dm+osteopor 05 usia lanjut
TRANSCRIPT
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Diabetes melitus pada Diabetes melitus pada usia lanjutusia lanjut
Harsinen Sanusi
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Diabetes melitus• Prevalensi semakin
meningkat• Dampak usia lanjut +
DM tipe 2 • Indonesia ledakan DM
tipe 2, nomor 4
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• Blindness• Renal failure• Disability• Amputations
Epidemiology of Diabetes Worldwide
• 151 million patients with diabetes• 2.1% of worldwide population• 97% are NIDDM patients• 221 million estimated by 2010• Complications of diabetes include
– Coronary artery disease – Peripheral vascular disease– Diabetic nephropathy– Stroke
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Patogenesis• Proses ketuaan Faktor risiko
independent intoleransi glukosa• Patogenesis = DM tipe 2 Faktor keturunan & Faktor genetik Disfungsi sel beta, resistensi insulin,
inkretin, lipolisis, neurotransmitter dysfunction, glukagon
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Increased lipolysisIncreased lipolysisDecreased glucose uptake into Decreased glucose uptake into muscle and adipose tissue and muscle and adipose tissue and increased hepatic glucose increased hepatic glucose output output
Hyperglycemia
Insulin resistanceInsulin resistance
-cell dysfunction-cell dysfunction
Elevated circulating FFA
glucotoxicity
glucotoxicity lipotoxicity
lipotoxicity
Insulin resistance and -cell dysfunction are linked
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Faktor risiko DM usia lanjut• Umur tua• Obesitas• Aktifitas fisik kurang• Obat-obatan• Genetik• Penyakit lain
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Gejala/kelainan DM usia lanjut • Katarak, glaukoma, retinopati diabetik• Pruritus / gatal pada kulit t/u vulva• Kontraktur dupuytren• Infeksi bakteri kulit,sal kemih• Infeksi jamur• Neuropati perifer/visceral• Amiotropi Ulkusneurotropik• PAP• PJK• Hipertensi
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Managing DiabetesDon’t be
Glucose –centricWe must treat the entire
metabolic system
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Pengobatan DM usia lanjut• Diet dan olahraga• Obat oral Sulfonilurea, non sulfonilurea Biguanid (metformin) Akarbose
Tiazolidindion • Insulin
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Interaksi obat dengan sulfonilurea
• Meningkatkan hipoglikemia Aspirin,fibrat, trimetoprim menggantikan
sulfonilurea dr ikatan albumin Alkohol, penyekat H2, antikoagulan
menghambat met. Sulfonilurea AntaPenyekat beta, simpatolitik antagonis
counter regulatory hormon • Memperburuk kontrol glukosa darah
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Interaksi obat dengan sulfonilurea
• Memperburuk kontrol glukosa darah Rifampicin, barbiturat meningkatkan
metabolisme Sulfonilurea Beta bloker antagonis sulfonilurea
HCT,Beta bloker, kortikosteroid, estrogen, phenitoin menghambat sekresi atau kerja insulin
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Insulin • Indikasi = DM tipe 2 lain• Pemantauan glukosa plasma ketat• Perlu bantuan orang lain• Hipoglikemia klirens insulin
menurun, sekresi glukagon menurun, sekresi epinefrin biasa terlambat
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Osteoporosis pada usia
lanjut
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OsteoporosisOsteoporosis adl penyakit tulang
yang ditandai pengeroposan tulang akibat menurunnya densitas dan kualitas tulang risiko mudah patah (fraktur)
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Claus Christiansen, Am J Med 1993 dan WHO 1998Claus Christiansen, Am J Med 1993 dan WHO 1998
Osteoporosis adalah problem kesehatan masyarakat, khususnya pada wanita pasca menopauseFraktur tulang pangkal paha (panggul) meningkat tajam khususnya Asia issue global kesehatan, sosial dan ekonomi.
EPIDEMIOLOGI
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Osteoporosis• Tidak ada data nasional Tidak ada data nasional • Tahun 2000, estimasi usia lanjut 16 Tahun 2000, estimasi usia lanjut 16
juta penduduk di Indonesiajuta penduduk di Indonesia• Osteoporosis / fraktur problem Osteoporosis / fraktur problem
kesehatan yang serius kesehatan yang serius
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Gambaran besarnya masalah osteoporosis di Indonesia
Jumlah penduduk Indonesia (1997): 207.000.000
Perkiraan patah tulang setiap tahun sebesar 750.000 dengan
rincian:• 150.000 patah tulang pinggul• 350.000 patah tulang punggung / pinggang• 130.000 patah tulang pergelangan tangan• 120.000 patah tulang lain
• Biaya kesehatan yang harus dikeluarkan: 1 milyar USD
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Faktor-faktor risiko• Tidak dapat dicegah:
- Umur tua - Kurus - Pernah patah • Dapat dicegah : - Perokok - Obat2: kortikosteroid - Kurang olahraga - Menopause - Immobilisasi lama - Alkoholik
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PATHOGENESIS OF OSTEOPOROSIS FRACTURES
Heredity
Fractures
Ageing
Menopause
LocalFactors
Sporadicfactors
InadequatePeak bone
mass
Increased Bone loss
Low bonedensity
Trauma
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Penyebab Osteoporosis• Osteoporosis Primer Osteoporosis tipe 1 Osteoporosis tipe 2 Osteoporosis Juvenile Osteoporosis usia muda
• Osteoporosis sekunder
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Bagaimana mengetahui seseorang menderita Osteoporosis?
• Tidak bergejala kecuali telah terjadi fraktur
• Pemendekan tinggi badan
• Tulang punggung semakin bungkuk.
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TATACARA DIAGNOSTIK
• Pemeriksaan Radiologis• Pemeriksaan densitas massa tulang
(BMD)• Pemeriksaan biokimiawi
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Penipisan massa tulang yang jelas terlihat apabila massa tulang telah berkurang 40% atau lebih
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Lokasi patah Osteoprosis
• Tulang belakang (Vertebra)
• Pangkal paha• Tulang2 di perifer
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1010
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Dasar Pengobatan Osteoporosis• Meningkatkan pembentukan tulang
Sodium fluorida Hormon paratiroid
Anabolik steroid
• Menghambat resorpsi tulangEstrogen ( Primarin, Livial)
Kalsitonin ( Miacalcic)Bisfosfonat ( Actonel R)KalsiumRaloxifen
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Calcium
U S I A (Tahun) KALSIUM (mg)
< 0.5
0.5 – 1
1 – 10
11 – 24
25 – 49
Menopause (Dg estrogen) < 65
Menopause (Tanpa estrogen) < 65
Hamil atau menyusui
Wanita > 65
400
600
800
1200 – 1500
1000
1000
1500
1200 – 1500
1500
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Calcitriol – calciumCalcitriol – calcium
Hormone replacement therapy Hormone replacement therapy
SERMs SERMs
Bisphosphonates Bisphosphonates (alendronate, risedronate)(alendronate, risedronate)
CalcitoninCalcitonin
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Upaya Pencegahan Osteoporosis
• Asupan kalsium• Sumber kalsium makanan• Tambahan (Suplementasi )
kalsium• Hindari merokok• Hindari minum alkohol• Olah raga dan tetap aktif (Senam osteoporosis)
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