Diabetes Untuk Umum

8/13/2019 Diabetes Untuk Umum

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dr. R. Bowo Pramono, SpPD


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CV : dr. R Bowo Pramono SpPD KEMD Lahir TEGAL 27-jan 1959 Istri: dr. Astuti SpS, 2 putri Dokter Umum: FK UGM 17-01-1985 SPPD : FK UGM 24-11-1997 KEMD : 14-05-2008Pekerjaan: 1987-2002 PKM Kedung Waringin Bekasi

1999-2004 RSU Selong Lombok Timur 2004-2010 RS DR Sardjito/FK UGM 2006-2013 Sekretaris Bagian Penyakit Dalam FK UGM 2007-2011 Sekretaris PAPDI Cabang Yogyakarta

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EPIDEMIOLOGY

WHO Estimation: Indonesia have peoplewith DM (2030):

Rural : 7,2 % from adult (>20 years old) Urban: 14,7 % from adult

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By 2030, 7 of the 10 Countries with theMost Diabetic Patients Will Be in Asia

IndiaChinaUSAIndonesiaPakistanBrazilBangladeshJapanPhilippinesEgypt

Country

2030

79.442.330.321.313.911.311.18.97.86.7

People withdiabetes(millions)

IndiaChinaUSAIndonesiaJapanPakistanRussian Fed.BrazilItalyBangladesh

Country

2000

31.720.817.78.46.85.24.64.64.33.2

People withdiabetes(millions)

123456789

10

Ranking

Wild S et al. Diabetes Care 2004;27(5):1047-53.


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Diagnosis (WHO classification)

Venous plasma glucose (mg/dL)

Normal Fasting &2h post-prandial

< 100< 140

Diabetes mellitus Fasting &2h post-prandial

> 126> 200

Impaired GlucoseTolerance (IGT)

Fasting &2h post-prandial

< 100140-199

Impaired FastingGlucose (IFG)

Fasting &2h post-prandial

100 - 125< 140

NB:In the absence of symptom, the diagnosis of DM must be confirmed by aseconddiagnosis test (i.e. fasting, random, or Oral Glucose Tolerance Test (OGTT) on

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Risk Factors of DMFamily history

Over weight/obese/inactivity AgeHypertensionDyslipidemia

DM Relative with DM Risk of DM

Type 1 MotherFatherSister or brotherTwin sister or brother

2%9%

10%50%

Type 2 MotherFatherBoth parentsSister or brotherTwin sister or brother

19%14%

25%75%

99%

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Type 2 diabetes is NOT a mild disease

DiabeticRetinopathy

Leading causeof blindness

in working ageadults 1

DiabeticNephrop athy

Leading cause ofend-stage renal disease 2

Cardiovascular

Disease

Stroke2 to 4 fold increase in

cardiovascular mortalityand strok e 3

DiabeticNeuropa thy

Leading cause of non-traumatic lower

extremity amputations 5

8/10 diabetic patientsdie from CV events 4

1 Fong DS, et al. Diabetes Care 2003; 26 (Suppl. 1):S99 S102. 2Molitch ME, et al. Diabetes Care 2003; 26 (Suppl. 1):S94 S98.3 Kannel WB, et al. Am Heart J 1990; 120:672 676. 4Gray RP & Yudkin JS. In Textbook of Diabetes 1997.

5Mayfield JA, et al. Diabetes Care 2003; 26 (Suppl. 1):S78 S79.


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Treatment options for type 2diabetes

Sulfonylureas 1st generation e.g. chlorpropamide,

tolbutamide 2nd generation e.g. glyburide,

gliclazide, glipizide, gliquidone 3rd generation e.g. glimepiride Modified release

Glinides/meglitinides Non-sulfonylureic e.g. repaglinide Amino acid derivatives e.g. nateglinide

Biguanides e.g. metformin

Thiazolidinediones e.g. rosiglitazone, pioglitazone

-glucosidase inhibitors e.g. acarbose

Insulin regular intermediate/long acting pre-mixed analogs

rapid actinglong acting

Fixed-dose oral antidiabetic

drug combinations e.g. glyburide/metformin,

glipizide/metformin,rosiglitazone/metformin


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Indikasi terapi Insulin: DM tipe 1

DM tipe 2 yang tidak terkontrol diet, olah raga,OHO. DM gestasional Gangguan faal hati & ginjal yang berat.

Dengan infeksi akut (selulitis, gangren), TBCberat, penyakit kritis (stroke/AMI)

Dengan KAD/HHS Dengan fraktur atau pembedahan mayor Kurus (BB rendah), terkait malnutrisi (DMTM) Dengan penyakit Graves Dengan tumor ganas Dengan pemberian kortikosteroid


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LOKASI PENYUNTIKKAN


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Sistem NovoLet


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Less Hypoglycemia Less Weight Gain

DM tipe 1


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1980


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1980 2009

Diabetes Untuk Umum

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