Tata Laksana DM dan Hipertensi Sesuai
Standar Di FKTP dan FKTRL serta
Revitalisasi Program Rujuk Balik
Iswandi Darwis
Bagian Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Lampung
Rumah Sakit Umum Daerah Dr. Hi. Abdul Moeloek
Bandar Lampung
Biodata
• Nama : dr. Iswandi Darwis, M.Sc, Sp.PD
• Tempat Tanggal Lahir : Tangerang, 16 Juni 1986
• Alamat : Perum Palem Permai 2 Blok A 2 Rajabasa Bandar Lampung
• Telpon : 081287635855
• Email :
[email protected]• Status : Menikah 1 orang anak
• Riwayat Pendidikan
– SD : SDN Tanah Tinggi 8 (1992-1998)
– SMP : SMPN 7 Tangerang (1998-2001)
– SMA : SMAN 2 Tangerang (2001-2004)
– S1 (dr) : Pendidikan Dokter FK Unila (2004-2010)
– Sp1 (Sp.PD) : Ilmu Penyakit Dalam FK UGM (2013-2017)
– S2 (M.Sc) : Ilmu Kedokteran Klinik FK UGM (2014-2018)
• Pekerjaan : ASN Kementrian Riset Teknologi dan Pendidikan Tinggi (Dosen
Fakultas Kedokteran Universitas Lampung)
Level of Competence
Standar Kompetensi Dokter Indonesia 2012
Burden of Disease
Burden of Disease
Presentation title Date 6
10 Penyakit Terbanyak di Klinik Penyakit Dalam RSUD Ragab Begawe Caram Kabupaten Mesuji
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Tuberkulosis CHF/HHD Dispepsia DM PPOK HT CAD ISK Asma Bronkitis Anemia Lain-lain
Definition
• Diabetes mellitus is a group of metabolic diseases
characterized by hyperglycemia resulting from
defects in insulin secretion, insulin action, or both.
• The chronic hyperglycemia of diabetes is
associated with long-term damage, dysfunction,
and failure of various organs, especially the eyes,
kidneys, nerves, heart, and blood vessels.
American Diabetes Association. Diabetes Care 2015 Jan; 38(Supplement 1): S8-S16
Classification
Type 1 diabetes
• due to β-cell destruction, usually leading to absolute insulin deficiency
Type 2 diabetes
• Due to a progressive insulin secretory defect on the background of insulin
resistance
Gestational diabetes mellitus (GDM)
• Diabetes diagnosed in the second or third trimester of pregnancy that is not
clearly overt diabetes
Others type
• monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset
diabetes of the young [MODY]), diseases of the exocrine pancreas (such as
cystic fibrosis), and drug- or chemical-induced diabetes (such as in the
treatment of HIV/AIDS or after organ transplantation)
American Diabetes Association. Diabetes Care 2015 Jan; 38(Supplement 1): S8-S16
Proportion of diabetes type
Genes 2015, 6(1), 87-123
Pathogenesis of type 2 Diabetes
Wanzhu Jin, Mary-Elizabeth Patti. Clinical Science Dec 15, 2008, 116 (2) 99-111
Mechanism of hyperglycemia in type 2 DM
Diabetes: Step care approach to management Dr. B. K. Iyer, 2015
Long-term Complication of type 2 diabetes
American Diabetes Association. Diabetes Care 2015 Jan; 38(Supplement 1): S8-S16
History of disease of Type 2 Diabetes
Standards of Medical Care in Diabetes 2015 (ADA) Diabetes Care
Gejala klasik
• Polidipsi
• polifagia
• poliuria penurunan
berat badan 10-2 0%
dalam 6 bulan terakhir
Alur diagnosis DM, PERKENI (2015)
Type 2 Diabetes Algorithm, Executive, Summary, Endocr Pract. 2017; 23 (No. 2 )
Type 2 Diabetes Algorithm, Executive, Summary, Endocr Pract. 2017; 23 (No. 2 )
Kapan penderita DM dirujuk ke RS
• Bila tidak terkontrol dengan kombinasi 3 jenis
OAD
• Bila terdapat kondisi komplikasi akut (KAD dan
HHS)
• Kadar HbA1C >9%
• Bila sudah ada komplikasi jangka panjang yang
membutuhkan tindak lanjut
Kapan penderita DM dirujuk balik
• Bila tidak ada komplikasi akut DM
• Bila indeks glikemia terkontrol
• Bila komplikasi kronik DM sudah mendapatkan
penanganan dan hanya melanjutkan terapi
saja
Glycemic, blood pressure and lipid control
Konversi nilai HbA1C dengan rerata kadar
glukosa
Standards of Medical Care in Diabetes 2015 (ADA) Diabetes Care
Klasifikasi hipertensi
Drugs combination for HT
BP Thresholds for and Goals of Pharmacological Therapy in Patients With Hypertension According to Clinical
Conditions
BP Threshold, BP Goal,
Clinical Condition(s)
mm Hg mm Hg
General
Clinical CVD or 10-year ASCVD risk ≥10% ≥130/80 <130/80
No clinical CVD and 10-year ASCVD risk <10% ≥140/90 <130/80
Older persons (≥65 years of age; noninstitutionalized, ≥130 (SBP) <130 (SBP)
ambulatory, community-living adults)
Specific comorbidities
Diabetes mellitus ≥130/80 <130/80
Chronic kidney disease ≥130/80 <130/80
Chronic kidney disease after renal transplantation ≥130/80 <130/80
Heart failure ≥130/80 <130/80
Stable ischemic heart disease ≥130/80 <130/80
Secondary stroke prevention ≥140/90 <130/80
Secondary stroke prevention (lacunar) ≥130/80 <130/80
Peripheral arterial disease ≥130/80 <130/80
ASCVD indicates atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular
disease; and SBP, systolic blood pressure.
Kapan penderita HT dirujuk ke RS
• Bila terdapat komplikasi akut hipertensi (krisis
hipertensi)
• Bila TD tidak terkontrol dengan kombinasi 3
obat antihipertensi
Kapan penderita HT dirujuk balik
• Bila tekanan darah terkontrol setelah
diberikan terapi di RS
• Bila komplikasi HT sudah mendapatkan
penanganan dan hanya melanjutkan terapi
saja
TERIMA KASIH
