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FACTS ON INDONESIA
2013
2007
5,7 %
8,500,000
>11,000,000
FACTS ON INDONESIA
Hospitals all over the country**
Type A
Type A
Type B
RSU 20
RSK 38
RSU 262
Type B
Type C
Type C
Type D
Type D
RSK 47
RSU 599
RSK 181
RSU 498
RSK 36
Glycemic targets
ADA1
FPG
<130 mg/dL
HbA1c
< 7.0%
PPG
<180 mg/dL
IDF2
FPG
<110 mg/dl
HbA1c
< 6.5%
PPG
<145 mg/dL
HbA1c
< 7%
PPG
<140 mg/dl
PERKENI3
FPG
<100 mg/dl
9.0
8.66
Mean HbA1c ( % )
8.60
8.5
8.15
8.03
8.0
8.18
7.87
7.5
Perkeni /
ADA
Target
7.0
6.5
6.0
Bangladesh
Indonesia
Malaysia
Philippines
Singapore
Thailand
Adapted from Mafauzy et al. Med J Malaysia 2011;66:175-81; Latif et al. Bangladesh Med Res Counc Bull
2011;37:11-16; Soewondo et al. Med J Indones 2010;19:235-44; Novo Nordisk data on file.
KADAR HbA1c
<7%
7-8%
GHS
GHS
Gaya Hidup
Sehat
8-9%
>9%
9-10%
>10%
+
Monoter
apiSU,
Met,
GHS
Konsensus
Pengelolaan dan Pencegahan
Diabetes Melitus tipe 2
di Indonesia
2011
+
Penurunan
GHS
berat
AGI,
Kombina
badan
Glinid,
si
+
Mengatur
TZD,
2 obat
GHS
diit
Kombina
Met,
SU,
Latihan
DPP-IV
si
+
AGI,
Jasmani
3 obat
teratur
Glinid,
Catatan
Kombina
Met,
SU,
1.Dinyatakan gagal bila
TZD,
si
AGI,
dengan terapi 2-3 bulan
DPP-IV
2 obat
tidak mencapai target
Glinid,
Met,
SU,
HbA1c <7%
TZD,
AGI,
2.Bila tidak ada
DPP-IV
pemeriksaan HbA1c
Glinid,
dapat digunakan
TZD
+
GHS
pemeriksaan glukosa
darah. Rata-rata glukosa
+
Basal
darah sehari
Insulin
dikonversikan ke HbA1c
Insulin
menurut kriteria ADA
Intensif*
*insulin intensif : penggunaan insulin basal bersamaan dengan insulin prandial
2010
DiabetesCare,Diabetologia.19April2012
DiabetesCare,Diabetologia.19April2012
DiabetesCare,Diabetologia.19April2012
Basal
Insulin
Basal
Insulin
Basal
Insulin
DiabetesCare,Diabetologia.
19April2012[Epubaheadofprint]
Basal
Insulin
Insulin
(multiple daily dosages)
Polypharmacy
Drug interactions
Side
effects
Cost
- Hypoglycemia
- Weight gain
- GI disturbances
Longer
Consultation
Diabetic
education
Compliance/ adherence
15
Hypoglycaemia/
weight gain
HbA1c
16
Severe hypoglycaemia
Male Female
Mild hypoglycaemia
Male
Female
Kidney problems
Male Female
Blindness
Not worried
Visual analogue scale showing patients worries about mild and severe
hypoglycaemic events, ranging from not worried to very worried
Pramming S, et al. Diabet Med 1991;8:21722
Very worried
18
Haemodynamic changes:
ECG changes:
longer QT interval
hypokalaemia
Haemorheological changes:
platelet activation
increased viscosity
Episodes accompanied by
cardiac symptoms (%)
20
15
10
5
0
Study of 72-h continuous glucose monitoring and
simultaneous cardiac Holter monitoring in patients with
T2DM treated with insulin and history of frequent
hypoglycaemia and coronary artery disease (n=19)
54 episodes of hypoglycaemia reported (BGL <70 mg/dl)
59 episodes of hyperglycaemia reported (BGL >200 mg/dl)
19
20
P<0.000
1
P=0.01
P<0.03
P=0.03
P<0.000
1
RR
P<0.000
1 P<0.000
1
Diabetes
duration
BMI
(kg/m2)
(years)
*History of peripheral neuropathy (yes vs. no); **per 1 year increase
Serum
creatinine
(mol/l)
Miller ME et al. BMJ 2010; 340:b5444
21
Obesity
SUs14
0.94.6
TZDs46
Insulin
resistance
Treatment
Metformin + SU
Type 2
diabetes
0.33.0
Meglitinides4,7,8
13
Metformin + TZD5,6,9
0.31.9
0.82.1
5 4 3 2 1 0 1
Weight
Weight
loss
neutral
4 5
Weight
gain
22
Compliance Study
Prospective Study in 11,896 T 2 DM Patients
11 %
6%
46 %
37 %
Compliance
1-3/month
1/week
>1/week
Guillausseau, Influence of Oral Antidiabetic drug compliance on metabolic Control in T2 DM, Diabetes Metab
2003, 29, 79 - 81
23
Individualized
Approach to therapy
management of
Approach
hyperglycemia
Less
string
ent
More
stringen
t
Highly motivated,
adherent, excellent selfcare capacities
Low
High
Newly diagnose
long
Short
Absent
Few/Mild
Severe
Absent
Established vascular
complications
Few/Mild
Severe
Important
comorbidities
Resources, support
Readily
Limited
32
Helping
patients stick
to their
therapy!
Drug
prescription
End
Discontinuation prescription
Compliance
Persistence (days)
Time
* Tolerability issues include symptoms of hypoglycaemia, constipation/diarrhoea, headaches, weight gain & water retention
Pollack MF et al. Diabetes Research & Clinical Practice 87 (2010) 204-210
33
Non-adherence to therapy
Knowledge deficit
Medication cost
Complicated regimens
Side effects
34
35
35
36
36
Cases(million)
1. China
92.3
2. Indonesia
7.6
3. Japan
7.1
4. Philippines
4.3
5. Thailand
3.4
6. Republic of Korea
3.2
7. Vietnam
3.2
8. Malaysia
2.1
9. Australia
1.9
10. Myanmar
1.8
Adapted from International Diabetes Federation. Diabetes Atlas Update 2012 .Available from
http://www.idf.org/sites/default/files/IDF_WP_5E_Update_FactSheet.pdf (accessed 9 Jan 2013)
37