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PENATALAKSANAAN DAN PENGELOLAANPENYAKIT KRONIS

DIABETES MELLITUS TIPE 2

Dr FX Rudhi Harsono SPD

7/21/2019 DM BPJS


APA PERAN KITA

???

MASALAH DM DI

INDONESIA

7/21/2019 DM BPJS


In!r"asin# DMPr"$a%"n!" in Indon"sia

1985 2007

WHO, Study Group 1985

RISKESDAS, 2007

5.7%

1.7%

NATIONAL

7/21/2019 DM BPJS


7/21/2019 DM BPJS


A&&ri'u&a'%" Ris( o) S"$"ra% Pr"di!&i$"Fa!&ors o) Pr"*dia'"&"s in Indon"sia

0%10%

20%

30%40%

50%0%

23.00%

47.30%5.50%

23.00%1.70%

44.40%

!r"or"ty#$ D&r'( )*ood pr((ur +AR 5.5%,$ Rdu& -'"(t &"r&u/r& +AR 47.3%$ Stop (o" +AR 44.4%.

't"o'* H'*t Sury 2007

24417 (u)6&t( /ro 33 pro"&( " Ido("'.

7/21/2019 DM BPJS


THE TOP 10 DM PREVALENCES OF THE 33 INDONESIAN PROVINCES AS REPORTED BY MINISTRY OF HEALTH – 2007

(The Resuls !" RIS#ESDAS$I%&!%es' Su&)$2007* Su++,'-e& %& Illus,e& . 2012$201/

D ' 1 e e

s P , ! 2 ' % 3 e P , e 2 l e % 3 e " ( M I L L I O N S 0

0

10

20

30

40

50

0

Ido("' +!opu*'t"o 230 "**"o # D 5.7% +'* 4.9% :'* .4%, ;ot'* D# 10 "**"o

I%&!%es' . I4T 10526 (Mle 576* Fe+le 106 T!l I4T . 1758 M'll'!%+,,-,

,MAL$9T

+,,-,

2#AL$BAR RIA9

+,.-/

0B#BLT

+1-

/

+1-3

3NAD S9L$9T

+1-,

+4-1

4:ATEN4 4RTLO

+4-4

1:ATIM

5

+-1

SBY

7506

D#I

+-

,.

S&ud6 Da&a 700 Pro$in!"s o) Indon"sia89 A#" : ,3 6rs; Sa<%"s ,5-,,/; Ur'anPou%a&ion- Dia#nosis; 'as"d on 9 Fas&in# ,.*,/ hrs; Ora% G%u!os" Loadin# 43 # 7=HO

,555*ADA 2..08; IGT 7i) Pos&%oadin# G%u!os" 9 ,/.*2.. <#>dL8; DM 7i) Pos&%oadin#G%u!os" 9 : 2.. <#>dL8

To&- DM ,.MRISKESDAS*2..4

DM ;576* DDM 15;6* 9DDM /526(2<536 (73576

;ot'* D# 10 T!l I4T . 1758 M

D 5.7%

DDM 9 Dia#no?"d DM 72-0@8UDDM 9 UnDia#no?"d DM

740-4@8

7/21/2019 DM BPJS


Indon"sia9 hroni! Dis"as"sSu"r"d '6 ASKES %i"n&s in 2.,.

ASKESC Indon"sian na&iona% h"a%&h insuran!" %an

No. DiagnosisTotal Cases Diagnosed

(Thousands)

1 R'* :'"*ur 11,875

2 Hyprt("o 29,3153 D"')t( **"tu( 420,743

4 <'&r 132,810

5 H'rt D"('( 247,203

6 Stro 117,35

7 A(t' 105,89

O(toporo("( 15,084

! Otr <ro"& D"('(( 220,151

7/21/2019 DM BPJS


Indon"sia9 aus" o) D"a&h

""(try o/ H'*t, Rpu)*"& o/ Ido("'. 2007.

No. Diseases (2""7) #

1 Stro 15.4

2 ;u)r&u*o("( 7.5

3 Hyprt("o .8

4 ;r'u' .5

5 !r"'t'* D"('(( .0

6 D"')t( **"tu( 5.7

7 '*"'&y 5.7

="r D"('(( 5.1

! <oro'ry Artry D"('(( 5.1

1" =o-r R(p"r'tory ;r'&t I/&t"o 5.1

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Dia'"&i! o<%i!a&ions

ID!S Ido("'

0

10

20

30

40

50

0

00-/

2.5

0.5

1-4

1.3

7.45.3

10.9

Rt"op'ty

urop'ty

!rot"ur"'D"'*y("(

:oot >*&r

Aput't"o

A"'

<I

H'rt :'"*ur

Stro

!AD

$i%&oangio'ath $a%&oangio'ath

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P"ran , 9 '"("rasa<a da%a< "arin#

%a6anan )as("s BPS

$ Do(&"r u<u<; Fas("s ri<"r;Pus("s<as

$ Do(&"r ro%anis

$ Do(&"r Fas("s s"(und"r$ Do(&"r Fas("s &"rsi"r

7/21/2019 DM BPJS


9PAYA #ESEHATAN PERORAN4AN

→ private goods

9PAYA #ESEHATAN MASYARA#AT

→ public goods

- RS Umum/Khusus Pusat- RS Umum/Khusus Propinsi

- Kemenkes- Dinkes Propinsi

- RS Umum/Khusus Kota/Kab

- BP4, BKMM, Klinik/Praktek Dr. Spes- Laboratorium Klinik

-

Dinkes Kota/Kab- BP4, BKMM, BKOM

- Puskesmas- Klinik/Praktek Dokter Umum- BP, BKI, Praktek Bi!an

- Puskesmas

-Pos"an!u, Polin!es,Posbin!u, !ll

- UKBM# Pos"an!u,Polin!es, Posbin!u, !ll

Str

ata

$%

Strata$&

Strata$'

Mas"arakat

Peroran(an/Keluar(a

Sistim KesehatanNasional

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Pus("s<as

Dr K"%uar#a

• D"&"(si dini• P"n!"#ahan ,• "n#o'a&an

RS Ka'>

Dr S"sia%is

• D"&"(si dini• P"n!"#ahan ,;2;0• P"<"ri(saan

%"n#(a aa%• P"n#"%o%aan

&"radu an&ar'a#ian

• PERSADIA

RS Pro>

Dr S Konsu%&an

• D"&"(si dini• P"n!"#ahan ,;2;0• P"<"ri(saan

(husus• P"n#"%o%aan

&"radu an&ar'a#ian

• Kasus (o<%"(s• PERSADIA

"arin# La6anan Pasi"n DM

7/21/2019 DM BPJS


Mana#"<"n& o) hroni! Dis"as" Pro#ra<7PROLANIS8

:'"*yDo&tor

!RO=AIS

G't-

pr

''r

<o(u*t'to"tor"

!r(&r"pt"o

I/o A((, d"(" " 2010

7/21/2019 DM BPJS


P"ran 2 9 D"&"(si Dini

S(rinin#

dia#nosis

7/21/2019 DM BPJS


$ S!r""nin# is !ondu!&"d on &hos" ho ha$"

diabetes risks; 'u& do no& sho an6 s6<&o<s

o) DM

$ S!r""nin# s""(s &o capture undiagnosed DM

or prediabetes so i& !an '" <ana#"d earlier

and <or" appropriatel

$ Mass s!r""nin# is no& r"!o<<"nd"d !onsid"rin#

&h" !os&s; hi!h ar" #"n"ra%%6 no& )o%%o"d '6

a!&ion %an )or &hos" ho "r" )ound a'nor<a%-

PERKENI9 S!r""nin#

7/21/2019 DM BPJS


C,'e,' "!, Tes'%= "!, D'ees '% As)+>!+' A&ul I%&''&uls7ADA*2.,/8

,- T"s&in# shou%d '" !onsid"r"d in a%% adu%&s ho ar" o$"r"i#h& 7BMI:23(#><2+8 and ha$" addi&iona% ris( )a!&ors9 h6si!a% ina!&i$i&6 rs&*d"#r"" r"%a&i$" i&h dia'"&"s hi#h*ris( ra!">"&hni!i&6 7"-#-; A)ri!an A<"ri!an; La&ino; Na&i$"

A<"ri!an; Asian A<"ri!an; Pa!i! Is%and"r8 o<"n ho d"%i$"r"d a 'a'6 "i#hin# :5 %' or "r" dia#nos"d i&h

GDM h6"r&"nsion 7:,/.>5. <<H# or on &h"ra6 )or h6"r&"nsion8 HDL !ho%"s&"ro% %"$"% 03 <#>dL 7.-5. <<o%>L8 and>or a &ri#%6!"rid"

%"$"% :23. <#>dL 72-12 <<o%>L8 o<"n i&h o%6!6s&i! o$arian s6ndro<" A, :3-4@; IGT; or IFG on r"$ious &"s&in#

o&h"r !%ini!a% !ondi&ions asso!ia&"d i&h insu%in r"sis&an!" 7"-#-;s"$"r" o'"si&6; a!an&hosis ni#ri!ans8 his&or6 o) D

2- In &h" a's"n!" o) &h" a'o$" !ri&"ria; &"s&in# )or dia'"&"s shou%d '"#ina& a#" /3 6"ars-

0- I) r"su%&s ar" nor<a%; &"s&in# shou%d '" r""a&"d a& %"as& a& 0*6"ar

in&"r$a%s; i&h !onsid"ra&ion o) <or" )r"Ju"n& &"s&in# d""ndin# onini&ia% r"su%&s 7"-#-; &hos" i&h r"dia'"&"s shou%d '" &"s&"d 6"ar%68

A

B

,

2

0

/

3

4

1

5

,.

7/21/2019 DM BPJS


Dia'"&"s S6<&o<s

Dia'"&"s %assi!S6<&o<s 78

Dia'"&"s %assi!S6<&o<s 7*8

FPG,2

,2

RBG:2.

.2.

.

FBG andPPG

FPG:,2

,2

RBG2.

.2.

.

Dia'"&"s M"%%i&us

GDP,2

,..*,23

GDS:2.

.,/.*,55

,..

,/

.

OGTT 2 hourBG

E$a%ua&ion o) Nu&ri&iona% S&a&usE$a%ua&ion Dia'"&i! o<%i!a&ions

E$a%ua&ion Di"&ar6 N""d and Di"&ar6

P%annin#

:2.

.

,/.*

,55

IGT IFGNor<a

%

,/.

Edu!a&ionDi"&ar6 P%annin#Ph6si!a% E"r!is"

A!hi"$in# Id"a% Bod6

="i#h&

a&au a&au

a&au

FBG C Fas&in# B%ood G%u!os"RBG C Rando< B%ood G%u!os"IGT C I<air"d G%u!os"

To%"ran!"IFG C I<air"d Fas&in#G%u!os"

PERKENI GUIDELINES 2.,,

PERKENI Di &i

7/21/2019 DM BPJS


11PERKENI9 Dia#nos&i!ri&"ria )or Dia'"&"s

M"%%i&us• %assi! s6<&o<s o) dia'"&"s rando< #%u!os" %as<a

%"$"%

2.. <#>dL- Rando< #%u!os" %as<a %"$"% is a &"s&

hi!h a!!"ss #%u!os" %as<a %"$"% a& a sin#%" &i<"

i&hou& !on!"rnin# a'ou& %as& <"a% s!h"du%"-or

• %assi!a% s6<&o<s o) dia'"&"s )as&in# %as<a

#%u!os"

,2 <#>dL- Fas&in# <"ans a&i"n&s no& #"&&in# in&a("!a%ori"s

)or <ini<u< 1 hours-

or

•

2*h %as<a #%u!os" a& #%u!os" &o%"ran!" &"s& 2..< >dL- G%u!os" &o%"ran!" &"s& don" ' &h" =HO

,

PERKENI Guid"%in" 2.,,

2

0

7/21/2019 DM BPJS


PERKENI 9 DIABETES PREENTION

H'=h$,'s? >!>ul'!% @ 30$)e,

!l&$ F+'l) h's!,) !" DM

$ C,&'!sul, &'s!,&e,$ Oe,e'=h$ Se&e%,) l'"e s)le$ #%!% IF4 !, I4T$ H)>e,e%s'!%$ Elee& ,'=l)e,'&e* l! HDL

!, !h$ H's!,) !" 4es'!%l DM$ H's!,) !" ='e% ',h

@ /000=$ PCOS

$ M"di!a%Nu&ri&iona%

Th"ra6

$ Ph6si!a% a!&i$i&6

$ ="i#h& r"du!&ion

$ I) o$"r"i#h&;r"du!" 'od6"i#h& '6 3*,.@

$ Ph6si!a% ""r!is")or 0. <inu&"s;3 &i<"s>""(

$ No& 6"&r"!o<<"nd"d

Ear%6 D"&"!&ion Li)"s&6%" han#"sPhar<a!o%o#6

Th"ra6

P"riodi! B%oodG%u!os" Ris(

Fa!&or Moni&orin#

$ H6"r&"nsion

$ D6s%iid"<ia

$ Ph6si!a% h"a%&h

$ Bod6 "i#h& !on&ro%

$ 2$h!u, O4TT 's he +!s

se%s''e +eh!& "!, e,l)

&ee'!% %& ,e!++e%&e&

s,ee%'%= es >,!e&u,e

Mana#"<"n&

H-D-L*O

H . H)>e,e%s'!%

D . D'eesL . L'>'& (D)sl'>'&e+'

C . S!> C'=,ee

(S+!?'%=

O . Oes') (e'=h

C!%,!l

7/21/2019 DM BPJS


P"ran 0 9 "%a6anan(o<r"h"nsi

$ Tr"a& &o &ar#"&

$ Edu(asi

$ T"rai Nu&risi

$ T"rai O%ah Ra#a

$ OHO

$ Insu%in$ P"ran da%a< ("#aa&an a(u&

$ P"ran da%a< d"&"(si (o<%i(asi (roni(

7/21/2019 DM BPJS


RISK D 7*8 RISK D 78

!MI "kg#m$% ,1-3 20 ,1-3 20

!&''D (&)*'SE

$ FPG 7<#>dL8 ,.. ,..

$ Pos& Prandia% BG 7<#>dL8 ,/. ,/.A+* ",% 4-. 4-.

!&''D PRESS)RE ,0.>1. ,0.>1.

&IPID

To&a% ho%"s&"ro% 7<#>dL8 2.. 2..

Tri#%6!"rid" 7<#>dL8 ,3. ,3.

HDL ho%"s&"ro% 7<#>dL8 :/. > :3. :/. > :3.

LDL ho%"s&"ro% 7<#>dL8 ,.. 4.

PERKENI GUIDELINES 2.,,

TARGET OF TREATMENT

7/21/2019 DM BPJS


$ Dia'"&"s !ar" <us& '"9 on&inuous; no& "isodi!

Proa!&i$"; no& r"a!&i$" P%ann"d; no& soradi!

Pa&i"n& !"n&"r"d ra&h"r &han ro$id"r

!"n&"r"d Pou%a&ion 'as"d; as "%% as indi$idua%

'as"d

T"a< !ar"

PERKENI9 S&andards o) ar"

7/21/2019 DM BPJS


$ Id"a% core team <"<'"rs9

? A h6si!ian or o&h"r ri<ar6 !ar" ro$id"r

? A nurs"

? A di"&i!ian 7a& %"as& on" o) ho< is !"r&i"ddia'"&"s "du!a&or8

$ O&h"r &"a< <"<'"rs i%% $ar6 a!!ordin# &o &h"a&i"n& n""d; a&i"n& %oad; or#ani?a&ion!ons&rain&s; r"sour!"s; !%ini!a% s"&&in# andro)"ssiona% s(i%%s

? "-#-9 odia&ris&; har<a!is&; s6!ho%o#i!a% orso!ia% or("rs

M"nsin# - Dia'"&"s ar"2...920912*5-

PERKENI9 S&andards o) ar"

7/21/2019 DM BPJS


$ Dail Acti-ities ? B" a!&i$" <os& o) &h" &i<"

? B" rodu!&i$"

$ Sel./Management Skills ? Pr"arin# i%%s; insu%in

? Fo%%o dru# s!h"du%" ? Sid" ""!& aar"n"ss

$ 0oot *are ? Dai%6 )oo& !ar" aroria&" sho"s

$ Medical *heckup

PERKENI9 Pa&i"n& Edu!a&ion

7/21/2019 DM BPJS


)ealth" eatin(# helh) "!!& h!'es* "!!& !+>!s''!%

(,s* >,!e'%* "* "'e,

Bo!" *ei(ht maintenan+e# h'ee& ,=e !" BMI !, ,e&ue&

; – 106 !" !&) e'=h

-er+ise

Monitorin(# sel"$+!%'!,'%= !" l!!& =lu!se* A1C

)"po(l"+emia# ,e%ess sel"$,e+e%

PERKENI9 Pa&i"n& Edu!a&ion

7/21/2019 DM BPJS


MAKAN PAGI SNACK MAKAN SIANG SNACKMAKAN MALAMSNACK

$1

1

21

1

$1

1

PR'SENTASE

jadual dan porsi makan

7/21/2019 DM BPJS


7/21/2019 DM BPJS


PEMANASAN LATIHAN INTI PENDINGINAN

20

MENIT

5MENIT

5MENIT

7/21/2019 DM BPJS


4@ 4 1@ 1 * 5@ : 5@ 5 * ,.@ : ,.@Li)"s&6%"

Modi!a&ion

Li)"s&6%"Modi!a&ion

In&"nsi$"Insu%in

Li)"s&6%"Modi!a&ion

Mono&h"ra6

M"&; SU; AGI;G%inid; TD;

DPP I*i

Li)"s&6%"Modi!a&ion

2 OADso<'ina&io

n


DPP I*i

Li)"s&6%"Modi!a&ion

0 OADs

o<'ina&ion


DPP I*i

Li)"s&6%"

Modi!a&ion

2 OADso<'ina&io

n


DPP I*i

Basa%Insu%inNo&"s9

Fai%9 no& a!hi"$in# A,! &ar#"& 4@a)&"r 2*0 <on&hs o) &r"a&<"n&7A,! C a$"ra#" '%ood #%u!os" !on$"rsion;ADA 2.,.8

PERKENI Guid"%in"s 2.,,

A%#ori&h< ons"nsus ADA>EASD 2..

7/21/2019 DM BPJS


Dia#nosis9

Li)"s&6%"

M"&)or<in

Li)"s&6%" M"&)or<in

Basa% insu%in

Li)"s&6%" M"&)or<in

Su%)on6%ur"a

Li)"s&6%" M"&)or<i

In&"nsi$" insu%in

S&" , S&" 2 S&" 0

Li)"s&6%" M"&)or<in

Pio#%i&a?on"7No h6o#%6!"<ia >"d"<a 7HF8> 'on" %oss8

Ti"r ,9 "%% $a%ida&"d !or" &h"rai"s

i"r 29 L"ss "%% $a%ida&"d !or" &h"rai"s

Li)"s&6%" M"&)or<in

GLP*, a#onis& '

7no h6o#%6!"<ia>"i#h& %oss >naus"a>$o<i&in# 8

Li)"s&6%" M"&)or<in

Pio#%i&a?on"

Su%)on6%ur"a a

Li)"s&6%" M"&)or<in

Basa% Insu%in

A%#ori&h< ons"nsus ADA>EASD 2..

Na&han DM; "& a%- Diabetes Care 2..1Q0,7,289,*,,-

7/21/2019 DM BPJS


7/21/2019 DM BPJS


III I;ES;IA= E@E IHIBI;ORS αCG*u&o("d'( I")"tor +AGI # A&'r)o(

αCAy*'( I")"tor +AI # ;d'"(t'(

1

2

:IED DOSE <OBIA;IO +:D< ;!ESG%u!o$an!" ; A<ar6%*M; Ga%$us<"&; anu<"& ; Ko<'i#%6?" XR++8 ; A!&os<"&; Du"& a!&

I I<RE;ICEHA<ERS DPP$/ INHIBITORS

S'$* V'l&$ * S$ * L'%$ * Al!$* De%$*

Du!$* Mel!$* Te%el'$=l'>'%* SYR$322* TA$<<<

+Su'r"Fd # ;6oropr'-"ro 199C2014

MAP OF ORAL ANTI DIABETES (OAD IN DAILY PRACTICE

I INS9LIN SECRETA4O49ESNON$S9s (Me=l'%'&es . Ne=l'%'&e* Re>=l'%'&e

S9s . 4l'u'&!%e* 4l'>'-'&e* 4l'l-'&e* 4l'e%l+'&e* 4l'+e>','&e

4PR/0 A=!%'s (TA#$7; . ;0$200 += !%eG&)5 The l!%=$h'% FAs +>l'") =lu!se$s'+ule& '%sul'% se,e'!%* ↑ 4LP$14LIMIN (%e e,h)&,!,'-'%e$!%'%'%= lss . IME4LIMIN (1;00 += 'eG&) . ↑I%sul'%* ↑ Musle =lu!se u>?e* ↓ H4P

INCRETIN ENHANCERS

1

2

/;

3

I O;HER S!E<I:I< +OS ;!ES

AS!1941, BI 10773 , <''*"/*oF", D'p'*"/*oF", Sr'*"/*oF", Ro*"/*oF", AEC228,

KG;C181, =C4211, ;SC033, C5433 O>h!s$Bl!?e, FBPse – I%h''!,4 INCB13738 (11βHSD1–'%h''!,5 Be,e,'%e . Rh'-!+!>'&'s

Sod"u G=u&o( &o ;r'(portrC2 +SG=;2CI")"tor(#1

2G*u&o"'( A&t"'tor +GKA# ;B=1, KC0941.

4

II

C t/or" , t/or" R +G*u&op' R, 3CGu'"d"oprop"o"&CA&"d

1

3 BIG>AIDE #

'

)

G*"t'F'r <*'(( +ur'C, R''C, I'C, ;('*"t'F'r # RI;

oCG*"t'F'r <*'(( +t'*"d'( # o Ed' 'd o W"t G'"

2 OC;@D( #

;HIA@O=IDIEDIOES +;@D(# G*"t'Fo <*'((

W"tdr'-

IS>=I SESI;I@ERS (R!s'$* Bl$* R'!$* L!e$* P'!$* Ne!$* D,$=l'-!%e

D=BSC3233 +I*'&" 5Be,e,'%e (Ch'%ese He, . I%sul'% Se%s''-e, %& I%,e'% E%h%e,

Ora% Dia'"&"s Dru#s in

7/21/2019 DM BPJS


(olongan (enerik NamaDagang

Mg#tab Dosis 3arian"mg%

&ama Ker4a"4am%

0rek#hari

5aktu

Sul.onilurea

(libenclamid

Daonil $61 7 1 $61 7 +1 +$ 7 $8 + 7 $

Sebelummakan

(lipi9idMinidiab 1 7 +: 1 7 $: +: 7 +; + 7 $

(lucotrol/<& 1 7 +: 1 7 $: +$ 7 +;== +

(likla9idDiamicron >: >: 7 2$: +: 7 $: + 7 $

Diamicron/MR 2: 7 ;: 2: 7 +$: $8 +

(likuidon (lurenorm 2: 2: 7 +$: ; 7 > $ 7 2

(limepirid

Amarl +/$/2/8 :61 7 ; $8 +

(lu-as +/$/2/8 + 7 ; $8 +

Amadiab +/$/2/8 + 7 ; $8 +

Metri +/$/2/8 + 7 ; $8 +

(linidRepaglinid

Deanorm + +61 7 ; 2

Nateglinid Starli +$: 2;: 7 2

Tia9olidindion

Pioglita9one

Actos +1 7 2: +1 7 81 $8 + Tidakbergantung 4ad@almakan

Deculin +1 7 2: +1 7 81 $8 +

Pioni +1 7 2: +1 7 81 +> 7 $8 +

Penghambat(luckosidaseal.a

Acarbose

(lucoba 1: 7 +:: +:: 7 2:: 2

!ersamasuapanpertamaEclid 1: 7 +:: +:: 7 2:: 2

Met.ormin

(lucophage 1:: 7>1:

$1: 7 2::: ; 7 > + 7 2

Ora% Dia'"&"s Dru#s inIndon"sia

7/21/2019 DM BPJS


olon(an enerik ama Da(an( M(/tab Dosis )arian 0m(1 Lama Ker2a 02am1 3rek/hari aktu

Pen(hambatDPP$I5

5il!a(liptin al6us 78 78 9 '88 '& 9 &4 ' 9 & :i!akber(antun( 2a!*almakan

Sita(liptin ;anu6ia &7, 78, '88 &7 9 '88 &4 '

Sa-a(liptin On(l"<a 7 7 &4 '

Obat Kombinasi:etap

Met=ormin >liben+lami!

lu+o6an+e

&78/'.&7

:otal (liben+lami!maksimal &8 m(/hari

'& 9 &4 ' 9 &

Bersama /sesu!ahmakan

788/&.7

788/7

limepiri! >Met=ormin

mar"l$Met 3D?

'/&78 &/788&

&/788 4/'888

Pio(lita<one> Met=ormin

Pioni- M'7/788 :otal pio(lita<one

maksimal 47 m(/hari'@ 9 &4 '

%8/@78

Sita(liptin >Met=ormin

;anumet78/788 :otal sita(liptin

maksimal '88 m(/hari'

78/'888

5il!a(liptin >Met=ormin

al6usmet

78/788

:otal 6il!a(liptinmaksimal '88 m(/hari

'& 9 &4 &78/@78

78/'888

Ora% Dia'"&"s Dru#s inIndon"sia

7/21/2019 DM BPJS


*omorbid Drugs

R"!urr"n&HYPOs

M"&)or<in > GLP*,RA > DPP/*inh >AGI > TD

O$"r"i#h& >O'"s"

GLP*,RA > DPP/*inh > M"&)or<in > AGI

ardio$as!u%arDis"as"s

M"&)or<in > TD > in!r"&in T 78

on#"s&i$"

H"ar& Fai%ur"

Insu%in > M"&)or<in 78 > In!r"&in T

hroni! Kidn"6Dis"as"

Insu%in > M"&)or<in 7!r"a&inin",-38 > DPP/ Inh 7adus& dos"8

Li$"r dis"as"s

Insu%in; TD 7h"a&os&"a&osis8; DPP*/

inh 78

Insu%in in

7/21/2019 DM BPJS


Sediaan InsulinA@al Ker4a

"'nset%

PuncakKer4a

"Peak%

&ama Ker4a"Duration%

Kemasan

Insulin Prandial "Meal Related%

Insulin Short Acting

Reguler "ActrapidBC 3umulinBR%

2:/;: menit2:/:menit

2/1 4am ialC pen#cartridge

Insulin Analog Rapid Acting

Insulin &ispro "3umalogB% 1/+1 menit2:/:menit

2/1 4am Pen#cartridge

Insulin (lulisine "ApidraB% 1/+1 menit2:/:menit

2/1 4am Pen

Insulin Aspart "No-orapidB% 1/+1 menit2:/:menit

2/1 4am PenC ial

Insulin Intermediate Acting

NP3 "InsulatardBC 3umulinB N% $/8 4am 8/+: 4am +:/+; 4am ialC Pen#cartridge

Insulin &ong Acting

Insulin (largine "&antusB% $/8 4am No Peak $:/$8 4am Pen

Insulin Detemir "&e-emirB% $/8 4am No Peak +;/$8 4am Pen

Insulin *ampuran

Insu%in inIndon"sia

7/21/2019 DM BPJS


Insu%inG%ar#in"7s%o8

7 ' 12 p 7 p 12 ' 7 '

U%&ra%"n&"7$"r6 s%o8

NPH>L"n&"7s%o8

R"#u%ar7)as&8

Hu<a%o#7$"r6 )as&8

PR'0I& INS)&IN S)!K)TAN

In"!&ion

7/21/2019 DM BPJS


In"!&iono) In&"r<"dia&"*a!&in# Insu%in 7 NPH or

LENTE 8

I 3 S > = I 3 E

: : E < ;

EA=S

A

or"

A/troo

E"

"t

!H =E;EORA=

Insu%in R"#i<"n onsis&in# o)

7/21/2019 DM BPJS


I 3 S > = I 3 E

: : E < ;

EA=S

Insu%in R"#i<"n onsis&in# o)B"d&i<" In"!&ion and Mornin# In"!&ion

o) In&"r<"dia&"*a!&in# Insu%in 7 NPH or LENTE 8

"t

!H =E;E

or"

A/troo

E"

!H =E;E

B

In"!&ions

7/21/2019 DM BPJS


In"!&ionso) Shor&*a!&in# Insu%in 7 LISPRO8 '")or" M"a%s

and

Basa% a&*%on#*a!&in# Insu%in 7 GLARGINE 8

I 3 S > = I 3 E

:

: E < ;

EA=S

=IS!RO

or"

=IS!RO

A/troo

=IS!RO

E"

G=ARGIE

7/21/2019 DM BPJS


+<*""&'* Epr"&( # ;6oropr'-"ro 1993C2014

IS>=I IJE<;IO SI;ES # <=O<K WISE RO;A;IO

S"t( o/ S< I(u*" I6&t"o (ou*d ) 't t H'*ty Ar'(

D"(t'& )t- t ;-o SI;ES o/ I6&t"o # ""'**y 2.5 &

4C0 31C45

1C75 1C30

7C90 1C15

P d % ( &

7/21/2019 DM BPJS


P"ran da%a< ("#aa&ana(u&

$ Ko<a hio#%i("<i

$ Ko<a hi"r#%i("<i

7/21/2019 DM BPJS


Ko<%i(asi hio#%i("<i

$ GD 4.

$ L"<"s; #"<"&ar; %aar; ("rin#a& din#in;'"rd"'ar d"'ar; #an##uan ("sadaran

$ Sadar <inu< <anis #u%a 'iasa; <a(an<anis; r"<"n; ro&i; nasi; (ar'ohidra&

$ Tida( sadar 9 ru<ah sa(i&; in)us #%u(osa

' l '& l' " l ' ' h l

7/21/2019 DM BPJS


+8 Tru" H6o#%6!"<ia 9 Th" / 7Four8 Hor<on"s GG <a6 '"S"!r"&"d 7a&"!ho%a<in"; G%u!a#on; or&iso%; Gro&h hor<on"8

++8 R"a!&i$" H6o#%6!"<ia 9 I) P%as<a G%u!os" Raid%6 &o '"Lo"r"d and Dros S&""%6 )-"- )ro< /.. &o 4.*5. <#>dL

+<*""&'* Epr"&( # ;6oropr'-"ro 199C2014

P,'l 4u'&el'%e !" H)>!=l)e+' 'h F!,+ul 3$2$1$1"!, Ps 'h D'ees Mell'us ! A!'& H!%e) M!!% Phe%!+e%

4lL9COSELEVEL

Tr"a&<"n& o) H6o#%6!"<ia i&hFORMULA 0*2*,*,

4L9COSE /06

(+=G&L1 FLACON . 2; +L 'h 10 = 4lu!se

J 30 +=G&L . I5V 4L9COSE /06* BOL9S 3 FLACONS FORM9LA $ 3

30$;0 +=G&L . I5V 4L9COSE /06* BOL9S 2 FLACONS FORM9LA $ 2;0$70 +=G&L . I5V 4L9COSE /06* BOL9S 1 FLACON FORM9LA $ 1

70$80 +=G&L . FORM9LA $ 1I5V 4L9COSE /06* BOL9S 1 FLACON

A)&"r ,3*0. <inu&"s o) Tr"a&<"n&; i) SMBG Shos on&inu"d

H6o#%6!"<ia; &h" Tr"a&<"n& Shou%d '" R""a&"d

Mana#"<"n& o) DKA9

7/21/2019 DM BPJS


Mana#"<"n& o) DKA9E$a%ua&ion

/4

*omplete Initial E-aluationIncluding "but not limited to%F

on!urr"n&%6; '"#in "<iri!a% uid r"sus!i&a&ion i&h.-5@ Na% a& ,... <L>hr-

onsid"r $o%u<" "ansions i) h6o$o%"<i! sho!( isr"s"n&-

on&inu" uid r"sus!i&a&ion un&i% $o%u<" s&a&us and!ardio$as!u%ar ara<"&"rs 7u%s"; BP8 ha$" '""nr"s&or"d-

$M"di!a% his&or6 and h6si!a%"a<ina&ion

$o<%"&" '%ood !oun& i&hdi"r"n&ia%

$Fin#"rs&i!( '%ood #%u!os"

$S"ru< !h"<is&ri"s7"%"!&ro%6&"s; BUN; rQ s"ru<("&on"s8

$Urin" )or urina%6sis and("&on"s

$u%&ur"s as indi!a&"d 7ound;'%ood; urin"; "&!-8

$h"s& a'do<ina% *ra6

$,2*%"ad EG

Adultpatient

@ith DKA

*ompleteInitial

E-aluation

InsulinTherapI 0luids

5hen Serum(lucose Reaches

$:: mg#d&

*ontinuing

Management

K G Repletion

!icarbonate?

7/21/2019 DM BPJS


7/21/2019 DM BPJS


PEN(E&'&AAN DM TIPE $

K"nda%i#%u(osa

• GHS>Di"&• La&ihan as<ani

• O'a&OHO>Insu%in

Ko<or'id

• Dis%iid"<i• Hi"r&"nsi• O'"si&as• P Koron"r

S(rinin# dan"n#"%o%aan

(o<%i(asi

• R"&inoa&i• N")roa&i• N"uroa&i• P

(ardio$as(u%"r• Ko<%i(asi

%ain

7/21/2019 DM BPJS


komplikasi Deteksi PengelolaanMi!roan#ioa&i

- R"&inoa&i Fundus(oi K"nda%i GD; %as"r &"rai

- N")roa&i Mi(roa%'u<in K"nda%i GD; T"( Darah;'a&asi ro&"in

N"uroa&i Mi(ro%a<"n Du%o"&in; #a'a"n&in;an&id" &risi(%i(

Ma(roan#ioa&i

- P'% drh an&un# EKG Ni&ra&; s&a&in; asirin

- P'% drh &"i T"s ASO; ABI;ar&"rio#ra asodi%%a&or;h"<or"o%o#i

- P'% drh o&a( T s!an !i&i!ho%in

K'MP&IKASI KR'NIK DM

7/21/2019 DM BPJS


Tan&an#an da%a< ra(&i( s"hari hari

K"nda%i<u&u

K"nda%i'ia6a

7/21/2019 DM BPJS


"nu&u

$ DM "n6a(i& (roni( ro#r"si) 9<or'idi&as; <or&a%i&as; (o<%i(asi;'ia6a &in##i

$ P"ran do(&"r BPS 9 d"&"(si dini dandia#nosis; '"("rasa<a da%a<

"arin#; sis&"< ruu(an

$ P"ran da%a< "%a6anan 9di"&;OR;OHO; Insu%in

$ P"ran da%a< ("#aa&an dan d"&"(si

(o<%i(asi (roni(

7/21/2019 DM BPJS


7/21/2019 DM BPJS


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