MALNUTRITION-RELATED DIABETES MELLITUS (MRDM)

KLASIFIKASI BERDASARKAN ETIOLOGI DMADA EXPERT COMMITTEE (1997)1. Type 1 (kerusakan sel defisiensi insuline absolute )a. mediasi imunb. Idiopathik

2. Type 2 (resistensi insulin dengan defisiensi insulin secara relatif)

3. Tipe spesifik yang lainGenetic defects of cell function Genetic defects in insulin action Diseases of the exocrine pancreas e.g. FCPD Endocrinopathies Drug - or chemical induced Infections Uncommon forms of immune-mediated diabetes Other genetic syndromes sometimes associated with diabetes 4. Diabetes Mellitus Gestational

PENDAHULUAN DMTMTipe yang jarang dari diabetes mellitus, yang merupakan kondisi terkait dengan malnutrisi jangka panjang.

Tanda tanda :insulinopenia, resistensi insulin, hiperglikemia dan kerusakan-sel beta pankreas.

Hal ini juga dikenal sebagai tropical diabetes atau tropical pancreatic diabetes mellitus.

Pasien-pasien ini berbadan kurus, berusia muda, hiperglikemia berat, dan membutuhkan dosis tinggi insulin untuk mengontrol kadar gula darahnya.

KLASIFIKASIFibrocalcific / Fibrocalculous diabetes pankreas (FCPD)

Protein-deficient pancreatic diabetes (PDPD) / protein deficient diabetes mellitus (PDDM)

FIBROCALCIFIC / FIBROCALCULOUS DIABETES PANKREAS (FCPD)DefinisiDiabetes sekunder yang disebabkan pankreatitis kronik non alkohol dengan penyebab yang pasti dan terdapat di daerah negara berkembang yang beriklim tropis.

Tanda tanda :Sosial ekonomi rendahOnset muda terutama di bawah usia 30 tahunGizi burukButuh insulin kontrol gula darahKetosis-resistensiRadiologi kalsifikasi pankreas dan / atau disfungsi eksokrin pankreas.

PROTEIN-DEFICIENT PANCREATIC DIABETES (PDPD)Memiliki karakteristik yang sama dengan FCPD tetapi tidak ada gejala klinis dan hasil radiologis berupa disfungsi pankreas dan resistensi relatif terhadap insulin.

PATOGENESIS PDPDDidasari oleh kadar nutrisi dalam tubuh dan mungkin dipengaruhi oleh pola makan sehari-hari.

Keadaan malnutrisi dengan atau tanpa defisiensi mikronutrien merupakan awal mula dari gangguan fungsi sel B pankreas.

KRITERIA DIAGNOSTIK

KOMPLIKASIKomplikasi Akut

Komplikasi Kronik

KOMPLIKASI AKUTInfeksi pyogenic dan fungal, scabies, and pulmonary tuberculosis

Hipoglikemia

Periodontitis

KOMPLIKASI KRONIKNeuropati otonom

Katarak

Retinopati

Nefropati

TERAPIDosis tinggi Insulin 150-200 Unit diberikan, walaupun tanpa adanya komplikasi atau menunjukkan adanya resistensi insulinDiet rendah lemakTeknik Operasi Pancreatic lithotomy, pancreaticojejunostomy,sphincterotomy,choledocho-jejunostomy

DAFTAR PUSTAKA ATDC Keystone Symposium, Practical Ways to Achieve Targets in Diabetes Care, July 17-20, 2014, Denver Tripathy BB, Samal KC. Protein Deficient Diabetes Mellitus (PDDM) in India. Int J Diab Dev Count 1993; 13: 3-13.World Health Organization. Diabetes mellitus.Tech Rep Ser 1985; 727: 20-4.Geevarghese, P.J. Pancreatic diabetes, Popular Prakasan, Bombay, 1968.M. Ramachandran, V.C. Mathew Roy, and K.I. John, Pancreatogenic diabetes proceedings of the First National Congress on Diabetes, Madras,India. January-2969.Zuidema PJ. Cirrhosis and disseminated calcification of the pancreas in patients with malnutrition Trop Geog Med 1959; 11: 70-4.Hegde JS, Jituri KH., Cannappa NK. Pancreatic diabetes in Hubli area (North Karnataka). J Asso Phy India 1976; 24: 305-307.Srinivasa S. BPNI Bulletin 1997; 1(3): 4-5.Philips DIW, Barker DJP, Hales CN. Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150-4.Shaper AG, Chronic pancreatic disease and protein malnutrition. Lancet 1960; 1223-30.Tripathy BB, Kar BC. Observations of clinical pattern of diabetes mellitus in India. Diabetes 1965; 14, 7: 404-12.Bajaj JS: Lilly lecture- diabetes Mellitus: A global perspective proceedings of 13th congress, IDF Federation 1989.Mohan V, Ramchandran A, Viswanathan M.Tropical diabetes. In The Diabetes Annual/1 Eds. K.G.M.M. Alberti and L.P. Krall. Elseviers Science Publishers B.V. 1985 pp 82-92.Tripathy BB, Kar BC. Observations on clinical patterns of diabetes mellitus in India, Diabetes 1965; 14: 404.Pai KN, Soman CR., Varghese R. Pancreatic diabetes. Proceedings of a symposium held in the Medical College, Trivandrum 1970.Mohan V., Ramchandran A., Viswanathan M. Diabetes Mellitus Science and Practice, Diabetic Research Centre, Madras 1984.Shaper AG. Aetiology of chronic pancreatic fibrosis with calcification seen in Uganda. Brit Med J 1964; 1: 1607-9.Castle WM, Wicks ACB. A follow-up of 93 newly diagnosed African diabetics for 6 years. Diabetologia 1980; 18: 121-3.Bajaj JS. Current concepts: classification, pathogenesis, and diagnosis of malnutrition related diabetes mellitus. IDF Bull 1988; 33: 17-21.Agrawal RP, Kochar A, Kaswan K, Sharma S, Kochar DK. Need a Better Recognition MMDM. Int J Diab Dev Ctries 2005; 25: 55-7.Mathew Roy VC. Situation of Diabetes in Kerala. III world symposium on health care for diabetics in developing countries, Cordoba, Spain; September 16-18, 1985.Kajubi SK. A short review of pancreatic diabetes in Uganda. E Afr Med J 1979; 56: 625-30.Abdulkadir J, Mengesha B, Welde Gebriel Z, Keen H, Worku Y, Gebre P, Bekele A, Urga K, Taddesse A-S. The clinical and hormonal (cpeptide and glucagon) profile and liability to ketoacidosis during nutritional rehabilitation in Ethiopian patients with malnutrition-related diabetes mellitus. Diabetologia 1990; 33: 222-7.Philip, G., Thomas, Philip Augustine., Surgery of chronic pancreatitis-a Kerala experience, Proceedings Inaugural Session Indian society of Pancreatology, Medical College, Trivandrum 6th November 1985.Geevarghese PJ, Kutty MA. Pancreatic extracts in pancreatic steatorrhoea. Indian Practitioner 1980; 1: 73-79.