Standard italiani per la cura del diabete mellito - AMD
Standard italiani per la cura del diabete mellito - AMD
Standard italiani per la cura del diabete mellito - AMD
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STANDARD ITALIANI PER LA CURA DEL DIABETE MELLITO<br />
SOMMARIO<br />
I. C<strong>la</strong>ssificazione e diagnosi .................................... 10<br />
A. Criteri diagnostici ........................................................ 10<br />
B. C<strong>la</strong>ssificazione................................................................. 10<br />
II. Screening <strong>del</strong> <strong>diabete</strong> tipo 2.............................. 14<br />
III. Screening e diagnosi <strong>del</strong> <strong>diabete</strong><br />
gestazionale........................................................................ 18<br />
IV. Prevenzione primaria <strong>del</strong> <strong>diabete</strong> tipo 2 21<br />
V. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong>...................................................... 26<br />
A. Valutazione iniziale ..................................................... 26<br />
B. Il controllo glicemico................................................. 27<br />
1. Valutazione <strong>del</strong> controllo glicemico......... 27<br />
a. Emoglobina glicata (HbA 1c ) ................... 27<br />
b. Automonitoraggio <strong>del</strong><strong>la</strong> glicemia......... 28<br />
2. Obiettivi glicemici ............................................... 29<br />
C. Terapia medica nutrizionale .................................. 31<br />
D. Terapia farmacologica................................................ 34<br />
1. Diabete tipo 1......................................................... 34<br />
2. Diabete tipo 2......................................................... 35<br />
E. Educazione terapeutica............................................. 43<br />
F. Attività fisica .................................................................... 44<br />
G. Valutazione psicosociale nel<strong>la</strong> terapia<br />
<strong>del</strong> <strong>diabete</strong> ......................................................................... 46<br />
H. Ma<strong>la</strong>ttie intercorrenti ................................................ 47<br />
I. Ipoglicemia ....................................................................... 47<br />
J. Vaccinazioni ..................................................................... 48<br />
K. Assistenza integrata <strong>del</strong> paziente diabetico... 49<br />
VI. Prevenzione e gestione <strong>del</strong>le<br />
complicanze <strong>del</strong> <strong>diabete</strong> ........................................ 51<br />
A. Ma<strong>la</strong>ttia cardiovasco<strong>la</strong>re........................................... 51<br />
1. I<strong>per</strong>tensione e suo trattamento ................... 51<br />
2. Dislipidemia e suo trattamento .................. 55<br />
3. Farmaci antiaggreganti piastrinici ............. 58<br />
4. Cessazione <strong>del</strong> fumo........................................... 60<br />
5. Screening e trattamento <strong>del</strong><strong>la</strong> cardiopatia<br />
coronarica .................................................................. 61<br />
B. Screening e trattamento <strong>del</strong><strong>la</strong> nefropatia<br />
diabetica.............................................................................. 64<br />
C. Screening e trattamento <strong>del</strong><strong>la</strong> retinopatia<br />
diabetica.............................................................................. 68<br />
D. Screening e trattamento <strong>del</strong><strong>la</strong> neuropatia<br />
diabetica.............................................................................. 71<br />
E. Disfunzione erettile..................................................... 74<br />
F. Cura <strong>del</strong> piede ................................................................ 75<br />
VII. Cura <strong>del</strong> <strong>diabete</strong> in popo<strong>la</strong>zioni specifiche 81<br />
A. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> in bambini e adolescenti 81<br />
1. Diabete tipo 1......................................................... 81<br />
2. Diabete tipo 2......................................................... 83<br />
B. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> prima e durante<br />
<strong>la</strong> gravidanza .................................................................... 89<br />
C. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> nelle <strong>per</strong>sone anziane .... 10<br />
VIII. Cura <strong>del</strong> <strong>diabete</strong> in contesti specifici....... 94<br />
A. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> in ospedale ........................... 94<br />
B. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> a scuo<strong>la</strong> e nell’assistenza<br />
diurna ................................................................................... 101<br />
C. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> nei campi educativi<br />
<strong>per</strong> diabetici...................................................................... 101<br />
D. La <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> negli istituti di correzione 102<br />
IX. Diabete <strong>mellito</strong> e normative.............................. 104<br />
A. Certificazione <strong>per</strong> <strong>la</strong> patente di guida............. 104<br />
B. Invalidità civile............................................................... 106<br />
C. Presidi sanitari <strong>per</strong> i soggetti affetti da<br />
<strong>diabete</strong> <strong>mellito</strong>................................................................ 107<br />
D. Farmaci con prescrizione soggetta a piano<br />
terapeutico......................................................................... 107<br />
X. Strategie <strong>per</strong> il miglioramento<br />
<strong>del</strong><strong>la</strong> <strong>cura</strong> <strong>del</strong> <strong>diabete</strong>................................................ 109<br />
Appendice<br />
Indicatori.................................................................................... 111