Sugiarto
Devisi Endokrin, Metabolik dan Diabetes Ilmu Penyakit Dalam FK / RSUD
Dr Moewardi Universitas Sebelas Maret Surakarta
Clinical
features Risk for diabetes complications
Years −10 −5 0 5 10 15 20 25 30
† ‡
Macrovascular Microvascular
*In NHANES, “chronic kidney disease" refers to people with microalbuminuria (albumin:creatinine ratio >30 µg/mg).
†In the NHANES analysis, "foot problems" includes foot/toe amputations, foot lesions, and numbness in the feet.
‡"Eye damage" includes a positive response by NHANES participants to the question, "Have you been told diabetes has affected your eyes/had retinopathy?"
Retinopathy is damage to the eye's retina. In NHANES, people without diagnosed diabetes were not asked this question, therefore, prevalence information for
nondiabetics is not available.
CHD = coronary heart disease; CHF = congestive heart failure.
American Association of Clinical Endocrinologists. State of Diabetes Complications in America Report. Available at:
http://www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf. Accessed March 9, 2009.
~ 66% Diabetic
Neuropathy
Chen H, Lamer TH, Rho RH et al. Mayo Clin Proceed. 79; 2004
Boulton AJM, Mailik RA, ArezzoJC, Sosenko JM. Diab.Care 27, 2004
Wendling Patrice. 45% of Diabetic Patients Not Reaching HbA1C Target. Internal Medicine News. July 15 2007;40(No.14):1, 20.
NEUROPATI DIABETIK
• Definisi :
• Adanya gejala atau tanda disfungsi syaraf perifir
pada pasien diabetes mellitus
• setelah mengeksklusi penyakit lainnya
• seperti malignansi, alkoholis kronik, defisiensi
nutrisi, infeksi, iatrogenic, dll
Pathogenesis of diabetic neuropathy
Diabetes mellitus,
Microvascular
Autoimmunity genetics/environments
Smoking, alcoho, diet inefficiency
Poor Glycaemic
control
Physiological Mediators
Metabolic initiators +
Endothelial function
oxidative stress
Diabetic neuropathy,
leakage of antigens with
further damage
Sachdev, 2009 ,Clinical Endocrinology dan Diabetes Mellitus
Impact of Diabetic Neuropathy
Peripheral Autonomic
III VI
Truncal
Ulnar
Median
Lateral
popliteal
SIGNS SYMPTOMS
•Diminished vibratory perception • Numbness, loss of feeling, prickling,
tingling
•Decreased knee and ankle reflexes
•Reduced protective sensation, such • Aching pain
as pressure, hot and cold, pain • Burning pain
•Diminished ability to sense position • Lancinating pain
of toes and feet • Unusual sensitivity or tenderness
when feet are touched (allodynia)
Boulton AJ, et al. Diabetes Care. 2005;28(4):956-962.
Neuropathic Pain
• Komponen :
• 1. Vaskuler (sistem kardiovaskuler ke sistem makrosirkulasi
selanjutkan ke mirkosirkulasi diameter < 100 mm).
• 2. Komponen darah
• eritrosit, leukosit dan trombosit
KOMPONEN VASKULER DAN ERITROSIT
INTERAKSI ERITROSIT DI VASKULER
AGEN HEMOREOLOGI
• Mikroangiopati diabetik,
• Gangguan mikrosirkulasi.
• Defisiensi nutrisi di jaringan.
MICROANGIOPATHY DAN NEUROPATHY ENDONEURAL
• Hiperplasi dan hipertropi endotelial ukuran lumen mengecil
• Aliran darah endoneural menurun.
• Degenerasi pericyte cell .
• Kerusakan nerve fiber atau C fiber
• --> kerusakan axon reflek.
• Agregasi trombosit dan fibrinogen.
• Aktifitas von Willebrand factor
• Cell adhesion molecules
• Perubahan transfortasi dan nutrisi.
• penurunan fungsi dan perbaikan jaringan.
Malik and Veves
(Forst dan Kunt, 2004) .
PATHOGENESIS OF DIABETIC NEUROPATHY.
Management of diabetic neuropathy
Evaluation
Standart methodology
(10 gm monofilament, modified NDS system)
Treatment
Glycaemic control,
lipid control
insulin therapy
IGF-I, IGF-II, Laminin B,
Nerve growth factor(NGF)
Nerve regeneration
+
Restoration of nerve function
Sachdev, 2009 ,Clinical Endocrinology dan Diabetes Mellitus
KESIMPULAN
• Diabetes mellitus suatu sindroma yang di tandai adanya
gangguan metabolisme karbohidrat, protein dan lemak yg
ditandai hiperglikemia kronik.
• Perubahan hemoreologi akibat hiperglikemia menyebabkan
komplikasi neuropati, retinopati dan nefropati DM.
• Agen hemoreologi meliputi: endotel, komponen darah dan
plasma.
• Hemoreologi berhubungan dengan mikroangiopati dan
neuropati endoneural
• Terapi pertama neuropati perifir diabetic adalah pencegahan
WAALAIKUM SALAM WR WB