Download - 20. Komplikasi Kronik Dm
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 1/31
1
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 2/31
2
Definisi
Diabetes mellitus is a group of metabolicdiseases characterized by hyperglycemia
resulting from defects in insulin secretion,
insulin action, or both(Expert Committee on the Diagnosis and Classification of Diabetes mellitus 2002)
Long-term damage, dysfunction, and failure
of various organs especially the eyes, kidneys,
nerves, heart, and blood vessels
Long-term damage, dysfunction, and failure
of various organs especially the eyes, kidneys,
nerves, heart, and blood vessels
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 3/31
Complications !
"etoacidosis#on$etotic %yperosmolar
syndrome
&actic asidosis
%ypogli$emi'$oma
etinopathy#ephropathy
#europathy
*acroangiopathy
Chronic ! +cute !
*icroangiopathy
C+D-D
.tro$e
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 4/31
Coronary heart disease
Cerebrovascular disease
Peripheral vasculardisease
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 5/31
Major cause of increasedmorbidity and mortality in
diabetes Underlying abnormality:
atherosclerosis
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 6/31
It is more common and occurs earlier than inpeople without diabetes
Ethnic dierences◦ Caucasians: more myocardial infarctions
◦ Chinese!apanese: more stro"es
#omen lose gender protection
Myocardial infarction is often painless $silent%
&lbuminuria increases ris" of vascular event
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 7/31
Compared to people without diabetes' peoplewith type ( diabetes have:
)he same ris" of heart attac" as those who
have already had a heart attac" )wo* to three*fold higher ris" of heart failure
+udden death occurs:* ,-. more often in men
* /--. more often in womenthan in peers without diabetes but of thesame age
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 8/31
0esearch shows the bene1ts ofreducing the controllable ris" factorsfor atherosclerosis
Controllable ris" factors are:
2 3yslipidaemia $especially 434 or 5bad5cholesterol%
2 +mo"ing and e6posure to tobacco smo"e
2 7igh blood pressure
2 3iabetes
2 8besity
2 Physical inactivity
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 9/31
Main predictors of C93 mortality
◦ 434 and 734 cholesterol
4ipid pro1le in type ( diabetes◦ raised triglycerides
◦ low 734
◦ raised small dense 434 particles
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 10/31
IDF – type 2diabetes
LDL <2.5 mmol/L (<95 mg/dl)
Triglyceride <2. mmol/L (<2!! mg/dl)
"DL c#olesterol $%.! mmol/L ($9 mg/dl)
&a'ada
rimary target
eco'dary target
LDL*& </+ 2.! mmol/L
T&,"DL*& <-.! mmol/L
'ited tates LDL <%!! mg/dlTriglycerides <%5! mg/dl
"DL $-! mg/dl
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 11/31
Prevalence
2 &ppro6imately twice thatof people withoutdiabetes
2 More common in menthan women before ageof 1fty
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 12/31
4oss of daynight variation in bloodpressure
◦ may be a sign of autonomicneuropathy )ype : normotensive until renal
disease develops
)ype (: hypertensive before sign ofrenal disease
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 13/31
!;C < and &3& recommendations
7ypertension blood pressure:
=>-?-mm7g )arget blood pressure goal in
diabetes: /-@-mm7g
Many people reAuire three ormore drugs to achieve therecommended target
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 14/31
&CE*inhibitors $*prils% &( 0eceptor bloc"ers $&tacand'
&vapro' Barvea' Micardis' )eveten% Calcium antagonists
$3ihydropyridine: ;orvasc' anidip'&dalat D and non*dihydropyridine:9erapamil' 3iltiaem%
3iuretics F*bloc"ers
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 15/31
+tro"es occur twice as often indiabetes and hypertension than
those with hypertension alone
)ransient Ischaemic &ttac"s$)I&s% occur two to si6 timesmore often
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 16/31
Prevention
2 &nti*hypertensive therapy
2 &spirin therapy2 +tatin therapy $C&03 +tudy%
2 &CE inhibitor therapy$Progress +tudy%
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 17/31
In the retina' glomerulus' and vasa nervorum'
diabetes*speci1c microvascular disease is
characteried by similar pathophysiologic
featuresG Clinical and animal model data indicate that
chronic hyperglycemia is the central initiating
factor for all types of diabetic microvasculardiseaseG
1/
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 18/31
1
Penyulit Menahun
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 19/31
HYPE!LY"EM#$
Polyol
Path%ay
$ntio&idant
Defence
!lucose
$uto&idation Polyol
Path%ay
'&idative
(actors
'&idative )tress
'* + '
LDL
'&idation
• ' dependent .asolidation• "a*/ • .)M" Proliferation
• Hemorheologic alternations• "oagulation activation• Hipo&ia
• ."• Endoneural
0lood (lo%
Heparan
)ulphate
.asculopathy etinopathy europathy ephropathy
Hiperglikemia – Oxidative Stress – Komplikasi vaskular menahun (Giugliano et al 1996, Modifikasi)
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 20/31
PE;HEF&F P&+)I FE4UM 3IBE)&7UI
7IPE04IBEMI& +EF&& J&B)80 0E+IB8 U)&M&
)E80I FI8BIMI& !&4U0 P84I84' 4IB&+I
;8;E;IM&)IB' PEMFE;)UB&; P08)EI; BI;&+E
C
20
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 21/31
JU;3U+B8PI JU;3&4 J4U80E+CEI; &;I80&P7H
$JJ&%G / +)&3IUM 03:
G 03 ;8;P084IJE0&)IJ
(G 03 P084IJE0&)IJ
/G M&BU48P&)I 3I&FE)I4
21
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 22/31
B8;)084 U4& 3&0&7
B8;)084 )EB&;&; 3&0&7
&F4&+I BE4E;!&0 7IP8JI+I+ ME4&4UI PEMFE3&7&; &)&U
0&3I&+I 7UFU;&; 08#)7 780M8; 3E;&; 03
J8)8B8&U4&+I 3E;&; +I;&0 4&+E0
◦ P&;0E)I;&4 03P &)&U 4&UB8M& ;E89&+BU4&0
◦ J8B&4 E3EM& M&BU4&
9I)0EB)8MI PE;3&0&7&; 9I)0EU+ &)&U &F4&)I8
0E)I;&
2
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 23/31
3EJI;I+I +I;308M B4I;I+ P&3& P&3IE;
3M H&; 3I)&;3&I 3E;&; &4FUMI;U0I&
ME;E)&P K /-- M(> !&M P&3& MI;IM&4 (
L PEME0IB+&&; 3&4&M BU0U; #&B)U /*
FU4&;G
PE;HEF&F U)&M& &&4 I;!&4 )E0MI;&4
3I &ME0IB& 3&; E08P&G
2
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 24/31
KLASIFIKASI
M8E;+E; B0I)E0I&:
)&7&P 7IPE0)08JI 3&; 7IPE0JI4)0&+IG 4J 3&; EB+B0E+I
&4FUMI; U0I; ME;I;B&)G
)&7&P ( +EC&0& B4I;I+ FE4UM )&MP&B BE4&I;&; H&;
FE0&0)IG 4J )E)&P ME;I;B&) PE;EF&4&; MEMF&;&
F&+&4I+ H&; )I3&B +PE+IJIB 3E;&; PE;I;B&)&; M&)0IB
ME+&;IUMG
)&7&P / I;+IPIE; MIB08&4FUMI;U0I& $/-*/-- M(>
!&M%G )EB&;&; 3&0&7 MU4&I ME;I;B&)G
)&7&P > ;EJ08P&)I 4&;!U) +I;308M ;EJ08)IB
FI&+&;H& )E0!&3I P&3& +)&3IUM I;I 4J ME;U0U;G
)&7&P , &&4 I;!&4 )E0MI;&4
23
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 25/31
)E0&;)U; +)&3IUMG
PE;3EB&)&; U)&M&:
◦ PE;E;3&4I&; F+
◦ PE;E;3&4I&; )EB&;&; 3&0&7
◦ PE0F&IB&; JU;+I I;!&4 3IE)' &;)I
7IPE0)E;+I &CE 3&; &)&U &0F
◦ PE;E;3&4I&; J&B)80*J&B)80 B8M80FI3
4&I; 8FE+I)&+' B&3&0 4EM&BG
2
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 26/31
3EJI;I+I ME0UP&B&; +U&)U I+)I4&7
3E+B0IP)IJ H&; ME;U;!UBB&; &3&;H&
&;U&; F&IB B4I;I+ M&UPU; +UF B4I;I+
H&; )E0!&3I P&3& 3I&FE)E+ ME4I)U+ )&;P&PE;HEF&F ;EU08P&)I PE0IJE0 4&I;;H&G
&;U&; I;I )E0M&+UB M&;IJE+)&+I
+8M&)IB 3&; &)&U 8)8;8M 3&0I +&0&JPE0IJE0G
24
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 27/31
P84I;EU08P&)I +E;+80I M8)80I 3I+)&4 H&;
+IME)0I+ &)&U 3I+)&4 +HMME)0IC&4 +E;+80HM8)80
P84H;EU08P&)7H $3P;%
)E0!&3I PE;U0&;&; JU;+I +E;+80IB H&;
P080E+IJ 3&; JU;+I M8)80IB $4EFI7 !&0&;%
H&; FE04&;+U; 3&0I F&I&; 3I+)&4 BE
P08B+IM&4G +&;&) )E0&;)U; BE)E4I)I&; PE;&MFI4&;
&;&M;E+I+ 3&; PEME0IB+&&; JI+IBG
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 28/31
E9&4U&+I )&7U;&;:
◦ 0EJ4EB M8)80IB
◦ JU;+I +E0&FU) +&0&J FE+&0 )E+ BU&;)IJIB&+I
+E;+&+I BU4I) +EPE0)I 0&+& E)&0
$FI8)E;+I8ME)E0% 3&; 0&+& )EB&; $E+)E+I8ME)E0%
◦ JU;+I +E0&FU) +&0&J BECI4 3E;&; )E+ +E;+&+I
+U7U
◦ E4EB)08MI80&JI
3
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 29/31
PE0&#&)&; UMUM B&BI
PE;E;3&4I&; 4UB8+& 3&0&7
ME3IB&ME;)8+&
◦ FE4UM &3& FUB)I BU&)
◦ &4384&+E 0E3UB)&+E I;7IFI)80 ME;CE&7 PEMFE;)UB&; +80FI)84 3&; J0UB)8+&
◦ PE;7&MF&) &CE
◦ ;EU08)08PI;
;E09E 08#) J&C)80
F0&I; 3E0IJE3 ;EU08)08PIC J&C)80
◦ &4P7& 4IP8IC &CI3
◦ PE;7&MF&) PBC
◦ &;4I8+I3E+
◦ &MM& 4I;84EIC &CI3
◦ &MI;8U&;I; PE;7&MF&) &Es
◦ 7UM&; I;)0&9E;8U+ IMU;848FU4I;
BIE
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 30/31
PE;E484&&; ;HE0I
◦ ;+&I3$IFUP08JE; >L-- M7&0I' +U4I;3&C (L(--
M7&0I%
◦ )0I+IB4IB &;)I3EP0E+&;) $ &MI)0IP)I4I; ,-*,- M'
IMIP0&MI -- M7&0I' ;80)0IP)I4I; ,-*,- M70%◦ &;)IB8;9U4+I $ &F&PE;)I; / L?-- M70'
B&0F&M&EPI; > L(-- M70%
◦ &;)I&0I)MI& $MELI44E)I; ,-*>,- M70%
◦ )8PIB&4 $C&P+&I+I; > L -'-<,.% J4UP7E;&I;E L/
M70
◦ )0&;+CU)&;EU+ E4EC)0IC&4 ;E09E +)IMU4&)I8;
4
7/23/2019 20. Komplikasi Kronik Dm
http://slidepdf.com/reader/full/20-komplikasi-kronik-dm 31/31