Diabetes Mellitus and its Treatment

Introduction

Diabetes mellitus or better known as "diabetes" in society is one of the "eternal" diseases that sufferers continue to appear in everyday life. This disease has a broad impact on patients, not only because it disrupts their health due to the various complications it causes, but also affects social life. In fact, the global prevalence of diabetes mellitus continues to increase from year to year. In 1995, the prevalence of diabetes mellitus in the world reached 4,0% and is expected to increase to 5,4% in 2025. Meanwhile in developing countries (including Indonesia), people with diabetes mellitus in 1995 have reached 84 million patients and are predicted to soar to 228 million patients in 2025 later.2

Definition and Classification of Diabetes Mellitus

Diabetes mellitus is a group of metabolic diseases with chronic hyperglycemia as the main disorder due to insufficiency of insulin action.4

Based on its etiology, the American Diabetes Association (2005) classifies diabetes mellitus into four types, namely:1,2

I. Diabetes Mellitus Type 1
(beta cell destruction, usually leading to absolute insulin deficiency)
A. Through immunologic processes
B. Idiopathic  

II. Diabetes Mellitus Type 2
(varies from predominance of insulin resistance with relative insulin deficiency to predominance of impaired insulin secretion with insulin resistance)

III. Other Types of Diabetes Mellitus

  • Genetic defects of beta cell function
  • Genetic defects in insulin action
  • Diseases of the exocrine pancreas
  • Endocrinopathy
  • Due to drugs/chemicals
  • Infection
  • Immunology (rare)
  • Another genetic syndrome
  • Diabetes Gestational (Gestational)

 
Diabetes Mellitus Clinical Manifestations

The classic complaint of diabetes mellitus includes four things, namely: polyuria, polydipsia, polyphagia, and unexplained weight loss. Other complaints that can also be found in patients with diabetes mellitus include patients feeling weak, itchy, tingling, blurred vision, and the presence of erectile dysfunction in men or pruritus of the vulva in women.1,2   

Diagnosis of Diabetes Mellitus

In making the diagnosis of diabetes mellitus, the benchmark that is used as a reference is, of course, blood glucose examination. In this case, the term screening examination and diagnostic test for diabetes mellitus is known.1,2

 
Screener Check

Screening examination is aimed at identifying groups that do not show symptoms of diabetes mellitus but have a risk of diabetes mellitus, namely: 1) Age > 45 years, 2) Overweight (with the criteria: BBR > 110% ideal body weight or BMI > 23 kg/m2) , 3) Hypertension (≥ 140/90 mmHg), 4) There is a history of diabetes mellitus in the lineage, 5) there is a history of repeated abortions, giving birth to babies with disabilities, or birth weight babies > 4000 grams, 6) HDL cholesterol levels ≤ 35 mg/day dl and or triglycerides ≥ 250 mg/dl.
 
Screening tests are carried out by checking current blood sugar levels (GDS) or fasting blood sugar (GDP), which can then be followed by a standard oral glucose tolerance test (OGTT). From the GDS examination, it is called diabetes mellitus if the GDS level is ≥ 200 mg/dl from venous plasma or capillary blood samples. Meanwhile, on the examination of GDP, it is said to be diabetes mellitus if the level of GDP is ≥ 126 mg/dl from venous plasma samples or ≥ 110 mg/dl from capillary blood samples.

Diagnostic Test

Diagnostic tests were carried out in groups showing signs or symptoms of diabetes mellitus. For those who experience typical symptoms of diabetes mellitus, GDS ≥ 200 mg/dl or GDP ≥ 126 mg/dl is sufficient to establish a diagnosis of diabetes mellitus. Whereas in patients who do not show typical symptoms of diabetes mellitus, if abnormal levels of GDS or GDP are found, then GDS/GDP should be re-examined or if necessary confirmed with OGTT to obtain abnormal numbers once again which are criteria for diagnosing diabetes mellitus (GDP ≥ 126). mg/dl, GDS ≥ 200 mg/dl on other days, or OGTT ≥ 200 mg/dl).  

Treatment of Diabetes Mellitus

Treatment of diabetes mellitus is very important in maintaining the stability of the patient's blood sugar levels in order to prevent the occurrence of various acute and chronic complications. This is done through the four main pillars of managing diabetes mellitus, namely:2,3
  1. Onboarding Education
    In the form of education and training on knowledge of managing diabetes mellitus for patients and their families.
  2. Meal planning
    Aims to maintain normal levels of blood glucose and lipids, optimal nutrition, and achieve/maintain ideal body weight. The recommended food composition for patients is as follows: 60-70% carbohydrates, 20-25% fat, and 10-15% protein.
  3. Physical exercise
    In the form of daily physical activity (walking to the market, gardening, etc.) and regular physical exercise (3-4x/week for ± 30 minutes).
  4. Pharmacological intervention
    Given if target blood glucose levels cannot be achieved with meal planning and physical exercise. Pharmacological interventions can be in the form of oral hypoglycemic drugs/OHO (insulin sensitizing, insulin secretagogue, alpha glucosidase inhibitors) and insulin, given in the following conditions:
  • Fast weight loss
  • Severe hyperglycemia with ketosis
  • Diabetic ketoacidosis
  • Non ketotic hyperosmolar hyperglycemia
  • Hyperglycemia with lactic acidosis
  • Failed with almost maximal dose of OHO combination
  • Severe stress (systemic infection, major surgery, AMI, stroke)
  • Uncontrolled gestational diabetes mellitus with meal planning,
  • Severe impaired renal/liver function
  • OHO contraindications or allergies          

Bibliography

  1. Gustaviani, R., 2006. Diagnosis and Classification of Diabetes Mellitus. Textbook of Internal Medicine, Publishing Center of the Faculty of Medicine, University of Indonesia, Jakarta, 1879.   
  2. Kurniawan, A., 2005. Current Review of Diabetes Mellitus. Collection of Papers One Day Symposium an Update on the Management of Diabetes Mellitus, Committee for Inauguration of New Doctors Period 151, Faculty of Medicine, Sebelas Maret University, Solo, 5.
  3. Association of Indonesian Internal Medicine Specialists, 2005. Diabetes Mellitus. Medical Service Standards, PB PAPDI, Jakarta, 7.
  4. Soegondo, S. 2011. Diagnosis, Classification, and Pathophysiology of Diabetes Mellitus. Collection of Comprehensive Management of Diabetes Mellitus Update Papers, Committee for the National Scientific Seminar on Continuing Medical Education, Faculty of Medicine Universitas Islam Indonesia, Jogjakarta, 11.

 

------------

By: dr. Dimas Satya Hendarta
Medical Faculty Educative Staff Universitas Islam Indonesia