REFERAT OADHaifa Taufik 201120401011078

2

Diabetes MellitusDiabetes MellitusKelainan sekresi dan

atau kerja insulinKelainan sekresi dan

atau kerja insulin

Penyakit metabolik

hiperglikemia

Penyakit metabolik

hiperglikemiaDMDM

WHO thn 2000 Indonesia keempat 8,4 juta jiwa.

Thn 2030 Indonesia keempat sebesar 21,3 juta jiwa.

WHO thn 2000 Indonesia keempat 8,4 juta jiwa.

Thn 2030 Indonesia keempat sebesar 21,3 juta jiwa.

Terapi PrimerTerapi Primer

sulfonilurea, meglitinid, penghambat a-glikosidase, biguanid, tiazolidinedion dan inhibitor DPP4

sulfonilurea, meglitinid, penghambat a-glikosidase, biguanid, tiazolidinedion dan inhibitor DPP4

OAD, Insulin, Cangkok Pankreas

Terapi SekunderTerapi Sekunder

Faktor Resiko

PatofisiologiPatofisiologi

KELUHAN KLINIS DM

KELUHAN KLASIK (+) KELUHAN KLASIK (-)

GDPAtauGDS

126------- 200

< 126--------< 200

GDPAtauGDS

126------- 200

100 - 126 < 100

ULANG GDP atau GDS

GDPAtauGDS

100 - 199

126------- 200

< 126--------< 200

TTGOGD 2 jam

200 140-199 < 140

DIABETES MELLITUS TGT GDPT NORMAL

Evaluasi status gisi, penyulit DM, peren-canaan makanan sesuai kebutuhan

Nasehat umum, perencanaan makanLatihan jasmani, berat idaman, belum perlu Tx penurun glukosaSumber: PERKENI

OAD

Sulfonilurea

Tiazolidinedion

Alpha glukosidase inhibitor

Biguanid

Meglitinide

Inhibitor DPP4

Summary : Mekanisme kerja OAD

Adapted from Sonnenberg and Kotchen Curr Opin Nephrol Hypertens 1998;7(5):551-555.

INCREASEGLUCOSE

ABSORPTION

MUSCLE

PANCREAS

ADIPOSE TISSUE

LIVER

INTESTINE

HYPERGLYCEMIA DECREASED PERIPHERAL

GLUCOSE UPTAKE

INCREASED GLUCOSE

PRODUCTION

DECREASED INSULIN

SECRETION

Therapy:Thiazolidinedion

es(Biguanides)

Therapy:SulfonylureasMeglitinides

Insulin

Therapy:Biguanides

Thiazolidinediones

Therapy:Alpha-glucosidase

inhibitors

INTESTINE

DeFronzo RA. Diabetes. ;37:667-687.Lebovitz HE. In Joslin's Diabetes Mellitus. :508-529

Blood glucose

Insulin resistance

1 Intestine: glucose absorption 2 Muscle and adipose tissue:glucose uptake

4 Liver: hepaticglucose output

3 Pancreas: insulin secretionSulfonylureas :

insulin secretion

Insulinresistance

Sulfonylureas: Mechanism of Action

Insulinresistance

Blood glucose

Insulin resistance

1 Intestine: glucose absorption

3 Pancreas: insulin secretionMeglitinidesInsulin secretion

4 Liver: hepatic glucose output

2 Muscle and adipose tissue:glucose uptake

Wolffenbuttel BHR. Eur J Clin Pharmacol. 1993;45:113-116.

C

Meglitinides: Mechanism of Action

DeFronzo RA et al. J Clin Endocrinol Metab. ;73:1294-1301.

Insulinresistance

Blood glucose

Insulin resistance

1 Intestine: glucose absorption

3 Pancreas: insulin secretion

4 Liver: hepatic glucose output Metformi HGO

2 Muscle and adipose tissue:glucose uptakeMetformin glucose utilization

Biguanid: Mechanism of Action

Whitcomb RW et al. In: Diabetes Mellitus. 1996.Cavaghan MK et al. J Clin Invest. 1997;100:530-537.

Ehrmann DA et al. J Clin Endocrinol Metab. 1997;82:2108-2116.

Blood glucose

Intestine: glucose absorption

Pancreas: insulin secretion

Muscle and adipose tissue: Thiazolidinediones insulin resistance

glucose uptake

Liver: hepaticglucose outputThiazolidinediones HGO

Thiazolidinediones: Mechanism of Action

Improve -cellfunction

1 Intestine: glucose absorptionAcarbose glucose absorption secondaryto digestion of carbohydrate

Insulinresistance

4 Liver: hepaticglucose output

Amatruda JM. In: Diabetes Mellitus. 1996.

Blood glucose

Insulin resistance

3 Pancreas: insulin secretion

2 Muscle and adipose tissue: glucose uptake

-Glucosidase Inhibitors :Mechanism of Action

Incretin=GLP-1 ↓

Pancreas: insulin secretion ↑

Sel alpha menurunkan glukagon

Normal

DM

Incretin=GLP-1

DPP-4 memecah inkretin

Insulin ↓, glukagon ↑

Inhibitor DPP-4

Inhibitor DPP-4, Mechanism

Stepwise management of type 2 diabetes

Insulin ± oral agents

Diet & exercise