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Culture Documents
2007
Diagnosed Diabetes 1.5%
2007 2013
Diagnosed Diabetes 1.5% 2.1%
67.85%
Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW, Tjokroprawiro A. The DiabCare Asia 2008 study-
Outcomes on control and complications of type 2 diabetic patients in Indonesia Med J Indones 2010 19; 4: 235-244.
Classification of diabetes
Type 1 diabetes
Beta-cell destruction, usually leading to absolute insulin
deficiency
Type 2 diabetes
Progressive insulin secretory defect on the background of beta-
cell dysfunction and insulin resistance
Gestational diabetes mellitus
Diabetes diagnosed in the second or third trimester of
pregnancy that is not clearly overt diabetes
Other specific diabetes types
Drug- or chemical-induced, e.g steroids, treatment of HIV/AIDS
or after organ transplantation
Genetic defects in beta cell function or in insulin action
Diseases of the exocrine pancreas (e.g. cystic fibrosis)
ADA - Standards of Medical Care in Diabetes – 2016. Diabetes Care, Vol. 39, Supplement 1, January 2016.
Classical diabetes symptoms
Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Jakarta: PB Perkeni, 2015
http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/symptoms/con-20034795
Other diabetes symptoms
Numbness
and/or tingling • In hands, legs and feet
Adapted from Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Jakarta: PB Perkeni, 2015.
Criteria for testing for diabetes or prediabetes in asymptomatic adults
*Polydipsia (frequent thirst), polyuria (frequent urination), polyphagia (extreme hunger), blurred
vision, weakness, unexplained weight loss.
†A1C should be used only for screening prediabetes. The diagnosis of prediabetes, which may
manifest as either IFG or IGT, should be confirmed with glucose testing.
‡Glucose criteria are preferred for the diagnosis of DM. In all cases, the diagnosis should be
confirmed on a separate day by repeating the glucose or A1C testing. When A1C is used for
diagnosis, follow-up glucose testing should be done when possible to help manage DM.
FPG, fasting plasma glucose; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; PG, plasma
glucose.
Q1. How is diabetes screened and diagnosed? 13
FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; PG, plasma glucose.
Cut-points: Diabetes, IGT and IFG
mg/dL
Fasting Plasma Glucose (FPG)
Diabetes
126
IFG
Impaired Fasting
Glucose
IGT
100
Impaired Glucose
Tolerance Diabetes
NGT
Normal Glucose
Tolerance
American Diabetes Association. Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes 2016.
Diabetes Care 2016;39(Suppl. 1): S13–S22
Diagnosis of Type 2 Diabetes
KONSENSUS: Pengelolaan Dan Pencegahan DM Type 2. 2015
•Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Jakarta: PB Perkeni, 2015.
What is good glycaemic control?
60 Microvascular disease
Incidence per 1.000
patient-years
40
Myocardial infarction
20
0
5 6 7 8 9 10 11 Mean HbA1c (%)
97 126 154 183 212 240 269 Mean mg/dl
Stratton IM et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35):
prospective observational study. BMJ 2000;321:405–12
Optimising blood glucose control
Myocardial
Good control is infarction
≤ 7.0% HbA1c
-14%
Microvascular
HbA1c complications
-1% -37%
Deaths related
to diabetes
-21%
Source: UKPDS = United Kingdom Prospective Diabetes Study. Stratton IM
et al. BMJ. 2000;321(7258):405-412.
Management of DM
• The major components of the treatment of diabetes are:
• Diet and
A Exercise
• Oral
B hypoglycaemic
therapy
• Insulin
C Therapy
A. Diet
Diet is a basic part of management in every case. Treatment cannot
be effective unless adequate attention is given to ensuring
appropriate nutrition.
Source: Konsensus Pengelolaan dan Pencegahan DMT2 di Indonesia. PERKENI. 2011. Diabetes Care 2012. Penatalaksanaan
Diabetes Melitus Terpadu. 2009
Practical monitoring scheme cont…
Source: Konsensus Pengelolaan dan Pencegahan DMT2 di Indonesia. PERKENI. 2011. Diabetes Care 2012. Penatalaksanaan
Diabetes Melitus Terpadu. 2009
Thank You