Professional Documents
Culture Documents
STANDAR OF MEDICAL
2010
Harsinen Sanusi
Division of Endocrinology and Metabolic Departement
of Internal Medicine Faculty of Medicine RS dr Wahidin
Sudirohusodo
Makassar
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; Joslins
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
Makassar 42 pengunjung26 DM
dengan hanya gula darah puasa.
The worldwide pandemic of
type 2 diabetes
350
prevalence (millions)
World wide diabetes
300
300
250 221
200
150
150
250
200
150
100
50
0
developed developing world
40
0
20-44 45-64 >65
120
2000
2025 DEVELOPING COUNTRIES
80
Millions
40
0
Age Group (years)
Number of people with IGT and diabetes in Indonesia (20-
70 y age group)
million
25 + 45.6 %
20.597
20
14.144
15
Diabetes
rank no. 4 rank no. 3 IGT
10 worldwide worldwide
5.129
5
2.888
0
2007 2025
+ 77.6 %
DM tipe 2: A silent killer
30% dari penduduk DMT2 tidak terdiagnosis
25
20
15
10
5 Diabetic
Non-diabetic
0
1995 1996 1997 1998 1999 2000 2001 2002
Year
N = 70.882
21%(14.873)had diabetes
Norhammar A. Heart Jan, 2007
Environmental factors Environmental factors
Overeating Genetic factors Genetic factors Pregnancy
Inactivity Endocrine diseases
Smoking Unknown Unknown
Diabetogenic drugs
Diabetogenic drugs Malnutrition in utero
Glucose toxicity
Hyperglycaemia
NIDDM
Diabetes Melitus
Patogenesis DM Tipe 2
Hiperglikemi
DeFronzo RA.Diabetes.37:667,1988
Saltiel J.Diabetes.45:1661-1669,1996
Robertson RP. Diabetes.43:1085,1994
Tokuyama Y. Diabetes 44:1447,1995
Stages of type 2 Diabetes in relationship to
100 -cell function
75
Beta cell function (%)
50
IGT Postprandial
Hyperglycemia Type 2
Type 2
25 Diabetes
Diabetes
Phase 1 Type 2
Phase 3
Diabetes
Phase 2
0
- 12 - 10 -6 -2 0 2 6 10 14
Years from diagnosis
hypoX-jsk-7-99
Diabetes Mellitus
Genetic susceptibility,
obesity, Western
lifestyle
Insulin
resistance IR -cell
dysfunction
Macrovascular Microvascular
Type 2 diabetes
complication complication
ADA 2010
Diagnosis Pre Diabetes
Gatal-gatal
Lesu, loyo
Kesemutan
Impotensi
Luka sukarsembuh
Tujuan pengobatan DM tipe 2:
DIABETISI KEBUTAAN
DIET GAGAL
KENDALIKAN GINJAL
TABLET GULA DARAH
INSULIN LUKA KAKI
TBC PARU
PERIORITAS PENGOBATAN
Gangguan Gangguan
mikrovaskuler makrovaskuler
OBAT OBAT ANTI DIABETES
Tablet:
Kerja pendek:3 kali perhari:
Novonorm, Starlix, Glucobay, Glucophage
Kerja sedang 2 kali perhari
Glibenklamid, Daonil,Gluronerm
Kerja lama 1 kali perhari
Glucotrol XL, Diamicron MR
Suntik insulin:
Kerja pendek : Actrapid, Humulin R, novorapid, apidra
Kerja sedang : Insulitard, Humulin N,
Kerja lama Lantus,levemir
Kombinasi humalo mix, novomix
Koma diabetik
Koma hiperglikemik
Koma hipoglikemik
Mikroangiopati diabetik
Makroangiopati diabetik
Major clinical manifestations
of atherothrombosis
Ischemic Transient
stroke ischemic attack
Myocardial Angina:
infarction Stable
Unstable
Peripheral arterial
disease:
Intermittent claudication
Rest Pain
Gangrene
Necrosis
AGES Osmotic
Effect Tissue damage
Pencegahan tertiair
Pencegahan Primer
Pola hidup olahraga, diet, stress
Exersice intensif mengurangi DM
Obat-obat : glucobay, metformin,
pioglitazone. Obat penurun berat badan
Pencegahan sekunder
Edukasi
Diet
Olahraga
Kontrol teratur
Normal
P. Primer Hiperglikemia
Diabetes
P.Sekunder
Komplikasi
P.Tertier
Akut Kronis