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Management
Common Definitions
Abbreviation Definition
Classification of Diabetes
• Type 1 diabetes
• Absolute insulin deficiency due to the destruction of
pancreatic beta-cells
• Type 2 diabetes
• Type 2 is characterized by insulin resistance with relative
insulin deficiency to a predominately secretary defect
with insulin resistance
• Other specific types
• Gestational diabetes
• Glucose intolerance first detected in pregnancy that often
resolves after the birth of the baby
Unexplained weight
• Weight Loss even if food in-
loss
take is normal
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1 2 3
Screen patients with Conduct 1st Blood Test Conduct 2nd Blood Test
diabetes risk factors (if required) and
establish Diagnosis
4
Inform Patient and
Initiate treatment
Slide 7
Diabetes Associated
Unmodifiable Risk Modifiable Risk
Risk
Clinical Test
(+) Classic (-) Classical
Symptoms Symptoms
Clinical Test
(+) Classic (-) Classical
Symptoms Symptoms
mg/dL
Fasting Plasma Glucose (FPG)
Diabetes
126
IFG (Impaired
Fasting Glucose
100
IGT (Impaired
Glucose Diabetes
NGT (Normal Tolerance)
Glucose
Tolerance)
Or
4. HbA1c ≥ 6,5% (NGSP)
Note:
• Classical symptom of diabetes (+), only need 1 abnormal BG
• No classical symptom of diabetes, need 2 x abnormal BG level in a different days
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ADA/EASD Algorithm
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Indonesia
Gol.Obat Cara Kerja Utama ESO Utama Penurunan HbA1c
Inadequate
+ 1 OAD + 2 OAD + 3 OAD
Lifestyle
INITIATE INSULIN
Insulin Indications
Absolut Indication
Type 1 Diabetes
Relative Indication
Patients who fail to reach target with OAD optimal dosage
(3-6 months)
Type 2 DM Outpatient with:
Pregnancy not controlled with diet
Infected Diabetes Feet
High Blood Glucose Fluctuations
Repeated History of Ketoacidosis
History of Pankreotomi
Besides the above, there are a number of conditions
where insulin is required, e.g. chronic liver, kidney
function interruption and high dosage steroid therapy
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Hubungan antara A1C dan eAG dijelaskan dengan rumus 28,7 X A1C - 46,7 = eAG
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Myocardial
Good control is infarction
≤ 7.0% HbA1c
-14%
HbA1c measures
the average
blood glucose Microvascular
level over the HbA1c complications
last three
-1% -37%
months
Deaths related
to diabetes
-21%
Source: UKPDS = United Kingdom Prospective Diabetes Study. Stratton IM
et al. BMJ. 2000;321(7258):405-412.
Slide 26
Source: Konsensus Pengelolaan dan Pencegahan DMT2 di Indonesia. PERKENI. 2011. Diabetes Care 2012. Penatalaksanaan
Diabetes Melitus Terpadu. 2009
Slide 27
Source: Konsensus Pengelolaan dan Pencegahan DMT2 di Indonesia. PERKENI. 2011. Diabetes Care 2012. Penatalaksanaan
Diabetes Melitus Terpadu. 2009
Slide 28
TERIMAKASIH
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