dr. R.

Bowo Pramono, SpPD

CV: dr. R Bowo Pramono SpPD KEMD

Lahir TEGAL 27-jan 1959 Istri: dr. Astuti SpS, 2 putri Dokter Umum: FK UGM 17-01-1985 SPPD : FK UGM 24-11-1997 KEMD : 14-05-2008 Pekerjaan: 1987-2002 PKM Kedung Waringin Bekasi 1999-2004 RSU Selong Lombok Timur 2004-2010 RS DR Sardjito/FK UGM 2006-2013 Sekretaris Bagian Penyakit Dalam FK UGM 2007-2011 Sekretaris PAPDI Cabang Yogyakarta
2

EPIDEMIOLOGY
WHO Estimation: Indonesia have people with DM (2030): Rural : 7,2 % from adult (>20 years old) Urban: 14,7 % from adult

29

By 2030, 7 of the 10 Countries with the Most Diabetic Patients Will Be in Asia
2000 People with diabetes (millions) 31.7 20.8 17.7 8.4 6.8 5.2 4.6 4.6 4.3 3.2 2030 People with diabetes (millions) 79.4 42.3 30.3 21.3 13.9 11.3 11.1 8.9 7.8 6.7

Ranking

Country

Country

1 2 3 4 5 6 7 8 9 10

India China USA Indonesia Japan Pakistan Russian Fed. Brazil Italy Bangladesh

India China USA Indonesia Pakistan Brazil Bangladesh Japan Philippines Egypt

30
Wild S et al. Diabetes Care 2004;27(5):1047-53.

Diagnosis (WHO classification)

Venous plasma glucose (mg/dL) Normal Diabetes mellitus Impaired Glucose Tolerance (IGT) Impaired Fasting Glucose (IFG) Fasting & 2h post-prandial Fasting & 2h post-prandial Fasting & 2h post-prandial Fasting & 2h post-prandial < 100 < 140 > 126 > 200 < 100 140-199 100 - 125 < 140

NB: In the absence of symptom, the diagnosis of DM must be confirmed by a second diagnosis test (i.e. fasting, random, or Oral Glucose Tolerance Test (OGTT) on a separate day 31

Risk Factors of DM
Family history
DM Type 1 Relative with DM Mother Father Sister or brother Twin sister or brother Risk of DM 2% 9% 10% 50%

Type 2

Mother Father Both parents Sister or brother Twin sister or brother

19%
14% 25% 75% 99%

Over weight/obese/inactivity Age Hypertension Dyslipidemia

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Type 2 diabetes is NOT a mild disease

Stroke Diabetic Retinopathy
Leading cause of blindness in working age adults1
2 to 4 fold increase in cardiovascular mortality and stroke3

Cardiovascular Disease
8/10 diabetic patients die from CV events4

Diabetic Nephropathy
Leading cause of end-stage renal disease2

Diabetic Neuropathy
Leading cause of nontraumatic lower extremity amputations5

1 Fong

DS, et al. Diabetes Care 2003; 26 (Suppl. 1):S99S102. 2Molitch ME, et al. Diabetes Care 2003; 26 (Suppl. 1):S94 S98. 36 1997. 3 Kannel WB, et al. Am Heart J 1990; 120:672 676. 4Gray RP & Yudkin JS. In Textbook of Diabetes 5Mayfield JA, et al. Diabetes Care 2003; 26 (Suppl. 1):S78 S79.

Treatment options for type 2 diabetes

Sulfonylureas
1st generation e.g. chlorpropamide, tolbutamide 2nd generation e.g. glyburide, gliclazide, glipizide, gliquidone 3rd generation e.g. glimepiride Modified release

-glucosidase inhibitors
e.g. acarbose

Insulin
regular intermediate/long acting pre-mixed analogs

Glinides/meglitinides
Non-sulfonylureic e.g. repaglinide Amino acid derivatives e.g. nateglinide

rapid acting long acting

Biguanides
e.g. metformin

Fixed-dose oral antidiabetic drug combinations

e.g. glyburide/metformin, glipizide/metformin, rosiglitazone/metformin

Thiazolidinediones
e.g. rosiglitazone, pioglitazone

Indikasi terapi Insulin:

DM tipe 1 DM tipe 2 yang tidak terkontrol diet, olah raga, OHO. DM gestasional Gangguan faal hati & ginjal yang berat. Dengan infeksi akut (selulitis, gangren), TBC berat, penyakit kritis (stroke/AMI) Dengan KAD/HHS Dengan fraktur atau pembedahan mayor Kurus (BB rendah), terkait malnutrisi (DMTM) Dengan penyakit Graves Dengan tumor ganas Dengan pemberian kortikosteroid

LOKASI PENYUNTIKKAN

Sistem NovoLet

50

53

 Less Hypoglycemia Less Weight Gain

DM tipe 1
54

1980

1980

2009