3/4 Lgre augmentation des complications du diabte de type 2]Conclusions 4/4 Comment amliorer davantage la prise en charge mdicale du diabte de type 2Diapositive 30Diapositive 31Diapositive 32Diapositive 33PHYSIOLOGIE PHYSIOPATHOLOGIE Diapositive 35Diapositive 36Diapositive 37Diapositive 38Diapositive 392PHYSIOPATHOLOGIE Les diffrents type de diabtes DIFFERENTS TYPE DE DIABETEDIABETE type 1(Histoire naturelle du diabte de type 1DIABETE type 2DIABETE type 2&Pathophysiologie du diabte de type 2DIABETE type 2 Diapositive 48PHYSIOPATHOLOGIE COMPLEXELes COMPLICATIONS )COMPLICATIONS chez le patient diabtique9Mcanismes probables des complications microvasculaires Diapositive 53LES COMPLICATIONS chroniquesSImpact du contrle du diabte sur les complications : diabte de diagnostic rcent CONCLUSIONDiapositive 57 Polices utilisesModle de conceptionServeurs OLE incorporsTitres des diapositives9p 8@ _PID_HLINKSA(ahttp://www.invs.sante.fr/publications/entred/entred_2007_2010/resultats_metropole_principaux.htm referencesahttp://www.invs.sante.fr/publications/entred/entred_2007_2010/resultats_metropole_principaux.htm referencesahttp://www.invs.sante.fr/publications/entred/entred_2007_2010/resultats_metropole_principaux.htm references_pCPHARMAPHARMA  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~                           ! 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