20. Komplikasi Kronik Dm

7/23/2019 20. Komplikasi Kronik Dm

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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



Complications !

"etoacidosis#on$etotic %yperosmolar

syndrome

&actic asidosis

%ypogli$emi'$oma

etinopathy#ephropathy

#europathy

*acroangiopathy

Chronic ! +cute !

*icroangiopathy

C+D-D

.tro$e



Coronary heart disease

Cerebrovascular disease

Peripheral vasculardisease



Major cause of increasedmorbidity and mortality in

diabetes Underlying abnormality:

atherosclerosis



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



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



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



Main predictors of C93 mortality

◦ 434 and 734 cholesterol

4ipid pro1le in type ( diabetes◦ raised triglycerides

◦ low 734

◦ raised small dense 434 particles



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



Prevalence

2 &ppro6imately twice thatof people withoutdiabetes

2 More common in menthan women before ageof 1fty



4oss of daynight variation in bloodpressure

◦ may be a sign of autonomicneuropathy )ype : normotensive until renal

disease develops

)ype (: hypertensive before sign ofrenal disease



!;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



&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



+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



Prevention

2 &nti*hypertensive therapy

2 &spirin therapy2 +tatin therapy $C&03 +tudy%

2 &CE inhibitor therapy$Progress +tudy%



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

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Penyulit Menahun



HYPE!LY"EM#$

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20. Komplikasi Kronik Dm