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DIABETES MELLITUS
Learning objectives
METS : OVERWEIGHT
DIABETES MELLITUS
Common definitions
Abbreviation
Definition
NGT
FPG
PPG
IGT
IFG
HbA1c
Classification of diabetes
Type 1 diabetes
Beta cell destruction, usually leading to absolute insulin deficiency
Type 2 diabetes
Progressive insulin secretory defect on the background of beta cell
dysfunction and insulin resistance
Gestational diabetes mellitus
Diabetes diagnosed in the second or third trimester of pregnancy that
is not clearly overt diabetes
Other specific diabetes types
Drug or chemical induced, e.g steroids, treatment of HIV/AIDS or after
organ transplantation
Genetic defects in beta cell function or in insulin action
Diseases of the exocrine pancreas (e.g. cystic fibrosis)
ADA - Standards of Medical Care in Diabetes 2016. Diabetes Care, Vol. 39, Supplement 1, January 2016.
Type 1 Diabetes
Type 2 Diabetes
Sudden
Gradual
Age at onset
Any age
(mostly young)
Mostly in adults
Body habitus
Thin or normal
Often obese
Ketoacidosis
Common
Rare
Usually present
Absent
Low or absent
More prevalent.
90-95% of all people with
diabetes in Asia
Onset
Autoantibodies
Endogenous insulin
Prevalence
Unhealthy lifestyle
Aging population
Dietary changes
Urbanisation
Sedentary lifestyle
2013
Diagnosed diabetes
1.5%
2.1%
Undiagnosed diabetes
4.2%
4.8%
10.2%
29.9%
2013
Diagnosed diabetes
1.5%
2.1%
Undiagnosed diabetes
4.2%
4.8%
10.2%
29.9%
2013
Diagnosed diabetes
1.5%
2.1%
Undiagnosed diabetes
4.2%
4.8%
10.2%
29.9%
67.85%
81.01%
40
Over
target
20
0
Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW, Tjokroprawiro A. The DiabCare Asia 2008 studyOutcomes on control and complications of type 2 diabetic patients in Indonesia Med J Indones 2010 19; 4: 235-244.
Beta cell
Islet
Normoglycemia
produces
insulin
NORMAL
Glucose Homeostasis
Alpha cell
produces
glucagon
FASTING
Liver
INPUT NUTRISI
13
TYPE 2 DM
Diminished
insulin
Beta cell
14
Normoglycemia
Hyperglycemia
produces
insulin
Glucose Homeostasis
Insulin resistance
(decreased glucose uptake)
Liver
Alpha cell
produces
glucagon
INPUT NUTRISI
High
blood
pressure
Abnormal
lipid levels
Urine
protein
High
blood glucose
Obesity
http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/symptoms/con-20034795
Fatigue
Regardless of exercise
Itchy skin
Impotence
Adapted from Konsensus PERKENI 2015. Pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia.
ADA - Standards of Medical Care in Diabetes 2016. Diabetes Care, Vol. 39, Supplement 1, January 2016
mg/dL
Diabetes
126
100
IFG
Impaired
Fasting Glucose
IGT
Impaired Glucose
Tolerance
NGT
Normal Glucose
Tolerance
140
Diabetes
200
mg/dL
FPG
<130 mg/dL
IDF2
FPG
<110 mg/dl
PERKENI3
FPG
<130 mg/dl
HbA1c
< 7.0 %
HbA1c
< 6.5 %
HbA1c
< 7.0 %
PPG
<180 mg/dL
PPG
<145 mg/dL
PPG
<180 mg/dl
The relationship between A1C and eAG is described by the formula 28.7 X A1C
46.7 = eAG
HbA1c
eAG
mg/dL
mmol/l
6.0
126
7.0
6.5
140
7.8
7.0
154
8.6
7.5
169
9.4
8.0
183
10.2
8.5
197
11.0
9.0
212
11.8
9.5
226
12.6
10.0
240
13.4
David M. Nathan, Judith Kuenen, Rikke Borg, Hui Zheng, David Schoenfeld, and Robert J. Heine, for the A1c-Derived Average
Glucose (ADAG) Study Group. Diabetes Care 2008
80
Microvascular disease
60
40
Myocardial infarction
20
0
5
10
11
97
126
154
183
212
240
269
-14%
HbA1c
-1%
-37%
-21%
Myocardial
infarction
Microvascular
complications
Deaths related
to diabetes
Source: Konsensus Pengelolaan dan Pencegahan DMT2 di Indonesia. PERKENI. 2011. Diabetes Care 2012. Penatalaksanaan
Diabetes Melitus Terpadu. 2009
Source: Konsensus Pengelolaan dan Pencegahan DMT2 di Indonesia. PERKENI. 2011. Diabetes Care 2012. Penatalaksanaan
Diabetes Melitus Terpadu. 2009
SGLT2
Nathan DM et al. Management of Hyperglycemia in type 2 Diabetes, a consensus algorithm for the initiation and adjustment of
therapy, a consensus statement from ADA/EASD. Diabetes Care 2006;29(8):1963-72.
American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes 2015.
Diabetes Care 2015;38(Suppl. 1):S41S48
Risiko
Kardiovaskular
(+)
18,5 - < 23
Glukosa darah
Puasa (mg/dL)
< 100
2 jam PP (mg/dL)
< 140
A1C (%)
< 7,0
< 7,0
Sistolik (mmHg)
130
130
Diastolik (mmHg)
80
80
< 100
< 70
Tekanan darah
Profil Lipid
Total kolesterol (mg/dL)
Trigliserid (mg/dL)
HDL kolesterol (mg/dL)
LDL kolesterol (mg/dL)
Metformin
Use of metformin based on eGFR
Proposed recommendations for use of metformin based on eGFR
eGFR level (ml/min per 1.73 m)
Action
60
<60 and 45
Continue use.
Increase monitoring of renal function (every 3-6
months).
<45 and 30
30
Stop metformin
Additional caution is required in patients at risk of acute renal injury or with anticipated
significant fluctuations in renal status, based on previous history, comorbidities, or
Potentially interacting medications
Lipska et al. Use of metformin in the Setting of Mild-to-Moderate Renal Insufficiency. Diabetes Care. Vo 34, 2011.1
Eat
: intelligently
Pray
: deeply
Love
: your Body
Move
: regularly
WE DO NOT DREAM.