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Hypoglycemic Agent
Prof. DR. dr. Hadyanto Lim, M.Kes,SpFK,FESC,FIBADept. of Pharmacology, Faculty of Medicine,
Methodist University of Indonesia-Medan
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Tekanan
Darah
KolesterolLDL
KencingManis
Merokok
S
TRESS
OKSID
ATIF
Kerusakan Pemb. Darah
Peradangan
NYER
I
DA
DA
Dzau VJ. Hypertension 2001; 37: 1047-52Ross, R. N Eng J Med 1999; 340: 115-126
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Patel A. et al. The ADVANCE collaborative Group N Engl J Med 2008; 358: 2560-72
Cumulative Incidences of Events, According to Glucose-Control Strategy
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Diabetes ? Classification of DM
The Regulation and Dysregulation of Blood Glucose
Clinical Features of Type I and Type DM
Criteria of DM Pathophysiological Basis of the Symptoms and
Signs of Diabetes
Complications of DM
Drugs Used in Controlling DM
Evidence-based medicine on DM
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A clinical syndrome characterized by
hyperglycemia due to absolute or relativedeficiency of insulin.
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Type 1 diabetes (results from -cell destruction, usually leading to
absolute insulin deficiency)
Type 2 diabetes (results from a progressive insulin secretorydefect on the background of insulin resistance)
Other specific types of diabetes due to other causes, e.g., geneticdefects in -cell function, genetic defects in insulin action, diseasesof the exocrine pancreas (such as cystic fibrosis), and drug orchemical-induced diabetes (such as in the treatment of AIDS or
after organ transplantation)
Gestational diabetes mellitus (GDM) (diabetes diagnosed duringpregnancy)
The classification of diabetes
American Diabetes Association 2010
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Etiologic Classification of Diabetes Mellitus
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Normal Glucose Metabolism
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1. A1C 6.5%. OR
2. FPG 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intakefor at least 8 h. OR
3. Two-hour plasma glucose 200 mg/dl (11.1 mmol/l) during anOGTT.
The test should be performed as described by the World Health
Organization, using a glucose load containing the equivalent of 75 g
anhydrous glucose dissolved in water. OR
4. In a patient with classic symptoms of hyperglycemia orhyperglycemic crisis, a random plasma glucose 200 mg/dl (11.1mmol/l).
American Diabetes Association 2010
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Pathophysiological Basis of the Symptoms and Signs of Diabetes
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Acute : Diabetic Ketoacidosis
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Chronic :
Macrovascular Disease (Coronary, Cerebral and
Peripheral vascular disease)
Microvascular Disease ( Diabetic microangiopathy)
: Diabetic Nephropathy, Diabetic Retinopathy,
Diabetic Neuropathy
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Insulin ResistanceHyperinsulinemiaand Atherosclerosis
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Drugs Used in Controlling Diabetes
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The Characteristics of Type I and Type II DM,Classified by National Diabetes Data Group in 1979
HLA, Human Leucocyte Antigen
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Insulin
Oral Antidiabetic
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Pharmacokinetic Profiles of Insulin
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Hypoglycemic Drugs
- Sulfonylurea drugs- Meglitinide drugs
- Rapaglinide (Prandin)
- Nateglinide (Starlix)
Antiglycemic Drugs
- Metformin- Thiazolidinediones
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
-Glucosidase Inhibitors- Acarbose (Precose) ,
- Miglitol (Glyset)
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Mechanism of Action of Oral Hypoglycemic Agents
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Pharmacologic Properties of Oral Antidiabeic Drugs
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FPG, Fasting Plasma Glucose Concentration
PPG, Postprandial glucose concentration HBA1c , Glycosylated hemoglobin conc.
Effects of Oral Antidiabetic Drugs
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Diet
Exercise
Drugs Education
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The Role of Amyloidogenic Islet Amyloid Polypeptide in the
Pathogenesis of type 2 Diabetes Mellitus
Prevalence of retinopathy by deciles of the distribution of
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Prevalence of retinopathy by deciles of the distribution ofPG, 2hrPPG and HbAlc in 40- to 74-year-old participants inthe National Health and Nutritional Epidemiologic Survey
(NHANES III).
x-axis ,the lower limit of each decile group. FPG=fasting plasma glucose;2hrPG=two-hour postprandial plasma glucose; HbA1c=glycosylated hemoglobin)
Pooled relative risk and risk difference (per 1000 patients over 5 years of treatment) estimates
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ofsevere hypoglycemia, by trial, early and more recent trial subgroups, and overall.ACCORD= Action to Control Cardiovascular Risk in Diabetes (12); ADVANCE = Action in Diabetes and
Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (13);UKPDS = United Kingdom Prospective Diabetes Study (8, 11); VADT = Veterans Affairs
Diabetes Trial (14).
Kelly T N et al. Ann Intern Med 2009;151:394-403