CURRICULUM VITAE

Nama

: DR.Dr. Aris Wibudi, SpPD

Tgl. Lahir

: Walikukun, 27 April 1954

Pendidikan .
1980
1991
1996
1998
1992
2006
Pekerjaan
2005 -

: Lulus FK UI
: Lulus Spesialis Peny. Dalam (FKUI)
: Modul DM 1 (Endokrin FKUI)
: Modul DM 2 (Endokrin FKUI)
: Edukator DM (PERKENI)
: S-3, IPB Bogor
: Staf Ahli RSPAD

Aris Wibudi

Pengelolaan Rasional
Diabetes Tipe-2

Distribution of oral glucose to tissues of

the body

Cherrington, A.D. Diabetes 1999; 48:1198-

Gangguan Metabolik Utama

pada DM-2
Resistensi Insulin

Defek sekresi insulin

Peningkatan Produksi Glukosa

Diabetes Care, 1999; 22:562

Resistensi
Insulin
OR
INSULIN
SENSITIZER

back

Insulin secretion (pmol/min)

Insulin secretion profiles in Type 2

diabetic
patients and healthy people
800
Healthy people

700

Type 2 diabetic patients

600
500
400
300
200
100
6am

10am

Polonsky KS. Et al., 1988

2pm

6pm

Time

10pm

2am

6am

Patterns of Insulin Response to

IV Glucose: Non-Diabetic and
Diabetic
Individuals
IV Glucose Stimulus

Insulin
Secretion
-10 -5

1ST
Phase
0

10

15 20 25

2ND
Phase
30 35

40 45 50

55 60 65

70 75 80

85 9

Type 2
Diabetes

Insulin
Secretion

-10 -5

Non-Diabetic

10

15 20 25 30 35 40 45 50 55 60

Time

65 70 75 80 85 9

Stages of type 2 Diabetes in relationship to

100
-cell function

Beta cell function (%)

75

50

IGT

Postprandial
Hyperglycemia

25

Type 2
Diabetes
Phase 1

Type 2
Diabetes
Phase 3

Type 2
Diabetes
Phase 2

0
- 12 - 10

-6

-2

Years
from diagnosis
hypoX-jsk-7-99

10

14

Insulin eksogen
ISLET ENHANCER

back

INSULIN
SEKRETAGOG

INSULIN
GLIKOGEN
GLIKOGEN
SINTASE
G

SA
O
K
LU

Produksi
Glukosa Hati

INSULIN
D
I
N
A
U
G
BI

TZ
D

DM

hiperglikemia

defek

PGA

asupan kalori

sekresi
insulin
sekretagog
insulin

absorbsi
PGA
HIPER
GLIKEMIA
metform
PGH

Insulin
resistensi
sensitizer
insulin

ABSORBSI

nutrisi/PGA

HGP
PGH

METFORMIN
Peakless LAI

SEKRESI
SEKRESI
INSULIN
INSULIN

INSULIN
INSULIN
SEKRETAGOG
short acting

RESISTENSI
INSULIN

INSULIN
SENSITIZER

prandial
hiperglikemia
AGI
sulfonilurea
Short acting
insulin

fasting
hiperglikemia
long acting
insulin
metformin

SU-SR

insulin

OAD

combination

insulin

OAD

insulin

OAD

combination

OAD

insulin

Site of action of OAD

Pencernaan

Insulin
sensitizer

AGI
Produksi
glukosa
hepatik

Insulin
sensitizer

nutrisi
Acarbose

Glukosa ekstrasel
Insulin
Metformin

Metformin

insulin

glinid
SU
Sekretagog insulin
Islet Enhancer

Sekresi insulin sel

beta pankreas

Ambilan
glukosa
otot

short

intermediate

Insulin
obat

long acting
biasa
peakless

Oral Anti Diabetic

OAD

1.

Biguanid

Metformin

2.

Insulin sekretagok
a. Sulfonilurea : glibenclamide
gliclazide
glipizid
- glikuidon
glimepiride
b. glinide

-glukosidase inhibitor (PGA)

4.

Insulin sensitizer

5.

Islet Enhancer

Diagnosis
Pilar Pengobatan
I
edukasi

II
Aktifitas
fisik

III
nutrisi

IV
obat

DM
Terapi
Terapi
Normoglikemi
Normoglikemi

Komplikasi

makro

lipid

Komplikasi
glukosa

mikro

regulasi glukosa

terapi
medikamentosa
hipertensi

komorbid

dislipidemi

FARMAKO TERAPI

Dokter

Pasien

Aspek pasien
1. Gemuk / kurus
2. Usia
3. Gangguan fungsi hati / ginjal
4. Lamanya DM
5. Hasil pemantauan glukosa darah

ASPEK DOKTER
Pengetahuan tentang obat

Pedoman
Penatalaksanaan
Algoritme
Kerja obat
Patofisiologi

Pedoman
Penatalaksanaan
Algoritme
Kerja obat
Patofisiologi

Algoritme Penatalaksanaan DM Tipe

2
DM Tipe 2
Insulin

Indikasi +

Indikasi
Gemuk

Tak Gemuk

Gemuk

DM Tipe 2
Gemuk
Pilar I, II, III
4 mgg

Pilar I, II, III

4 mgg

B / PG

2-4 mgg

Gemuk

B / PG

SU
2-4 mgg

INSULIN

Tidak Gemuk

DM Tipe 2
Tidak Gemuk
Pilar I, II, III
4 mgg

Pilar I, II, III

+
SU / PG / B
2-4 mgg

Tidak Gemuk

SU + B / PG
2-4 mgg

SU + B + PG
2-4 mgg

INSULIN

Pedoman
Penatalaksanaan
Algoritme
Kerja obat
Patofisiologi

Natural History of Type 2

Diabetes
Insulin sensitivity

Insulin secretion

30%

Type 2
diabetes

50%

50%

IGT

70-100%

70%

Impaired glucose
metabolism

150%

100%

Normal glucose metabolism

100%

Diabetes Obes Metab 1999; 1(1): S1

Stages of type 2 Diabetes in relationship to

100
-cell function

Beta cell function (%)

75

50

IGT

Postprandial
Hyperglycemia

25

Type 2
Diabetes
Phase 1

Type 2
Diabetes
Phase 3

Type 2
Diabetes
Phase 2

0
- 12 - 10

-6

-2

Years
from diagnosis
hypoX-jsk-7-99

10

14

Historical Algorithm of
Therapy for Type 2 Diabetes
Inadequate
nonpharmacologic
therapy

Oral agent

2 Oral
agents

3 Oral
agents

Add
insulin

Adapted from Mudaliar S et al. In: Ellenberg and Rifkins Diabetes Mellitus, 6th ed. New York, NY:
Appleton and Lange; 2003:531-557.

Proposed Algorithm of
Therapy for Type 2 Diabetes
Inadequate nonpharmacologic
therapy

Severe
symptoms
Severe
hyperglycaemia
Ketosis

Oral
agent

2 Oral
agents

3 Oral
agents

Pregnancy

Add Insulin Earlier in the Algorithm

DOSIS
mulai dosis kecil
tingkatkan bertahap
atau

kombinasi

Monitor Pemantauan
Glukosa darah

Puasa

Hepatic
Glucose
production
Insulin basal

Prandial
Beban
glukosa
Insulin sekresi cepat
Prandial insulin

Kemungkinan yang didapat

Glukosa darah
Puasa

Post Prandial

Normal

Normal

II

Normal

III
IV

< puasa

IV
GDN / PP

Insulin basal

- Insulin prandial

III
GDN / PP

Insulin basal kurang

Insulin prandial baik

II
GDN / PP

Insulin prandial

Ringkasan ( 1 )
Penatalaksanaan DM
Tailored to the patient
Team Work Network
Penurunan Glukosa segera
Penyerta

Ringkasan (2)
Pilar Penatalaksanaan
Edukasi
Terapi Nutrisi
Aktifitas Fisik
Obat (bila perlu)

Ringkasan (3)
Pedoman Farmakologik
ALGORITMA
PATOFISIOLOGI
KERJA OBAT

Ringkasan (4)
Tersedia pilihan
OAD
INSULIN

Ringkasan (5)
INSULIN
Short acting
Intermediate
Mixed

Ringkasan (6)
OAD
Sulfonilurea :
Generasi I
Generasi II
Generasi III

Repaglinid
Biguanid
PG
Insulin Sensitiser

Ringkasan (7)
Terapi Kombinasi
Kapan saja
Jangan golongan sama