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7/24/2019 Manajemen DM PIT

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TYPE 2 DIABETES MELLITUS

FROM PREVALENCE TO CLINICALGUIDELINES


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Definition

Type 2 diabetes is a chronic

progressive metabolic disorder Characterized by defects in both

insulin action (insulin resistance)

and insulin secretion (-cell failure)


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Type 2 Diabete

Type 2 diabetes is the most common

clinical form of diabetes(about 90-9! of all cases)

"revalence tends to increase in the

#orld


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P!e"a#en$e of type 2 %iabete

Western

$urope (2002) % ! in the middle-aged and older population &' (2002) % !

&nited *ingdom % 2! (over +0s) ,evelopment countries % . / 2 !


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In%oneia

anado % 1.!

Tasimalaya % .!

*ec3 'esean % 0.!(Tana Tora4a)

'urabaya % .+5-.+6!

7aarta % 2.! aassar % 2.9!


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Eti&ate an% p!o'e$tion of t(e p!e"a#en$e

of %iabete )*++,-2.*./

8areham 73 edicine :nt 2002; 02()% -53


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0ito!y of %iabete $#aifi$ation

8oung diabetics

- dult diabetics- $lderly diabetics

, (91)

- "re diabetes

- 'uspect diabetes- Chemical?latent diabetes

- =vert diabetes


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7oslin (96)

-


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Classification (, 200+)

Type diabetes

Type 2 diabetes

=ther type diabetes

@estational diabetes


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Dio!%e! of 1#y$e&ia etio#o1i$ type an% ta1e

,3 ,iabetes Care 200+; 26%-03


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olan 773 edicine :nt 2002; 02()% 1-03


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etabolic disorders in type 2 diabetes

0epati$ 1#3$oep!o%3$tion

Pan$!ea

Li"e!

In3#ine$!etion

0ype!1#y$e&ia

M3$#e

G#3$oe3pta4e

In3#in!eitan$e5

In3#in%efi$ien$y

5


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Feat3!e of type 2 %iabete

&sually presents in over-50s

=nset is gradual

,iagnosis often missed (up to 0! of cases)

ot associated #ith etoacidosis. though etosis canoccur

:mmune marers is only 0!

Aamily history is often positive

lmost 00! concordance in identical t#ins ,iet. eBercise and oral medication can often control

hyperglycemia; insulin may be reuired later in thedisease


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Metabo#i$ yn%!o&e 6 $#ini$a# feat3!e of

in3#in !eitan$e

:nsulin resistance


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Clinical symptoms of diabetes

'pecific complaints o specific complaints

Aasting glucose

t time glucose

F 21 G 21

F 200 G 200

F 21

F 200

0-2

0-99G 0

Hepeat % at time glucose

or fasting glucose

Aasting glucose

t time glucose

F 21

F 200

G 21

G 200

=@TT

2h pp

F 200 +0-99

ormal:@T :mpaired A@,:I$T$' $EE:T&'

G +0

A#1o!yt(&

of Dia1noi


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Dia1noti$ $!ite!ia fo! %iabete

"lasma glucose at time F 200 mg?dl

Aasting plasma glucose F 21 mg?dl

2-hour plasma glucose F 200 mg?dl

(after 6-g oral glucose test)


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P#a&a 1#3$oe fo! %ia1noi

G#3$oe #e"e# )&17%#/ Sa&p#e Not DM Un$e!tainDM

DM

P#a&a 1#3$oe at ti&e Vein b#oo% 8 **. **.-*++ 9 2..

Capi##a!yb#oo%

8 +. +.-*++ 9 2..

Fatin1 p#a&a 1#3$oe Vein b#oo% 8 **. **.-*2: 9 *2;

Capi##a!yb#oo%

8 +. +.-*.+ 9 **.


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P!in$ip#e of &ana1e&ent of

type 2 %iabete

$ducation

Aood planning

$Bercise

"harmacological intervention


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E%3$ation

8hat is type 2 diabetes J

Controlling

onitoring

*no#ledge improvement


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Foo% p#annin1

Aood composition J

:deal body#eight Iody ass :ndeBAsia Pacific Classification

&nder#eight G .ormo#eight .-22.9

=ver#eight F 25.0

t ris 25.0-2+.9=bese 2.0-29.9

=bese 2 F 50


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Foo% $o&poition

10-60!20-2!

0-!


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E


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P(a!&a$o#o1i$a# inte!"ention


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D!31 Me$(ani& of a$tion A%"e!e effe$t De$!eae of

0bA*$'ulfonylurea insulin secretion I8


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Aasting glucose (mg?dl) 0 - 09 0 - 2 F 21

2h-pp glucose (mg?dl) 0 - ++ + - 69 F 0


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P!e"ention of %iabete

"rimary prevention


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S$!eenin1 fo! %iabete

3 ge % F + years old

23 8eight % HI8 F 0!. I: F 25 g?m5

53


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