{"id":1062,"date":"2021-02-05T12:48:01","date_gmt":"2021-02-05T05:48:01","guid":{"rendered":"https:\/\/yhoccongdong.org\/tieu-duong\/ca-lam-sang-kiem-soat-duong-mau-o-benh-nhan-dai-thao-duong-type-2\/"},"modified":"2024-05-11T00:37:27","modified_gmt":"2024-05-10T17:37:27","slug":"ca-lam-sang-kiem-soat-duong-mau-o-benh-nhan-dai-thao-duong-type-2","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/tieu-duong\/ca-lam-sang-kiem-soat-duong-mau-o-benh-nhan-dai-thao-duong-type-2\/","title":{"rendered":"Ca l\u00e2m s\u00e0ng &#8211; Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2"},"content":{"rendered":"<h2><strong>Gi\u1edbi thi\u1ec7u<\/strong><\/h2>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u01b0\u1edbi \u0111\u00e2y minh h\u1ecda gi\u00e1 tr\u1ecb c\u1ee7a vi\u1ec7c theo d\u00f5i \u0111\u01b0\u1eddng huy\u1ebft \u1edf ng\u01b0\u1eddi l\u1edbn m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, t\u00f9y thu\u1ed9c v\u00e0o th\u1eddi gian, ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh.<\/p>\n<p>T\u1ea7n su\u1ea5t theo d\u00f5i t\u1ed1i \u01b0u, m\u00e1y \u0111o \u0111\u01b0\u1eddng v\u00e0 que th\u1eed \u0111\u01b0\u1eddng, v\u00e0 vai tr\u00f2 c\u1ee7a h\u1ec7 th\u1ed1ng theo d\u00f5i \u0111\u01b0\u1eddng li\u00ean t\u1ee5c (CGM) kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf \u0111\u00e2y.<\/p>\n<h2><strong>Ca l\u00e2m s\u00e0ng 1<\/strong><\/h2>\n<p>B\u1ec7nh nh\u00e2n (BN) n\u1eef 56 tu\u1ed5i l\u00e0m vi\u1ec7c ph\u1ee5 b\u00e1n qu\u1ea7n \u00e1o, c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00e1t n\u01b0\u1edbc, m\u1ec7t m\u1ecfi v\u00e0 b\u1ecb nhi\u1ec5m n\u1ea5m \u00e2m \u0111\u1ea1o. BN cao 163 cm v\u00e0 n\u1eb7ng 120 kg, BMI = 45 kg\/m2. Gi\u00e1 tr\u1ecb \u0111\u01b0\u1eddng m\u00e1u ng\u1eabu nhi\u00ean (b\u1ea5t k\u1ef3) l\u00e0 290 mg\/dL (16,1 mmol\/L), HbA1C = 9.4%, ch\u1ee9c n\u0103ng gan v\u00e0 th\u1eadn b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p>Ch\u1ebf \u0111\u1ed9 \u0103n c\u1ee7a BN ch\u1ee9a nhi\u1ec1u ch\u1ea5t b\u00e9o v\u00e0 carbohydrate tinh ch\u1ebf, v\u00e0 b\u00e0 \u00edt t\u1eadp th\u1ec3 d\u1ee5c. BN th\u01b0\u1eddng xem ti vi v\u00e0i ti\u1ebfng v\u00e0o m\u1ed7i bu\u1ed5i t\u1ed1i, trong l\u00fac xem c\u00f4 \u0103n t\u1eeb hai \u0111\u1ebfn ba chi\u1ebfc b\u00e1nh r\u00e1n b\u1ecdc \u0111\u01b0\u1eddng. Kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch, nh\u01b0ng c\u00f4 th\u01b0\u1eddng xuy\u00ean b\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u.<\/p>\n<p>B\u1ec7nh nh\u00e2n s\u1eb5n s\u00e0ng thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 kh\u00f4ng mu\u1ed1n d\u00f9ng qu\u00e1 nhi\u1ec1u thu\u1ed1c.<\/p>\n<h3><strong>Kh\u1edfi tr\u1ecb<\/strong><\/h3>\n<p>Kh\u1edfi tr\u1ecb ph\u00f9 h\u1ee3p bao g\u1ed3m:<\/p>\n<ul>\n<li>Gi\u00e1o d\u1ee5c BN v\u1ec1 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng b\u1eb1ng t\u00e0i li\u1ec7u, video v\u00e0 g\u1eb7p g\u1ee1 chuy\u00ean gia (n\u1ebfu c\u00f3), tham d\u1ef1 c\u00e1c l\u1edbp \u0111\u00e0o t\u1ea1o t\u1ef1 qu\u1ea3n l\u00fd b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng v\u00e0\/ho\u1eb7c tham gia nh\u00f3m h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec m\u1eafc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng lo\u1ea1i 2 kh\u00e1c.<\/li>\n<li>Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, ch\u1eb3ng h\u1ea1n gi\u1ea3m l\u01b0\u1ee3ng calo, lo\u1ea1i tr\u1eeb carbohydrate tinh ch\u1ebf ra kh\u1ecfi ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c. C\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u b\u1eb1ng vi\u1ec7c \u0111i b\u1ed9 10 \u0111\u1ebfn 15 ph\u00fat m\u1ed7i ng\u00e0y v\u00e0 t\u0103ng d\u1ea7n th\u1eddi gian \u0111i b\u1ed9 \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau m\u00f4ng mu\u1ed1n (\u00edt nh\u1ea5t 30 ph\u00fat m\u1ed7i ng\u00e0y, n\u0103m ng\u00e0y m\u1ed7i tu\u1ea7n).<\/li>\n<li>Kh\u1edfi tr\u1ecb v\u1edbi Metformin, t\u0103ng li\u1ec1u d\u1ea7n d\u1ea7n \u0111\u1ebfn t\u1ed5ng li\u1ec1u 2g\/ng\u00e0y, chia u\u1ed1ng nhi\u1ec1u l\u1ea7n.<\/li>\n<li>Theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u, giai \u0111o\u1ea1n \u0111\u1ea7u \u0111o v\u00e0o m\u1ed7i bu\u1ed5i s\u00e1ng (l\u00fac \u0111\u00f3i), v\u00e0 th\u1ec9nh tho\u1ea3ng \u0111o v\u00e0o hai \u0111\u1ebfn ba gi\u1edd sau \u0103n v\u00e0 c\u1ea3 tr\u01b0\u1edbc l\u1eabn sau khi t\u1eadp th\u1ec3 d\u1ee5c. Theo d\u00f5i gi\u00e1 tr\u1ecb \u0111\u01b0\u1eddng m\u00e1u \u0111\u00f3i h\u00e0ng ng\u00e0y v\u00e0 \u0111\u01b0\u1eddng huy\u1ebft sau \u0103n th\u01b0\u1eddng xuy\u00ean s\u1ebd gi\u00fap b\u1ec7nh nh\u00e2n th\u1ea5y ngay l\u1eadp t\u1ee9c nh\u1eefng bi\u1ebfn \u0111\u1ed5i \u0111\u01b0\u1eddng m\u00e1u li\u00ean quan t\u1edbi h\u00e0nh vi c\u1ee7a h\u1ecd.<\/li>\n<li>M\u1ee5c ti\u00eau c\u1ee7a c\u00f4 l\u00e0 \u0111\u1ea1t ng\u01b0\u1ee1ng \u0111\u01b0\u1eddng m\u00e1u \u0111\u00f3i v\u00e0 \u0111\u01b0\u1eddng m\u00e1u tr\u01b0\u1edbc \u0103n l\u00e0 80-130 mg\/dL (4,4-7,2 mmol\/L), \u0111\u01b0\u1eddng m\u00e1u sau \u0103n t\u1eeb hai \u0111\u1ebfn ba gi\u1edd l\u00e0 &lt;180 mg\/dL (10,0 mmol\/L).<\/li>\n<\/ul>\n<p>Khi b\u1ec7nh nh\u00e2n v\u00e0o vi\u1ec7n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng d\u1ecb h\u00f3a n\u1ed5i tr\u1ed9i nh\u01b0 gi\u1ea3m c\u00e2n kh\u00f4ng ch\u1ee7 \u00fd v\u00e0 t\u0103ng \u0111\u01b0\u1eddng m\u00e1u, A1C &gt;10% (86 mmol\/mol) ho\u1eb7c glucose &gt;300 mg\/dL (16,7 mmol\/L), th\u01b0\u1eddng BN \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng li\u1ec7u ph\u00e1p insulin, b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec7u ph\u00e1p insulin n\u1ec1n v\u00e0 c\u00f3 th\u1ec3 b\u1ed5 sung insulin theo b\u1eefa \u0103n n\u1ebfu c\u1ea7n. Trong b\u1ed1i c\u1ea3nh n\u00e0y, theo d\u00f5i \u0111\u01b0\u1eddng huy\u1ebft tr\u01b0\u1edbc v\u00e0 sau b\u1eefa \u0103n gi\u00fap \u0111\u01b0a ra c\u00e1c quy\u1ebft \u0111\u1ecbnh v\u1ec1 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng c\u0169ng nh\u01b0 ch\u1ec9nh li\u1ec1u insulin.<\/p>\n<p>Khi \u0111\u1ea1t \u0111\u01b0\u1ee3c th\u00e0nh c\u00f4ng trong vi\u1ec7c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, gi\u1ea3m c\u00e2n v\u00e0 gi\u1ea3m\/lo\u1ea1i b\u1ecf nguy c\u01a1 ng\u1ed9 \u0111\u1ed9c glucose, c\u00f3 th\u1ec3 cho BN thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb t\u1eeb li\u1ec7u ph\u00e1p insulin sang c\u00e1c li\u1ec7u ph\u00e1p kh\u00f4ng d\u00f9ng insulin. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 thi\u1ebfu insulin tr\u1ea7m tr\u1ecdng v\u00e0 c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb v\u1edbi insulin k\u00e9o d\u00e0i.<\/p>\n<h3><strong>Theo d\u00f5i ban \u0111\u1ea7u\u00a0<\/strong><\/h3>\n<p>BN \u0111\u00e3 d\u00f9ng metformin 1000mg hai l\u1ea7n m\u1ed7i ng\u00e0y, dung n\u1ea1p t\u1ed1t. BN \u0111\u1ec3 \u00fd r\u1eb1ng m\u1ee9c \u0111\u01b0\u1eddng m\u00e1u c\u1ee7a m\u00ecnh t\u0103ng l\u00ean \u0111\u00e1ng k\u1ec3 sau khi \u0103n b\u1eefa s\u00e1ng v\u00e0 b\u1eefa t\u1ed1i. M\u1ee9c \u0111\u01b0\u1eddng m\u00e1u kh\u00f4ng t\u0103ng sau b\u1eefa tr\u01b0a k\u1ec3 t\u1eeb khi c\u00f4 chuy\u1ec3n sang \u0103n m\u1ed9t b\u1eefa salad l\u1edbn v\u00e0o bu\u1ed5i tr\u01b0a. C\u00f4 c\u0169ng \u0111\u1ec3 \u00fd r\u1eb1ng m\u1ee9c \u0111\u01b0\u1eddng m\u00e1u cao h\u01a1n sau khi \u0103n b\u00e1nh k\u1ebfp v\u1edbi xi-r\u00f4 v\u00e0 u\u1ed1ng n\u01b0\u1edbc cam; \u0111\u01b0\u1eddng m\u00e1u th\u1ea5p h\u01a1n sau khi \u0103n tr\u1ee9ng v\u1edbi m\u1ed9t l\u00e1t b\u00e1nh m\u00ec n\u01b0\u1edbng nguy\u00ean c\u00e1m v\u00e0o b\u1eefa s\u00e1ng. \u0110\u01b0\u1eddng m\u00e1u l\u00ean cao nh\u1ea5t sau khi \u0103n m\u00ec \u00dd (pasta) ho\u1eb7c pizza v\u00e0o b\u1eefa t\u1ed1i.<\/p>\n<p>C\u00f4 \u1ea5y ghi l\u1ea1i nh\u1eadt k\u00fd th\u1ef1c ph\u1ea9m c\u1ee7a m\u00ecnh, sau \u0111\u00f3 \u0111i g\u1eb7p chuy\u00ean gia dinh d\u01b0\u1ee1ng, t\u00ecm hi\u1ec3u v\u1ec1 h\u00e0m l\u01b0\u1ee3ng carbohydrate v\u00e0 calo trong th\u1ef1c ph\u1ea9m v\u00e0 kh\u1ea9u ph\u1ea7n \u0103n. C\u00f4 b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng m\u1ed9t \u1ee9ng d\u1ee5ng \u0111i\u1ec7n tho\u1ea1i gi\u00fap theo d\u00f5i l\u01b0\u1ee3ng carbohydrate v\u00e0 calo trong m\u1ed7i b\u1eefa \u0103n, c\u0169ng nh\u01b0 \u0111\u1ebfm s\u1ed1 b\u01b0\u1edbc \u0111i h\u00e0ng ng\u00e0y, \u1ee9ng d\u1ee5ng \u0111i\u1ec7n tho\u1ea1i n\u00e0y \u0111\u00e3 gi\u00fap c\u00f4 gi\u1ea3m s\u1ef1 bi\u1ebfn \u0111\u1ed5i \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 gi\u00fap gi\u1ea3m c\u00e2n. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1t n\u01b0\u1edbc, hay m\u1ec7t m\u1ecfi v\u00e0 nhi\u1ec5m tr\u00f9ng \u00e2m \u0111\u1ea1o c\u0169ng gi\u1ea3m d\u1ea7n sau \u0111\u00f3.<\/p>\n<p style=\"text-align: center\"><strong>B\u1ea3ng 1<\/strong><\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-large wp-image-36438\" src=\"https:\/\/yhoccongdong.com\/tieu-duong\/wp-content\/uploads\/sites\/5\/2021\/01\/Untitled-3-1024x464-1.png\" alt=\"\" width=\"618\" height=\"280\" \/><\/p>\n<ul>\n<li>Sau hai th\u00e1ng, gi\u00e1 tr\u1ecb \u0111\u01b0\u1eddng m\u00e1u \u0111\u00f3i c\u1ee7a BN trong m\u1ed9t tu\u1ea7n \u0111i\u1ec3n h\u00ecnh dao \u0111\u1ed9ng kho\u1ea3ng t\u1eeb 141mg\/dL (7,8 mmol\/L) \u0111\u1ebfn 204 mg\/dL (11,3 mmol\/L) nh\u01b0 trong b\u1ea3ng (B\u1ea3ng 1).<\/li>\n<li>Sau ba th\u00e1ng, BN \u0111\u00e3 t\u0103ng th\u1eddi gian t\u1eadp th\u1ec3 d\u1ee5c c\u1ee7a m\u00ecnh l\u00ean 30 ph\u00fat m\u1ed7i ng\u00e0y, n\u0103m bu\u1ed5i t\u1ed1i m\u1ed7i tu\u1ea7n. BN ti\u1ebfp t\u1ee5c \u0103n b\u1eefa tr\u01b0a v\u1edbi r\u1ea5t \u00edt carbohydrate (ch\u1ee7 y\u1ebfu l\u00e0 salad). C\u00e2n n\u1eb7ng c\u1ee7a c\u00f4 gi\u1ea3m xu\u1ed1ng c\u00f2n 108 kg, gi\u00e1 tr\u1ecb \u0111\u01b0\u1eddng m\u00e1u \u0111\u00f3i trung b\u00ecnh l\u00e0 178 mg\/dL (9,9 mmol\/L) v\u00e0 gi\u00e1 tr\u1ecb A1C l\u00e0 8,3%.<\/li>\n<\/ul>\n<p>B\u1ea1n \u0111\u1ec1 ngh\u1ecb BN d\u00f9ng m\u00e1y theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c (CGM) trong m\u1ed9t tu\u1ea7n. Sau khi xem x\u00e9t d\u1eef li\u1ec7u \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c, c\u00f4 r\u1ea5t ng\u1ea1c nhi\u00ean khi th\u1ea5y n\u1ed3ng \u0111\u1ed9 glucose trong m\u00e1u t\u0103ng l\u00ean nhi\u1ec1u sau b\u1eefa s\u00e1ng v\u00e0 b\u1eefa t\u1ed1i (h\u00ecnh 1). \u0110i\u1ec1u n\u00e0y c\u00e0ng th\u00fac \u0111\u1ea9y BN gi\u1ea3m l\u01b0\u1ee3ng carbohydrate trong nh\u1eefng b\u1eefa \u0103n \u0111\u00f3.<\/p>\n<p>BN \u0111\u00e3 h\u1ecdc \u0111\u01b0\u1ee3c r\u1ea5t nhi\u1ec1u v\u1ec1 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng v\u00e0 nh\u1eefng h\u1eadu qu\u1ea3 c\u00f3 th\u1ec3 x\u1ea3y ra trong t\u01b0\u01a1ng lai t\u1eeb vi\u1ec7c \u0111\u1ecdc s\u00e1ch v\u00e0 t\u1eeb c\u00e1c nh\u00f3m h\u1ed7 tr\u1ee3. C\u00f4 \u0111\u1eb7t m\u1ee5c ti\u00eau ng\u1eafn h\u1ea1n c\u1ee7a m\u00ecnh l\u00e0 gi\u1ea3m gi\u00e1 tr\u1ecb A1C xu\u1ed1ng d\u01b0\u1edbi 7,5% v\u00e0 m\u1ee5c ti\u00eau d\u00e0i h\u1ea1n l\u00e0 A1C d\u01b0\u1edbi 7%.<\/p>\n<p style=\"text-align: center\"><strong>H\u00ecnh 1: Theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c c\u1ee7a BN (CGM)<\/strong><\/p>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-36439 size-full\" src=\"https:\/\/yhoccongdong.com\/tieu-duong\/wp-content\/uploads\/sites\/5\/2021\/01\/hhh.png\" alt=\"\" width=\"739\" height=\"476\" \/><\/p>\n<h3><strong>\u0110i\u1ec1u tr\u1ecb ti\u1ebfp theo\u00a0<\/strong><\/h3>\n<p>B\u1ea1n ch\u00fac m\u1eebng BN v\u1ec1 nh\u1eefng l\u1ed1i s\u1ed1ng t\u1ed1t c\u1ee7a h\u1ecd v\u00e0 \u0111\u1ed9ng vi\u00ean h\u1ecd ti\u1ebfp t\u1ee5c duy tr\u00ec l\u1ed1i s\u1ed1ng n\u00e0y. \u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau A1C, BN c\u0169ng \u0111\u01b0\u1ee3c cung c\u1ea5p m\u1ed9t s\u1ed1 l\u1ef1a ch\u1ecdn thu\u1ed1c b\u1ed5 sung. Do BN v\u1eabn mong mu\u1ed1n gi\u1ea3m c\u00e2n, b\u1ea1n k\u00ea \u0111\u01a1n th\u00eam thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 GLP-1 d\u00f9ng 1 l\u1ea7n\/tu\u1ea7n song song v\u1edbi metformin. Nh\u00f3m thu\u1ed1c n\u00e0y h\u1ed7 tr\u1ee3 gi\u1ea3m c\u00e2n. BN \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u ti\u1ebfp t\u1ee5c \u0111o \u0111\u01b0\u1eddng m\u00e1u m\u1ed7i s\u00e1ng tr\u01b0\u1edbc khi \u0103n s\u00e1ng v\u00e0 th\u1ec9nh tho\u1ea3ng \u0111o th\u00eam v\u00e0o nh\u1eefng th\u1eddi \u0111i\u1ec3m kh\u00e1c. (Xem <a href=\"https:\/\/www.uptodate.com\/contents\/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?sectionName=Weight+loss&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H1201791&amp;source=see_link#H1201791\">&#8220;Thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 peptit 1 gi\u1ed1ng<\/a> <a href=\"https:\/\/www.uptodate.com\/contents\/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?sectionName=Weight+loss&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H1201791&amp;source=see_link#H1201791\" target=\"_blank\" rel=\"noopener\">glucagon \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2&#8243;, ph\u1ea7n &#8216;Gi\u1ea3m c\u00e2n&#8217;)<\/a><\/p>\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 c\u0169ng c\u00f3 th\u1ec3 gi\u00fap BN gi\u1ea3m c\u00e2n v\u00e0 n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng khi BN c\u00f3 suy tim.<\/p>\n<p>Tuy nhi\u00ean, BN n\u00e0y c\u00f3 ti\u1ec1n s\u1eed hay nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u t\u00e1i ph\u00e1t, d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng n\u00e0y. N\u1ebfu BN lo l\u1eafng nhi\u1ec1u v\u1ec1 chi ph\u00ed \u0111i\u1ec1u tr\u1ecb, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc d\u00f9ng sulfonylurea (SU) thay v\u00ec thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 GLP-1. Tuy nhi\u00ean SU c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 ti\u1ec1m \u1ea9n l\u00e0 g\u00e2y t\u0103ng c\u00e2n v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. V\u00ec c\u00e1c thiazolidinediones c\u0169ng c\u00f3 li\u00ean h\u1ec7 v\u1edbi t\u0103ng c\u00e2n n\u00ean kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng thu\u1ed1c n\u00e0y cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf DPP-4 kh\u00f4ng t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u00e2n n\u1eb7ng, nh\u01b0ng \u0111\u1eaft ti\u1ec1n v\u00e0 n\u00f3i chung kh\u00f4ng hi\u1ec7u qu\u1ea3 b\u1eb1ng c\u00e1c ch\u1ea5t ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 GLP-1. (Xem <a href=\"https:\/\/www.uptodate.com\/contents\/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus?sectionName=Monotherapy+failure&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H7554285&amp;source=see_link#H7554285\" target=\"_blank\" rel=\"noopener\">&#8220;Qu\u1ea3n l\u00fd t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng<\/a> <a href=\"https:\/\/www.uptodate.com\/contents\/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus?sectionName=Monotherapy+failure&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H7554285&amp;source=see_link#H7554285\">huy\u1ebft dai d\u1eb3ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2&#8243;, ph\u1ea7n &#8216;Th\u1ea5t b\u1ea1i \u0111\u01a1n tr\u1ecb li\u1ec7u&#8217;<\/a>)<\/p>\n<p>Trong ba th\u00e1ng sau \u0111\u00f3, gi\u00e1 tr\u1ecb \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a BN ti\u1ebfp t\u1ee5c c\u1ea3i thi\u1ec7n, c\u00e2n n\u1eb7ng ti\u1ebfp t\u1ee5c gi\u1ea3m, v\u00e0 A1C hi\u1ec7n t\u1ea1i l\u00e0 7,3%. B\u1ea1n ch\u00fac m\u1eebng BN, \u0111\u1ed3ng th\u1eddi \u0111\u1ed9ng vi\u00ean BN ti\u1ebfp t\u1ee5c ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng v\u00e0 d\u00f9ng metformin. Li\u1ec1u d\u00f9ng thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 GLP-1 \u0111\u01b0\u1ee3c t\u0103ng l\u00ean \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a. B\u1eb1ng vi\u1ec7c ti\u1ebfp t\u1ee5c gi\u1ea3m c\u00e2n v\u00e0 \u0111\u01b0\u1ee3c t\u0103ng li\u1ec1u ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 GLP-1 l\u00ean cao h\u01a1n, BN c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau A1C c\u1ee7a m\u00ecnh (d\u01b0\u1edbi 7%).<\/p>\n<p>\u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p BN kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau A1C v\u1edbi metformin v\u00e0 thu\u1ed1c ch\u1ee7 v\u1eadn th\u1ee5 th\u1ec3 GLP-1, c\u00f3 th\u1ec3 b\u1ed5 sung th\u00eam m\u1ed9t lo\u1ea1i thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u n\u1eefa. N\u1ebfu li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p thu\u1ed1c kh\u00f4ng d\u00f9ng insulin v\u1eabn ch\u01b0a \u1ed5n, n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi insulin, th\u01b0\u1eddng kh\u1edfi \u0111\u1ea7u b\u1eb1ng vi\u1ec7c b\u1ed5 sung th\u00eam m\u1ed9t li\u1ec1u insulin n\u1ec1n 1 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>(Xem <a href=\"https:\/\/www.uptodate.com\/contents\/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus?sectionName=Dual+agent+failure&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H7554297&amp;source=see_link#H7554297\" target=\"_blank\" rel=\"noopener\">&#8220;Qu\u1ea3n l\u00fd t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft dai d\u1eb3ng \u1edf b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u00fdp 2&#8221;, ph\u1ea7n &#8216;Th\u1ea5t<\/a> <a href=\"https:\/\/www.uptodate.com\/contents\/management-of-persistent-hyperglycemia-in-type-2-diabetes-mellitus?sectionName=Dual+agent+failure&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H7554297&amp;source=see_link#H7554297\">b\u1ea1i do t\u00e1c nh\u00e2n k\u00e9p&#8217; <\/a>v\u00e0 <a href=\"https:\/\/www.uptodate.com\/contents\/insulin-therapy-in-type-2-diabetes-mellitus?sectionName=DESIGNING+AN+INSULIN+REGIMEN&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H3812883387&amp;source=see_link#H3812883387\" target=\"_blank\" rel=\"noopener\">&#8220;Li\u1ec7u ph\u00e1p insulin trong b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u00fdp 2&#8221;, ph\u1ea7n &#8216;Thi\u1ebft k\u1ebf ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb<\/a> <a href=\"https:\/\/www.uptodate.com\/contents\/insulin-therapy-in-type-2-diabetes-mellitus?sectionName=DESIGNING+AN+INSULIN+REGIMEN&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H3812883387&amp;source=see_link#H3812883387\">b\u1eb1ng insulin&#8217;<\/a>.)<\/p>\n<p>C\u0169ng c\u1ea7n nh\u1ea5n m\u1ea1nh r\u1eb1ng m\u1ed9t trong nh\u1eefng l\u00fd do ph\u1ed5 bi\u1ebfn nh\u1ea5t khi\u1ebfn b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 s\u1ed1 A1C qu\u00e1 cao l\u00e0 do &#8220;s\u1ef1 tr\u00ec tr\u1ec7 l\u00e2m s\u00e0ng&#8221; (clinical inertia), khi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung theo b\u1eadc trong ph\u00e1c \u0111\u1ed3 kh\u00f4ng \u0111\u01b0\u1ee3c th\u00eam v\u00e0o \u0111\u1ee7 s\u1edbm.<\/p>\n<h2><strong>Ca l\u00e2m s\u00e0ng 2<\/strong><\/h2>\n<p>M\u1ed9t BN nam 63 tu\u1ed5i b\u00e9o ph\u00ec, \u0111\u00e3 m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng 33 n\u0103m. B\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng c\u1ee7a \u00f4ng \u0111\u00e3 c\u00f3 bi\u1ebfn ch\u1ee9ng b\u1ec7nh th\u1eadn, b\u1ec7nh l\u00fd th\u1ea7n kinh, t\u0103ng huy\u1ebft \u00e1p, lo\u00e9t b\u00e0n ch\u00e2n, b\u1ec7nh v\u00f5ng m\u1ea1c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u0103ng sinh v\u00e0 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean. V\u1ebft lo\u00e9t \u1edf ch\u00e2n c\u1ee7a \u00f4ng \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i m\u1ed9t ph\u00f2ng kh\u00e1m v\u00e0 \u00f4ng \u0111\u01b0\u1ee3c khuy\u00ean tr\u00e1nh mang n\u1eb7ng cho \u0111\u1ebfn l\u00fac l\u00e0nh l\u1ea1i. Thu\u1ed1c ch\u1eefa \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u00f4ng \u0111ang d\u00f9ng bao g\u1ed3m:<\/p>\n<ul>\n<li>Metformin 1000mg x 2 l\u1ea7n\/ng\u00e0y<\/li>\n<li>Semaglutide 1mg h\u00e0ng tu\u1ea7n<\/li>\n<li>Insulin glargine 26 \u0111\u01a1n v\u1ecb tr\u01b0\u1edbc khi ng\u1ee7 v\u00e0 insulin aspart theo c\u00e1c b\u1eefa \u0103n<\/li>\n<\/ul>\n<p>BN h\u1ea7u nh\u01b0 qu\u00ean d\u00f9ng insulin aspart theo b\u1eefa \u0103n, \u0111\u1ed3ng th\u1eddi \u0103n v\u1eb7t su\u1ed1t c\u1ea3 ng\u00e0y, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u00e0o bu\u1ed5i chi\u1ec1u v\u00e0 bu\u1ed5i t\u1ed1i. BN c\u00f3 theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u \u0111\u00f3i, gi\u00e1 tr\u1ecb \u0111\u01b0\u1eddng m\u00e1u \u0111\u00f3i trung b\u00ecnh l\u00e0 148 mg\/dL (8,2 mmol\/L), c\u00e1c tri\u1ec7u ch\u1ee9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft nh\u1eb9 v\u00e0 c\u0169ng hi\u1ebfm g\u1eb7p. A1C c\u1ee7a BN l\u00e0 8.2%.<\/p>\n<h3>Di\u1ec5n gi\u1ea3i v\u00e0 ti\u1ebfp c\u1eadn<\/h3>\n<p>BN \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n d\u00f9ng CGM qu\u00e9t gi\u00e1n \u0111o\u1ea1n (isCGM) \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 dao \u0111\u1ed9ng \u0111\u01b0\u1eddng m\u00e1u trong m\u1ed9t ng\u00e0y v\u00e0 gi\u1eefa c\u00e1c ng\u00e0y. H\u1ec7 th\u1ed1ng CGM qu\u00e9t gi\u00e1n \u0111o\u1ea1n (flash CGM) \u00edt t\u1ed1n k\u00e9m h\u01a1n so v\u1edbi CGM th\u1eddi gian th\u1ef1c. C\u1ea3m bi\u1ebfn glucose c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea5y d\u01b0\u1edbi da b\u1edfi chuy\u00ean gia y t\u1ebf.<\/p>\n<p>\u0110\u1ec3 xem c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u01b0\u1eddng m\u00e1u g\u1ea7n \u0111\u00e2y v\u00e0 xu h\u01b0\u1edbng \u0111\u01b0\u1eddng m\u00e1u, ng\u01b0\u1eddi d\u00f9ng vu\u1ed1t m\u1ed9t \u0111\u1ea7u \u0111\u1ecdc qua b\u1ed9 c\u1ea3m bi\u1ebfn\/b\u1ed9 truy\u1ec1n \u0111\u01b0\u1ee3c \u0111eo tr\u00ean c\u00e1nh tay. B\u00e1o c\u00e1o \u0111\u01b0\u1eddng m\u00e1u c\u00e1 nh\u00e2n qua thi\u1ebft b\u1ecb ho\u1eb7c smartphone cho bi\u1ebft c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u01b0\u1eddng huy\u1ebft trong 8 gi\u1edd g\u1ea7n nh\u1ea5t (theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa &#8211; AGP).<\/p>\n<p style=\"text-align: center\"><strong>H\u00ecnh 2: B\u00e1o c\u00e1o theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c ngo\u1ea1i tr\u00fa<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" class=\"aligncenter size-full wp-image-36440\" src=\"https:\/\/yhoccongdong.com\/tieu-duong\/wp-content\/uploads\/sites\/5\/2021\/01\/jjh.png\" alt=\"\" width=\"686\" height=\"590\" \/><\/p>\n<p>D\u1eef li\u1ec7u t\u00f3m t\u1eaft trong hai tu\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ea3i xu\u1ed1ng l\u00fac BN t\u00e1i kh\u00e1m (h\u00ecnh 2). BN \u0111\u00e3 r\u1ea5t ng\u1ea1c nhi\u00ean khi th\u1ea5y c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c t\u0103ng cao li\u00ean quan t\u1edbi c\u00e1c b\u1eefa ch\u00ednh v\u00e0 b\u1eefa \u0103n v\u1eb7t. \u00d4ng b\u1eaft \u0111\u1ea7u quan t\u00e2m h\u01a1n \u0111\u1ebfn th\u1ee9c \u0103n c\u1ee7a m\u00ecnh (\u0111\u1eb7c bi\u1ec7t l\u00e0 carbohydrate) v\u00e0 d\u00f9ng insulin aspart theo c\u00e1c b\u1eefa \u0103n, d\u1ef1a theo t\u1ef7 l\u1ec7 insulin so v\u1edbi carbohydrate.<\/p>\n<p>\u00d4ng c\u0169ng gi\u1ea3m \u0103n v\u1eb7t bu\u1ed5i t\u1ed1i. M\u1ed9t li\u1ec1u insulin glargine bu\u1ed5i s\u00e1ng \u0111\u01b0\u1ee3c th\u00eam v\u00e0o, \u0111\u1ed3ng th\u1eddi gi\u1ea3m li\u1ec1u insulin glargine bu\u1ed5i t\u1ed1i. V\u1edbi nh\u1eefng thay \u0111\u1ed5i n\u00e0y, vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u c\u1ee7a BN \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n v\u00e0 v\u1ebft lo\u00e9t \u1edf ch\u00e2n c\u1ee7a BN c\u0169ng \u0111\u00e3 l\u00e0nh.<\/p>\n<h2><strong>B\u00ecnh lu\u1eadn<\/strong><\/h2>\n<p>V\u1edbi nh\u1eefng ca l\u00e2m s\u00e0ng tr\u00ean, ch\u00fang t\u00f4i c\u1ed1 g\u1eafng ch\u1ec9 ra r\u1eb1ng \u0111o \u0111\u01b0\u1eddng m\u00e1u v\u00e0o c\u00e1c th\u1eddi \u0111i\u1ec3m, c\u00e1c b\u1ed1i c\u1ea3nh kh\u00e1c nhau trong ng\u00e0y c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y BN th\u1ef1c h\u00e0nh thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c. C\u00e1c thi\u1ebft b\u1ecb theo d\u00f5i \u0111\u01b0\u1eddng m\u00e1u li\u00ean t\u1ee5c (CGM) theo th\u1eddi gian th\u1ef1c v\u00e0 qu\u00e9t gi\u00e1n \u0111o\u1ea1n c\u00f3 th\u1ec3 cho nh\u1eefng th\u00f4ng tin quan tr\u1ecdng, gi\u00fap BN c\u00f3 \u0111\u1ed9ng l\u1ef1c thay \u0111\u1ed5i h\u00e0nh vi.<\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb CGM chuy\u00ean nghi\u1ec7p, \u0111\u01b0\u1ee3c \u0111eo trong m\u1ed9t th\u1eddi gian ng\u1eafn v\u00e0 sau \u0111\u00f3 tr\u1ea3 l\u1ea1i ph\u00f2ng kh\u00e1m \u0111\u1ec3 xem d\u1eef li\u1ec7u \u0111\u01b0\u1eddng m\u00e1u, c\u0169ng c\u00f3 th\u1ec3 gi\u00fap h\u01b0\u1edbng d\u1eabn BN. CGM s\u1ebd ch\u1ec9 hi\u1ec7u qu\u1ea3 khi BN th\u1ef1c s\u1ef1 \u0111i\u1ec1u ch\u1ec9nh ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng ho\u1eb7c ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb sao cho th\u00edch h\u1ee3p d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 \u0111\u01b0\u1eddng m\u00e1u.<\/p>\n<p>C\u00f3 m\u1ed9t v\u00e0i th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e1nh gi\u00e1 l\u1ee3i \u00edch c\u1ee7a CGM \u1edf BN \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 h\u01a1n so v\u1edbi type 1. Vi\u1ec7c \u1ee9ng d\u1ee5ng c\u00f4ng ngh\u1ec7 n\u00e0y n\u00ean \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 ho\u00e1 tu\u1ef3 theo b\u1ed1i c\u1ea3nh b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u1ed9ng l\u1ef1c thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng c\u1ee7a h\u1ecd. (Xem <a href=\"https:\/\/www.uptodate.com\/contents\/self-monitoring-of-glucose-in-management-of-nonpregnant-adults-with-diabetes-mellitus?sectionName=TYPE+2+DIABETES&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H4&amp;source=see_link#H4\">&#8220;T\u1ef1 theo d\u00f5i l\u01b0\u1ee3ng<\/a> <a href=\"https:\/\/www.uptodate.com\/contents\/self-monitoring-of-glucose-in-management-of-nonpregnant-adults-with-diabetes-mellitus?sectionName=TYPE+2+DIABETES&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H4&amp;source=see_link#H4\" target=\"_blank\" rel=\"noopener\">\u0111\u01b0\u1eddng trong qu\u1ea3n l\u00fd ng\u01b0\u1eddi l\u1edbn kh\u00f4ng mang thai m\u1eafc b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng&#8221;, ph\u1ea7n &#8216;B\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng lo\u1ea1i<\/a> <a href=\"https:\/\/www.uptodate.com\/contents\/self-monitoring-of-glucose-in-management-of-nonpregnant-adults-with-diabetes-mellitus?sectionName=TYPE+2+DIABETES&amp;search=Cases+illustrating+problems+with+insulin+therapy+for+type+2+diabetes+mellitus&amp;topicRef=1778&amp;anchor=H4&amp;source=see_link#H4\">2&#8242;<\/a>.)<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p><a href=\"https:\/\/www.uptodate.com\/contents\/cases-illustrating-blood-glucose-monitoring-in-type-2-diabetes\/print?search=Cases%20illustrating%20problems%20with%20ins%E2%80%A67%2F10\" target=\"_blank\" rel=\"noopener\">Cases illustrating blood glucose monitoring in type 2 diabetes<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00e1c ca l\u00e2m s\u00e0ng ch\u1ec9 ra r\u1eb1ng \u0111o \u0111\u01b0\u1eddng m\u00e1u v\u00e0o c\u00e1c th\u1eddi \u0111i\u1ec3m, c\u00e1c b\u1ed1i c\u1ea3nh kh\u00e1c nhau trong ng\u00e0y c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y b\u1ec7nh nh\u00e2n th\u1ef1c h\u00e0nh thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c.<\/p>\n","protected":false},"author":373,"featured_media":1064,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1022,1020,1019,1018,1028,1017],"tags":[885,886,823],"series":[204],"coauthors":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ca l\u00e2m s\u00e0ng - Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng<\/title>\n<meta name=\"description\" content=\"Ca l\u00e2m s\u00e0ng - Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/yhoccongdong.com\/tieu-duong\/ca-lam-sang-kiem-soat-duong-mau-o-benh-nhan-dai-thao-duong-type-2\/\" \/>\n<meta property=\"og:locale\" content=\"vi_VN\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ca l\u00e2m s\u00e0ng - Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 - Y H\u1ecdc C\u1ed9ng \u0110\u1ed3ng\" \/>\n<meta property=\"og:description\" content=\"Ca l\u00e2m s\u00e0ng - Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2\" \/>\n<meta property=\"og:url\" content=\"https:\/\/yhoccongdong.com\/tieu-duong\/ca-lam-sang-kiem-soat-duong-mau-o-benh-nhan-dai-thao-duong-type-2\/\" \/>\n<meta property=\"og:site_name\" content=\"D\u1ef1 \u00e1n Ti\u1ec3u \u0110\u01b0\u1eddng\" \/>\n<meta property=\"article:author\" content=\"https:\/\/www.facebook.com\/superclumsy\" \/>\n<meta property=\"article:published_time\" content=\"2021-02-05T05:48:01+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-10T17:37:27+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/yhoccongdong.com\/tieu-duong\/wp-content\/uploads\/sites\/5\/2021\/01\/ca-lam-sang-kiem-soat-duong-mau-o-benh-nhan-dai-thao-duong-type-2_optimized.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"660\" \/>\n\t<meta property=\"og:image:height\" content=\"330\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BS. 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