farmakoterapi diabetes tipe 2.pdf
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FARMAKOTERAPI DIABETES TIPE 2
Dra. Retnosari Andrajati , PhD. Apt.Fakultas Farmasi Universitas Indonesia
Forum Apoteker Indonesia Jakarta, 4 April 2012
WHO definition
Diabetes mellitus isa metabolic disorder of multiple
etiology, characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
Epidemiologi
Diabetes is highly prevalent, afflicting approximately 150 million people worldwide.
The number is expected to rise to 300 million in the year 2025 .
Much of this increase will occur in developing countries. (WHO 2003 Adherence to long –term therapies;Evidence for action)
DM di Indonesia
2006 ; Kematian di RS 2.38%(Indonesian Health Profile 2007)
2007 Kematian 5,7% (Indonesian Health profile 2008,Ministry of Health Republik Indonesia)
Prediksi WHO: 8.4 million 2000 21.3 million in 2030. (Konsesus Pengelolaan dan Pencegahan DMtipe 2 di
Indonesia, PB PERKENI)
DM Etiological Type Konsesus Pengelolaan dan Pencegahan DMtipe 2 di Indonesia, PB PERKENI
TypeType
Type 1Type 1 AutoimmuneAutoimmuneIdiopathicIdiopathic
Type 2Type 2 Predominantly insulin Predominantly insulin resistance.resistance.Predominantly secretory Predominantly secretory defectdefect
Other specific typesOther specific types
Gestational DiabetesGestational Diabetes
DiabetesTipe 2
90% DM Terkait dengan berat badan berlebih dan
resistensi insulin. Fungsi Sel beta pankreas menurun sejalan dengan
waktu terapi insulin dapat diperlukan. Gejala dapat sama dengan DM tipe 1 , tetapi
sering lemah terlambat diketahui.
Diagnosis berdasarkan gula darah
glucose plasma
fasting 2 hour postprandial
Normal <100 mg/dl < 140 mg/dlPradiabetes1 00-125 mg/dl -IFG/IGT - 140-199 mg/dlDiabetes ≥ 126 mg/dl > 200
mg/dl
IFG : Impaired fasting glucoseIGT : Impaired glucose tolerance
Glycated haemoglobin HBA1c
Apa akibat dari DM ?
Komplikasi akut : infeksi, hipoglikemia, ketoasidosis.Kronik: mata, ginjal, saraf dan kardiovaskuler.
Sasaran terapi
Mempertahankan kadar glukosa darah pada tingkat yang sedapat mungkin normal
Menghindari komplikasi akut dan kronik
Meningkatkan risiko penyakit jantung dan stroke 50% orang dengan DM meninggal karean penyakit jantung dan stroke.
Neuropati + menurunnya aliran darah ulkus kaki amputasi.
10-20% penderita DM gagal ginjal Diabetic neuropathy (50%) : kesemutan, nyeri, baal
dan lemah pada tangan dan kaki Diabetic retinopathy, krn kerusakan pembuluh darah kebutaan Sesudah 15 tahun 10 % gangguan penglihatan2%
buta.
Komplikasi DM
Tujuan terapi
• Mengeliminasi gejala hiperglikemia;• Mencapai kontrol optimum;• Menurunkan komplikasi mikro dan
makrovaskuler;• Menganani gangguan penyerta;• Sedapat mungkin membuat pasien
mencapai pola hidup normal
Terapi
EdukasiRekomendasi nutrisi Latihan Farmakoterapi
Obat hipoglikemik oralGolonganGolongan Contoh Contoh Mekanisme kerjaMekanisme kerjaSulfonilureaSulfonilurea Gliburid/glibenklaGliburid/glibenkla
mid, glipizid, mid, glipizid, glikazid, glikuidonglikazid, glikuidon
Merangsang sekresi kel Merangsang sekresi kel pankreaspankreas
BiguanidBiguanid MetforminMetformin Menurunkan produksi Menurunkan produksi glukosa hatiglukosa hati
MeglitinadMeglitinad ReplaginidReplaginid Merangsang sekresi kel Merangsang sekresi kel pankreaspankreas
ThiazolidindionThiazolidindion Rosiglitazon, Rosiglitazon, troglitazon, troglitazon, pioglitazonpioglitazon
Meningkatkan kepekaan Meningkatkan kepekaan reseptor insulinreseptor insulin
Inhibitor Inhibitor aglukosidaseaglukosidase
Akarbose, miglitolAkarbose, miglitol Menghambat enzimMenghambat enzim--enzim enzim pencernaanpencernaan
ROTDPaling umum: ggn saluran cerna, mual, panas, rasa penuh.Hipoglikemi, reaksi alergi pd kulit, eksim, pruritis, eritema, urtikaria, fotosensitif, leukopenia, trombositopenia, anemia aplastik, agranulositosit, anamia hemolitik, lemah, parestresia, tinitus, pusing, vertigo, malaise, test fungsi hati meningkat.
Monitoringhipoglikemia, Syndrome of inappropriate secretion of antidiuretic hormone (SIADH):retensi air dg hiponatremia
Thiazolidinedion
Rosiglitazon, pioglitazon, troglitazon
Mekanisme kerja:Memperbaiki sensitivitas insulinpd sel otot dan lemakMenghambat glukoneogenesis di hati
ROTD gangguan Kardiovaskuler
Alfa glukosidase inhibitor
Akarbose
oligosakarida kompleks
MK: menghambat pencernaan karbohidratglukosa yg diabsorpsi<
ROTD:77%: flatuluns33%: diare21%: nyeri perutReksi hipersensitivitas : ruam : jarang
Obat ADO baru
DPP-4 Inhibitors: menghambat enzim (DPP-4) yang secara normal mendeaktivasi protein (GLP-1) yang mempertahankan sirkulasi insulin
.Sitagliptin. Incretin Mimetics: menyerupai kerja inkretin untuk
merangsang pembentukan insulin
Criteria of Controlled Diabetes
good borderline poor
Fasting blood glucose 80-<100 100-125 ≥126
2 hour postprandial 80-144 145-179 ≥180
Hba1c (%) <6.5 6.5-8 >8
Total cholesterol <200 mg/dl 200-250 >250
HFL cholesterol >45 (male) 35-45 <35
>55(female) 45-55 <45
LDL cholesterol <100 100-130 >130
Fasting triglycerides <200 200-250 >250
Criteria of Controlled Diabetes
good borderline poor
Body mass index(kg/m2)
male <25.0 25.0-27.0 >27.0
female <24.0 24.0-26.0 >26
Blood pressure (mmHg) <130/80 - -
Essential components of diabetic counseling
Counseling regarding the disease Counseling regarding lifestyle
modifications Counseling regarding medications Counseling regarding acute complications Counseling regarding chronic complications Counseling in special populations Counseling regarding self Monitoring of Glucose
Counseling regarding lifestyle modifications
Diet Carbohydrates 46-65% Protein 10-20% Fat 20-25%
Exercise and physical activity
Alcohol intake and smoking
Counseling points for oral hypoglycemic agents
Counseling points for insulin
References1. Konsensus Pengelolalan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2006.
Available at: http://www.perkeni.net (Accessed on 2 th August 2010) 2. Pharmaceutical care untuk penyakit diabetes. Departemen Kesehatan RI, 2006.3. Diabetes fact sheet no.312,World Health Organization 2009. Available at
http://www.who.int/mediacentre/factsheets/fs312/en/print.html (accessed on 4th August 2010)
4. Khatib OMN ed.Guidelines for the prevention, management and care of Diabetes mellitus. World Health Organization 2006. Available at http://www.who.int(accessed on 2th August 2010).
5. Palaian S., Role of pharmacist in counseling Diabetes Patients. The Internet Journal of Pharmacology 2005 : Volume 4 Number 1. (accessed on 2th August 2010)
6. Jennings DL., Ragucci KR., Chumney ECG., Wessel AM., Impact of clinical pharmacist intervention on diabetes related quality of life in an ambulatory care clinic. Pharmacy Practice 2007:5(4): 169-173. Available at www.pharmacy.practice.org((accessed on 2th August 2010)
7. Working together to manage diabetes. A guide for pharmacy, podiatry, optometry and dental professional .National Diabetes Education Program 2007. Available at www.cdc.gov/phtnonline ((accessed on 2th August 2010)
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