deteksi dini dan pencegahan kaki diabetes - blitar 2010
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Achmad Rudijanto
Divisi Endokrin MetabolikDepartemen Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas BrawijayaRSUD dr. Saiful Anwar Malang
2010
2
Diabetes is an increasing healthcare epidemic throughout the world
Global projections for the number of people with diabetes (20–79 age group), 2007–2025 (millions)
AfricaEastern Mediterraneanand Middle EastEurope
North America
South and Central America
South-East Asia
Western Pacific
28.340.5+43%
16.232.7+102%
10.418.7+80%
24.544.5+81%
53.264.1+21%
67.099.4+48%
46.580.3+73%
IDF. Diabetes Atlas 3rd Edition – 2006
Worldwide:246 million people in 2007380 million projected for 202555% increase
RiskesdasRiskesdas, 2008:, 2008:-- Prevalence 5.7%Prevalence 5.7%-- Pre DM Pre DM 11.0% 11.0%
PrediabetesPrediabetes
Pasien terdiagnosisDM
Pasien terdiagnosisDM
Pasien DM belumterdiagnosis
Pasien DM belumterdiagnosis
RISDKESDAS, 2007
Diagnosed DM = 1,5%Undiagnosed DM = 4,2%
Total DM = 5,7%GTG = 10,2 %
RISDKESDAS, 2007
Diagnosed DM = 1,5%Undiagnosed DM = 4,2%
Total DM = 5,7%GTG = 10,2 %
List of countries with the highest numbers of estimated cases of diabetes for 2000 and 2030List of countries with the highest numbers of estimated cases of diabetes for 2000 and 2030
2000 2030
Ranking Country
People withDiabetes(millions) Country
People withDiabetes(millions)
1 India 31.7 India 79.4
2 China 20.8 China 42.3
3 U.S. 17.7 U.S. 30.3
4 Indonesia 8.4 Indonesia 21.3
5 Japan 6.8 Pakistan 13.9
6 Asian 5.2 Brazil 11.3
7 Russian Federation 4.6 Bangladesh 11.1
8 Brazil 4.6 Japan 8.9
9 Italy 4.3 Philippines 7.8
10 Bangladesh 3.2 Egypt 6.7
Sarah Wild. Diabetes Care 27, 2004
KriteriaKriteria Diagnosis Diagnosis HiperglikemiHiperglikemi
TIPE 2 DIABETES PADA SAAT DIAGNOSISTIPE 2 DIABETES PADA SAAT DIAGNOSIS
20% 20% RETINOPATIRETINOPATI
9% NEUROPATI
UP TO 50% PENYAKIT
JANTUNG / PEMB. DARAH
8% NEFROPATI
Wild S. Diabetes Care 29, 2006
TakTerdiagnosis
tipe 2 diabetes ~
7 juta
Teriagnosedtipe2 2 diabetes
~ 23 juta
GTG ~ 70 juta
TH2030
KOMPLIKASI AKUT HIPERGLKEMIA
Diabetic KetoacidosisHyperglycemic Hyperosmoler State
HIPOGLIKEMIA
KOMPLIKASI KRONIK Kaki DMGagal ginjaldll
KOMPLIKASI AKUT HIPERGLKEMIA
Diabetic KetoacidosisHyperglycemic Hyperosmoler State
HIPOGLIKEMIA
KOMPLIKASI KRONIK Kaki DMGagal ginjaldll
PROBLEMA KAKI DIABETES
Setiap 30 detik, terdapat kehilangan satu kaki akibat diabetes diseluruh dunia.70% amputasi kaki diseluruh dunia disebabkanoleh diabetes.Sebagian besar amputasi dimulai oleh adanyaulkus kaki.Berita baik: sekitar 85% amputasi akibat ulkusdiabetes dapat dicegah.
Patomekanisme kaki diabetes
Kelainan pembuluh darah
Kerusakan syaraf
PROBLEMA KAKI DIABETES
Risk Factors for UlcerationRisk Factors for Ulceration
General or Systemic Contributions:• Uncontrolled hyperglycemia• Duration of diabetes• Peripheral vascular disease• Blindness or visual loss• Chronic renal disease• Older age
General or Systemic Contributions:• Uncontrolled hyperglycemia• Duration of diabetes• Peripheral vascular disease• Blindness or visual loss• Chronic renal disease• Older age
Local Issuues:• Peripheral neuropathy• Structural foot deformity• Trauma and improperly fitted shoes• Callus• History of prior ulcer/amputation• Prolonged elevated pressure• Limited joint mobility
Local Issuues:• Peripheral neuropathy• Structural foot deformity• Trauma and improperly fitted shoes• Callus• History of prior ulcer/amputation• Prolonged elevated pressure• Limited joint mobility
HIGHHIGH
MODERATEMODERATE
LOWLOW
ACTIVEACTIVE
DIABETIC FOOT RISK STRATIFICATION AND TRIAGEDIABETIC FOOT RISK STRATIFICATION AND TRIAGEPresence of active ulceration, spreading infection, critical ischemia, gangrene or unexplained hot, red, swollen foot with or without the presence of pain
Previous ulceration or amputation or more than one risk factor present e.g. loss of sensation or sign of peripheral vascular disease with callus or deformity
One risk factor present e.g. loss of sensation or signs of peripheral vascular disease without callus or deformity
No risk factors present e.g. no loss of sensation, no sign of peripheral vascular disease and no other risk factors
Annual screening by a suitably trained Health Care Professional Agreed self management plan. Provide written and verbal education with emergency contact numbers. Appropriate access to podatrist when required
Annual assessment by podatrist. Agreed and tailored management/ treatment plan by podatrist according to patient needs. Provide written and verbal education with emergency contact members
Annual assessment by specialist podatrist. Agreed and tailored management / treatment plan by specialist podatrist according to patient needs. Provide written and verbal education with emergency contact numbers. Referral fro specialist intervention if/when requred
Rapid referral to and management by a member of a Multidisciplinary Foot Team. Agreed and tailored management/treatment plan according to patient needs. Provide written and verbal education with emergency contact number. Referral for specialist intervention when required
ACTIONACTION
ACTIONACTION
ACTIONACTION
ACTIONACTION
Definition Definition
Definition Definition
Definition Definition
Definition Definition
These risk categories relate to the use of the SCI-DC foot risk startification tool
RIS
IKO
AM
PU
TAS
IR
ISIK
O A
MP
UTA
SI
PENCEGAHAN PRIMERPENCEGAHAN PRIMER
Tujuan Utama: mengidentifikasi risikp terjadinya ulkus kaki
Skor Risiko Karakteristik3 •Ada neropati
•Terjadu ulkus sebelumnya•Ada penyakit pembuluh darah tepi
2 •Ada neropati•Tanpa adanya ulkus sebelumnya•Ada deformitas
1 •Ada neropati•Tanpa adany ulkus sebelumnya•Tanpa deformitas
0 •Tanpa neropati•Tanpa adanya ulkus sebelumnay•Tanpa deformitas
ApakahApakah kitakita telahtelah ““benarbenar”” dalamdalammengklasifikasimengklasifikasi risikorisiko terjadinyaterjadinya ulkusulkus kaki kaki diabetes?diabetes?
Apa manfaat pencegahan?
Keuntungan untuk masa mendatang:
• Penurunan terjadinya ulkus kaki sampai 50-70%• Penurunan nagka kejadian amputasi• Penurunan biaya kesehatan dan sosial• Perbaikan kualitas hidup terkait derajat kesehatan
Pencegahan Primer Kaki Diabetic :
dimulai dengan pengobatan DM
PencegahanPencegahan Primer Kaki Diabetic :Primer Kaki Diabetic :
dimulaidimulai dengandengan pengobatanpengobatan DM DM
MenejemenMenejemen DiabetesDiabetes
Kontrol glukosa:• Diet/life style• Latihan• Obat oral/insulin
Penyakitpenyerta:• Dislipidemia• Hipertentsi• Obesita• CHD• Problem Nutrisi
Komplikasipenyerta:• Retinopati• CVD• Nefropati• Neuropati• Infeksi• Komplikasi yg lain
Harrison, 2005
diabetes mellitus treatmentdiabetes mellitus treatment
1. Diet 1. Diet 2. 2. ExcersiceExcersice
4. Drugs / Insulin 4. Drugs / Insulin 3. BW control3. BW control 5. Routine control5. Routine control
BersamaBersamaterasaterasa ringanringan
Pemeriksaan kaki secara berkala
Gunakan alas kaki yang benar
Pemeriksaan pembuluh darah dan syaraf
AnkleAnkle--Brachial Index (ABI)Brachial Index (ABI)
Right ABIHigher right ankle pressureHigher arm pressure
Leftt ABIHigher left ankle pressureHigher arm pressure
- Noncompressible- Normal- Bordeline (equivocal)- Mild-to-moderate peripherral
arterial disease- Severe peripheral arterial
disease
Doppler UltrasonographyDoppler Doppler UltrasonographyUltrasonography
Pencegahan Primer
RIS
IKO
AM
PU
TAS
IR
ISIK
O A
MP
UTA
SI
PENCEGAHAN PRIMERPENCEGAHAN PRIMER
Tujuan Utama: mengidentifikasi risiko terjadinya ulkus kaki
Skor Risiko Karakteristik3 •Ada neropati
•Terjadu ulkus sebelumnya•Ada penyakit pembuluh darah tepi
2 •Ada neropati•Tanpa adanya ulkus sebelumnya•Ada deformitas
1 •Ada neropati•Tanpa adany ulkus sebelumnya•Tanpa deformitas
0 •Tanpa neropati•Tanpa adanya ulkus sebelumnya•Tanpa deformitas
RIS
IKO
AM
PU
TAS
IR
ISIK
O A
MP
UTA
SI
PENCEGAHAN PRIMERPENCEGAHAN PRIMER
Tujuan Utama: mengidentifikasi risiko terjadinya ulkus kaki
Skor Risiko Karakteristik
3•Ada neropati•Terjadu ulkus sebelumnya•Ada penyakit pembuluh darah tepi
2•Ada neropati•Tanpa adanya ulkus sebelumnya•Ada deformitas
1•Ada neropati•Tanpa adany ulkus sebelumnya•Tanpa deformitas
0•Tanpa neropati•Tanpa adanya ulkus sebelumnya•Tanpa deformitas
Bila telah terjadi ulkus, apa yang harusdilakukan?
Pencegahan sekunder: Pemeriksaan harianPencegahanPencegahan sekundersekunder: : PemeriksaanPemeriksaan harianharian
Sol Sol sepatusepatu
Angka kejadian ulang ulkus kaki diabetes
DIABETES DAYDIABETES DAYDIABETES DAY
World Diabetes Day World Diabetes Day 14 November14 November
Indonesian Diabetes Day Indonesian Diabetes Day 12 July12 July
Shift in care approach Shift in care approach Shift in care approach
patients
provider
providerprovider
provider
provider
Patients as provider for himselfPatients as provider for himself
Patient oriented
Provider oriented
Menghadapi hal baruMenyangkal kenyataanTimbul marahTidak siaptidak tahu apa
yang harus dilakukanMerasa tidak amanTakut kehilanganMerasa tidak bergunaPutus asa
Empowering
Did we prepare?
Ringkasan
Prevalensi diabetes semakin tinggiSering disertai komplikasi a.l kaki diabetesKaki diabetes penyebab utama amputasiDimulai dengan timbulnya ulkus85% amputasi dapat dicegahPerhatian dan perawatan harian merupakankunci utama pencegahan
AkuAkuIndo
nesiaIndo
nesia
AkuAkuPER
SADIA
PERSAD
IA
AkuAkubisabisa
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