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OAD
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REFERAT OADHaifa Taufik 201120401011078
2
Diabetes MellitusDiabetes MellitusKelainan sekresi dan
atau kerja insulinKelainan sekresi dan
atau kerja insulin
Penyakit metabolik
hiperglikemia
Penyakit metabolik
hiperglikemiaDMDM
WHO thn 2000 Indonesia keempat 8,4 juta jiwa.
Thn 2030 Indonesia keempat sebesar 21,3 juta jiwa.
WHO thn 2000 Indonesia keempat 8,4 juta jiwa.
Thn 2030 Indonesia keempat sebesar 21,3 juta jiwa.
Terapi PrimerTerapi Primer
sulfonilurea, meglitinid, penghambat a-glikosidase, biguanid, tiazolidinedion dan inhibitor DPP4
sulfonilurea, meglitinid, penghambat a-glikosidase, biguanid, tiazolidinedion dan inhibitor DPP4
OAD, Insulin, Cangkok Pankreas
Terapi SekunderTerapi Sekunder
Faktor Resiko
PatofisiologiPatofisiologi
KELUHAN KLINIS DM
KELUHAN KLASIK (+) KELUHAN KLASIK (-)
GDPAtauGDS
126------- 200
< 126--------< 200
GDPAtauGDS
126------- 200
100 - 126 < 100
ULANG GDP atau GDS
GDPAtauGDS
100 - 199
126------- 200
< 126--------< 200
TTGOGD 2 jam
200 140-199 < 140
DIABETES MELLITUS TGT GDPT NORMAL
Evaluasi status gisi, penyulit DM, peren-canaan makanan sesuai kebutuhan
Nasehat umum, perencanaan makanLatihan jasmani, berat idaman, belum perlu Tx penurun glukosaSumber: PERKENI
OAD
Sulfonilurea
Tiazolidinedion
Alpha glukosidase inhibitor
Biguanid
Meglitinide
Inhibitor DPP4
Summary : Mekanisme kerja OAD
Adapted from Sonnenberg and Kotchen Curr Opin Nephrol Hypertens 1998;7(5):551-555.
INCREASEGLUCOSE
ABSORPTION
MUSCLE
PANCREAS
ADIPOSE TISSUE
LIVER
INTESTINE
HYPERGLYCEMIA DECREASED PERIPHERAL
GLUCOSE UPTAKE
INCREASED GLUCOSE
PRODUCTION
DECREASED INSULIN
SECRETION
Therapy:Thiazolidinedion
es(Biguanides)
Therapy:SulfonylureasMeglitinides
Insulin
Therapy:Biguanides
Thiazolidinediones
Therapy:Alpha-glucosidase
inhibitors
INTESTINE
DeFronzo RA. Diabetes. ;37:667-687.Lebovitz HE. In Joslin's Diabetes Mellitus. :508-529
Blood glucose
Insulin resistance
1 Intestine: glucose absorption 2 Muscle and adipose tissue:glucose uptake
4 Liver: hepaticglucose output
3 Pancreas: insulin secretionSulfonylureas :
insulin secretion
Insulinresistance
Sulfonylureas: Mechanism of Action
Insulinresistance
Blood glucose
Insulin resistance
1 Intestine: glucose absorption
3 Pancreas: insulin secretionMeglitinidesInsulin secretion
4 Liver: hepatic glucose output
2 Muscle and adipose tissue:glucose uptake
Wolffenbuttel BHR. Eur J Clin Pharmacol. 1993;45:113-116.
C
Meglitinides: Mechanism of Action
DeFronzo RA et al. J Clin Endocrinol Metab. ;73:1294-1301.
Insulinresistance
Blood glucose
Insulin resistance
1 Intestine: glucose absorption
3 Pancreas: insulin secretion
4 Liver: hepatic glucose output Metformi HGO
2 Muscle and adipose tissue:glucose uptakeMetformin glucose utilization
Biguanid: Mechanism of Action
Whitcomb RW et al. In: Diabetes Mellitus. 1996.Cavaghan MK et al. J Clin Invest. 1997;100:530-537.
Ehrmann DA et al. J Clin Endocrinol Metab. 1997;82:2108-2116.
Blood glucose
Intestine: glucose absorption
Pancreas: insulin secretion
Muscle and adipose tissue: Thiazolidinediones insulin resistance
glucose uptake
Liver: hepaticglucose outputThiazolidinediones HGO
Thiazolidinediones: Mechanism of Action
Improve -cellfunction
1 Intestine: glucose absorptionAcarbose glucose absorption secondaryto digestion of carbohydrate
Insulinresistance
4 Liver: hepaticglucose output
Amatruda JM. In: Diabetes Mellitus. 1996.
Blood glucose
Insulin resistance
3 Pancreas: insulin secretion
2 Muscle and adipose tissue: glucose uptake
-Glucosidase Inhibitors :Mechanism of Action
Incretin=GLP-1 ↓
Pancreas: insulin secretion ↑
Sel alpha menurunkan glukagon
Normal
DM
Incretin=GLP-1
DPP-4 memecah inkretin
Insulin ↓, glukagon ↑
Inhibitor DPP-4
Inhibitor DPP-4, Mechanism
Stepwise management of type 2 diabetes
Insulin ± oral agents
Diet & exercise