Nama : Prof . Dr. dr. Darmono, SpPD,K-EMD, FINASIMTempat & tgl lahir : Tuban, 8 Oktober 1945Jabatan sekarang : Kepala Sub Bagian Endokrin-Metabolik, Bagian Ilmu Penyakit Dalam

FK Undip / RSUP Dokter Kariadi, Semarang Riwayat pendidikan : - Dokter Umum FK Undip,1973

- Spesialis Penyakit Dalam FK Undip,1980 - Konsultan Endokrin Metabolik Diabetes FK Undip – Perkeni, 1990 - Doktor (topik diabetes malnutrisi) FK Undip, FK UGM, FK Unair, FKUI, Int Med Dept, Univ Hosp, Med Fac, Free Univ Amsterdam, 1990

Organisasi profesi : • Anggota Ikatan Dokter Indonesia (IDI) tahun 1973 – sekarang.• Anggota Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI) tahun 1980 sekarang. • Member of Asean federation of Endocrine Society (AFES) since 1980. • Sekretaris Perkumpulan Endokrinologi Indonesia (PERKENI) Cabang Semarang tahun 1980 – 2007. • Wakil Ketua I Perkumpulan Endokrinologi Indonesia (PERKENI) Cabang Semarang tahun 2007 – 2013• Ketua Perkumpulan Endokrinologi Indonesia (PERKENI) Cabang Semarang tahun 2013 - sekarang• Anggota Perkumpulan Andrologi Indonesia tahun 1984 – sekarang.• Ketua Persatuan Diabetes Indonesia (PERSADIA) Cabang Semarang tahun 1980 – 2002. • Member of International Diabetes Federation (IDF) since 1985. • Anggota Tim Pengendalian Defisiensi Iodium FK Undip, RSUP Dr Kariadi, Depkes RI, tahun 1990 – sekarang• Anggota Konsultan Pengendalian Defisiensi Iodium Depkes RI tahun 1993 – sekarang.• Member of West Pacific Region (WPR) of Diabetes Educator since 1995.• Sekretaris kelompok Studi Tiroidologi FK Undip, RSUP Dr kariadi tahun 1996 – sekarang.• Ketua Umum Pengurus Besar Persatuan Diabetes Indonesia (PERSADIA) tahun 2002 – 2005.• Penasehat Pengurus Persatuan Diabetes Indonesia (PERSADIA) tahun 2005 – sekarang. • Anggota Kelompok Studi Sexual Ambiguous FK Undip, RSUP Dr Kariadi, tahun 2002 – sekarang. • Anggota Perkumpulan Obesitas Indonesia tahun 2003 – sekarang. • Anggota Tim Operasi Penyesuaian Kelamin RSUP Dr Kariadi tahun 2003 – sekarang.• Anggota Tim Kajian Pengembangan Sumber Daya Manusia FK Undip tahun 2003 – sekarang. • Ketua Bidang Organisasi Kelompok Studi Sito Genetik (Ambiguous Genetalia) FK Undip RSUP Dr Kariadi tahun 2006 – sekarang.Penghargaan : Tanda Kehormatan Satyalancana Karya Satya dari Presiden RI tahun 2002

CURICULUM VITAE

ATHEROGENIC DYSLIPIDEMIAAND TYPE 2 DIABETES

MACROVASKULAR RISK

Prof Darmono MD PhD, Internist, EndocrinologistDiv of Endocrinology and Metabolism

Dept of Medicine, Med Fac, Diponegoro Univ, Kariadi Hospital, Semarang

Education and Development of Medical ProfessionDOCLink (Diabetes – Obesity – Cardiovascular – Link)

Jakarta, August 2014

PERKUMPULANENDOKRINOLOGII N D O N E S I A

PERKENI

IGT DM

Brain Heart Peripheral artery

Tendency ofatherosclerosis

Diabetic risk factors Dyslipidemia Hypertension Hyperinsulinemia Obesity

Insulinresistance

UnderlyingPathogenic factors

Glucose

Lipid

Insulin (IGF-1)mediator

⊕

Early detection and treatment hyperglicemia dyslipidemia

Mortality80%

75% CVD

25%stroke

PAD

MACROANGIOPATHY

( Prothrombotic )

Plateletactivity

Endothelialdysfunction

Prostacyclinproduction

plasmacoagulability

fibrinolysis

Heart Brain Peripheral artery

atheroscleroticocclusive disease

● Hyperglycemia● Hyperinsulinemia

Vasc. growthpromoting factor

Diabetic serumgrowth factor 1

Insulin-likeGrowth factor

Proliferationof vasc smoothmuscle

Vasc complication

Atherosclerosis

AGEP

LDL

Atheroma

Connect tissueProliferation

Lipid profile disorders

Fibrotic Calsified Ulceration

Lipid filled plaques/ fatty plaques

/ atheroma

Artherialsub intima

Thrombosis Emboli

Vasccomplication

Tryglyseride LDL HDL

Risk factors

CRP Fibr Homocyst APO-L-B L-A Visk Plasma

Age DM peripheral neuropathy

+

AtheroscleroticOcclusive disease

Procoagulant tissue factor

Leucocyte adhession molecules

Chemostatic substances

Compounds impairing fibrinolysis (Plasminogen activator)

Endothelial cell nitric oxyde

Stimulator vasodilation Inhibitor

Inflammation Proliferation Platelet aggregation

Regulation disorderof vasc tone

Endothelialreceptor

(marker of inflammation) + –

Lipid profile as risk factors of CVDin diabetic patients

RiskLDL

cholesterol(mg/dl)

HDL cholesterol

(mg/dl)

Tryglyseride(mg/dl)

High 130 < 40 400

Moderate 100 – 129 40 – 59 150 – 399

Low < 100 60 < 150

Correlation of lipid profileand risk of CVD

IdealSpecial

attentionHigh risk

Total Cholesterol

< 200 200 – 239 240

LDL CholesterolCVD ( - )CVD ( + )

< 130 < 100

130 – 159 130 – 159

160 160

HDL Cholesterol

> 45 36 – 45 < 35

TryglyserideCVD ( - )CVD ( + )

< 200< 150

200 – 399200 – 399

400 400

Criteria of Diabetic Control

Well

controledmoderate

Poor

controled

Fasting glucose (mg/dl) 80 – 109 110 – 125 126

Post prandial glucose 80 – 144 145 - 179 180

HbA1c (%) < 6.5% 6.5 – 8.0 > 8

Total cholesterol (mg/dl) < 200 200 – 239 240

LDL (mg/dl) < 100 100 – 129 130

HDL (mg/dl) Male > 45, female > 50

Tryglyseride (mg/dl) < 150 150 – 199 200

BMI (kg/m2) 18.5 – 22.9 23 – 25 > 25

Blood pressure (mmHg) 130/80 > 130-140/ > 80-90 > 140/90

Note : venous plasma material

DM

Fasting Lipoprotein

LDL < 100 mg/dlTrygl < 150 mg/dlHDL > 40 mg/dl

LDL 100 mg/dlTrygl 150 mg/dlHDL 40 mg/dl

monitoring of lipid profile( 3 – 6 month )

monitoring of lipid profile( 1 yr )

Diabetic control

Lipid control

Trygl > 150 mg/dlLDL > 100 mg/dlHDL > 40 mg/dl

Tryg > 150 mg/dl LDL > 100 mg/dl

Fibrate Statin Fibrate + resin

Fibrate StatinFibrate

Preparations Drugs Lipoprotein effect Contra Indication

Statin Lovastatin

Pravastatin

Simvastatin

Fluvastatin

Atorvastatin

Rosuvastatin

Pitavastatin

LDL 18-55%

HDL 5-15%

Tryglyseride 7-30%

Acute or chronic liver dysfunction

Ezetimibe LDL 15-20%

HDL 1-4%

Tryglyseride 5-10%

In combination with statin (contra indikation for acute and chronic

hepatic dysfunction)

Bile acid squestrants

Cholestyramine

Colestipol

Colesevalam

LDL 15-30%

HDL 3-5%

Tryglyseride sqa

Dysbetaliproteinemia

Tryglyseride > 400 mg/dl

Nicotinic acid LDL 5-25%

HDL 15-35%

Tryglyseride 20-50%

Chronic hepatic dysfunction

Fibric acid derivatives

Gemfibrozil

Fenofibrate

LDL 5-20% ( in patients with high tryglyseride)

HDL 10-20%

Tryglyserid 20-50%

Severe hepatic dysfunction

Severe renal dysfunction

Pharmacological treatment for correction of lipid profile