panduan praktik klinis-dm (dr.bima)

8/13/2019 Panduan Praktik Klinis-DM (Dr.bima)

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PANDUAN PRAKTIK KLINIS (PPK)

RSUD WALUYO JATI, KRAKSAAN

2013 2015

DIABETES MELITUS

1. Pengert !n (De" n # ) $en%r%t American Diabetes Association (ADA) t!&%n 2010, D !'ete#

e t%# er%*!+!n #%!t% +e * + *en-!+ t et!' + eng!n

+!r!+ter #t + & *erg +e ! -!ng ter/! +!ren! +e ! n!n #e+re# n#% n,

+er/! n#% n, !t!% +e %! %!n-!.2. An! ne# # 1. Ke %&!n K !# + D$, -! t% P %r !, P "!g !, P *# !, !n

*en%r%n!n er!t ! !n

2. Ke %&!n ! n, -! t% e !& '! !n, +e#e %t!n, g!t! , !t! +!'%r,

!n #"%ng# ere+# *! ! *r !, #ert! *r%r t%# % !e *! ! 4!n t!3. K !# " +!#

. Pe er +#!!n 6 # + Peng%+%r!n t ngg '! !n, 'er!t '! !n, !n ng+!r * ngg!ng Peng%+%r!n te+!n!n !r!&, ter !#%+ *eng%+%r!n te+!n!n !r!&

! ! * # # 'er r %nt%+ en7!r +e %ng+ n!n ! !n-!

& * ten# rt #t!t +, #ert!ankle brachial index (A I),%nt%+

en7!r +e %ng+ n!n *en-!+ t *e '% %& !r!& !rter te*

Pe er +#!!n "%n %#+ *

1


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Pe er +#!!n r ngg! % %t !n +e en/!r t r

Pe er +#!!n /!nt%ng

8 ! %!# n! , '! + #e7!r! *! *!# !%*%n eng!n #tet #+ *

Pe er +#!!n e+#tre t!# !t!# !n '!4!&, ter !#%+ /!r

Pe er +#!!n +% t (acantosis nigrican !n 'e+!# te *!t

*en-%nt +!n n#% n) !n *e er +#!!n ne%r g #

T!n ! t!n ! *en-!+ t ! n -!ng !*!t en '% +!n D$ t *e

! n

5. Kr ter ! D !gn # # Kriteria Diagnosis DM:

1. 9e/! ! + !# + D$ : g %+ #! * !# ! #e4!+t% ; 200 g< L (11,1

.0


3/6

>. Pe er +#!!n Pen%n/!ng 1. D !+%+!n *! ! +e * + eng!n re# + t ngg %nt%+ D$, -! t%

+e * + %# ! e4!#! t%! ( 0 t!&%n), 'e# t!#, te+!n!n !r!&

t ngg , r 4!-!t +e %!rg! D$, r 4!-!t +e&! !n eng!n 'er!t

'! !n !& r '!- .000 gr, r 4!-!t D$ *! ! +e&! !n, !n

# * e !.2. D !+%+!n eng!n *e er +#!!n g% ! !r!& #e4!+t%, +! !r

g %+ #! !r!& *%!#!, +e % !n +%t eng!n Te# T er!n#

9 %+ #! Or! (TT9O) #t!n !r. Unt%+ +e * + re# + t ngg

-!ng &!# *e er +#!!nn-! neg!t e *er % !+%+!n

*e er +#!!n *en%n/!ng % !ng!n #et !* t!&%n, '!g *!# en 'er%# !

5 t!&%n t!n*! "!+t r re# + , *e er +#!!n *en%n/!ng !*!t

!+%+!n #et !* 3 t!&%n.

3. Pe er +#!!n *en-!r ng 'ert%/%!n %nt%+ ene %+!n *!# en

eng!n D$, T9T, !%*%n 9DPT, #e& ngg! !*!t t!ng!ne' & n #e7!r! te*!t. P!# en eng!n T9T !n 9DPT /%g!

#e'%t #e'!g! nt er!n# g %+ #!, er%*!+!n t!&!*!n

#e ent!r! en%/% D$.

. T9T D !gn # # T9T teg!++!n ' ! #ete !& *e er +#!!n

TT9O !*!t+!n g %+ #! * !# ! 2 /! #ete !& 'e'!n !nt!r!

1 0 1BB g< L (>,? 11,0


4/6

5. 9DPT D !gn # # 9DPT teg!++!n ' ! #ete !& *e er +#!!n

g %+ #! * !# ! *%!#! !*!t+!n !nt!r! 100 125 g< L (5,=

=,B


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nsulin sensiti ing agent

3. In#% n, eng!n n +!# *engg%n!n!n #e'!g! 'er +%t

Pen%r%n!n 'er!t '! !n -!ng 7e*!t

@ *erg +e ! 'er!t -!ng #ert! +et # #

Ket !# # # !'et 7

@ *erg +e ! & *er # !r n n +et t +

@ *erg +e ! eng!n !# # # !+t!t

9!g! eng!n + ' n!# O@O # # *t !

Stre# 'er!t ( n"e+# # #te +, *er!# 'e#!r, I$A, #tr +e)

Ke&! !n eng!n D$< !'ete# e t%# ge#t!# n! -!ng t !+

ter+en ! eng!n *eren7!n!!n !+!n

9!ngg%!n "%ng# g n/! !t!% &!t -!ng 'er!t

K ntr! n +!# !n !t!% ! erg ter&! !* O@O

B. 8 %+!# 1. $e !+%+!n !t &!n /!# !n ter!t%r, 3 +! t !* ngg% #e ! ! E

0,5 /! -!ng # "!tn-! #e#%! FRIP8 (F nt n% #, R&-t 7! ,

Pr gre## e, 8n %r!n7e tr! n ng). $ #! n-! / gg ng, /! !n +!+ ,

!r , ren!ng, 'er#e*e !, !n en !-%ng.

2. $eng!t%r * ! !+!n &!r !n -! t% eng!n en% 3 * r# 'e#!r

%nt%+ !+!n *!g (20G), # !ng (30G) !n # re (25G) #ert! 2 3

* r# ( !+!n!n r ng!n, 10 15G) !nt!r!n-! , eng!n

+ n#% t!# *! ! !& !t!% *!+!r g H ter e' & !&% % #e'e %

e !+%+!n et D$.

3. $en%r%n+!n er!t '! !n & ngg! en7!*! 'er!t '! !n e!

. $e !t%& !t%r!n #e ! ! n% '!t @ *erg +e + Or! !t!%

*engg%n!!n *re*!r!t n#% n %nt%+ en7eg!& + * +!# !n

e *er'! + +%! t!# & %* *!# en.

10. Pr gn # # A t! %' ! ! ' n! < ! !

A #!n!t n! %' ! ! ' n! < ! !

A "%ng# n! %' ! ! ' n! < ! !11. T ng+!t 8 en# I


6/6

1 . In +!t r $e # P!# en !'ete# e + t!nt!ng!n #e% %r & %* %nt%+

en7!*! !n en/!g! +! !r g %+ #! !r!& #e e+!t %ng+ n +e

!ng+! n r ! . Deng!n *engen ! !n g +e ! -!ng 7 7 +,

re# + ter/! n-! + * +!# +r !#+% er !n ne%r *!t

en%r%n #e7!r! 'er !+n!. Se'!g! t! '!&!n, / +! & *erten#

!n & *er * e ! t!ng!n #e7!r! !gre# ", re# + ter/! n-!

+ * +!# !+r !#+% er /%g! en%r%n #e7!r! r!#t #.

Se+ t!r =0G *!# en D$ t *e I -!ng en !*!t n#% n !*!t

'ert!&!n #e*ert r!ng n r ! , # #!n-! !*!t eng! !

+e'%t!!n, g!g! g n/! +r n +, !n +e %ng+ n!n en ngg!

en/! e' & 7e*!t.

15. Ke*%#t!+!!n 1. De*!rte en Ke#e&!t!n RI. 2005. Pharmaceutical are +ntuk

Pen'akit Diabetes$ellitus. D re+t r!t n! 6!r !# K %n t!#

!n K n +. J!+!rt!.

2. P8RK8NI. 2011. ,e-isi onsensus Pengelolaan dan

Pencegahan Diabetes $elitus ti&e ! di ndonesia .

3. A er 7!n D !'ete# A## 7 !t n. P # t n #t!te ent St!n !r # "

$e 7! F!re n D !'ete# 2010. D !' F!re. 2010 33 (S%** .1)

. A er 7!n A## 7 !t n " F n 7! 8n 7r n g #t (AAF8)

D !'ete# $e t%# F n 7! Pr!7t 7e 9% e ne# T!#+ 6 r7e.

AAF8 $e 7! g% e ne# " r 7 n 7! *r!7t 7e " r t&e

!n!ge ent " !'ete# e t%#. 8n Pr!7t. 200> 13 (S%** .1)

5. N er @$S, W!#*! / S, R!7& !n A$, et ! . /uku A#ar lmu

Pen'akit Dalam% 0ilid disi 2 . J!+!rt! ! ! *ener' t

6!+% t!# Ke +ter!n Un er# t!# In ne# !. 200>

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