DIABETES MELITUS

Definisi

Diabetes mellitus adalah suatu

kelompok penyakit metabolik yang
ditandai oleh hiperglikemia akibat
defek pada:
Kerja insulin
Sekresi insulin
Atau keduanya

Klasifikasi

DM Tipe 1
DM Tipe 2
DM Gestasional
Tipe DM yang lain

Etiologi

Type 1 DM:
- Genetic
- Autoimmune

Type 2 DM
- Genetic
- Lifestyle

KERJA INSULIN NORMAL

Patofisiologi

TANDA DAN GEJALA DM

TIPE 1

Polyphagia,
polydipsi

Fatigue

Poliuri

Weight Loss

Mata Kabur

Kriteria Diagnosis

Normal
- BSN : 70-99 mg/dL
- BSPP : 100-139 mg/dL
Risk to diabetes (Prediabetes)
- BSN : 100-125 mg/dL
- BSPP : 140-199 mg/dL
Diabetes
- BSN : > 126 mg/dL
- BSPP : > 200 mg/dL
classical symptoms

Faktor Resiko DM

Usia > 35 tahun.

BB > 110% ideal BB
Hypertension (BP > 140/90 mmHg)
Family history of DM
Recurrent stillbirth, giant baby
HDL-cholesterol < 35 mg/dL,
triglyceride > 250 mg/dL

Komplikasi

Possible Pathogenesis of Diabetic

Complications
Overall Glycemic Control (HbA
)
(HbA1c
1c)
Hyperglycemic
Hyperglycemic
"Peaks"
"Peaks"

Fasting/Preprandial
Fasting/Preprandial
glucose
glucose elevations
elevations

Acute
Acute toxicity
toxicity

Chronic
Chronic toxicity
toxicity

Tissue
Tissue lesion
lesion

Complications

Diabetic complication
Acute:
1. Diabetic ketoacidosis
2. Hyperosmolar Hyperglycemia
State
3. Hypoglycemia
Chronic:
4. Angiopathy
Macro: stroke, CAD, Diabetic foot
Micro: retinopathy, nephropathy
2. Neuropathy
Peripher: pain, paresthesia,
numbness
Autonom: ED, CDM, gastropathy

TERAPI

Summary of glucose-lowering interventions

Intervention

Expt. decreased
in A1C (%)

Advantages

Disadvantages

Lifestyle

1.0-2.0

Broad benefits

Insufficient for most within first year

Metformin

1.0-2.0

Weight neutral

GI side effects, contraindicated with renal

insufficiency

Insulin

1.5-3.5

No dose limit, rapidly

effective, improved lipid
profile

1-4 injections daily, monitoring, weight gain,

hypoglycemia, analogues are expensive

Sulfonylurea

1.0-2.0

Rapidly effective

Weight gain, hypoglycemia (especially with

glibenclamide or chlorpropamide)

TZD

0.5-1.4

Improved lipid profile

(pioglitazone), potential
decrease in MI (pioglitazone)

GLP-1 agonist

0.5-1.0

Weight loss

Acarbose

0.5-0.8

Weight neutral

Glinide

0.5-1.5

Rapidly effective

Pramlintide

0.5-1.0

Weight loss

DPP-4
inhibitor

0.5-0.8

Weight neutral

Fluid retention, CHF, weight gain, bone fractures,

expensive, potential increase in MI
(rosiglitazone)
Two injections daily, frequent GI side effects,
long-term safety not established, expensive
Frequent GI side effects, three times/day dosing,
expensive
Weight gain, three times/day
dosing, hypoglycemia,
expensive
Three injections daily, frequent GI side effects,
long-term safety not established, expensive
Long-term safety not established, expensive

Nathan DM, et al. Diabetes Care. 2008;31:1-11

Konsensus PERKENI 2011

Indonesian Vildagliptin Product Information, 2007.

Thank You