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FARMAKOTERAPI

DIABETES MELLITUSPROGRAM MFK

BUDI SUPRAPTIDEPARTEMEN FARMASI KLINIS

FAKULTAS FARMASIUNIVERSITAS AIRLANGGA

1

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DIABETES MELLITUS

•Sekelompok gangguan metabolik

hiperglikemia

kronik, ditandai oleh

•Berhubungan abnormalitas metabolisme, karbohidrat,

lemak, protein

•Disebabkan defek sekresi insulin, sensitivitas

insulin atau keduanya•Komplikasi kronis mikrovaskular, makrovaskular

neuropati

dan

2

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T2DM (people 20-79 yrs !" #$e T%P &0 '%UNTRIES

20 0 ()#20&0 ()#1.2.3.

.!.".#.

$.%.

&ndia'hina (sa)akistanBra*il&ndonesia+e i-oBanglades

ussian

$#,/"2,"3",/13,$12,#12,/11,%

1/,1/,3$,"

1.2.3.

.!.".#.$.%.

&ndia'hina

(saussianBra*il0erman)akistan

apan&ndonesia

!/,$3,2

2",$%,"#,"#,!#,1#,1#,/",$ 1/. gypt1/.+e i-o

Diabetes tlas, 2//% 3

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DIABETES MELLITUS di INDONESIA??

•Sekitar 50% pen andan! DM "e#$ terdia!n&'i'

• (5% P) terdia!n&'i' * en+a#ani pen!&"atan

• ,0% an! en+a#ani pen!&"atan * terkenda#i "aik

• Rerata -apaian ."A/ 1%K&n'en'$' Perkeni 20//

PERLU ASU.AN KEFARMASIAN3P.ARMA EUTI AL ARE4

4

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BATASAN DIABETES MELLITUS

Kr!#er!* +!*,"os#! DM .

&/ GDA 200 1, +l ( &&3& 11ol L +e",*" ,e)*l* DMA4* --- 5* #6 *p*p6" #*"p* 1e1per$*#! *"

)*", *#er* $!r 1* *"

ATAU

5* #6 se)*

2/ GDP &2 1, +l (7 11ol L /P6*s* --- #!+* *+* *s6p*" *lor! sel*1* 8

)*1ATAU

/ GD 200 1, +l ses6+*$ e *" ,l6 os* 7: , p*+* TTG%

ATAU

;/ Pe1er! *s**" < A&4 = 3:> (ADA 20&0

l* #ers#*"+*r!s*s! +e",*" *! 5

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GANGGUAN T%LERANSI GLUK%SA (IGT

G6l* +*r*$ p6*s*

Nor1*l . ? &&01, +lGTGDM

. &&0 1, +l #e#*p! ?. &2 1, +l

&2 1, +l

G6l* +*r*$ -TTG% .Nor1*lGTGDM

.

.

.

? &;0 1, +l &;0 1, +l #e#*p!

= 200 1, +l? 200 1, +l

2: > er e1 *", 1e")*+! DMDM-pe"e#*p*" +!*,"os* ole$ l!"!s!

"

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$

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RISK FA'T%RS

5amily history6besity 7 8 2/9 over &B: or B+& 82! ;

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SK & & 0

D+ >&) 1Status betaC-ell autoCantibodyriAayat keluarga risiko tinggi

tipe 2B+& 8 2!

D+

dengan minimal satu faktor risiko(sia 8 ! tahun

D+

KC KC +BB berlebihdengan 2 faktor risiko

1. riAayat kelg D+C2

2. native ameri-ans, afi-an ameri-ans, hispani- ameri-an,asians=south pa-ifi-s islanders atau risk faktor lain

setiap 3 tahun seEak usia 1/ tahun=pubertasD+ 0 S> S&6 ?

kunEungan prenatal= ada risk fa-tor

bila negat 1if / F ulangi usia kehamilan 2 C2$

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K? S&5&K S& D& B > S + ??&>(S

CC

D+D+

tipe & karena destruksi sel betaCCCdefisiensi insulin absoluttipe && karena resistensi insulin dan atau defek sekresi

insulintipe lain C D+

CCC

penyakit dari pankreas eksokrin 7pankreatitis, eoplasia;endokrinopati 7al. a-romegaly, -ushing syndrome;induksi obat atau *at kimia dan lain2

C D+ 0estasional

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ETI%L%GICD+ tipe &

C utoimunC &nfeksi virus0enetikC

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13

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1

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EFEK METAB%LIK INSULIN7di liver, otot, dan Earingan adipose;

(! K< ( *r o$!+r*# .meningkatkan 7↑; glikogenesis

7↑; glikolisis7otot, liver;

menurunkan 7↓; glikogenolisis 7otot, liver;7↓; glukoneogenesis7liver;

(!! l!p!+* . 7↑;7↑ ;7↓;

penggunaan lemak diet 7adipose;lipogenesis 7adipose;ketogenesis 7otot, liver, adipose;sintesis protein 7otot, liver,

adipose; proteolisis 7otot, liver,

(!!! pro#e!". 7↑;

7↓;

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S-hemati- diagram of glu-oseCstimulated insulin release from B -ell

1$

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1## p F 1// normal or &0>

## D+2 1%

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Major MetabolicDefectsin Type 2

Diabetes• )eripheral insulin resistan-e

mus-le and fatin

• De-reased pan-reati-insulin se-retion

• &n-reased hepati- glu-oseoutput

Haffner SM, et al. Diabetes 'are , 1999

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Development andProgressionof Type 2 Diabetes

*→ Insulin → IGT/ IFG → Type 2

Diabetesesistance

!GT

Glucos

e

"#$ "% $ % #$ #% 2$ 2% &$

elativ

e

'ctivity

(epatic and

perip(eral

Insulin

level

)#$ )% $ % #$ #% 2$ 2% &$ ears from Diabetes

Diagnosis*+onceptual representation,- - -

Insulin resistance 8

(epatic and perip(er

9eta"cell function

Postprandial glucose

Fasting glucose

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Dual defe-t of type 2 diabetes treating amoving target

β-4ellDys@6"4#

!o"

I"s6l!"Res!s#*"

4e

Type 2D!* e#e

s

I"s6l!"

Res!s#*"4e

Nor1*l IGT % es!#y D!*,"os!s o@ #ype 2

+!* e#es

Pro,ress!o" o@ #ype 2 +!* e#es

DeFronzo R et al. Diabetes Care 1992;15:318-68

β-4ell F*!l6re

'o"4e"#r*#!o"

I"s6l!"Res!s

E6,ly4*e1!*

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PERAN

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GLP (Gl64*,o" l! e pep#!+eGIP (,*s#r!4 !"$! !#ory polypep#!+e

2!

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2"

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2#4

6 , Suppl 2, Gol 11/, o.3, S$C1 , 2/1/

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Se res! !"s6l!"-respo" "6#r!e"

2$

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3/

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K6 )?&K S& D

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K6+)?&K S& D+

K%MPLIKASI AKUT

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DIABETES MELLITUS

K%MPLIKASI

KR%NIKAKUT

C hiperglikemia akut

C hipogkilemia komainfeksi

foot ul-er

mikrovaskuler

7a; retinopathi

makrovaskuler

7a; ' D7b; 'GD7-; )GD

C ketoasidosis koma

C hiperosmolar 7$//C2 //; koma

C laktoasidfosis koma

7b; nefropathi

7i; mikroalbuminuria7ii; progresif S 5

7-; neuropathi7i; peripheral simetrisneuropatiiii; mononeuropati7iv; otonomik neuropati 70&>,

dis.se ual;

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D!* e#! +er1op*#!

3

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3!

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3"

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DATA LAB%RAT%RIUM

CGl6 os* +*r*$C< A&'CPep#!+* '

CEle #rol!#CBGA - A"!o" K*#!o" G*p

CPro@!l l!p!+C'o1ple#e Bloo+CF6",s! ,!")*lCUr!"*l!s!s

'ell

3#