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"Atas rekomendasi dokter spesialis pelayanan Rujuk Balik ke puskesmas dianjurkan bagi pasien di RS yang menderita penyakit kronis termasuk diabetes melitius. Penelitian ini bertujuan untuk melihat faktor-faktor yang berhubungan dengan kesediaan pasien diabetes mellitus tipe 2 peserta JKN di RSU Jagakarsa untuk dirujuk balik ke FKTP.Desain potong lintang dan pendekatan kualitatif melalui wawancara mendalam digunakan dalam studi ini. Hasil penelitian menunjukkan bahwa kepercayaan pasien terhadap dokter layanan primer, persepsi pasien mengenai ketersediaan obat di fasilitas kesehatan primer, jarak tempuh terhadap fasilitas kesehatan primer dan dukungan keluarga dan teman berhubungan dengan kesediaan pasien untuk dirujuk balik. Disarankan untuk mengembangkan SOP rujuk balik di RS dan mengembangkan pojokrujuk balik.

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Back referral service to primary care is provided for JKN patients including diabetes mellitus type 2 patients as recommended by the internal medicine specialist. This studyaim is to analyse the factors that related to willingness of the patients to be referred to primary care after receiving care at the hospital in Jagakarsa Hospital. This study is using quantitative method with cross sectional design, followed by qualitative method with in depth interview.

The study revealed that trust to the primary health care physician, perception on medicine availability in primary health care facility, accessiibility and support from family and friend affect patient willingness to agree with back referral service. The study suggested to develop standard procedure for back referral and initiate back referral corner in hospital."

"Peningkatan Prevalensi Penderita Diabetes Mellitus di era JaminanKesehatan Nasional, akan meningkatkan beban pembiayaan kesehatan.Implementasi Program Rujuk Balik yang melibatkan banyak instansi menjadisangat penting dalam memberikan efisiensi bagi pembiayaan maupun pasien.Penelitian ini untuk mengetahui faktor-faktor yang mempengaruhi implementasikebijakan program rujuk balik pasien diabetes mellitus stabil di Rumah SakitUmum Daerah Johar Baru Tahun 2017 melalui teori Van Meter dan Van Horn. Penelitian ini menggunakan pendekatan kualitatif dengan disain studimelalui content analisis dan metode triangulasi dan pendekatan kuantitatif dengandisain studi kasus. Data primer didapat melalui wawancara mendalam, kuesioner,observasi, dan telaah dokumen. Untuk data sekunder dari dokumen dan literatur. Dari hasil penelitian menunjukan bahwa implementasi Program RujukBalik di Rumah Sakit Umum Daerah Johar Baru belum berjalan efektif. Peranankolaborasi antara pembuat dengan pelaksana kebijakan harus semakin baiksehingga implementasi Program Rujuk Balik akan berjalan dengan optimal.

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The effect of increasing prevalence of Diabetes Mellitus in UniversalHealth Coverage era will increase the cost of finance. Implementation of RereferenceProgram involve many institution that make important for giving financeand patient rsquo s service more efficient. Objective of this reseach is to find theeffectiveness of Re reference policy of Stabil Diabetes Mellitus at Johar BaruHospital in 2017 according to Van Meter and Van Horn theory.

This reseach is using quantitative and qualitative approach with studydesign by analysis content and triangulation method. Primary data is procured fromdeepening inteview, quesioner, observation and documents. Secondary dataprocured from documents and literatures.

From result of this reseach showed that Re reference Program is lessoptimum at Johar Baru Hospital. Collaboration between the policy maker and theimplemeters of Re reference Program need to be better, so there implementation ofRe reference Program will be optimum."

"Diabetes Melitus (DM) tipe 2 merupakan penyakit yang memerlukan pengelolaan berkelanjutan khususnya dalam pengendalian kadar glukosa darah untuk mencegah atau memperlambat terjadinya komplikasi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan pengendalian kadar glukosa darah pasien DM tipe 2 yang meliputi umur, jenis kelamin, durasi penyakit, kepatuhan minum obat, kepatuhan diet, asupan (karbohidrat, protein, lemak, serat), indeks glikemik, aktivitas fisik, pengetahuan dan dukungan keluarga. Desain penelitian yang digunakan adalah cross sectional, dengan responden 86 pasien DM tipe 2 rawat jalan di Poliklinik Penyakit Dalam RSJ Prof. Dr. Soerojo Magelang pada bulan April-Mei 2013. Pengumpulan data dilakukan melalui wawancara kuesioner, food recall 1x24 jam, pengukuran berat badan dan tinggi badan serta pencatatan hasil pemeriksaan kadar glukosa darah puasa dari catatan medik pasien. Analisis statistik menggunakan uji Chi square dan Anova. Hasil penelitian menunjukkan 61,6% responden memiliki pengendalian kadar glukosa darah buruk. Hasil analisis bivariat menunjukkan terdapat hubungan bermakna antara kepatuhan minum obat, kepatuhan diet, pengetahuan, asupan lemak dan dukungan positif keluarga dengan pengendalian kadar glukosa darah. Berdasarkan hasil tersebut, diharapkan petugas kesehatan dapat meningkatkan edukasi dan evaluasi terkait diet pasien kepada pasien dan keluarga pasien serta memberikan motivasi bagi pasien dan keluarga pasien mengenai pentingnya peran keluarga dalam pengelolaan diabetes.

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Type 2 Diabetes Mellitus is a disease that requires continuous management particularly in blood glucose control to prevent or slowing complication. The objective of this study was to identify factors related to blood glucose control in type 2 Diabetes Mellitus includes age, gender, duration of disease, medication adherence, dietary adherence, intake (carbohydrate, protein, fat, fiber), glycemic index, physical activity, knowledge and family support. The design used in this study is cross sectional, with 86 outpatients at Internal Medicine Clinic Prof. Dr. Soerojo Psychiatric Hospital Magelang in April-May 2013 as respondent. Data were collected through interview with questionnaire, 1x24 hour food recall, weight and height measurement and record blood glucose assessment result from patient medical record. Statistical analysis used Chi square and Anova test. The result of this study showed that 61,6% respondents have poor blood glucose control. Bivariate analysis indicated that there were significance association between medication adherence, dietary adherence, knowledge, fat intake, and positive family support with blood glucose control. Based on that result, health workers are expected to improve education and evaluation for patient and their family regarding patient dietary and improve education and motivation for patient and their family regarding the importance of family support in diabetes management."

"Efikasi diri dan kepatuhan merupakan faktor yang penting dalam meningkatkan kualitas hidup pasien DM tipe 2. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat efikasi diri dan kepatuhan dengan kualitas hidup pasien DM tipe 2 yang menjalani rawat jalan di Rumah Sakit di Jakarta.Desain dalam penelitian ini adalah cross sectional, dengan jumlah sampel 125 pasien DM tipe 2. Alat ukur yang digunakan adalah Diabetes Management Self-Efficacy (DMSES), the Diabetes Activities Questionare (TDAQ), dan Diabetes Quality Of Life (DQOL).Hasil penelitian menunjukkan bahwa efikasi diri (0,0005), dan kepatuhan (0,0005) berhubungan secara signifikan dengan kualitas hidup dengan variabel yang paling dominan adalah kepatuhan.Hasil uji multivariat menunjukkan bahwa variabel efikasi diri, kepatuhan, tingkat pendidikan, dan depresi menentukan kualitas hidup pasien DM. Perlunya dikembangkan pengkajian dan intervensi keperawatan yang berfokus pada efikasi diri dan kepatuhan pasien DM tipe 2.

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Self-efficacy and adherence are important factor in improving the quality of life of patients with type 2 diabetes. This study aimed to determine the relationship between self-efficacy and adherence to the quality of life of patients with type 2 diabetes mellitus in an outpatient unit of a Hospital in Jakarta.

This study was a cross-sectional, with sample of 125 patients with type 2 diabetes mellitus. The Diabetes Management Self- Efficacy (DMSES), the Diabetes Activities Questionare (TDAQ), and the Diabetes Quality of Life (DQOL) were employed as instruments.

The results showed that selfefficacy (0.0005), and adherence (0.0005) were significantly associated with quality of life and the most dominant variable is adherence.

Multivariate test results indicate that the variable self-efficacy, adherence, education level, and depression determines quality of life of diabetic patients. This study suggestsis the need fornursing assessment and interventions that focus on the self-efficacy and adherence diabetes mellitus patient."

"Diabetes Melitus tipe 2 merupakan penyebab kematian ke-2 pada kelompok usia 45-54 tahun di daerah perkotaan, sedangkan di pedesaan menduduki peringkat ke-6. Angka kejadiannya berhubungan dengan adanya resistensi insulin akibat berbagai macam faktor. Pola paling umum dijumpai adalah dislipidemia terutama hipertrigliseridemia dan pengurangan kadar HDL. Penelitian ini dirancang untuk melihat gambaran kadar trigliserida pada pasien DM tipe 2 yang berobat ke Poli IPD RSCM pada tahun 2010. Didapatkan bahwa dari 108 subyek, 55 orang berusia ≥55 tahun, 68 orang berjenis kelamin perempuan, 71 orang tidak merokok, dan 84 orang dengan kadar trigliserida normal. Dari hasil analisis didapat hubungan tidak bermakna antara kadar trigliserida dengan usia (Mann-Whitney, p = 0.104), jenis kelamin (Chi-square, p = 0.062), perilaku merokok (Chi-square, p = 0,973), kadar gula darah puasa (Mann-Whitney, p = 0.973), dan kadar gula darah dua jam post prandial. (Mann-Whitney, p = 0.539). Rerata TG berdasarkan analisis data adalah 140,5 (49-1144) mg/dL. Nilai rerata kadar glukosa darah puasa (GDP) 186,5 (114-559) mg/dL. Analisis data menunjukkan sebaran tidak normal dengan rerata kadar gula darah dua jam post prandial (GD2PP) sebesar 291 (178-582) mg/dL.

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Type 2 diabetic melitus is the second death cause on urban residencies age ranged 45-54 year old, while it is the 6th leading death cause on rural area, based on RISKEDA 2007. High rate of prevalencies is because insulin resistancies as results of multifactorial. Most common patern is dislipidemia especially hypertriglyceride and low level of HDL. This researh is designed to picture triglyceride level on type 2 diabetic melitus patients in RSCM on year 2010. Known that from 108 subjects, 55 are aged ≥55 year old, 68 are women, 71 don’t smoke and 84 with normal level of triglyceride. From analitic processes, known that triglyceride level is not associated with age (Mann-hitney, p = 0.104), sex (Chi-square, p = 0.062), smoking habbit (Chi-square, p = 0,973), fasting blood glucose (Mann-Whitney, p = 0.973), and 2 hours post-prandial blood glucose (Mann-Whitney, p = 0.539). Mean rate of triglyceride level is 140,5 (49-1144) mg/dL. Mean rate fasting blood glucose is 186,5 (114-559) mg/dL. Data analysis doesn’t show normal distribution on mean rate of level 2 hours post prandial blood glucose 291 (178-582) mg/dL."

"Tingkat kepatuhan diet di Indonesia rata-rata masih rendah. Diet dalam menjaga makanan seringkali menjadi kendala karena masih tergoda dengan segala makanan yang dapat memperburuk kesehatan. Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang berhubungan dengan kepatuhan diet pada penderita diabetes melitus tipe 2. Penelitian ini menggunakan disain cross-sectional. Sampel yang diteliti adalah seluruh penderita diabetes melitus tipe 2 dengan rentang usia 25-65 tahun yang sedang rawat jalan, sampel diambil dengan metode non-random sampling dengan teknik purposive sampling sebanyak 130 orang. Pengumpulan data dilakukan melalui pengukuran antropometri, pengisian kuesioner, form food recall 1x24 jam dan semiquantitative food frequency questionnaire (SFFQ). Hasil penelitian menunjukkan sebanyak 13,8% responden yang patuh diet. Hasil uji chi-square menunjukkan ada hubungan yang bermakna antara kepatuhan diet diabetes melitus tipe 2 dengan jenis kelamin (p=0,008) dan lama menderita (p=0,044). Hasil uji regresi logistik menunjukkan lama menderita merupakan faktor dominan yang berhubungan dengan kepatuhan diet diabetes melitus tipe 2. Penderita diabetes melitus diharapkan untuk memperhatikan pola makan yang dianjurkan dan melaksanakannya dengan baik, mampu secara aktif untuk meningkatkan pengetahuannya terkait penyakit diabetes melitus dan faktor-faktor terkait lainnya dan tetap mempertahankan pola makan yang sudah dijalankan bagi yang sudah lama menderita diabetes melitus tipe 2.

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The level of dietary adherence in Indonesia is still low. Diet in maintaining food is often become an obstacles because the patient is still tempted by all food that can worsen their health. The purpose of this study is to determine the factors that associated with dietary adherence in type 2 diabetes mellitus patients. This study was using a cross-sectional design. The samples studied were all type 2 diabetes mellitus type 2 with the age range 25-65 years was outpatient, samples were taken with non-random sampling method with purposive sampling of 130 people. Data were collected through anthropometric measurements, filling-out questionnaires, 1x24 hour food recall and dan (semiquantitative food frequency questionnaire) SFFQ form.

The results showed 13.8% of respondents were diet-compliant. There were significant relationship between gender (p=0.008) and length of suffering (p=0.044) with between dietary adherence. The result of logistic regression test showed that the duration of suffering is the dominant factor associated with dietary adherence in type 2 diabetes mellitus patients. Type 2 diabetes mellitus patients were expected to pay attention to the diet recommended and carry it out well, to actively to improve the knowledge related to the disease diabetes mellitus and related to the other factors and still preserve diet that has been run for who has long been suffering from type 2 diabetes mellitus."

"ABSTRAK Latar Belakang. Prevalensi disfungsi tiroid lebih tinggi pada pasien diabetes dibandingkan populasiumum. Hipotiroidisme memperburuk komplikasi, morbiditas, mortalitas, dan kualitas hidup pasiendiabetes melitus tipe 2 (DM tipe 2). Faktor risiko hipotiroidisme pada pasien DM tipe 2 selama ini masihkontradiktif dan belum dikaji secara lengkap. Keberadaan sistem skor hipotiroidisme pada pasien DMtipe 2 diperlukan untuk membantu diagnosis dan menapis pasien DM tipe 2 yang memerlukanpemeriksaan laboratorium fungsi tiroid sebagai baku emas diagnosis hipotiroidisme.Tujuan. Mengetahui prevalensi dan determinan hipotiroidisme pada pasien DM tipe 2.Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Divisi Metabolik Endokrin(Poliklinik Diabetes) RSCM pada Juli sampai September 2015 dengan metode sampling konsekutif.Subjek menjalani anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium (TSH dan fT4). Analisisdata dilakukan dengan program statistik SPSS Statistics 17.0 untuk analisis univariat, bivariat,multivariat, dan Receiving Characteristics Operator (ROC) dan SPSS Statistics 20.0 untuk analisisbootstrapping pada Kalibrasi Hosmer-Lemeshow.Hasil. Sebanyak 303 subjek dianalisis untuk mendapatkan proporsi disfungsi tiroid dan 299 subjekdianalisis untuk mendapatkan determinan hipotiroidisme. Sebanyak 23 subjek (7,59%) terdiagnosishipotiroidisme, terdiri dari 43,5% subjek hipotiroid klinis dan 56,5% subjek hipotiroid subklinisberdasarkan Indeks Zulewski dan/atau Indeks Billewicz, dengan 16,7% hipotiroid klinis dan 83,3%hipotiroid subklinis berdasarkan hasil pemeriksaan fT4. Determinan hipotiroidisme pada pasien DMtipe 2 adalah riwayat penyakit tiroid di keluarga dengan OR sebesar 4,719 (95% IntervalKepercayaan/IK 1,07-20,8, p = 0,04), keberadaan goiter dengan OR sebesar 20,679 (95% IK 3,49122,66, p = 0,001),kontrol glikemik yang buruk dengan OR sebesar 3,460 (95%IK 1,075-11,14, p = 0,037), dan adanya sindrom metabolikOR sebesar 25,718 (95% IK 2,21-299,99, p = 0,01). Simpulan. Proporsi hipotiroidisme pada pasien DM tipe 2 adalah 7,59%. Determinan diagnosis dan komponen sistem skor hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga, keberadaan goiter, kontrol glikemik yang buruk, dan adanya sindrom metabolik. Sistem skor yang diberi nama Skor Hipotiroid RSCM ini diharapkan menjadi alat bantu diagnosis hipotiroidisme pada pasienDM tipe 2. ABSTRACT Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results.303subjectsincludedforproportionstudyofthyroiddysfunctionand299subjectsincludedforanalysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01).Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results.303subjectsincludedforproportionstudyofthyroiddysfunctionand299subjectsincludedforanalysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01).Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients."

"Latar Belakang Diabetes melitus dapat menyebabkan gangguan sistem saraf otonom (SSO) yang disebut sebagai neuropati otonom diabetik. SSO mengendalikan banyak sistem organ dan salah satu gangguannya dapat bermanifestasi sebagai disfungsi ereksi (DE). Prevalensi DE dan neuropati otonom diabetik di dunia masih beragam dan hubungan keduanya masih memiliki hasil yang bervariasi. Dengan deteksi dini neuropati otonom diabetik diharapakan dapat turut mendeteksi DE dan mencegah progresifitas DE menjadi lebih berat. Terdapat pilihan skrining untuk mendeteksi neuropati otonom salah satunya dengan Survey of Autonomic Symptom (SAS) dan pemeriksaan variabilitas detak jantung (HRV)Tujuan Mengetahui proporsi dan hubungan antara neuropati otonom dengan disfungsi ereksi pada DMT2 yang dinilai dengan kuesioner SAS dan pemeriksaan HRVMetode Penelitian ini menggunakan studi potong lintang dari 86 pasien DMT2 di Poliklinik Metabolik Endokrin RSUPN dr. Cipto Mangunkusumo sejak Agustus 2021 hingga November 2021. Pasien dilakukan wawancara dengan kuesioner SAS, IIEF-5, dan Pemeriksaan HRV. Dilakukan analisis multivariat untuk menilai hubungan variabel bebas dan terikat setelah dikontrol dengan variabel-variabel perancu yang berhubungan.Hasil Pada penelitian ini didapatkan proporsi pasien DE pada DMT2 sebanyak 59,3%. Proporsi pasien neuropati otonom yang dinilai dengan HRV sebanyak 94,3% dan neuropati otonom yang dinilai dengan kuesioner SAS sebanyak 41,9%. Terdapat hubungan secara statistik bermakna setelah dilakukan analisis multivariat antara neuropati otonom diabetik yang dinilai dengan kuesioner SAS dengan DE (adjusted OR 18,1 [IK95% 3,90-84.33]). Pemeriksaan HRV dalam penelitian ini tidak menunjukan hubungan yang signifikan secara statistik dengan DE.Kesimpulan Proporsi pasien dengan neuropati otonom diabetik yang dinilai dengan kuesioner SAS didapatkan sebesar lebih dari 40% dan yang dinilai dengan HRV lebih dari 90%. Terdapat hubungan yang secara statistik bermakna antara neuropati otonom diabetik yang dinilai dengan kuesioner SAS dengan DE.

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Background Diabetes mellitus (DM) affecting the autonomic nervous system known as diabetic autonomic neuropathy (DAN), which controls many organ systems and can manifest as erectile dysfunction (ED). The range of ED and DAN prevalence has been found to vary widely depending on the baseline comorbidities in the population of the subject studied. Autonomic neuropathy is still rarely studied and its relationship with erectile dysfunction needs to be explored whether the two variables are related. By early detection of autonomic neuropathy, it is hoped that can help detect ED and prevent the progression more severe. There are screening options to see autonomic neuropathy: survey of Autonomic Symptoms (SAS) questionnaire and Heart rate variability (HRV) test.

Objective To determine the proportion and relationship between diabetic autonomic neuropathy and erectile dysfunction in Type 2 DM using SAS questionnaire and HRV examination

Methods Cross-sectional study of 86 type 2 DM patients at the Metabolic Endocrine Polyclinic, dr. Cipto Mangunkusumo from August 2021 to November 2021. Patients were interviewed with the IIEF-5 questionnaire, SAS and HRV examination. Multivariate analysis with logistic regression analysis was performed to assess the relationship between diabetic autonomic neuropathy with ED in the type 2 DM population.

Results In this study, the proportion diabetic autonomic neuropathy in Type 2 DM was 41.9% with SAS questionnaire and 94,3% with HRV, and Proportion of ED was 59.3%. The proportion of autonomic neuropathy who had ED was 91.7% with SAS and 69,7% with HRV. There was a statistically significant relationship between diabetic autonomic neuropathy use SAS and ED (adjusted OR 18.1 [95% CI 3.90-84.33]). HRV examination did not show an association with ED in this study.

Conclusion More than half of the subjects had erectile dysfunction and almost all of the patients with diabetic autonomic neuropathy had erectile dysfunction. There is a statistically significant relationship between diabetic autonomic neuropathy using SAS questionnaire and ED."

"Latar Belakang: Peningkatan kadar high sensitivity C-reactive protein ( hsCRP ) dan kekakuan arteri berhubungan dengan peningkatan insiden kejadian kardiovaskular dan peningkatan mortalitas akibat penyakit jantung koroner pada pasien diabetes melitus tipe 2.Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara kadar hsCRP dan kekakuan arteri pada pasien diabetes melitus tipe 2.Metode : Melalui studi cross-sectional, dilakukan pemeriksaan kadar hsCRP dan derajat kekakuan arteri karotis pada 40 pasien dengan diabetes melitus tipe 2. Kekakuan arteri karotis kommunis diperiksa dengan doppler echotracking system untuk menentukan pulse wave velocity (PWV) atau kekakuan arteri karotis lokal (carotid-PWV).Hasil : Nilai median hsCRP pada penelitian ini adalah 4,5 (0,2 - 18,9) mg/L dan nilai rata-rata kekakuan arteri karotis adalah 8,8 ±1,7 m/detik. hsCRP berkorelasi kuat dengan karotid-PWV (r = 0,503, P = 0,001). Korelasi hsCRP dengan karotid-PWV ini tetap terlihat setelah dilakukan koreksi terhadap umur, indeks masa tubuh dan mean arterial pressure (r = 0,450, P = 0,005).Kesimpulan : Setelah dilakukan koreksi terhadap umur, indeks masa tubuh dan mean arterial pressure, hsCRP berkorelasi positif cukup kuat dengan kekakuan arteri pada pasien diabetes melitus tipe 2.

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Background: The elevated level of high-sensitivity C-reactive protein (hsCRP) and arterial stiffness are associated with higher incidences of cardiovascular events and with increased mortality from coronary heart disease in type 2 diabetic patients.

Aim: The aim of this study was to investigate the relationship between hsCRP and arterial stiffness in type 2 diabetic patients.

Methods: A cross-sectional study was conducted to assess the plasma levels of high sensitive C-reactive protein and carotid arterial stiffness among 40 patients with type 2 diabetes mellitus. The common carotid artery was studied by a doppler echotracking system to determine the local carotid pulse wave velocity (carotid-PWV).

Results: The median value of hsCRP in this study was 4.5 (0.2 to 18.9) mg/L and the average value of local carotid stiffness was 8.8 ± 1.7 m/sec. hsCRP showed a strong correlation with carotid-PWV (r = 0.503, P = 0.001). Levels of hsCRP were independently associated with carotid-PWV after adjusting for age, body mass index, and mean arterial pressure (r = 0,450, P = 0,005).

Conclusion: After adjusting for age, body mass index, and mean arterial pressure, hsCRP was strongly positively correlated with arterial stiffness in patients with type 2 diabets mellitus."

"Latar Belakang: Insidensi dan prevalensi diabetes melitus tipe 2 (DMT2) terus meningkat. Penurunan imunitas yang terjadi pada DMT2 dapat meningkatkan risiko infeksi. Kontrol gula darah yang baik bermanfaat dalam pengendalian infeksi dan pencegahan komplikasi makro dan mikrovaskuler tetapi penelitian yang melibatkan pasien DMT2 usia lanjut masih belum konklusif. Serial kasus ini dilakukan untuk melihat efektivitas kontrol gula darah terhadap kesintasan pasien DMT2 yang dirawat di rumah sakit, dan untuk implementasi tatalaksana nutrisi sesuai kebutuhan dan kondisi klinis pasien. Metode: Pasien pada serial kasus ini berusia antara 47 ? 65 tahun. Penyulit infeksi pada keempat pasien ini yaitu gangren diabetikum, selulitis, dan sepsis dengan infeksi paru dan infeksi saluran kemih. Tatalaksana nutrisi pasien dilakukan sesuai dengan rekomendasi American Diabetes Association dan Therapeutic Lifestyle Changes disesuaikan dengan kondisi klinis dan toleransi pasien. Perhitungan kebutuhan nutrisi menggunakan rekomendasi untuk perawatan pasien sakit kritis bagi pasien yang dirawat di intensive care unit (ICU), dan menggunakan perhitungan dengan formula Harris-Benedict bagi yang dirawat di ruangan dengan faktor stres sesuai derajat hipermetabolisme pasien. Pasien dipantau selama 7 ? 11 hari. Edukasi diberikan kepada pasien dan keluarga selama perawatan dan saat akan pulang. Hasil: Dalam pemantauan, tiga pasien menunjukkan perbaikan klinis, toleransi asupan, dan laboratorium, dan dapat dipulangkan, sedangkan satu pasien meninggal dunia. Kesimpulan: Kontrol gula darah, asupan nutrisi yang adekuat, dan edukasi yang sesuai, dapat meningkatkan kesintasan pasien DMT2 dengan penyulit infeksi yang dirawat di rumah sakit.

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Background: The incidence and prevalence of type 2 diabetes mellitus (T2DM) is increasing. Immune disfunction in T2DM patient may increase the risk of infection. The appropriate blood glucose control has a benefit in infection control and macro and microvascular complication prevention. The Studies of glycaemic control included older patients did not find convincing evidence. The aim of this case series is to assess the association between glycaemic control and clinical outcome of hospitalized T2DM patient with comorbid infection, and to provide appropriate nutrition therapy based on individual nutrition needs.

Method: Patients in this case series were between 47 - 65 years old. There of those patients were diagnosed T2DM with comorbid gangrenous diabeticum, cellulitis, and sepsis with lung infection and urinary tract infection. Two patients need intensive care in ICU, and another patients in the ward. Two patients received nutrition therapy as critically ill condition, and the rest as American Diabetic Association recommendation, with basal calorie requirement were calculated using Harris-Benedict formula and stress factor suitable for metabolic changes. Monitoring was done for 7 - 11 days. Education was done for the patient and family during hospitalization and discharge planning.

Results: Three patients showed the improvement of clinical conditions, intake tolerance, and laboratory results, whatever one patient was pass away.

Conclusion: Glycaemic control, adequate nutrition intake, and intensive education, may improve survival rate in hospitalized T2DM patient with infection as comorbid."