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"ABSTRAKBackground: hypoglycemia is a major adverse event of insulin therapy for diabetes mellitus patients. The study was conducted to evaluate the incidence of hypoglycemia among insulin treated patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) in the Indonesian cohort. Methods: this Indonesian cohort study consisted of retrospective and prospective evaluation of hypoglycemic episodes, using International Operations Hypoglycemia Assessment Tool (IO HAT) in 374 patients with diabetes (T1DM; n=17 or T2DM; n=357). The patients of ≥18 years of age and treated with insulin for >12 months were selected for this study (ClinicalTrials.gov number: NCT02306681). Results: a total of 374 patients were enrolled in this study and completed SAQ1. All patients with T1DM (17 [100%]), and 347 (97.2%) patients with T2DM completed SAQ2. Almost all the patients in the 4-week prospective period reported at least one hypoglycemic event (T1DM 100%, T2DM 99.4%) and the incidence rate of any hypoglycemia was 67.5 events per patient-year (PPY) and 25.7 events PPY for T1DM and T2DM patients, respectively. Among patients with T1DM and T2DM, 5.9% and 36.4%, respectively, did not know what hypoglycemia was at baseline, also high proportion of patients had impaired hypoglycemic awareness in the study (82.4% and 62.7%, respectively). Conclusion: overall, high proportion of patients reported hypoglycemic events in the prospective period indicating under reporting during the retrospective period due to recall bias. Therefore, there is a need for patient education program to improve the awareness of hypoglycemia in diabetes patient in Indonesia."

"Tujuan: mengembangkan sistem skor dan menentukan nilai tambah diagnostik albuminuria dalam mengestimasi carotid intima-media thickness (CIMT). Metode: studi potong lintang dilakukan di poliklinik endokrin RSCM bulan Maret-Mei 2012 pada pasien DMT2 tanpa komplikasi serebrokardiovaskular, penyakit ginjal kronis (PGK) stadium ≥ III, dan tidak merokok. Kami melakukan analisis statistik yang dilanjutkan dengan pembuatan sistem skor. Hasil: dari 71 subjek, didapatkan CIMT dan albuminuria masing-masing sebesar 67,6% dan 73,3%. Dari 48 subjek dengan CIMT, sebanyak 87,5% mengalami albuminuria. Pemeriksaan albuminuria memiliki sensitivitas sebesar 87,5%. Penambahan nilai albuminuria akan meningkatkan AUC sebesar 2,3%. Skor estimasi untuk variabel lama terdiagnosis DM, hipertensi, dislipidemia berturut-turut sebesar 1, 2, 1. Skor probabilitas CIMT pada skor <2, 2, dan >2 sebesar 15%, 57%, dan 90%. Kesimpulan: pemeriksaan albuminuria meningkatkan nilai tambah diagnostik CIMT. Sistem skor dapat digunakan sebagai alat skrining terhadap CIMT pada pasien DM tipe 2 tanpa komplikasi serebrokardiovaskular, PGK stadium ≥ III, dan tidak merokok. Aim: to develop a scoring system and measure the diagnostic added value of albuminuria to estimate CIMT. Methods: cross-sectional study was done in Endocrine Outpatient Clinic Cipto Mangunkusumo Hospital between March-May 2012 in T2DM patients without history of cerebrocardiovascular event, CKD stage ≥ III, and smoking.Bivariate analysis and multivariate (logistic regression) analysis was done, followed by developing the scoring system. Results: from 71 subjects, there were 67.6% with increased CIMT and 73.3% with albuminuria. From 48 subjects with increased CIMT, 87.5% had albuminuria. Albuminuria measurement had high sensitivity (87.5%).Adding albuminuria measurement will increase the AUC as 2.3%. Estimation score for duration of DM, hypertension, dyslipidemia were as follows 1, 2, 1 respectively. Probability score of increased CIMT for score <2, 2, and >2 was as follows 15%, 57%, and 90%. Conclusion: albuminuria measurement increase the diagnostic value of CIMT.Scoring system can be used as a screening tool to estimate the increased of CIMT in type 2 DM patients without history of cerebrocardiovascular event, CKD stage ≥ III, and smoking"

"ABSTRAKDiabetes melitus adalah salah satu penyakit tidak menular yang menyebabkan 4% kematian di Indonesia. Efektivitas obat antidiabetes tipe 2 biasanya dilihat dari nilai HbA1c yang mencerminkan rata-rata glukosa darah pasien, glukosa darah 2 jam postprandial dan glukosa darah puasa. Terapi diabetes melitus tipe 2 memiliki berbagai pola terapi kombinasi. Terapi yang berbeda akan memberikan efektivitas yang berbeda pula. Penelitian ini bertujuan untuk membandingkan efektivitas terapi kombinasi metformin-sulfonilurea dan metformin-akarbose terhadap parameter glikemik pasien diabetes melitus tipe 2 yaitu nilai HbA1c, glukosa darah 2 jam postprandial dan glukosa darah puasa. Penelitian ini merupakan penelitian kohort retrospektif dengan pengumpulan data primer dan sekunder menggunakan teknik total population sampling. Data primer yang digunakan adalah hasil pengisian kuesioner dan data sekunder didapatkan dari rekam medis dan sistem informasi rumah sakit. Hasil analisis menunjukkan bahwa tidak ada perbedaan bermakna antara responden yang menggunakan metformin-sulfonilurea dibandingkan dengan responden yang menggunakan metformin-akarbose terhadap perubahan nilai HbA1c (p value=0.060). Hasil analisis juga menunjukkan bahwa tidak ada hubungan yang bermakna antara metformin-sulfonilurea dan metformin-akarbose dengan nilai glukosa darah 2 jam postprandial akhir (p value=0.655) dan nilai glukosa darah puasa akhir (p value=0.460). Variabel olahraga mempengaruhi efektivitas metformin-sulfonilurea dan metformin-akarbose terhadap perubahan nilai HbA1c, variabel jenis kelamin terhadap perubahan nilai glukosa darah 2 jam postprandial dan variabel diet terhadap perubahan nilai glukosa darah puasa. Kesimpulan dari penelitian ini adalah Tidak terdapat perbedaan bermakna pada perbandingan efektivitas antara terapi kombinasi metformin-sulfonilurea dan metformin-akarbose.

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ABSTRACTDiabetes mellitus is an uninfectious disease that causes 4% of deaths in Indonesia. The effectiveness of type 2 antidiabetic drugs is usually seen from the HbA1c value that reflects the patient's average blood glucose, 2-hour postprandial blood glucose and fasting blood glucose. Type 2 diabetes mellitus therapy has various combination therapy patterns. Different therapies will provide different effectiveness. This study aims to compare the effectiveness of metformin-sulfonylurea and metformin-acarbose combination therapy on glycemic parameters of type 2 diabetes mellitus patients, namely HbA1c value, postprandial 2 hours blood glucose and fasting blood glucose. This research is a retrospective cohort study with primary and secondary data collection using purposive sampling technique. Primary data used are the results of filling out the questionnaire and secondary data obtained from medical records and hospital information systems. The analysis showed that there was no significant difference between respondents who used metformin-sulfonylurea compared with respondents who used metformin-acarbose to changes in the HbA1c value (p value=0.060). The analysis also showed that there was no significant relationship between metformin-sulfonylurea and metformin-acarbose with 2 hours postprandial blood glucose value (p value=0.655) and fasting blood glucose value (p value=0.460). Sports variable affects the effectiveness of metformin-sulfonylureas and metformin-acarbose on changes in HbA1c values, gender variable on changes in postprandial 2 hours blood glucose values and dietary variable on changes in fasting blood glucose values. The conclusion of this study is that the effectiveness comparison of metformin-sulfonylurea and metformin-acarbose combination therapy is not significant."

"Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients."

"Self management diabetes berdampak positif terhadap peningkatan outcome klinis. Observasi pada fasilitas pelayanan kesehatan menunjukkan pelaksanaan edukasi kurang efektif. Inovasi teknologi dapat menjadi alternatif solusi dalam mengatasi masalah ini. Penelitian bertujuan mengetahui pengaruh aplikasi self management berbasis android terhadap tingkat pengetahuan dan perilaku self management pada pasien diabetes melitus tipe 2. Penelitian ini berdesain quasi eksperimental pre-posttest dengan kelompok kontrol. Partisipan direkrut di poli rawat jalan dan rawat inap sejak Juni-Agustus 2020. Analisis data menggunakan SPSS versi 25 pada 66 responden. Pada analisis bivariat, terdapat peningkatan pengetahuan pada kelompok intervensi di akhir penelitian (p=0,07). Tidak ada pengaruh aplikasi terhadap perilaku self management diabetes (p=0,940). Pada analisis multivariat, didapatkan hubungan yang signifikan antara penggunaan aplikasi (p=0,045) dan tingkat pengetahuan sebelumnya (p=0,0001) terhadap tingkat pengetahuan posttest. Aplikasi D-SyIs berpotensi meningkatkan pengetahuan diabetes. Perbaikan desain aplikasi diharapkan dapat meningkatkan efektivitas penggunaan aplikasi.

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Self management diabetes has positive impact on increasing clinical outcome. Field observation in healthcare setting showed an ineffective implementation of health education. Technology innovation could be an alternative solution to solve this problem. This research was to examine the effect of android based self management apps towards diabetes self management behavior and diabetes knowledge among type 2 diabetes mellitus patients. A pre-posttest quasy experimental design with control group is used. Participants were recruited from outpatient and inpatient from June to July 2020. SPSS version 25 was used to analyse 66 participants. In bivariat analysis, there was enhancement of diabetes knowledge in intervention group (p=0,07) at the end of research. There was no significant different in self management (p=0,908). In multivariate analysis, there were significant effect of D-SyIs apps (p=0,045) and previous diabetes knowledge (p=0,0001) towards diabetes knowledge. This apps has potential effects to increase diabetes knowledge. Upgrading the app design is needed to increase the apps effectiveness."

"Obesity is a common comorbidity of type-2 diabetes and one of the most modifiable risk factors for preventing other comorbid conditions, such as diabeticnephropathy and cardiovascular disease. Using a cross-sectional design, this study aimed to determine eating behavior, factors related with obesity and thedominant factor of obesity in patients with type-2 diabetes. Data were collected from 133 members of the Chronic Disease Countermeasure Program inJatinegara Primary Health Care, East Jakarta, that were selected using purposive sampling. Food intake was assessed by 1 × 24-hour food recall and theFood Frequency Questionnaire, Physical activity was assessed by the Global Physical Activity Questionnaire. Results showed that 63.9% of the surveyedtype-2 diabetics were obese (body mass index ≥ 25 kg/m2) and that the respondents consumed more fat than the recommended value (30.77% ± 9.06%)but less energy than the required value (62.06% ± 23.67%). The prevalence of obesity among adults with type-2 diabetes could be associated with nutritional knowledge, education level, and the length of suffering from the disease. Nutritional knowledge was found to be a dominant factor associated with obesity."

"This book outlines best practice and scientific progress in the management of people with type I diabetes who undertake a sport at any level. The book explores endocrine response to exercise, hypoglycemia and dietetics in the diabetic patient, and provides real-life examples of type I diabetes management at the professional athlete level. It is the first source of reference for specialists in diabetes when seeking advice on how to manage their patient and provides practical advice for equipping the type I diabetes patient with the ability to fulfill their sporting potential."

"Diabetes melitus merupakan suatu kelompok penyakit metabolik dengan karakteristik hiperglikemia. Kondisi hiperglikemia dapat menyebabkan terjadinya berbagai komplikasi pada diabetes melitus, salah satunya adalah nefropati diabetik. Pendeteksian nefropati diabetik dapat dilakukan dengan menghitung nilai eLFG maupun UACR. Di sisi lain, senyawa 8-iso-Prostaglandin F2? yang merupakan salah satu biomarker stres oksidatif sedang diteliti sebagai penanda awal gangguan fungsi ginjal. Tujuan dari penelitian ini adalah menganalisis kadar 8-iso-Prostaglandin F2? dengan bertambahnya durasi DM tipe 2 dan korelasinya dengan nilai eLFG. Subjek penelitian terdiri dari 2 kelompok, yaitu kelompok pasien DM tipe 2 n = 48 dan kelompok subjek non DM n = 13 di Puskesmas Kecamatan Pasar Minggu. Kadar 8-iso-Prostaglandin F2? diukur dengan menggunakan ELISA dan nilai eLFG dihitung menggunakan persamaan CKD-EPI. Hasil uji beda rerata menunjukkan terdapat perbedaan kadar 8-iso-Prostaglandin F2? p = 0,010 tetapi tidak terdapat perbedaan nilai eLFG p = 0,610 pada pasien DM tipe 2 tahun 2016-2017. Hubungan antara kadar 8-iso-Prostaglandin F2? dengan eLFG berdasarkan persamaan CKD-EPI pada sampel DM tipe 2 r = 0,293; p = 0,043 . Sehingga diketahui bahwa terdapat hubungan positif bermakna antara kadar 8-iso-Prostaglandin F2? dengan nilai eLFG pada pasien DM tipe 2 tahun 2016-2017.

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Diabetes mellitus is a group of metabolic diseases with characteristics of hyperglycemia. Hyperglycemia can lead to various complications in diabetes mellitus, one of them is diabetic nephropathy. Detection of diabetic nephropathy can be done by calculating both eLFG and UACR values. On the other hand, the 8 iso Prostaglandin F2 compound which is one of the oxidative stress biomarkers is being investigated as an early marker of impaired renal function.

The objective of this study was to analyze the level of 8 iso Prostaglandin F2 with increasing duration on T2DM patients and its correlation with eGFR. Samples were divided into two groups, which was T2DM patients n 48 and non DM subjects n 13 at Pasar Minggu Community Health Center. 8 iso Prostaglandin F2 concentrations were measured using ELISA and eGFR were calculated using CKD EPI equation.

The result of mean different test showed there was difference of 8 iso Prostaglandin F2 concentration p 0,010 but there was no difference of eGFR value p 0,610 on T2DM patients in 2016 2017. The correlation between 8 iso Prostaglandin F2 and eGFR in T2DM samples r 0,293 p 0,043 . The results showed that there was a significant positive correlation between 8 iso Prostaglandin F2 concentration and eGFR CKD EPI equation on T2DM patients in 2016 2017."

"ABSTRAKKontrol glukosa darah dapat dipertahankan melalui perawatan mandiri. Motivasi melakukan self monitoring blood glucose (SMBG) yang baik dapat meningkatkan diabetes self management pada pasien diabetes melitus tipe 2.Tujuan penelitian ini adalah untuk mengetahui hubungan motivasi melakukan SMBG dengan diabetes self management pada pasien diabetes melitus tipe 2.Penelitian ini menggunakan metode kuantitatif observasional analitik dengan pendekatan crossectional, melibatkan 96 pasien. Alat ukur yang digunakan berupa kuesioner karakteristik responden, Treatment Self Regulation Questionare, Diabetes Self Management Questionare, Diabetes Knowledge Scale.Hasil penelitian menunjukkan terdapat hubungan yang bermakna antara motivasi melakukan SMBG dengan diabetes self management (p = 0,001). Hasil analisis regresi logistik menunjukkan motivasi melakukan SMBG berhubungan dengan didabetes self management setelah dikontrol variabel pengetahuan.Kesimpulan diperlukan perhatian khusus dari perawat untuk meningkatkan motivasi melakukan SMBG pada pasien diabetes melitus tipe 2 dalam self care management.

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ABSTRACT

Glycemic control could be maintained through diabetes self-management. Motivation to perform self-monitoring blood glucose (SMBG) could improve diabetes self-management in type 2 diabetes mellitus patients.

The purpose of this study was to explore the relationship between motivation to perform SMBG and diabetes self-management in patients with type 2 diabetes mellitus.

This study applied quantitative method with a cross sectional approach, involving 96 patients. The Instruments used were questionnaires for respondent characteristics, Treatment Self-Regulation Questionnaires, Diabetes Self Management Questionnaire and Diabetes Knowledge Scale.

The results show that there was a significant relationship between motivation to perform SMBG and diabetes selfmanagement (p = 0,001). Results of logistic regression analysis showes that motivation to perform SMBG is associated with diabetes self-management after controlled by knowledge variable.

In conclusion it is a necessarily for nurses to provide attention to increase motivation to perform SMBG in patients with type 2 diabetes mellitus as part of self care management."

"Tujuan: Mengumpulkan informasi mengenai penanganan dan komplikasi diabetes, serta kesadaran pengendaliandiri sendiri penderita diabetes di Indonesia. Studi ini juga mengevaluasi perspektif dokter, aspek psikologis, dankualitas hidup pasien.Metode: Studi non-intervensi, potong lintang, merekrut 1832 pasien dari pusat kesehatan sekunder dan tersierdi Indonesia. Data mengenai demografi , riwayat medis, faktor resiko, dan laporan pemeriksaan klinis termasuklaboratorium dikumpulkan dari rekam medis pasien. Sampel darah dikumpulkan untuk pengukuran HbA1c yangtersentralisasi.Hasil: Di antara 1832 pasien, 1785 individu memenuhi syarat untuk dianalisis. Rata-rata usia adalah 58,9+9,6tahun. Lamanya menderita diabetes 8,5+7,0 tahun. Mayoritas pasien (97,5%) menderita diabetes tipe 2.67,9% pasienmemiliki kontrol diabetes yang buruk (A1c: 8,1 ± 2,0%). 47,2% pasien memiliki kadar Glukosa Plasma Puasa >130mg/dL (161,6±14,6 mg/dL). Dislipidemia dilaporkan pada 60% pasien (834/1390) dan 74% (617/834) di antaranyamendapatkan obat hipolipidemik. Neuropati merupakan komplikasi paling umum (67.2%); komplikasi diabeteslainnya antara lain: katarak: 14.5% Retinopati diabetik non-proliferatif: 8.3%, kreatinin serum>2 mg/dl: 3.6%,ulkus yang sudah sembuh: 3.8%, angina pectoris 9.9% dan stroke 5.6%. Sekitar 81.3% pasien menerima terapi obathipoglikemik oral (OHO) (± insulin), 37,7% pasien menerima terapi insulin (±OHO). Penggunaan biguanide diikutioleh sulfonylurea. Mayoritas pasien menggunakan insulin manusia 73,2%, regimen premiks 58,5%, insulin analog24,9%. Mayoritas respon indeks kesehatan WHO-5 jatuh dalam teritori positif.Kesimpulan: Kontrol glikemik yang buruk pada mayoritas pasien diabetes perlu diperhatikan. Terdapat kebutuhan untukpenyesuaian terapi dari sebagian besar pasien menuju terapi farmakologis yang lebih intensif dan pendekatan multidisiplinerharus digunakan. Temuan studi ini perlu dikomunikasikan kepada pembuat kebijakan dan dokter untuk membantumereka memberikan perawatan kesehatan dan fasilitas yang baik.

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AbstractAim: To collect information on diabetes management, diabetes complications, and awareness of self-control indiabetic population of the country. This study also evaluated the physician perspectives, psychological aspects, andquality of life of diabetic patients.Methods: This was a non-interventional, cross-sectional study, which recruited 1832 patients from secondary andtertiary medical centers across Indonesia. Data on demography, medical history, risk factors and clinical examinationreports including laboratory assessments were collected from medical records of patients. Blood samples of all patientswere collected for centralized HbA1c measurements.Results: Among 1832 patients, 1785 individuals were eligible for analysis. The mean age of the patients was 58.9+9.6years. The mean duration of diabetes was 8.5+7.0 years. Majority (97.5%) of the patients had type 2 diabetes. 67.9%had poor control of diabetes (A1c:8.1 ± 2.0%). 47.2% had FPG>130 mg/dL (161.6±14.6 mg/dL). Dyslipidemia wasreported in 60% (834/1390) and 74% (617/834) of those received lipid lowering treatment. Neuropathy was most commoncomplication (63.5%); other complications were: Diabetic retinopathy 42%, nephropathy 7.3%, severe late complications16.9%, macrovascular complications 16%, microvascular complications 27.6%. About 81.3% of patients were on OADs(± insulin), 37.7% were on insulin (±OADs). Majority used biguanides followed by sulfonylureas. Human insulin was usedby 73.2%, premix regimen 58.5%, analogues usage was 24.9%. Majority of the WHO-5 well being index responses fell inpositive territory.Conclusion: Poor glycaemic control in majority of patients is a concern. There is a need for a large proportion ofpatients to be adjusted to more intensive pharmacotherapy and a multi-disciplinary approach for management shouldbe adopted. The study fi ndings should be communicated to policymakers and physicians to help them provide properhealthcare and its facilities in Indonesia."