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MALNUTRITION-RELATED DIABETES

MELLITUS (MRDM)

KLASIFIKASI BERDASARKAN ETIOLOGI DM


ADA EXPERT COMMITTEE (1997)

1. Type 1 (kerusakan
insuline absolute )
a. mediasi imun
b. Idiopathik

sel defisiensi

2. Type 2 (resistensi insulin


defisiensi insulin secara relatif)

dengan

3. Tipe spesifik yang lain


a.Genetic defects of cell function
b.Genetic defects in insulin action
c.Diseases of the exocrine pancreas e.g. FCPD
d.Endocrinopathies
e.Drug - or chemical induced
f.Infections
g.Uncommon forms of immune-mediated diabetes
h.Other genetic syndromes sometimes associated with
diabetes
4. Diabetes Mellitus Gestational

PENDAHULUAN DMTM
Tipe yang jarang dari diabetes mellitus, yang
merupakan kondisi terkait dengan malnutrisi
jangka panjang.
Tanda tanda :
insulinopenia, resistensi insulin,
kerusakan-sel beta pankreas.

hiperglikemia

dan

Hal ini juga dikenal sebagai tropical diabetes atau


tropical pancreatic diabetes mellitus.
Pasien-pasien ini berbadan kurus, berusia muda,
hiperglikemia berat, dan membutuhkan dosis
tinggi insulin untuk mengontrol kadar gula
darahnya.

KLASIFIKASI
1. Fibrocalcific / Fibrocalculous diabetes pankreas
(FCPD)
2. Protein-deficient pancreatic diabetes (PDPD) /
protein deficient diabetes mellitus (PDDM)

FIBROCALCIFIC / FIBROCALCULOUS DIABETES


PANKREAS (FCPD)
Definisi
Diabetes sekunder yang disebabkan pankreatitis kronik
non alkohol dengan penyebab yang pasti dan terdapat di
daerah negara berkembang yang beriklim tropis.

Tanda tanda :

Sosial ekonomi rendah


Onset muda terutama di bawah usia 30 tahun
Gizi buruk
Butuh insulin kontrol gula darah
Ketosis-resistensi
Radiologi kalsifikasi pankreas dan / atau disfungsi
eksokrin pankreas.

PROTEIN-DEFICIENT PANCREATIC DIABETES


(PDPD)
Memiliki karakteristik yang sama dengan FCPD
tetapi tidak ada gejala klinis dan hasil radiologis
berupa disfungsi pankreas dan resistensi relatif
terhadap insulin.

PATOGENESIS PDPD
Didasari oleh kadar nutrisi dalam tubuh dan
mungkin dipengaruhi oleh pola makan seharihari.
Keadaan malnutrisi dengan atau tanpa defisiensi
mikronutrien
merupakan
awal
mula
dari
gangguan fungsi sel B pankreas.

KRITERIA DIAGNOSTIK

KOMPLIKASI
1. Komplikasi Akut
2. Komplikasi Kronik

KOMPLIKASI AKUT
Infeksi pyogenic dan fungal, scabies, and
pulmonary tuberculosis
Hipoglikemia
Periodontitis

KOMPLIKASI KRONIK
Neuropati otonom
Katarak
Retinopati
Nefropati

TERAPI
Dosis tinggi Insulin 150-200 Unit diberikan,
walaupun
tanpa
adanya
komplikasi
atau
menunjukkan adanya resistensi insulin
Diet rendah lemak
Teknik
Operasi

Pancreatic
lithotomy,
pancreaticojejunostomy,sphincterotomy,choledoc
ho-jejunostomy

DAFTAR PUSTAKA
1.
2.
3.
4.
5.

ATDC Keystone Symposium, Practical Ways to Achieve Targets in Diabetes Care, July 17-20, 2014,
Denver

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