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DIABETES MELITUS
(EPIDEMIOLOGY,PATHOPHYSIOLOGY
,DIAGNOSIS,MANAGEMENT)
10,0
8,0
No. 14 7,7 7,8
8,1
8,5 8,6
6,8
6,6
6,2
6,0
6,0 5,7
5,4 5,5
5,2 5,3 5,3
5,0
4,8
4,5 4,6
4,1 4,1 4,2
4,0 3,7 3,8
3,4
3,2 3,3
3,0 3,0
0,0
(Riskesdas 2007)
Increasing DM
Prevalence in Indonesia
NATIONAL
6.9%
5.7%
1.7%
Islet b-cell
Decreased
Incretin Effect
Increased
Impaired Lipolysis
Insulin Secretion
Islet a-cell
Hyper-
glycaemia
Increased
Decreased Glucose
HGP
Uptake
Neurotransmitter
Dysfunction
Genetic and environmental risk factors impact
inflammation, autoimmunity, and metabolic
stress are leading to hyperglycemia
10
Puasa
5
0
Resistensi
250
Insulin
Fungsi sel
Relatif (%)
200
150
100 Tingkat Insulin
50 Kegagalan sel (~ - 50%)
0
PERUBAHAN MAKROVASCULAR
Gambaran
Klinis
PERUBAHAN MIKROVASCULAR
Tahun 10 5 0 5 10 15 20 25
Elevated
Liver Plasma FFA
Reduced
Plasma Insulin
Decreased Glucose Transport
& Activity (expression) of GLUT4
Hyperglycemia
Adipose tissue
insulin
resistance
ADIPOSE TISSUE
MUSCLE
Lipolysis LIVER
Hyperglycemia
Genetic Rare
abnormalities disorders
INSULIN
RESISTANCE
Type 2
diabetes PCOS
Hypertension Atherosclerosis
Dyslipidemia
Reaven GM. Physiol Rev. 1995;75:473-486
Clauser, et al. Horm Res. 1992;38:5-12.
-cell dysfunction
• Reduced ability of -cells to secrete
insulin
• Impaired ability of -cells to
compensate for insulin resistance
• Genetic and environmental
pathophysiology
20% 50%
Normoweight
30% Underweight
Obesity
Diet nutrition
Physical activity/Exercise/Sport
Pharmacologic Oral