Manajemen DM PIT
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Transcript of 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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THANK YOU