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diabetes melitus

diabetes melitus

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DIABETES MELLITUS

DIABETES MELITUS
 Current

issue perkembangan diabetes melitus  Konsep medik diabetes melitus  Penatalaksanaan dan Pencegahan diabetes melitus

Diabetes Melitus
Definisi :
Suatu sindrom yang ditandai dengan adanya hiperglikemi kronis serta terganggunya metabolisme karbohidrat, lemak dan protein yang berkaitan dengan kurangnya jumlah atau kerja dari insulin secara relatif maupun absolut
Ref. : Peter H. Bennett; Definition, Diagnosis, and Classification of Diabetes Mellitus and Impaired Glucose Tolerance; Joslin’s Diabetes Mellitus; 13th ed.; 1994; hal. 193

DIABETES MELITUS
PENYAKIT MENAHUN  TIDAK BISA DISEMBUHKAN  DIKENDALIKAN  TIDAK BERGEJALA PENGOBATAN DILALAIKAN  TIDAK TERKENDALI KOMPLIKASI AKUT DAN MENAHUN  KEMATIAN

World View • • • • • 177 million worldwide 4th leading cause of death by disease India 33 million people with diabetes China 23 million people with diabetes Population of diabetes will double to triple by 2025 • One out of every three Americans born today will develop diabetes Time magazine December 2003. CDC .

keturunan.  .BERAPA BANYAK DIABETISI? Tergantung ras. dibanding negara maju  Indonesia. pola hidup  Negara berkembang meledak. rata-rata 4-5% 6 %  Makassar 42 pengunjung26 DM dengan hanya gula darah puasa. umur.

. Diabet Med 1997. Amos et al.The worldwide pandemic of type 2 diabetes 350 World wide diabetes prevalence (millions) 300 300 250 200 150 150 100 2000 2010 2025 221 International Diabetes Federation Diabetes Atlas 2000.14 (Suppl 5):S1-S85.

S.U. Diabetes Prevalence  18 Million Diabetes kills 1 American every 3 minutes  New case diagnosed every 40 seconds More deaths than AIDS and breast cancer combined   Average life expectancy: 15 years less than non-diabetes population .

Two Worlds: Developed and Developing Estimated number of diabetics (millions) 1995 350 300 250 200 150 100 50 0 developed 2000 2025 developing world King H et al. Diabetes Care. 21: 1414-1431 .1998.

120 2000 2025 DEVELOPED COUNTRIES 80 Millions 40 0 20-44 120 2000 2025 Millions 45-64 >65 DEVELOPING COUNTRIES 80 40 0 Age Group (years) .

888 rank no. 3 worldwide + 45.6 % 20. 3rd Edition 2006 million 25 20 15 10 5 0 2007 2025 14.6 % .Number of people with IGT and diabetes in Indonesia (2070 y age group) IDF . 4 worldwide 5.144 rank no.Diabetes Atlas.597 Diabetes IGT + 77.129 2.

http://diabetes. Diabetes Care 1993.gov/ dm/pubs/statistics/index.DM tipe 2: A silent killer  30% dari penduduk DMT2 tidak terdiagnosis  50% pasien baru diagnosis DMT2 sudah menderita komplikasi  65-80% pasien DMT2 meninggal o/k PKV  2-4X pasien DMT2 untuk mendapat PJK dan 2 X stroke National Institute of Diabetes and Digestive and Kidney Diseases.16:1022-5 .niddk.htm#7 [Accessed 1 December 2005] Wingard DL et al.nih.

873)had diabetes .Crude one-year mortality 1995 to 2002 in patients with and without diabetes Mortality improvement was seen in both groups but a fatal outcome remained higher among patients with diabetes. 30 25 20 15 10 5 Diabetic Non-diabetic 0 1995 1996 1997 1998 1999 2000 2001 2002 Year Norhammar A. 2007 N = 70. Heart Jan.882 21%(14.

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Environmental factors •Overeating •Inactivity •Smoking •Diabetogenic drugs Environmental factors Genetic factors Unknown Genetic factors Unknown •Pregnancy •Endocrine diseases •Diabetogenic drugs •Malnutrition in utero Insulin resistance Glucose toxicity Hyperglycaemia B.cell defects Impaired glucose tolerance Worsening B-cell functions • ? Amyloid deposition •Malnutrition in utero NIDDM .

1996 Robertson RP.Diabetes.37:667.43:1085.1988 Saltiel J. Diabetes 44:1447.Diabetes Melitus Patogenesis DM Tipe 2 Defisiensi Insulin Aksi / Kerja Insulin Hiperglikemi DeFronzo RA. Diabetes.45:1661-1669.1994 Tokuyama Y.1995 .Diabetes.

Stages of type 2 Diabetes in relationship to 100 -cell function 75 Beta cell function (%) 50 IGT 25 Postprandial Hyperglycemia Type 2 Diabetes Phase 1 Type 2 Diabetes Phase 2 2 6 10 Type 2 Diabetes Phase 3 0 .10 -6 -2 0 14 Years from diagnosis hypoX-jsk-7-99 .12 .

obesity. Western lifestyle Insulin resistance IR  -cell dysfunction Macrovascular complication Type 2 diabetes Microvascular complication (Expert Committee on the Diagnosis and Classification of Diabetes mellitus 2002) .Diabetes Mellitus Genetic susceptibility.

Diagnosis Diabetes melitus .

5%  Gula darah puasa > 126 mg/dL  Gula darah 2 jam postprandial setelah beban glukosa 75 gr  >200 mg/dL  Gula darah sewaktu disertai gejala klinis khas >200mg/dL  ADA 2010 .Diagnosis DM Hb A1C >6.

Diagnosis Pre Diabetes Pemeriksaan gula darah puasa 100-125 mg/dL Glukosa Darah Puasa Terganggu (GDPT)  Pemeriksaan gula darah 2 jam post prandial pada TTGO 140199 mg/dl  Toleransi Glukosa Terganggu (TGT)  .

25 suppl1: S22 * May not be correct for all ethnic groups. Diabetes care 2004.Risk factors for type 2 diabetes • Umur >45 tahun • Obese • inaktifitas fisik • ibu/bapa diabetes •Sebelumnya sudah TGT atau GDPT • Pernah diabetes waktu hami (DM Gestasi) atau melahirkan bayi >4kg • Hipertensi (> 140/90 mm Hg) • HDL cholesterol < 35 mg/dl and/or trigliseride level > 250 mg/dl • Polycystic ovary syndrome • Hystory of vascular disease ________________________________________________________ Diabetes care 2002.27:S12 .

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Classification of Diabetes Mellitus  Type 1 diabetes  Immune-mediated  Idiopathic  Other Specific Types     Type 2 diabetes Gestational Diabetes Mellitus (GDM)     Genetic defects/syndromes Diseases of the exocrine pancreas Endocrinopathies Drug-induced Infections Uncommon immunemediated .

Polifagi. Polidipsi)  BB turun  Gatal-gatal  Lesu.Manifestasi klinis 3 P (Poliuri. loyo  Kesemutan  Impotensi  Luka sukarsembuh  .

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187-192 .Tujuan pengobatan DM tipe 2:  Menekan/mengurangi gejala klinik hiperglikemia  Mencegah onset / progresivitas komplikasi vaskuler diabetik dengan kontrol metabolik jangka lama Charbonnel V Therapeutique des Entretitiens1997.

patients should aim for FPG.0 80 – 110 100 .180 Target for most patients Normal range (if it can be safely achieved) < 6.130 100 .140 * Treatment goals and strategies must be tailored to the patient. preprandial and postprandial PG targets .Targets for Glycemic Control Target A1C (%) <7 FPG/preprandial 2h(mg/dl) postprandial (mg/dl) 80 . with consideration given to individual risk factors To achieve an A1C  7.0%.

LEMAK DARAH ROKOK HIPERTENSI OLAHRAGA PENYAKIT JANTUNG KORONER STROKE KEBUTAAN BERAT BADAN DIABETISI DIET TABLET INSULIN KENDALIKAN GULA DARAH GAGAL GINJAL LUKA KAKI TBC PARU .

dislipidemia.hipertensi. intoleransi glukosa. hiperinsulinemia Gangguan mikrovaskuler Gangguan makrovaskuler .PERIORITAS PENGOBATAN Kendalikan glukosa darah Kendalikan sindroma metabolik: Obesitas.

Gluronerm Kerja lama 1 kali perhari Glucotrol XL. Humulin R. Humulin N. apidra Kerja sedang : Insulitard. novomix .levemir Kombinasi humalo mix. Kerja lama Lantus. Glucophage Kerja sedang 2 kali perhari Glibenklamid.OBAT OBAT ANTI DIABETES  Tablet: Kerja pendek:3 kali perhari: Novonorm. Glucobay. novorapid. Starlix. Daonil. Diamicron MR  Suntik insulin: Kerja pendek : Actrapid.

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Koma diabetik Koma hiperglikemik Koma hipoglikemik Mikroangiopati diabetik Makroangiopati diabetik .

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Cerebrovasc Dis 2002. .Major clinical manifestations of atherothrombosis Ischemic stroke Myocardial infarction Transient ischemic attack Angina: • Stable • Unstable Peripheral arterial disease: • • • • Intermittent claudication Rest Pain Gangrene Necrosis Adapted from: Drouet L. 13(suppl 1): 1–6.

etc) DAG = Diacyl glycerol PKC = Proteinkinase .Hiperglikemia Glycation Polyol Pathway Osmotic Effect DAG-PKC Pathway Oxidants Cytokines AGES Tissue damage Endothelial Cell Dysfunction Chronic Complication (Atherosclerosis.

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PENCEGAHAN DM  Pencegahan primer  Pencegahan sekunder  Pencegahan tertiair .

pioglitazone. Obat penurun berat badan  .Pencegahan Primer Pola hidup  olahraga. metformin. stress Exersice intensif  mengurangi DM  Obat-obat : glucobay. diet.

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Pencegahan sekunder Edukasi  Diet  Olahraga  Obat anti diabetes ( oral atau insulin)  Kontrol teratur  .

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ginjal . GDPT Diabetes P. mata. Primer prediabetes Hiperglikemia TGT. otak.Tertier Akut Koma diabetik Kronis Jantung.Sekunder Komplikasi P. kaki.Normal P.

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Sulaemana Mosquue Istambul .

Istambul .St Sophia.

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