Terapi medikamentosa
diabetes melitus
DR. Dr. Tjokorda Gde Dalem Pemayun, SpPD-KEMD
2025
TJOKORDA GDE DALEM PEMAYUN. MD, PhD
Internist Endocrinologist
Dr. Kariadi General Hospital, Dr. Soetomo street, No.18, Semarang
Phone 062-24-8454873; Mobile 081329270858
EDUCATIONS
• GP-Medical School, Udayana University, Denpasar, 1986
• Internist, Diponegoro University, Semarang, 1998
• Endocrinologist, Diponegoro University, Semarang, 2007
• PhD, Diponegoro University, Semarang, 2012
OCCUPATIONS
• Military doctor, Indonesian NAVY, Dr. Ramelan Hospital, Surabaya,1986-1990
• United Nation High Commissioner fo Refugees (UNHCR) Galang Island, Riau, 1987
• Sanglah General Hospital, Denpasar 1990-1992
• Dr Soemarno Hospital, Kuala Kapuas, Central-Borneo, 1998-2000
• Endocrinology Division, Internal Medicine Department, Dr. Kariadi General Hospital, Semarang, 2001
• Member of IDD, Central Laboratory Diponegoro University, Indonesia, 2007
• Member of Ambogous Genetalia Team, Diponegoro University, Dr Kariadi Hospital, 2005
• Head of Endocrinology Division, Depart of Internal Medicine, Dr. Kariadi Hospital, Semarang, 2015-2022
• Bali Royal Hospital Denpasar 2023.
• Siloam Bali Hospital 2023.
• President of Indonesian Thyroid Association 2021-now
Agenda
Obesity: apple style and pear style
Modifiable risk factors
1. Obese/Overweight
2. Low physical activity
3. Unbalanced diet
4. Prediabetes (higher than normal blood sugar, but
not enough to be considered type 2 diabetes)
Non-Modifiable risk factors
1. Family history of diabetes
2. Older than 45 years old
3. South Asian, African, Hispanic, American Indian, or Caribbean
ethnicity
4. Low birth weight
5. Previous pregnancy with gestational diabetes
6. History of polycystic ovary syndrome (PCOS) or others
Is remission possible?
What approaches may be most effective?
1) Very Low Calorie Diets 1) Explore your options
2) Learn to burn fat and protect muscle
3) Lose weight without hunger
4) Reduce medications
2) Low Carbohydrate Diets 5) Regain your quality of life
Metformin
Initial dose: 500 mg orally twice a day or 850 mg orally once a day
Metformin : contra indication
• eGFR <30 ml/min (dose
reduction to 500 mg twice daily
if eGFR <45 ml/min)
• Liver failure or cirrhosis
• Severe advanced heart failure
Sulfonylureas
Sulfonylureas : advers effects and combination
Thiazolidinediones
Thiazolidinediones : adverse effects
[Link]: Fluid retention, peripheral edema and
[Link] gain: A common side effect
[Link] failure: can cause congestive heart failure
[Link]: can increase the risk of bone fractures
Hyperglycemia: combination Metformin + TZD ?
Metformin and thiazolidinediones: When taken together,
they can improve glycemic control and reduce the risk of vascular complications
Incretin-based therapy
DPP-4 inhibitor
1. Block DPP-4, which breaks
down incretins
2. Increase levels of incretins, like
GLP-1, which stimulate insulin
production
3. Decrease glucagon production
4. Slow stomach and intestines,
which can lead to feeling full
faster and a slightly decreased
appetite
SGLT-2 inhibitors
SGLT-2 inhibitors
Canagliflozin: Dapagliflozin: Empagliflozin:
Insulin
Insulin
treatment
Agenda
Gizi pada diabetes
usia lanjut
Olahraga pada
diabetes usia lanjut
Obat-obatan pada
diabetes usia lanjut
Insulin pada diabetes
usia lanjut
Insulin pada diabetes usia
lanjut
Selalu
Bahagia
Selalu
Bersama
