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Mellitus
Ulvi Nur Rista
Sasaran Pembelajaran
Mampu
Insulin
Glucagon*
Gangguan
metabolisme
karbohidrat,
lemak, dan
protein
Disebabkan oleh
penurunan
sekresi insulin
dan/atau
penurunan
sensitivitas
insulin terhadap
reseptornya
Ditandai adanya
hiperglikemia
Peripheral
Neuropathy
Nephropathy
Cardiovascular
Disease
Sexual
Dysfunction
Chronic
Hyperglycemia
Retinopathy
Autonomic
Neuropathy
Type 2
Diabetes (9095% of
diabetes)
Prediabetes
Gestational
Diabetes
(GDM)
Secondary
Diabetes
Diabetes Mellitus
Tipe 1
Insulin-Dependent Diabetes = Juvenile-Onset
Diabetes
Patofisiologi-DM tipe 1
Autoimun
Destruksi
sel
pankreas
Insulin
Idiopathic
Hiperglikemia
Persisten
Absolute
Insulin
Deficiency
Diagnosis DM tipe 1
Hiperglikemia
Ketoacidosis
Antibody testing (+) ditemukan
autoimmune marker, antara lain
Islet cell autoantibodies
Autoantibodies to insulin
Autoantibodies to GAD
Goal of Treatment
Mencapai
Continous subcutaneous
insulin infusion (CSII)
insulin pump therapy.
Prediabetes
Increased Risk For Diabetes
Prediabetes
Prediabetes-Risk Factor
Prediabetes-Diagnosis
Rekomendasi
skrining: interval
pemeriksaan minimal 3
tahun
Rekomendasi
monitoring: Interval
pemeriksaan minimal 1
tahun.
Goal of Treatment
Mencegah onset terjadinya
diabetes mellitus
Diabetes Mellitus
Tipe 2
Insulin- Non-Dependent Diabetes
Patofisiologi-DM tipe 2
Sekresi
Glucagon
Defisiensi
GLP-1
Hiperglikemia
Persisten
Sekresi
Insulin
Fungsi sel
pankreas
Incretin effect
(GLP-1 & GIP)
Resistensi
Insulin
Goal of Treatment
Mencapai
Glycemic Target
GLP-1
DPP-4
agonist
inhibitor
receptor
Sekresi
Metformin
Glucagon
Sediaan
Insulin
Defisiensi
GLP-1
Hiperglikemia
Persisten
Sekresi
Insulin
SGLT-2
inhibitor
Resistensi
Insulin
Metformin
Fungsi sel
Incretin effect
pankreas
(GLP-1 &GIP)
SU
Glinide
DPP-4
inhibitor
TZD
Terapi Farmakologi
Kelas
Jenis
Keunggulan
Efek samping
Biguanide
Metformin
CVD events;
No hypoglycemia;
Low cost
GI side effect
risk ~
dosis
Sulfonilurea
Glibenclamide,
Glipizide,
Glimepiride
Thiazolidinedione (TZD)
Pioglitazone
No hypoglycemia;
HDL-C;
TG;
Low cost
weight;
Peripheral
edema;
Heart failure
Terapi Farmakologi
Kelas
Jenis
Keunggulan
Efek samping
DPP-4
Inhibitor
Linagliptin,
Sitagliptin,
Vildagliptin,
Saxagliptin
No hypoglycemia
Side effect
(rare)
pancreatitis,
skin rash
GLP-1
reseptor
agonis
Liraglutide
No hypoglycemia;
weight
GI side effect
SGLT-2
inhibitor
Dapagliflozin
No hypoglycemia;
weight;
blood pressure
Polyuria;
volume
depletion/
hypotension;
genitourinary
infections
Terapi Farmakologi
Kelas
Jenis
Keunggulan
Efek samping
Glinides
Repaglinide
post-prandial
glucose
Hypoglycemia
weight
Alphaglucosidase
inhibitor
Acarbose
No hypoglycemia;
post-prandial
glucose
Non-systemic
GI side effect
microvascular
risk
Reduce HbA1c >>
Hypoglycemia
weight
Insulin
Rapid Acting;
Short acting;
Intermediate
acting;
Long acting;
Premixed
Glulisine, Lispro,
Aspart
Insulin Regular
NPH
Detemir, Glargine
Farmakokinetik Insulin
Farmakodinamik Insulin
Terapi Non-Farmakologi
1.
2.
3.
4.
Diet
Physical Activity
Maintain normal weight/ Reduction
body weight 7%
Self monitoring blood glucose
Reference
1.
2.
3.
4.