simpo awam - komplikasi diabetes melitus

8/17/2019 Simpo Awam - Komplikasi Diabetes Melitus

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DR. dr. Eva Decroli, SpPD-

KEMD, FINASIMCurriculum Vitae :

T.TGL-L : Padang Panjang,19 Desember 1959

Jabatan e!arang :- "P PPD # $" %nand

- "etua ubbagian &etab'li!

(nd'!rin'l'gi )ag. #PD $" %nand

Jabatan *ang Perna+ Disandang :

-/ : e!retaris )agian #PD $" %nand

/-11 : e!retaris PPD #PD $" %nand


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"'m0li!asi Diabetes &elitus

Dr. dr. Eva Decroli, Sp.PD-KEMD, FINASIM

Simposium Umum PIB XI Pada!", # Fe$ruari %&'(

Pa!"era!)s Beac* +oel


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eca0: T+e g'al '2 diabetes management is t' secure '0timal

gl3cemic c'ntr'l t' a4'id c'm0licati'ns

Diabetic

retinopathy

Leading cause

of blindness

in working-ageadults1

Diabetic

nephropathy

Leading cause of

end-stage renal

disease2

Cardiovascular disease

Stroke

1.2- to 1.8-foldincrease instroke3

Diabetic

neuropathy

Leading cause of

non-traumatic

lower extremity

amputations5

75 diabetic

patients

die from !"

e#ents$

1 Fong DS, et al. Diabetes Care 2003;e 26 (Suppl.1):S99–S102. 2 olit!" #, et al. Diabetes Care 2003; 26 (Suppl.1):S9$–S9%. 3 &annel ', et al. * +eart 1990; 120:6-2–6-6. $ra/ u45in S. e7tboo5 o8 Diabetes 199-. a/8iel4 , et al. Diabetes Care 2003; 26 (Suppl.1):S-%–S-9.

Microvascular Macrovascular

%iabetic &oot

'rectile %ysfunction

()e most secreti#e

!omplication of %*


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eca0: is! '2 C'm0licati'ns increases as b16c increases

Stratton et al. 2000;321:$0–12

/'0

/'0

Updaed Mea! +$A'c 123

Adjusted for age, sex, ad et!ic group

I ! c i d e ! c e p e r ' . & & &

p a i e ! - 4 e a r s


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eca0: #t7s t+e diabetes-related c'm0licati'ns 8 n't t+e diabetes

medicine - t+at carries t+e biggest c'st t' t+e s'ciet3

"ost icreases #it! a factor of $$.% if patiets develop co&plicatios'ASKES Data(

)S*

%++%++

%++

SS 2010 npublis"e4 4ata

$$.%/


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P'siti4e legac3 e22ect '2 earlier gluc'se c'ntr'l

Provides lo!"-erm reducio!s i! $o* microvascular a!dmacrovascular complicaio!s

%0 p12.2 $30 p12.22 0 p12.224 50 p12.23

A6

dia7etesedpoitMicrovascul

ar disease

M6ocardi

alifarctio

Deat!

'a6cause(

0 p12.2%$$%0

p12.2255

0 p12.33 $0 p12.2

+++, at end of /%0RRR5 a e!d FU 1media! 6. 4ears3

RRR7 relaive ris8 reducio! o9 i!e!sive *erap4over co!ve!io!al *erap4

&DS %0. +ol*an et al.


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Diabetes e0+r'0at+3Characteristics

• Persise! al$umi!uria

• Dia$eic rei!opa*4

• +4pere!sio!

• Decli!e i! 8id!e4 9u!cio! 1a$ou '% mlmi!4ear3


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Diabetes e0+r'0at+3Prevention and Treatment

DCCT. Diabetes 1996;45:1289–98

:l4caed *aemo"lo$i! 123

6 '%

&.&

&.(

&.6

&.0

&.%

''' ;

P r o $ a $ i l i 4 o 9

m

i c r o a l $ u m i ! u r i a

•Mai!ai! i"* "l4caemic a!d $loodpressure co!rol

• Muli9acorial diseasema!a"eme!7

• a!i*4pere!sive a"e!s• "ood $lood "lucose co!rol

• co!rol o9 d4slipidaemia

• mo!iori!" re!al 9u!cio!

• li9es4le c*a!"es, i!cludi!"

smo8i!" cessaio! a!dlo


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&icr' &acr'-albuminuria

$3!8 2 - $55 &g+$3! 922 &g+$3!

:ado& spot8 2 - $55 &cg+&g 922 &cg+&g

Morig spot8 2 ; $55 &cg+&g 922 &cg+&g

Dipstic


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atural +ist'r3 '2 diabetic ne0+r'0at+3

.

FunctionalGFR

(90-95%)

Microalbuminuria,hypertension

Proteinuria, nephroticsyndrome, GFR

)riar6 protei excretio=F:

U r i ! a r 4 p r o e i ! e = c

r e i o ! 1 m " d 3

>ears

: l o m e r u l a r 9 i l r a i o ! r a e 1 : F R 3 1 m ? m i ! 3

&

'&

'&&

&

'& ' %& %

%&

%&&

'&&&

&&&

I!cipie! dia$eic!ep*ropa*4

Pre @ver dia$eic!ep*ropa*4

E!d-sa"ere!al disease

' % / (

>ora , et al. n: o"nson , Fee"all/ , e4s. Co*pre"ensi?e Clini!al


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Diabetes etin'0at+3

No-Dia7etic:etia

Dia7eticMaculopat!6

ProliferativeDia7etic:etiopat!6


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Diabetes etin'0at+3Risk Factors and Classification

•Poor "l4caemic a!d $loodpressure co!rol i!crease*e ris8 o9 rei!opa*4

• Five cae"ories7

• Mild No!proli9eraive

• ModeraeNo!proli9eraive

• Severe No!proli9eraive

• proli9eraive

• adva!ced dia$eic e4e

disease

• maculopa*4

C"atur?e4i et al. Diabetes Care 2001;2$:2%$–9

?o!do! +$A 'c 123 R

e i ! o p a * 4

i ! c i d

e ! c e 1 o d d s r a i o

3

( 0 #

&

'&

6;

/

/&

%

%&

'

'&

D +$A 'c 123

.; ;.; '&.6#.66.60.; ''.#


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Diabetes etin'0at+3Prevention and Treatment

• Mai!ai! i"* "l4caemic a!d $lood pressure co!rol

• Re"ular e4e e=ami!aio!s

• rea


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Diabetes eur'0at+3Risk Factors and Common Types

• +4per"l4caemia is*e leadi!" cause o9dia$eic !europa*4

• Alco*ol ma8es

!europa*4


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Diabetes eur'0at+3Prevention and Treatment

• Mai!ai! i"* "l4caemicco!rol o reduce *e ris8 orpro"ressio! o9 !europa*4

• E=clude or reaco!ri$uor4 9acors7

• alco*ol e=cess• viami! B'% de9icie!c4

• uraemia• @99er pai! relie9 $ased o!

*e domi!a! s4mpoms

DCC.


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(rectile D3s2uncti'nDefinition

ED is t!e ia7ilit6 to ac!ieve ad &aitai a erectio

ade>uate for itercourse to t!e &utual satisfactio of

t!e &a ad !is parter.

:e&e&7er, 7ot! parters i a relatios!ip are affected


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(rectile D3s2uncti'nBackground

G %0-4%0 of &e #it! dia7etes #ill experiece at least so&edegree of ED

G Me #it! dia7etes ted to develop erectile d6sfuctio 2 to% 6ears earlier t!a &e #it!out dia7etes.

G Me #it! dia7etes #ill !ave ED

H %20-20 i 9 %2 6ears old

H 5%0 i 942 6ears old


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(rectile D3s2uncti'nRisk Factors

:is< Factors

Neuropat!6

Perip!eral vascular disease

Poor gl6ce&ic cotrol

Dia7etes duratio ad co&plicatios

Age ad !ig! ?MI

S&o


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Cardi'4ascular DiseasesPatients with Type 2 Diabetes at a increased risk of CD

• Ris8 o9 cardiovascular diseaseis "reaer i! paie!s


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Cardi'4ascular DiseasesRisk for !yocardial infaction and stroke increases with progression to Type 2 Diabetes

"a#te fr$% H& et al. Diabetes Care 2''2; 25:1129(!4

Relaive ris8 9or MI a!d sro8e i!


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Pre4enti'n '2 Cardi'4ascular Diseases

4apte4 8ro* Sta*ler et al. Diabetes Care 1993;16:$3$–$$

• Reduce ris8 9acors 9orcardiovascular disease7

• sop smo8i!"

• rea *4pere!sio!

•rea *4perlipidaemia

• improve "l4caemic co!rol

• reduce


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P''r C'ntr'l '2 CV is! $act'rs in Diabetes ;6(<

)a*a+ )H et al. J"M" 2''4

CV risk factors target Frequency

• 0-!)olesterol 2 mgdl 45.2 mmoll 52

• 6/ 138 mmg 3

• b91c 7. 37

• 9ll t)ree risk factors controlled 7

•

nc)anged !" risk factors from 1::1 to 2


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'. +4pere!sio!

%. D4slipidemia

/. A!iplaele a"e!s

(. Smo8i!" cessaio!

. +D scree!i!" a!d reame!

Treatment '2 Cardi'4ascular Diseases is! 2act'rs

Diabetes Care 2012


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Treatment '2 Cardi'4ascular Diseases is! 2act'rs

Hypertension SBP 130-139 or DPB 80-89 mmHg: lifestylemodication (DASH for 3 mont!s" if fails #!armacological agents

SBP $1%0 or DBP $90 mmHg:&ifestyle modication '#!armacologicalt!era#y

Dyslipidemia &ifestyle modication ' statins

Antiplatelet agents* As#irin andor clo#idogrel

Smoking cessation Sto# smo)ing" co*nseling

CHD screening andtreatment

A+,- and as#irin and statin (if notcontraindicated

Diabetes Care 2012

*Depends on risk factors (???)


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30ertensi'n

G SBP '(& or DBP #& mm+" li9es4le mod p*armacolo"ical*erap4

G SBP '/&-'/# or DPB 6&-6# mm+"7 li9es4le modi9icaio! 1DAS+39or / mo!*s, i9 9ails p*armacolo"ical a"e!s

G Admi!iser o!e or more a!i-+ meds a $edime

G Mo!ior 8id!e4 9u!cio! a!d serum poassium i! p receivi!" AE-

Is, ARBs, or diureics

G Remem$er7 AE-Is a!d ARBs are co!rai!dicaed i! pre"!a!c4

G BP ar"e SBP '/&mm+" C DBP 6&mm+"

Diabetes Care 2012


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Aan!et 3-1, 11-=2. 200%

Mea-a!al4sis o9 Sai! reame! i! Dia$ees:is< reductio of cliical outco&es

per (& m"d? 1'.& mmol?3 reducio! i! ?D? c*oleserol

• %'2 reducio! maJor vascular eve!s

• %2 reducio! i! coro!ar4 revascularisaio!

• %'2 reducio! i! sro8e

• #2 reducio! i! all-cause morali4

• '/2 reducio! i! D morali4

•

No di99ere!ce i! !o!-vascular morali4 I!depe!de! o9 $aseli!e ?D? or prior D


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tatin C'nclusi'n

• Sai! *erap4 s*ould $e co!sidered 9or all i!dividuals


28/35

=+at is +30'gl3cemia>

eurogeic s6&pto&s due to lo# plas&a glucose levels

• ?o< plasma "lucose levels de9i!ed as7

• ;& m"d? 1ADA3'

• 0& m"dl 1PERKENI3%

• ;% m"d? 1DA3/

• S4mpoms respo!d o *e admi!israio! o9 car$o*4drae/

1. D. Diabetes Care 200;2%:12$–9; 2. #


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=+3 address +30'gl3cemia in diabetes training

•Reduci!" +$A 'c levels associaed


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&'st c'mm'n s3m0t'ms '2 30'gl3cemia

Paie!s 123

ircumoral paraes*esia

Di99iculies i! co!ce!raio!

Slurred speec*

Blurred visio!

& %& (& 0& 6& '&&

+u!"er

Palpiaio!s

eri"o

old 9eeli!"

A!=ie4

Eup*oria

ea8!ess

remor

S


31/35

is! $act'rs '2 30'gl3cemia

• :e!eral ris8 9acors 9or *4po"l4caemia7',%

• dela4ed or missed meal

• co!sumi!" a smaller meal *a! pla!!ed

• e=ercise

• use o9 dia$ees medicaio!s

• dru"alco*ol co!sumpio!

• i!creased i!suli! se!siivi4 or decreased i!suli! cleara!ce

• Ris8 9acors 9or maJor *4po"l4caemia7/,(

• a"eduraio! o9 dia$ees reame!

• i!e!sive "l4caemic co!rol

• *4po"l4caemia u!a


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Pre4enti'n '2 30'gl3cemic (4ents

• Education

• 3m0t'ms

• el2 management

• Pr'0er 2''d inta!e in t+era03

• $'r elderl3 0atients, caregi4er s+'uld als' be educated

• Repetitive education in patients with decreased cognitive function

• Self monitoring blood glucose (SMBG)

• Exercise planning

• &easuring bl''d gluc'se be2're e?ercise

•

C'nsuming carb'+3drate• 6djust insulin d'se based 'n t+e bl''d gluc'se le4el

• Right type and dose for therapy


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Treatment '2 mild 30'gl3cemia

Firs7 '&L%& " 9as-aci!" car$o*4drae, e.".7

; ; glucose ta7lets@

; 52;C2 &l fi6 dri< or s>uas! 'ot diet(@@

; #o teaspoos of sugar added to a cup of cold dri


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Treatment '2 m'derate-t'-maj'r 30'gl3cemia

Paie! reuires assisa!ce


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simpo awam - komplikasi diabetes melitus

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