dm-mfk 2016 edit
TRANSCRIPT
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FARMAKOTERAPI
DIABETES MELLITUSPROGRAM MFK
BUDI SUPRAPTIDEPARTEMEN FARMASI KLINIS
FAKULTAS FARMASIUNIVERSITAS AIRLANGGA
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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
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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'$' Perkeni 20//
PERLU ASU.AN KEFARMASIAN3P.ARMA EUTI AL ARE4
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BATASAN DIABETES MELLITUS
Kr!#er!* +!*,"os#! DM .
&/ GDA 200 1, +l ( &&3& 11ol L +e",*" ,e)*l* DMA4* --- 5* #6 *p*p6" #*"p* 1e1per$*#! *"
)*", *#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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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$//C2 //; koma
C laktoasidfosis koma
7b; nefropathi
7i; mikroalbuminuria7ii; progresif S 5
7-; neuropathi7i; peripheral simetrisneuropatiiii; mononeuropati7iv; otonomik neuropati 70&>,
dis.se ual;
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D!* e#! +er1op*#!
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3!
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3"
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DATA LAB%RAT%RIUM
CGl6 os* +*r*$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#