Komplikasi diabetes melitus diera saat ini

diabetes melitus

1. Medical Doctor
Specialist
Work
Dr. Tulus Widiyanto Sp PD
Resume
University of Indonesia
Departement of internal Medicine-University of Indonesia
Al Islam Hospital Bandung
Trainee for Rheumatology Consultant -University of Padjajaran, Bandung
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2. Recognizing Diabetes Complications
Tamamedi Online Course for General Practitioners
Dr. Tulus Widiyanto Sp PD
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3. Outline
01
Definition
& Epidemiology
Pathophysiology
Recognizing
Pathophysiology
Treatment for Complications
02
03
04

4. Types of Diabetes
Definitions
Diabetes is chronic hyperglycemia caused by either
defect in insulin secretion, insulin resistance, or both
of them.
1.Type 1 DM
2.Type 2 DM
3.Gestational DM
4.Other Type of DM
1
PERKENI. Pedoman Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 Dewasa di Indonesia 2021.
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5. 415 Million
1.5 Million Deaths
Complications
Epidemiology
In Recent Decades there is increase numbers of people
with diabetics.
In 2019 Diabetes has lead to 1.5 million deaths worldwide.
48% death to patient aged < 70 years.
More patient diagnosed with Diabetes means more patient
with complications of diabetes
1
Harding JL, Pavkov ME, Magliano DJ, Shaw JE, and Gregg EW. Global trends in diabetes complications: a review of
current evidence. Diabetologia (2019) 62:3–16.
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6. Pathophysiology
Ominous Octet
Egregious Eleven
8 Factors that contribute to diabetes
Pathophysiology (2008)
11 Separate yet connected
pathophysiology of diabetes
2
PERKENI. Pedoman Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 Dewasa di Indonesia 2021.
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7. Pathophysiology of Complication
Vasculopathy
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate toidentify potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).
2

8. Pathophysiology of Complication
Inflammation
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate toidentify potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).
2

9. Pathophysiology of Complication
Inflammation
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).
2

10. Complications
of Diabetes
Acute
Hypoglycemia
Hyperglycemia
Chronic
Macrovascular
Microvascular
Tomic D, Shaw JE, and Magliano DJ. The burden and risks of emerging complications of diabetes mellitus. Nature Reviews Endocrinology, Vol 18, September 2022.
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2

11. NoDuration Types of ComplicationDisease Specific
1Acute Hypoglycemia
Hyperglycemia Hyperglycemia Hyperosmolarity state (HHS)
Diabetec Ketoacidosis (DKA)
2Chronic Macrovascular Coronary Artery Disease (CAD)
Cerebro-Vascular Disease (CAD)
Peripheral Arterial Disease (PAD)
Microvascular Retinopathy Diabetics
Nephropathy Diabetics
Neuropathy Diabetics
Tomic D, Shaw JE, and Magliano DJ. The burden and risks of emerging complications of diabetes mellitus. Nature Reviews Endocrinology, Vol 18, September 2022.
Sponsored By:
2

12. Whipple’s Triad
Hypoglycemia
Decrease in blood sugar < 70 mg/dl with or without
autonomic symptoms
1.Symptoms of Hypoglycemia
2.Low blood glucose level
3.Symptoms improvement after treatment
3
PERKENI. Pedoman Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 Dewasa di Indonesia 2021.
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13. Hyperglycemia Hyperglycemic State (HHS)
Hyperglycemia
1.High blood sugar (300-600 mg/dl)
2.Symptoms of Acidosis
3.High level serum ketone
4.High anion gap
5.Increase Plasma Osmolarity (300-320 mOsm/mL)
1.Very High blood sugar (>600 mg/dl)
2.No symptoms of acidosis
3.Increase plasma osmolarity (>320 mOsm/mL)
4.Plasma Ketones (+/-)
5.Normal or slightly increase anion gap
3
PERKENI. Pedoman Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 Dewasa di Indonesia 2021.
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Diabetic Ketoacidosis (DKA)

14. Coronary Artery Disease (CAD)
•CAD is caused by Atherosclerosis
•Stable Angina, Unstable Angina, STEMI, dan
NSTEMI
•ECG and cardiac enzyme is used as marker for
cardiac involvement
3
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The main cause of death in diabetics patient
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate toidentify potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).

15. Peripheral Arterial Disease (PAD)
•Exclude cerebral artery and coronary artery
•Can be detected by Ankle Brancial Index examination
(ABI).
•ABI > 0.9 Normal, ABI 0.5-0,9 Moderate claudication,
ABI < 0.4 Resting Pain
•Fontaine Classification:
3
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Occlusive disease of peripheral artery
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate toidentify potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).

16. Cerebro Vascular Disease (CVD)
•Small artery disease and atherosclerosis of cervical and
intracranial artery
•Detect: TIA, Confusion, double vision, loss of vision,
headache, speaking difficulties.
•MSCT: Subcortical infarcts
3
Sponsored By:
CVD Is 3 times more common in diabetics
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate toidentify
potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).

17. 10%
20%
70%
Retinopathy
•75% of patient with T2DM develop retinopathy
•Proliferative (PDR) and Non-Proliferative (NPDR)
•Detect for: Sudden visual disturbance, double visions, floaters
Antar SA. Diabetes mellitus: Classification, mediators, and
complications; A gate toidentify potential targets for the
development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).
3
Sponsored By:

18. Nephropathy
Late Phase:
Small Kidney
•Leading Cause of Chronic Renal Failure
•Can be detected by albuminuria/microalbuminuria in
spot urine collection
•Abdominal Ultrasound:
Early Phase:
Kidney Enlargement
3
Antar SA. Diabetes mellitus: Classification, mediators, and complications; A gate toidentify potential targets for the development of new effective treatments. Biomedicine &
Pharmacotherapy 168 (2023).
Sponsored By:
3

19. Neuropathy
•Symetrical: Sensory and autonomous
nervous system
•Asymetrical: Sensory and Motoric
nervous system
•Symtomps: Glove parathesia,
parasthesia in extremities
3
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20. Treatment of
Complications

21. NoDurationTypes of
Complication
Disease Specific Treatment Approach
1AcuteHypoglycemia Dextrose Infusion
HyperglycemiaHyperglycemia Hyperosmolarity state (HHS)Fluid and insulin
Diabetec Ketoacidosis (DKA) Fluid and insulin
2ChronicMacrovascularCoronary Artery Disease (CAD) Anti-platelet & Anti-diabetics
Cerebro-Vascular Disease (CAD) Anti-platelet & Anti-diabetics
Peripheral Arterial Disease (PAD) Anti-platelet & Anti-diabetics
MicrovascularRetinopathy Diabetics Anti-Angiogenesis & Anti-diabetics
Nephropathy Diabetics ARB/ACE-1, SGLT-2, GLP1-RA
Neuropathy Diabetics Gabapentin
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4

22. Dr. Tulus Widiyanto Sp PD
Tamamedi.id
[email protected]
[phone]
Thank you
Tamamedi Online Course for General Practitioners