Diabetes

Mellitus
Ulvi Nur Rista

Sasaran Pembelajaran
Mampu

memahami pengertian Diabetes Mellitus

Mampu membedakan kriteria Diabetes Mellitus
Mampu mendeteksi risiko, tanda, dan gejala
terjadinya Diabetes Mellitus
Mampu memberikan rekomendasi pengobatan terapi
farmakologi Diabetes Mellitus
Mampu melakukan monitoring efektivitas dan efek
samping pengobatan Diabetes Mellitus

Organ Produksi Insulin

Hormon Regulasi Gula Darah

Insulin

Glucagon*

* Glycogenolisis & Gluconeogenesis

Mean 24-hour physiologic serum insulin and plasma glucose

levels in nondiabetic subjects
Am J Med, vol. 113, issue 4, Gerich, Novel insulins: expanding options in diabetes management, pp. 308316

Definisi Diabetes Mellitus

Gangguan
metabolisme
karbohidrat,
lemak, dan
protein

Disebabkan oleh
penurunan
sekresi insulin
dan/atau
penurunan
sensitivitas
insulin terhadap
reseptornya

Ditandai adanya
hiperglikemia

Diabetes Mellitus -- Komplikasi

Cerebrovascular
Disease

Peripheral
Neuropathy
Nephropathy

Cardiovascular
Disease

Sexual
Dysfunction

Chronic
Hyperglycemia
Retinopathy
Autonomic
Neuropathy

Klasifikasi Diabetes Mellitus

Type 1
Diabetes
(5-10% of
diabetes)

Type 2
Diabetes (9095% of
diabetes)

Prediabetes

Gestational
Diabetes
(GDM)

Secondary
Diabetes

Diabetes Mellitus
Tipe 1
Insulin-Dependent Diabetes = Juvenile-Onset
Diabetes

Patofisiologi-DM tipe 1
Autoimun
Destruksi
sel
pankreas

Insulin

Idiopathic

Hiperglikemia
Persisten

Absolute
Insulin
Deficiency

Diagnosis DM tipe 1
Hiperglikemia

Ketoacidosis
Antibody testing (+) ditemukan
autoimmune marker, antara lain
Islet cell autoantibodies
Autoantibodies to insulin
Autoantibodies to GAD

Goal of Treatment
Mencapai

glycemic target, tanpa tanda

hipoglikemia
Mencegah onset dan progresi dari
komplikasi mikrovaskular dan
makrovaskular
Menurunkan angka kematian

Terapi Farmakologi DM tipe 1

Multiple dose injection
insulin basal-bolus
dapat menggunakan:
1. Kombinasi Insulin
rapid acting/short
acting & Insulin long
acting
2. Penggunaan mixed
insulin (mix insulin
rapid acting &
intermediate acting)

Continous subcutaneous
insulin infusion (CSII)
insulin pump therapy.

Glycemic Target (ADA, 2014)

Prediabetes
Increased Risk For Diabetes

Prediabetes

Prediabetes-Risk Factor

Prediabetes-Diagnosis

Prediabetes = Impaired Fasting Glucose (IFG)

dan/atau Impaired Glucose Tolerance (IGT)

PrediabetesScreening & Monitoring

Skrining dilakukan
pada dewasa usia
45 tahun terutama
dengan faktor risiko

Rekomendasi
skrining: interval
pemeriksaan minimal 3
tahun
Rekomendasi
monitoring: Interval
pemeriksaan minimal 1
tahun.

Goal of Treatment
Mencegah onset terjadinya
diabetes mellitus

Diabetes Mellitus
Tipe 2
Insulin- Non-Dependent Diabetes

Diagnosa Diabetes Mellitus

Patofisiologi-DM tipe 2
Sekresi
Glucagon

Defisiensi
GLP-1
Hiperglikemia
Persisten

Sekresi
Insulin

Fungsi sel
pankreas

Incretin effect
(GLP-1 & GIP)

Resistensi
Insulin

Goal of Treatment
Mencapai

glycemic target, tanpa tanda

hipoglikemia
Mencegah onset dan progresi dari
komplikasi mikrovaskular dan
makrovaskular
Menurunkan angka kematian

Glycemic Target (ADA, 2015)

Glycemic Target

Terapi Farmakologi DM tipe 2

GLP-1
agonist
receptor

GLP-1
DPP-4
agonist
inhibitor
receptor
Sekresi
Metformin
Glucagon

Sediaan
Insulin

Defisiensi
GLP-1
Hiperglikemia
Persisten

Sekresi
Insulin

SGLT-2
inhibitor

Resistensi
Insulin
Metformin

Fungsi sel
Incretin effect
pankreas
(GLP-1 &GIP)

SU
Glinide

DPP-4
inhibitor

TZD

ADA, Standars of Medical Care

in Diabetes. 2014

Terapi Farmakologi
Kelas

Jenis

Keunggulan

Efek samping

Biguanide

Metformin

CVD events;
No hypoglycemia;
Low cost

GI side effect
risk ~
dosis

Sulfonilurea

Glibenclamide,
Glipizide,
Glimepiride

Microvascular risk; Hipoglikemia

Low cost
weight

Thiazolidinedione (TZD)

Pioglitazone

No hypoglycemia;
HDL-C;
TG;
Low cost

weight;
Peripheral
edema;
Heart failure

Terapi Farmakologi
Kelas

Jenis

Keunggulan

Efek samping

DPP-4
Inhibitor

Linagliptin,
Sitagliptin,
Vildagliptin,
Saxagliptin

No hypoglycemia

Side effect
(rare)
pancreatitis,
skin rash

GLP-1
reseptor
agonis

Liraglutide

No hypoglycemia;
weight

GI side effect

SGLT-2
inhibitor

Dapagliflozin

No hypoglycemia;
weight;
blood pressure

Polyuria;
volume
depletion/
hypotension;
genitourinary
infections

Terapi Farmakologi
Kelas

Jenis

Keunggulan

Efek samping

Glinides

Repaglinide

post-prandial
glucose

Hypoglycemia
weight

Alphaglucosidase
inhibitor

Acarbose

No hypoglycemia;
post-prandial
glucose
Non-systemic

GI side effect

microvascular
risk
Reduce HbA1c >>

Hypoglycemia
weight

Insulin
Rapid Acting;
Short acting;
Intermediate
acting;
Long acting;
Premixed

Glulisine, Lispro,
Aspart
Insulin Regular
NPH
Detemir, Glargine

Diabetes Obes Metab. 2011 Aug; 13(8): 677684

Farmakokinetik Insulin

Diabetes Obes Metab. 2011 Aug; 13(8): 677684

Farmakodinamik Insulin

Terapi Non-Farmakologi
1.
2.
3.
4.

Diet
Physical Activity
Maintain normal weight/ Reduction
body weight 7%
Self monitoring blood glucose

Reference
1.

2.

3.

4.

American Diabetes Association. Standars of Medical

Care in Diabetes 2014. Diabetes Care. Jan, 2014; 37(1):
p.S14-80.
American Diabetes Association. Standars of Medical
Care in Diabetes 2015. Diabetes Care. Jan, 2015; 38(1):
p.S1-90.
Dipiro, JT., Tablert RI., Yee GC., Matze GR., Wells BG.,
et al. 2008. Pharmacotherapy: A patophysiologic
approach, 7th edition. Appleton & Lange, Stamford
Morello CM. Pharmacokinetics and pharmacodynamics
of insulin analogs in special populations with type 2
diabetes mellitus. Int J Gen Med. 2011; 4: p. 82735.