macrovascular complication in diabetes mellitus

8/10/2019 Macrovascular Complication in Diabetes Mellitus

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Macrovascular Complication in

Diabetes Mellitus

Hadi Purnomo



PENDAHULUAN

Diabetes kini merupakan masalah kesehatan duniadengan 1! "t kasus

Peningkatan kasus akan ter"adi di negara berkembang dengan la"u peningkatan #$$ %

Diabetes tipe 1 bermani&estasi pada masa kanak'kanak dan de(asa dengan ge"ala berupa penurunan)) tiba'tiba serta hiperglikemia berat

Diabetes tipe # lebih ringan daripada diabetes tipe

1* +$ , -$ % penderitan.a mengalami kegemukan/edua tipe diabetes terkait dengan gangguan

"antung* stroke* tekanan darah tinggi* gangguangin"al* sara& dan kebutaan



U.S. Hospitalization for

Chronic Complications of Diabetes

Cardiovascular 77%

Other 4%

Ophthalmic 4%

Neuroloic !%

"enal #%



Diabetes and 0ncreased C risk 2he 3ramingham 4tud.5 6AMA 1-++7#8$79:8'8$5 3atal AM0 in men (ith DM

double5 3atal AM0 ini (omen (ith DM;uadruple

High out o& hospital &atalit. &ollo(ing &irst

AM0 in men (ith DM2here&ore diabetic treatment should includeoptimal therap. &or both o& these disease



Aging population → more sedentar. <over(eight → incidence DM↑

+$ % o& death → cardiovascular disease

± !: % 0schemic Heart DiseaseDM t.pe 0 = t.pe 007 #=+

DM → t(ice incidence o& AC4 1*: , # >

death a&ter AM0



Pathoph.siolog. = macrovasc compl5

asculopathic state caused b. multiple

metabolic derangement =

H.pergl.cemia

H.perinsulinemia

Abberancies o& the coagulation s.stem

Associated other risk &actors = obesit.* old*

h.pertention



H.perinsulinemia→ premature atherosclirotic

disease A (eak independent risk &actor D.slipidemia = high LDL < total 2rigl.cerides

decreased HDL

Elevated LDL = smal , dense ↑

gl.cation o& LDL

Coagulation 4.stem =

Platelet &unction →↑ trombo>ane A#

?eduction in li&e span ↑ von @illebrand &actor

&ibrinogen* d5driver* thrombin PA0'0 and activit. &actor

000



Changes in vasoreactivit.↓ No production and action

↑ No scavenging

)lunted vasomotor reactivit. caused b. microvascularatherosclerosis

Neuropathic changes → autonomis neuropath. → unopposed s.mpathetic tone → plague instabilit.→ ↑ AC4* arrh.tmogenicit.* CH34ensor.neuropath. → at.pical chest pain →

delanged to hospitalAltere anaerobic mechanism = inappropriate &ree&att. acid metabolism→ impair vasoreactivit.* ↑ arrh.thninogenicit.* decrease contractilit.*

increased in&arct sie

Associated &actors



Mortalit. a&ter acute coronar. s.ndrome in

diabetic patient still high compare to non DM

0nsulin anaerobic metabolism

2o reverse this derrangement (ith B0/therap.

0schemic preconditioning

2he used o& anti gl.cemic drugs



4uggested 2herap.3LU0D4

0N4UL0N

P2A440UM

)0CA?)NA2E



!5

15

45

/5

'5

5

5

5 ' / 4 1

+ o r t

a l i t 6 % 7 ) 8 5.55

Diabetic

Non&

Diabetic

9ive&ear mortalit amon diabetics and non diabetics durin

follo* up after mocardial infarction

Duration of follo* up6ears

Herlitz : (cta +ed Scand#;;



5

5

#5

;5

75

!5

15

45

/5

5 ' / 4 1

S u r v

i v a l 6 % 7

Diabetic

Non&

Diabetic

Survival rates for diabetic and non&diabetic sub<ects aed !1

ears or more=*ith anioraphical proven C(D

Duration of follo* up6ears

2arzila :> et al (m : Cardio##4?74-//4&#



Diabetes and Coronar (rter Disease

8 ! ears 7 ears Duration of diabetes

$he /.1&ear incidence 6% of CHD death *ith respect to the

median of Hb(c and duration of diabetes.

%4

'

5

;

!

4

'

5

@uusisto et al Diabetes 4/?#!5&#!7= ##4

Hb(c A#.;Hb(c 8#.;



0ea,l related to theduration of the diabetes

Diabetes and Coronar (rter Disease

$pe&' Diabetes

+acrovascular complication

' B/ times hiher than non diabetic

Hih prevalence of cardio&vascular complications

at dianosisOccurs before diabetes develops 63$

nsulin resistance sndrome



Coronar +ortalit in Diabeticand Non Diabetic +en

5 '5 /5 45 15 !

;5

!5

45

'5

5

5

Diabetic

Non Diabetic 4 5 e a r

C H D m o r t a l i t p

e r 4 5 5 5

Sstolic blood pressure 6mmH

;5

!5

45

'5

5

5

Diabetic

Non Diabetic

4 1 ! 7

4 5 e a r

C H D m o r t a l i t p

e r 4 5 5 5

Serum cholesterol 6mmol>

Stamler et al Diabetes Care !-4/4&444=



Conclusion of 2lood )ressure ControlConclusion of 2lood )ressure ControlStudStud

$he U@)DS has sho*n that tiht blood

pressure control reduces the ris, of

diabetic macro and microvascular

complications

U K P D

S



Coronary Angiography in Diabetic Patients

1. Diabetes is associated with more severe

atherosclerosis of the coronary vesselsindependently of other risk factors

2. The effect of diabetes on coronary atherosclerosisis greater in women than in men

. Coronary atherosclerosis e!plains the higher cardiacmortality of diabetic patients". Diabetic patients witho#t P$% &previo#s myocardial

infarction' have a similar degree of coronaryatherosclerosis and mortality rates as non(diabeticpatients with P$%

). Protein#ria is not by itself a marker of coronaryatherosclerosis b#t does identify* especially indiabetic people* a s#bgro#p of patients at high risk

of cardiac death Natali ( et al Diabetoloia '555?4/-!/'&



(pproaches for "is, "eductionin $pe&' Diabetic )atients

Stop smo,in

Optimize diabetes control

Screen and treat hprtension

Screen and treat dslipidemia3ive dietar adviceOptimizin diabetes control

+aintainin ideal bod *eiht

>o*erin lipids

ncourae aerobic eEercise

Schernthaner 3Schernthaner 3

##!##!



Kesimpulan

F Diabetes <elas merupa,an fa,tor risi,o ):@ an independenF +a,in tini ,adar Hb(c ma,in tini

,emun,inan mendapat ):@F @orelasi ,adar lu,osa darah pp lebih bai,

dibandin denan puasa dalam ,aitannadenan ):@ 6belum ada 2+

F @elainan vascular pada diabetes lebihbana, berma,na pada ,elainan multi vessel

F Hubunan antara lamana diabetes denanprevalensi ):@ tida, cu,up ,uat



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macrovascular complication in diabetes mellitus

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