{"id":10531,"date":"2020-06-19T09:18:59","date_gmt":"2020-06-19T09:18:59","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10531"},"modified":"2020-06-19T09:18:59","modified_gmt":"2020-06-19T09:18:59","slug":"smartdiab-2020","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/smartdiab-2020\/","title":{"rendered":"\u201cSMARTDIAB 2020 \u2013 \u00a0Managementul Diabetului Zaharat \u2013 centrat pe pacient\u201d"},"content":{"rendered":"

\"\"<\/a><\/p>\n

Interviu cu Prof. univ. dr. Gabriela Radulian, pre\u0219edintele Societ\u0103\u021bii de Neuropatie Diabetic\u0103<\/em>\u00a0<\/em><\/p>\n

Una dintre complica\u021biile pe termen lung ale diabetului zaharat este reprezentat\u0103 de neuropatia diabetic\u0103. Conform studiilor, 1 din 10 pacien\u021bi cu simptome de\u00a0 neuropatie diabetic\u0103 a declarat c\u0103 nimeni nu i-a spus c\u0103 sufer\u0103 de aceast\u0103 afec\u021biune.<\/em><\/span><\/p>\n

Datorit\u0103 simptomelor resim\u021bite de persoanele care sufer\u0103 de neuropatie diabetic\u0103, aceast\u0103 afec\u021biune poate avea importante efecte negative asupra calit\u0103\u021bii vie\u021bii.<\/em><\/span><\/p>\n

SMARTDIAB 2020 este organizat sub egida Academiei de \u0218tiin\u021be Medicale \u0219i va include trei conferin\u021be multidisciplinare a c\u0103ror tematic\u0103 este legat\u0103 de abordarea multidisciplinar\u0103 a complica\u021biilor pacientului cu diabet zaharat.<\/em><\/span><\/p>\n

Pentru a afla \u00een avanpremier\u0103 informa\u021bii noi \u0219i utile pentru practica zilnic\u0103, at\u00e2t a medicilor speciali\u0219ti, c\u00e2t \u0219i a medicilor de familie implica\u021bi \u00een \u00eengrijirea persoanelor cu diabet zaharat ce vor fi abordate cu ocazia SMARTDIAB 2020, am discutat cu doamna profesor universitar dr. Gabriela Radulian \u2013 pre\u0219edintele Societ\u0103\u021bii de Neuropatie Diabetic\u0103.<\/em><\/span><\/p>\n

Programul SMARTDIAB 2020 va include 3 conferin\u0163e multidisciplinare cu tema Manage-mentul Diabetului Zaharat \u2013 centrat pe pacient, coordonat \u0219tiin\u0163ific de dumneavoastr\u0103. Ce ne pute\u0163i spune despre acest program \u0219i care sunt obiectivele lui?<\/strong><\/p>\n

Obiectivul Programului SMARTDIAB 2020 vizeaz\u0103 managementul integrat al persoanei cu diabet zaharat \u00eentr-o abordare holistic\u0103. Prezen\u0163a medicilor din specialit\u0103\u0163i cum ar fi cardiologie, neurologie, nefrologie, oftalmologie, chirurgie, ortopedie, dermatologie,\u00a0 \u00eenseamn\u0103 de fapt o abordare multidisciplinar\u0103 \u00een scopul cre\u0219terii calit\u0103\u0163ii vie\u0163ii persoanelor cu diabet zaharat. SMARTDIAB este o ini\u0163iativ\u0103 care reune\u0219te medici din diverse zone ale \u0163\u0103rii. Primul eveniment a fost la Bucure\u0219ti anul trecut, iar cele 3 conferin\u0163e care se vor desf\u0103\u0219ura \u00een 2020 vor fi \u00een ordine la T\u00e2rgu Jiu \u00een martie, apoi \u00een mai va fi la Ploie\u0219ti \u0219i \u00een octombrie, din nou la Bucure\u0219ti. Implicarea local\u0103 este determinant\u0103 \u00een Programul SMARTDIAB pentru c\u0103 \u00een acest mod putem realiza faptul c\u0103, \u00een toat\u0103 \u0163ara exist\u0103 aceast\u0103 implicare multidisciplinar\u0103 pentru \u00eengrijirea diabeticilor cu complica\u0163ii cronice.<\/em><\/p>\n

Care sunt problemele cu care v\u0103 confrunta\u0163i ca pre\u0219edinte a Societ\u0103\u0163ii de Neuropatie Diabetic\u0103?<\/strong><\/p>\n

\u00cen calitate de Pre\u0219edinte al Societ\u0103\u0163ii de Neuropatie Diabetic\u0103 mi-am propus s\u0103 realizez \u00een primul r\u00e2nd o abordare a persoanei cu neuropatie diabetic\u0103 \u00een contextul reducerii riscului de amputa\u0163ie. Programele de educa\u0163ie pe care le desf\u0103\u0219ur\u0103m vizeaz\u0103 \u00een primul r\u00e2nd pacien\u0163ii cu diabet zaharat \u0219i neuropatie diabetic\u0103, realizarea materialelor pe care le-am distribuit \u0219i mai ales permanentele \u00eent\u00e2lniri cu ei, vizeaz\u0103 preven\u0163ia de fapt a neuropatiei diabetice, dar mai ales a ceea ce noi numim \u201epicior diabetic\u201d; pentru c\u0103 pe fondul neuropatiei diabetice apari\u0163ia leziunilor, a ulcera\u0163iilor care ulterior se pot infecta genereaz\u0103 acest risc extrem de amputa\u0163ie, iar amputa\u0163ia modific\u0103 profund calitatea vie\u0163ii acestor persoane. Pe de alt\u0103 parte implicarea noastr\u0103 pe linie de educa\u0163ie s-a materializat prin realizarea unor programe \u00een care am implicat \u0219i medici de familie, av\u00e2nd ateliere de formatori \u00een cadrul Societ\u0103\u0163ii Na\u0163ionale de Medicin\u0103 de Familie, \u00een contextul \u00een care medicul de familie reprezint\u0103 ast\u0103zi prima persoan\u0103 care realizeaz\u0103 de fapt screeningul diabetului zaharat. Totodat\u0103 nu trebuie s\u0103 uit\u0103m \u0219i faptul c\u0103 la nivel de Societate de Neuropatie Diabetic\u0103, implicarea tinerilor diabetologi \u00een ceea ce \u00eenseamn\u0103 \u00eengrijirea persoanelor cu neuropatie sau cu picior diabetic pentru mine a reprezentat o prioritate, \u0219i m\u0103 bucur c\u0103 al\u0103turi de tinerii mei colegi am realizat totodat\u0103 \u0219i o serie de cercet\u0103ri care au fost publicate sau comunicate la diverse manifest\u0103ri \u0219tiin\u0163ifice, at\u00e2t \u00een Rom\u00e2nia c\u00e2t \u0219i la nivel interna\u0163ional.<\/em><\/p>\n

Care sunt priorit\u0103\u0163ile Societ\u0103\u0163ii de Neuropatie Diabetic\u0103 \u00een prevenirea complica\u0163iilor frecvente a diabetului?<\/strong><\/p>\n

Screeningul neuropatiei trebuie realizat chiar din perioada de prediabet. Ast\u0103zi exist\u0103 foarte multe date \u0219tiin\u0163ifice publicate \u00een care se eviden\u0163iaz\u0103 prezen\u0163a neuropatiei diabetice chiar \u00eenainte de diagnosticul de diabet. Ce \u00eenseamn\u0103 acest lucru? Pe de o parte apari\u0163ia simptomatologiei specifice legate de neuropatie, tradus\u0103 prin modific\u0103rile sensibilit\u0103\u0163ilor tactile, termice, dureroase sau vibratorii, iar pe de alt\u0103 parte \u0219i apari\u0163ia unor deficite motorii, care se pot constata \u0219i la cei cu toleran\u0163\u0103 alterat\u0103 la glucoz\u0103.<\/em><\/p>\n

Exist\u0103 programe sau colabor\u0103ri interna\u0163ionale pentru specializarea medicilor \u00een neuropatie diabetic\u0103?<\/strong><\/p>\n

A\u0219a cum afirmam implicarea tinerilor speciali\u0219ti diabetologi \u00een programe sau colabor\u0103ri interna\u0163ionale a constituit pentru mine o prioritate. \u00centotdeauna mi-am dorit foarte mult s\u0103 investesc \u00een tineri, pentru c\u0103 doar prin ei putem duce mai departe prestigiul \u0218colii Rom\u00e2ne\u0219ti de Diabetologie. \u00cen acest context, i-am angrenat \u00eentr-o serie de programe de cercetare \u0219tiin\u0163ific\u0103 viz\u00e2nd neuropatia diabetic\u0103 periferic\u0103, cea autonom\u0103, fapt care a generat realizarea unor lucr\u0103ri \u0219tiin\u0163ifice de valoare, care au fost confirmate \u0219i prin participarea la ultimul Congres European Neurodiab din 2019 unde prezen\u0163a Rom\u00e2niei a fost consistent\u0103. Dintre ace\u0219tia 6 tineri speciali\u0219ti s-au eviden\u0163iat cu rezultate ale cercet\u0103rii \u0219tiin\u0163ifice, finalizate cu 5 postere care au fost prezentate \u00een cadrul evenimentului Neurodiab 2019, \u0219i o prezentare oral\u0103 realizat\u0103 de colectivul de tineri speciali\u0219ti \u00een neuropatie diabetic\u0103 din Institutul Na\u0163ional de Diabet, Nutri\u0163ie \u0219i Boli Metabolice \u201eNicolae Paulescu\u201d din Bucure\u0219ti.<\/em><\/p>\n

Cum se poate \u00eembun\u0103t\u0103\u0163i accesul pacien\u0163ilor la serviciile clinicilor specializate \u00een podiatrie?<\/strong><\/p>\n

Atunci c\u00e2nd vorbim de managementul neuropatiei diabetice vorbim din nou de o echip\u0103 multidisciplinar\u0103 \u00een care pe l\u00e2ng\u0103 diabetolog \u0219i neurolog este nevoie \u0219i de chirurgul vascular, atunci c\u00e2nd neuropatia se asociaz\u0103 \u0219i cu boala arterial\u0103 periferic\u0103, dar vorbim \u0219i de asistentul educator, \u0219i \u00een primul r\u00e2nd de podiatru. Podiatrul este elementul cel mai important \u00een aceast\u0103 echip\u0103, \u00een condi\u0163iile \u00een care \u00eengrijirea piciorului trebuie realizat\u0103 \u00eempreun\u0103 cu medicul chirurg, astfel \u00eenc\u00e2t podiatrul s\u0103 sesizeze orice fel de modificare la nivelul piciorului diabetic, pentru c\u0103 a\u0219a cum \u0219tim cu to\u0163ii \u00een condi\u0163iile \u00een care apar deja leziuni, ulcera\u0163ii, infec\u0163ii sau gangrene, este clar c\u0103 riscul de amputa\u0163ie este foarte mare, \u0219i din p\u0103cate evolu\u0163ia este cele mai\u00a0 multe ori imprevizibil\u0103. De aceea, tratamentul corect al oric\u0103rei leziuni, constituie de fapt, un \u00eenceput \u00een ceea ce prive\u0219te salvarea acelui picior de la o posibil\u0103 amputa\u0163ie. S\u0103 nu uit\u0103m totodat\u0103 c\u0103 odat\u0103 realizat\u0103 o amputa\u0163ie, riscul de reinterven\u0163ie pentru o nou\u0103 amputa\u0163ie este cu mult mai mare, iar ele ast\u0103zi se asociaz\u0103, a\u0219a cum \u0219tim cu to\u0163ii, \u0219i cu\u00a0 mortalitate crescut\u0103.<\/em><\/p>\n

Care sunt complica\u0163iile cronice, cel mai adesea \u00eent\u00e2lnite datorate diabetului zaharat?<\/strong><\/p>\n

Cea mai frecvent\u0103 complica\u0163ie cronic\u0103 a diabetului zaharat este neuropatia diabetic\u0103. Datele interna\u0163ionale subliniaz\u0103 faptul c\u0103 2 din 3 pacien\u0163i cu diabet zaharat prezint\u0103 neuropatie. Este \u00eentr-adev\u0103r alarmant\u0103 prezen\u0163a neuropatiei mai ales \u00een condi\u0163iile \u00een care vorbeam, despre modificarea calit\u0103\u0163ii vie\u0163ii, dar \u0219i despre sc\u0103derea speran\u0163ei de via\u0163\u0103. Totodat\u0103 aproximativ jum\u0103tate din pacien\u0163ii afla\u0163i \u00een programul de hemodializ\u0103 sunt cei cu diabet zaharat. Iat\u0103 deci al\u0103turi de neuropatie exist\u0103 o alt\u0103 complica\u0163ie microvascular\u0103 important\u0103 a diabetului zaharat, respectiv boala cronic\u0103 renal\u0103 cu evolu\u0163ie c\u0103tre insuficien\u0163a renal\u0103. \u0218i \u00eentregind tabloul acestor complica\u0163ii microvasculare se adaug\u0103 \u0219i retinopatia diabetic\u0103, \u0219tiut fiind faptul c\u0103 cecitatea este mai frecvent \u00eent\u00e2lnit\u0103 la persoanele cu diabet zaharat.<\/em><\/p>\n

Nu putem s\u0103 nu men\u0163ion\u0103m totodat\u0103 \u0219i prezen\u0163a complica\u0163iilor de tip macrovascular la persoanele cu diabet zaharat: prin afectarea circula\u0163iei la nivel coronarian exist\u00e2nd risc crescut de apari\u0163ie a infarctului miocardic, sau la nivel cerebrovascular asociind frecvent apari\u0163ia accidentelor vasculare cerebrale. Nu \u00een ultimul r\u00e2nd ca \u0219i complica\u0163ie macrovascular\u0103 trebuie s\u0103 vorbim \u0219i despre boala arterial\u0103 periferic\u0103, extrem de dificil de diagnosticat clinic, pentru c\u0103 de cele mai multe ori pacien\u0163ii cu diabet sunt asimptomatici, deci nu prezint\u0103 semnele specifice de claudica\u0163ie intermitent\u0103. Dar prezen\u0163a bolii arteriale periferice poate fi extrem de u\u0219or de diagnosticat, prin determinarea unui indice glezn\u0103-bra\u0163, care nu este o investiga\u0163ie dificil\u0103, dureaz\u0103 doar 2-3 minute, dar cu ajutorul c\u0103reia putem identifica acele persoane care prezint\u0103 boal\u0103 arterial\u0103 periferic\u0103 \u0219i care de cele mai multe ori asociaz\u0103 \u0219i prezen\u0163a neuropatiei diabetice.<\/em><\/p>\n

C\u00e2t este de important\u0103 alimenta\u0163ia s\u0103n\u0103toas\u0103 \u00een cazul persoanelor cu diabet?<\/strong><\/p>\n

Vorbeam despre programul SMARTDIAB \u0219i despre c\u00e2t de important este managementul diabetului zaharat centrat pe pacient. Cea mai important\u0103 m\u0103sur\u0103 \u00een cazul acestui management o reprezint\u0103 optimizarea stilului de via\u0163\u0103. Schimbarea stilului de via\u0163\u0103 la persoanele cu diabet este o verig\u0103 greu de manageriat \u00een contextul de care discut\u0103m, pentru c\u0103 este vorba despre un nou stil de via\u0163\u0103, care la o v\u00e2rst\u0103 de 40-50 de ani este cu mult mai greu de realizat, dec\u00e2t la o v\u00e2rst\u0103 t\u00e2n\u0103r\u0103. Se recomand\u0103 instituirea acelor m\u0103suri de tip nutri\u0163ional,\u00a0 la care restric\u0163ia caloric\u0103 la cei cu obezitate devine mai important\u0103, \u0219i deci aportul energetic mai redus, simultan cu stimularea activit\u0103\u0163ii fizice, propun\u00e2ndu-ne de fiecare dat\u0103 o sc\u0103dere ponderal\u0103 de 5 p\u00e2n\u0103 la 10%. Distribu\u0163ia acestor calorii trebuie furnizat\u0103 de proteine, lipide \u0219i glucide, \u0219i vorbind despre glucide din start la persoana cu diabet zaharat nu se recomand\u0103 consumul zah\u0103rului, \u0219i a tuturor alimentelor care con\u0163in zah\u0103r, \u00een contextul \u00een care prezen\u0163a zah\u0103rului \u00een alimenta\u0163ie asociaz\u0103 \u0219i cre\u0219teri ale glicemiei mai ales postprandial, iar hiperglicemia cronic\u0103 fiind de fapt cea care determin\u0103 apari\u0163ia complica\u0163iilor cronice.<\/em><\/p>\n

C\u00e2t de important\u0103 este abordarea holistic\u0103 a pacientului cu diabet zaharat?<\/strong><\/p>\n

Abordarea holistic\u0103 a pacientului cu diabet zaharat este singura modalitate prin care se poate vorbi despre o mai bun\u0103 colaborare medic-pacient. De ce spun acest lucru, pentru c\u0103 a\u0219a cum rezult\u0103 \u0219i din consensul 2018 ADA-EASD (Asocia\u0163ia Diabetologilor Americani \u0219i Asocia\u0163ia European\u0103 de Studiu a Diabetului) acest management centrat pe pacient, \u00eentr-o abordare multidisciplinar\u0103, de fapt vizeaz\u0103 simultan \u0219i implicarea pacientului \u00een ceea ce este \u201eself management\u201d. Este simplu s\u0103 realiz\u0103m ni\u0219te recomand\u0103ri, dar foarte important este ca pacientul s\u0103 fie receptiv la schimbarea stilului de via\u0163\u0103 prin interven\u0163ia nutri\u0163ional\u0103 \u0219i prin activitate fizic\u0103, dar acest self management \u00eenseamn\u0103 \u0219i aderen\u0163\u0103 la tratament, \u0219i mai ales monitorizarea complica\u0163iilor cronice.<\/em><\/p>\n

\u00a0\u00cen momentul de fa\u0163\u0103 exist\u0103 o leg\u0103tur\u0103 corect\u0103 \u00eentre to\u0163i deciden\u0163ii implica\u0163i \u00een stabilirea tratamentului corect a pacientului diabetic?<\/strong><\/p>\n

\u00cen Rom\u00e2nia prevalen\u0163a diabetului zaharat conform studiului PREDATORR este de 11,6%. <\/em>Este foarte important, ca atunci c\u00e2nd vorbim despre diabetul zaharat s\u0103 ne g\u00e2ndim c\u0103 num\u0103rul mare de persoane cu diabet zaharat existent ast\u0103zi, genereaz\u0103 costuri foarte mari \u00een sistemele de s\u0103n\u0103tate. Ori prezen\u0163a acestui num\u0103r foarte mare de pacien\u0163i cu diabet zaharat determin\u0103 nu numai implicarea sistemelor de s\u0103n\u0103tate, dar simultan vorbim \u0219i despre o implicare economic\u0103 \u0219i social\u0103, mai ales social\u0103, la cei cu amputa\u0163ii, care de fapt necesit\u0103 o \u00eengrijire special\u0103.\u00a0 \u00cen acela\u0219i timp, se impune s\u0103 semnal\u0103m faptul c\u0103 diabetul zaharat, ca problem\u0103 de s\u0103n\u0103tate public\u0103, trebuie s\u0103 reprezinte obiectul preocup\u0103rii unui num\u0103r mare de factori de decizie: de la decidentul politic, la entitatea care este responsabil\u0103 de politicile publice de s\u0103n\u0103tate, deci Ministerul S\u0103n\u0103t\u0103\u0163ii; la societatea civil\u0103 prin reprezentan\u0163ii s\u0103i, asocia\u0163iile de pacien\u0163i, to\u0163i ace\u0219tia fiind\u00a0 implica\u0163i\u00a0 \u00eentr-un program de s\u0103n\u0103tate public\u0103, sub bagheta forului metodologic, reprezentat de Societatea Rom\u00e2n\u0103 de Diabet, Nutri\u0163ie \u0219i Boli Metabolice.<\/em><\/p>\n

La Congresul Federa\u0163iei Rom\u00e2ne de Diabet mi-am anun\u0163at candidatura pentru func\u0163ia de Pre\u0219edinte al Societ\u0103\u0163ii Rom\u00e2ne de Diabet, Nutri\u0163ie \u0219i Boli Metabolice \u0219i pornind de la \u00eentrebarea dumneavoastr\u0103, dac\u0103 voi fi aleas\u0103, voi realiza \u00eempreun\u0103 cu to\u0163i deciden\u0163ii implica\u0163i \u00een managementul diabetului zaharat cre\u0219terea calit\u0103\u0163ii \u00eengrijirii persoanelor cu diabet \u0219i implementarea Programului de Preven\u0163ie a diabetului zaharat \u00een Rom\u00e2nia<\/em><\/p>\n

\u00cempreun\u0103 cu colegii mei diabetologi vom depune toate eforturile, ca to\u0163i pacien\u0163ii cu diabet zaharat s\u0103 fie permanent monitoriza\u0163i, s\u0103 beneficieze de un tratament modern \u0219i astfel riscul apari\u0163iei complica\u0163iilor cronice s\u0103 se reduc\u0103 substan\u0163ial.<\/em><\/p>\n

\u00a0\u00cen \u00eencheiere v\u0103 rug\u0103m s\u0103 transmite\u0163i un mesaj pentru colegii dumneavoastr\u0103 care vor participa la SMARTDIAB?<\/strong><\/p>\n

Mesajul SMARTDIAB este unul singur: managementul persoanei cu diabet zaharat este important pentru noi medicii, indiferent de specialitatea pe care o avem.<\/em><\/p>\n

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Interviu cu Prof. univ. dr. Gabriela Radulian, pre\u0219edintele Societ\u0103\u021bii de Neuropatie Diabetic\u0103\u00a0 Una dintre complica\u021biile pe termen lung ale diabetului zaharat este reprezentat\u0103 de neuropatia diabetic\u0103. Conform studiilor, 1 din […]<\/p>\n","protected":false},"author":4,"featured_media":10533,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276],"tags":[],"class_list":["post-10531","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu"],"yoast_head":"\n\u201cSMARTDIAB 2020 \u2013 \u00a0Managementul Diabetului Zaharat \u2013 centrat pe pacient\u201d - Jurmed - Medici<\/title>\n<meta name=\"description\" content=\"SMARTDIAB 2020 vizeaz\u0103 managementul integrat al persoanei cu diabet zaharat \u00eentr-o abordare holistic\u0103 din specialit\u0103\u0163i cum ar fi cardiologie, neurologie\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/smartdiab-2020\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u201cSMARTDIAB 2020 \u2013 \u00a0Managementul Diabetului Zaharat \u2013 centrat pe pacient\u201d - 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