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"Aim: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer.

Methods: a cohort study (February-October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG).

Results: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications.

Conclusion: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing."

"[Latar Belakang: Diabetes melitus (DM) tipe 1 merupakan penyakit kronik yang sering ditemukan pada anak dan remaja yang disebabkan oleh proses autoimun terhadap sel β sehingga sel β tidak mampu memproduksi insulin. Salah satu komplikasi dari DM tipe 1 adalah nefropati diabetik. Sampai saat ini, tidak ada data mengenai prevalens dan faktor risiko nefropati diabetik pada DM tipe 1 di Indonesia. Metode: Dalam penelitian ini, variabel yang diteliti hubungannya dengan nefropati diabetik ialah terapi yang digunakan, kadar HbA1C, mikroalbuminuria, durasi DM tipe 1, umur saat awitan DM tipe 1, jenis kelamin, dan riwayat diabetik ketoasidosis (DKA). Penelitian ini menggunakan desain potong lintang retrospektif dengan 51 subjek. Data berasal dari rekam medik Rumah Sakit Cipto Mangunkusumo dan diperoleh menggunakan metode consecutive sampling.Hasil: Prevalens nefropati diabetik adalah sebesar 17,6%. Satu – satunya faktor yang berhubungan dengan nefropati diabetik adalah mikroalbuminuria (p=0,008; PR=5,29; IK95%=1,53-18,30), sedangkan terapi yang digunakan, kadar HbA1C, durasi DM tipe 1, umur saat awitan DM tipe 1, jenis kelamin, dan riwayat DKA tidak berhubungan bermakna dengan nefropati diabetik.Kesimpulan: Berdasarkan penelitian ini, prevalens nefropati diabetik sebagai komplikasi DM tipe 1 pada anak di RSCM adalah 17,6%. Faktor yang berhubungan dengan nefropati diabetik adalah mikroalbuminuria.Saran: Perlu ditingkatkan pencatatan dan pemantauan pasien di RSCM untuk memudahkan proses pengobatan dan penelitian. Selain itu, perlu dilakukan penelitian prognostik multivariat lebih lanjut dengan sampel yang lebih banyak, Background:Type 1 diabetes mellitus (DM) is a chronic disease which has high prevalence among pediatric patients. It is caused by β cells autoimmunity which cause inability to produce insulin. One of the complications of type 1 DM is diabetic nephropathy. Until now, there is no information about prevalence and risk factor of diabetic nephropathy in Indonesia.Methods:We calculated diabetic nephropathy prevalence in Indonesia and analyzed the relation between diabetic nephropathy and type 1 DM therapy, HbA1C concentration, microalbuminuria, type 1 DM duration, age at diagnosis, gender, and diabetic ketoacidosis history. This was a retrospective cross sectional study, consist of 51 subjects. Data was collected from patient’s medical record in Rumah Sakit Cipto Mangunkusumo using consecutive sampling.Results:The prevalence of diabetic nephropathy was 17.6%. Bivariate analysis showed that microalbuminuria has a statistically significant relation with diabetic nephropathy (p=0,008; PR=5,29; IK95%=1,53-18,30) while type 1 DM therapy, HbA1C concentration, type 1 DM duration, age at diagnosis, gender, and diabetic ketoacidosis history didn’t have a statistically significant relation with diabetic nephropathy.Conclusion: The prevalence of diabetic nephropathy was 17.6%. Factor that is associated with diabetic nephropathy was microalbuminuriaSuggestion: Medical records recording and patient monitoring improvement in RSCM is needed. Moreover, further multivariate prognostic research with a larger subjects and improvement in medical record recording is also necessary]"

"Diabetes sering menyebabkan komplikasi ulkus kaki diabetik (UKD) yang penyembuhannya terhambat pada fase inflamasi dan terjadi gangguan pada pembentukan jaringan granulasi. LL-37 memiliki aktivitas antimikrobial, memicu angiogenesis, serta migrasi dan proliferasi keratinosit. Penelitian ini menganalisis pengaruh krim LL-37 terhadap kecepatan penyembuhan UKD derajat ringan dengan mengkaji IL-1a, TNF-a, serta pola dan jumlah kolonisasi bakteri aerob.Penelitian ini adalah uji klinis buta ganda acak yang dilaksanakan Januari 2020–Juni 2021 di RSUPN dr. Cipto Mangunkusumo dan RSUP Persahabatan, Jakarta. Subjek adalah penyandang UKD tanpa infeksi atau infeksi derajat ringan, berusia 18–60 tahun, ABI 0,9–1,3, luas luka ≥ 2 cm2, kedalaman luka sampai dengan subkutis, dan tanpa infeksi sistemik. Subjek dibagi menjadi kelompok krim LL-37 dan plasebo yang dioles dua kali seminggu selama 4 minggu. Dilakukan pengamatan luka pada akhir minggu dengan metode planimetri dan fotografi digital lalu diolah dengan ImageJ. Subjek diperiksa kadar IL-1a dan TNF-a cairan luka dengan metode ELISA dan kultur bakteri aerob dari apusan luka pada setiap akhir minggu.Kadar LL-37 cairan luka pada kelompok LL-37 adalah 1,07 (0,37–4,96) ng/mg protein dan plasebo sebesar 1,11 (0,24–2,09) ng/mg protein (p = 0,44). Penurunan luas luka pada hari ke-14, ke-21, dan ke-28 dibandingkan hari ke-1 pada kelompok LL-37 lebih besar daripada plasebo, walaupun tidak bermakna. Pada kelompok LL-37 terjadi peningkatan luas jaringan granulasi yang lebih besar daripada plasebo pada semua hari, walaupun hanya bermakna pada hari ke-14 yaitu 0,95 (±1,34) cm2 pada kelompok LL-37 dibandingkan -0,24 (±1,01) cm2 pada kelompok plasebo (p = 0,020). Terjadi peningkatan indeks granulasi yang secara konsisten lebih besar dan bermakna (p < 0,05) pada kelompok LL-37 dibandingkan plasebo pada semua hari. Tidak terjadi penurunan kadar IL-1a dan TNF-a yang lebih besar pada kelompok LL-37. Pada hari ke-1, frekuensi bakteri aerob terbanyak adalah S. aureus yaitu 37,1% pada kelompok LL-37 dan 45% pada kelompok plasebo. Penurunan jumlah koloni bakteri pada kelompok plasebo lebih besar dibandingkan dengan kelompok LL-37 pada hari ke-28 dibandingkan dengan hari ke-1, walaupun tidak bermakna (p = 0,98).Simpulan: Kadar LL-37 pada UKD kedua kelompok rendah. Pemberian LL-37 mempercepat penyembuhan UKD tanpa infeksi maupun derajat ringan dengan meningkatkan indeks granulasi. Pemberian LL-37 tidak menurunkan kadar IL-1a dan TNF-a pada UKD. Pemberian LL-37 tidak memengaruhi pola dan jumlah kolonisasi bakteri aerob pada UKD.

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Diabetes often causes DFU (diabetic foot ulcer). Wound healing in DFU has prolonged inflammation phase and defective granulation tissue formation. LL-37 has antimicrobial property, induces angiogenesis, and keratinocyte migration and proliferation. This study analyzes the efficacy of LL-37 cream on wound healing rate in DFU with mild infection by examining IL-1a, TNF-a, and aerobic bacteria colonization.

This study was a randomized double-blind controlled trial conducted from January 2020–June 2021 at RSUPN dr. Cipto Mangunkusumo and RSUP Persahabatan, Jakarta. Subjects were patients with uninfected DFU or DFU with mild infection according to IDSA, aged 18–60 years old, ABI 0.9–1.3, wound area ≥ 2 cm2, wound no deeper than subcutaneous layer, and without systemic infection. Subjects were divided into the LL-37 cream and placebo cream group which were applied twice a week for 4 weeks. Wounds were measured at the end of every week using planimetric method and digital photography and subsequently processed with ImageJ. The levels of IL-1a and TNF-a from wound fluid were measured using the ELISA method and aerobic bacteria culture was performed using wound swabs.

The level of LL-37 from wound fluid in the LL-37 group was 1.07 (0.37–4.96) ng/mg protein and in the placebo group was 1.11 (0.24–2.09) ng/mg protein (p = 0.44). The decrease in wound area on day 14, 21, and 28 compared to day 1 in the LL-37 group was greater than in the placebo group, although the difference was not significant. In the LL-37 group, there was a greater increase in granulation tissue area than in the placebo group on each day, although the difference was only significant on day 14 which was 0.95 (±1.34) cm2 in the LL-37 group compared to -0.24 (± 1.01) cm2 in the placebo group (p = 0.020). There was a consistently and significantly greater increase in granulation index (p < 0.05) in the LL-37 group compared to placebo group on each day. There was no greater decrease in IL-1a and TNF-a levels in the LL-37 group. On day 1, the highest frequency of aerobic bacteria was S. aureus which was 37.1% in the LL-37 group and 45% in the placebo group. The decrease in the number of bacterial colonies in the placebo group was greater than in the LL-37 group on day 28 compared to day 1, although the difference was not significant (p = 0.98).

Conclusion: The level of LL-37 in DFU was low in both groups. Administration of LL-37 accelerated the healing of uninfected DFU or DFU with mild infection by increasing the granulation index. Administration of LL-37 did not reduce the levels of IL-1a and TNF-a in DFU. Administration of LL-37 did not affect the pattern and number of colonization of aerobic bacteria in DFU."

"ABSTRAKPenelitian ini bertujuan untuk mengetahui hubungan aktivitas fisik, self-care diabetic, dan distress diabetic dengan kualitas hidup diabetisi tipe 2 di Kecamatan Kalideres Jakarta Barat. Penelitian menggunakan metode cross sectional, dengan jumlah sampel 333 diabetisi tipe 2. Teknik pengambilan sample dilakukan secara probability sampling dengan teknik proporsi sampling dan metode random sampling. Sample penelitian ini adalah berusia lebih dari 45 tahun yang mengalami diabetes melitus tipe 2 dan tinggal di tengah masyarakat serta dapat membaca dan menulis dan tidak mengalami amputasi yang mengganggu mobilitas. Analisis bivariat menggunakan uji Anova, Uji pearson corelation, dan Uji t independen. Hasil penelitian menunjukkan ada hubungan aktivitas fisik, self-care diabetic, dan distress diabetic dengan kualitas hidup lansia yang mengalami diabetes melitus tipe 2 di masyarakat p

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ABSTRACTThis study to determine the relationship of physical activity, self care diabetic, and diabetic distress with the quality of life of people with type 2 diabetes in Kalideres Sub district, West Jakarta. The research used cross sectional method, with 333 samples of people with type 2 diabetes. Sampling technique was done by probability sampling with technique of proportion of sampling and random sampling method. The sample of this study is over 45 years old who have type 2 diabetes mellitus and live in the community and can read and write and do not experience amputations that interfere with mobility. Bivariate analysis using Anova test, Pearson correlation test, and independent t test. The results showed that there was an association of physical activity, self care diabetic, and diabetic distress with the quality of life of elderly with type 2 diabetes mellitus in society p "

"Background: Diabetes Mellitus is a chronic disease characterised by elevated levels of blood glucose known ashyperglycaemia. Diabetes is due to impaired insulin action in the metabolism of glucose and can result in impairedwound healing. Excessive production of pro-inflammatory cytokines, an increased number of macrophages andneutrophils, and decreased levels of transforming growth factor ? beta 1 (TGF-β1) serum can be characteristic ofimpaired wound healing. This study aims to determine the effects of squid extract on certain wound parameters such aslevels of tumour necrosis factor ? alpha (TNF-α), and TGF-β1 serum and the number of macrophages and neutrophils.Methods: This was a post-test only, randomized controlled group study that was conducted on male Wistar rats.Experimental animals were divided into 6 groups; (1) normal wound with standard diet, (2) diabetic wound withstandard diet, (3) diabetic wound with chitosan supplement, (4) diabetic wound given squid extract orally once a day,(5) diabetic wound given squid extract orally twice a day, and (6) diabetic wound given squid extract orally once everytwo days. Levels of TNF-α and TGF-β1 serum were observed using Enzyme-Linked Immunosorbent Assay.Haematocylin and eosin staining was used to observed macrophage and neutrophil counts. All data was analysedstatistically by one-way analysis of variance. Results: TNF-α serum levels showed a significant decrease (p < 0.05) insubjects that received squid extract orally once every two days. The mean levels of TGF-β1 showed no significantdifferences. The mean number of macrophage cells showed a significant decrease (p < 0.05) in all treatment groups.The mean number of neutrophil cells also showed significant decrease (p < 0.05) in all treatment groups. Conclusions:Squid extract is effective in lowering the TNF-α serum levels and the number of macrophages and neutrophils cells inWistar rats. However, there were insignificant findings on increasing levels of TGF-β1 serum. This data suggests thatsquid extract is most effective during the inflammatory phase of wound healing which takes places about 2-4 days afterwound creation."

"Latar belakang: Diperkirakan sekitar 15% penderita diabetes akan mengalami diabetic foot ulcer (DFU) dalam masa hidupnya. Negative Pressure Wound Therapy (NPWT) terbukti lebih efektif dibandingkan dengan perawatan konvensional. NPWT menciptakan lingkungan luka yang lembab, peningkatan aliran darah lokal dan merangsang jaringan granulasi sehingga mempercepat penyembuhan luka. Penelitian ini dilakukan untuk mengetahui faktor risiko yang memengaruhi lama rawat DFU dengan NPWT.Metode Penelitian: Penelitian ini merupakan studi retrospektif dengan desain cross sectional analitik pada 105 subjek yang dirawat pada Januari 2016 sampai Desember 2018 di RS dr. Cipto Mangunkusumo. Karakteristik dan demografi pasien dan faktor risiko diambil dari rekam medik. Durasi perawatan dari aplikasi pertama NPWT hingga luaran sebagai hasil, kemudian dianalisis terhadap faktor risiko yang memengaruhinya.Hasil Penelitian: Lama rawat DFU dengan NPWT adalah 19,9 ± 19,3 hari. Faktor risiko yang mempengaruhi lama rawat adalah riwayat ulkus (r = 0,01; p = 0,034), kedalaman luka (r = 0,292; p = 0.003), Hb (r = 0,05; p = 0,039), HbA1c (r = 0,06; p = 0,033), albumin (r = 0,06; p = 0,017), PCT (r = 0,10; p = 0,035), dan lama menderita DM (r = 0,193; p = 0,009).Kesimpulan: Penelitian ini menunjukkan bahwa lama rawat DFU dengan NPWT dipengaruhi oleh faktor sitemik (lama menderita DM, Hb, HbA1c, albumin, dan PCT) dan faktor lokal (riwayat ulkus sebelumnya dan kedalaman luka). Kedalaman luka merupakan faktor yang paling berhubungan positif terhadap lama perawatan DFU pasca NPWT (r = 0,292, p = 0,003). Intervensi pada faktor risiko yang dapat diperbaiki sebelum penggunaan NPWT patut dilakukan untuk memaksimalkan penggunaan NPWT dan mengurangi lama perawatan.

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Background: It is estimated that around 15% of diabetic patients will experience diabetic foot ulcer (DFU) in their lifetime. Negative Pressure Wound Therapy (NPWT) is proven to be more effective than conventional treatments. NPWT creates a moist wound environment, increases local blood flow and stimulates tissue granulation thereby accelerating wound healing. This study was conducted to determine the risk factors that affect the length of stay of DFU with NPWT. Knowing this risk factors may be helpful for optimizing management strategy.

Methods: This research is a retrospective study with a cross-sectional analytic design in 105 subjects treated in January 2016 to December 2018 at RS. dr. Cipto Mangunkusumo. Patient characteristics, demographics and risk factors were taken from medical records. The length of stay of the patient from the first application of NPWT to its outcomes was the main result, then the correlation to the risk factors that influence it was analyzed.

Results: The length of stay of DFU with NPWT was 19.9 ± 19.3 days. Risk factors affecting the length of stay were history of ulcers (r = 0.01; p = 0.034), wound depth (r = 0.292; p = 0.003), Hb (r = 0.05; p = 0.039), HbA1c (r = 0.06; p = 0.033), albumin (r = 0.06; p = 0.017), PCT (r = 0.10; p = 0.035), and duration of DM (r = 0.193; p = 0.009).

Conclusions: This study showed that the length of stay of DFU with NPWT was influenced by systemic factors (duration of DM, Hb, HbA1c, albumin, and PCT) and local factors (history of previous ulcers and wound depth). The depth of the wound was the most positively related factor to the length of stay in DFU post NPWT (r = 0.292; p = 0.003). Interventions on the risk factors that can be corrected before the application of NPWT may amplify the result of NPWT and reduce the length of treatment."

"ABSTRAKPenyakit ginjal diabetik adalah suatu komplikasi yang disebabkan oleh diabetes melitus. Perkembangan penyakit ini mengarah kepada penyakit ginjal stadium akhir (ESRD) dan kardiovaskular yang meningkatkan morbiditas dan mortalitas pasien. Hal ini menunjukkan pentingnya manajemen terapi pada penyakit ginjal diabetik. Saat ini kontrol glikemik dan tekanan darah adalah manajemen utama pada penyakit ginjal diabetik. Walaupun demikian, diketahui beberapa pasien tetap mengalami progresivitas menjadi ESRD. Hal ini menunjukkan bahwa diperlukannya terapi baru untuk penyakit ginjal diabetik. Beberapa tahun terakhir telah dilakukan penelitian penelitian untuk menemukan target terapi baru yang berpotensi untuk terapi penyakit ginjal diabetik. Tulisan ini bertujuan untuk menelusuri, menelaah dan mensintesis hasil studi perkembangan terbaru untuk terapi penyakit ginjal diabetik pada golongan obat inhibitor sodium-glucose cotransporter 2 (SGLT2 inhibitor), agonis glucagon-like peptide-1 (GLP-1 agonist), antagonis endothelin-1 receptor (ET-1 antagonist) dan antagonis nonsteroidal mineralocorticoid receptor. Penelusuran literatur dilakukan dengan sistematik pada pusat data Pubmed, ScienceDirect, dan SpringerLink dan dipilah berdasarkan kriteria inklusi dan eksklusi yang ditetapkan. Efektivitas obat dievaluasi melalui kadar albuminuria dan estimasi laju filtrasi glomerulus. Berdasarkan hasil studi literatur 3 tahun terakhir, diperoleh hasil bahwa inhibitor SGLT2 dan agonis GLP 1 terbukti memiliki efek perlindungan ginjal dan kardiovaskular pada pasien diabetes melitus tipe 2. Kedua golongan tersebut juga dapat menurunkan tekanan darah dan berat badan. Studi saat ini juga menunjukkan antagonis ET 1 dan antagonis nonsteroidal mineralocorticoid receptor juga memiliki potensi sebagai terapi penyakit ginjal diabetik dikarenakan efeknya yang dapat mengurangi albuminuria pasien diabetes melitus tipe 2. Namun demikian untuk memastikan efikasi dan keamanan obat harus dilakukan uji klinis lebih lanjut.

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ABSTRACT

Diabetic kidney disease is a complication caused by diabetes mellitus. The development of the disease leads to end-stage renal disease (ESRD) and cardiovascular disease which increases patients morbidity and mortality. This show the importance of therapeutic management in diabetic kidney disease. Nowadays, glycemic control and blood pressure are the main management of diabetic kidney disease. However, it is known that some diabetes patients still progress to ESRD, highlighting the need to identify novel therapies for diabetic kidney disease. The last few years research has been carried out to find new therapeutic targets for therapy diabetic kidney disease. This article review aims explore, examine, and synthesize to new therapeutic studies for diabetic kidney disease in sodium glucose cotransporter 2 (SGLT2) inhibitor, glucagon-like peptide-1 (GLP-1) agonist, endothelin 1 receptor (ET-1) antagonist, dan nonsteroidal mineralocorticoid receptor antagonist. Literature searches were carried out systematically in Pubmed, ScienceDirect, and SpringerLink data centers and sorted according to inclusion and exclusion criteria. Efficacy of the drug was evaluated through the levels of albuminuria and estimated glomerular filtration rate (eGFR). Recent study showed that SGLT2 inhibitors and GLP 1 agonist have renal and cardiovascular protective effects in patient with type 2 diabetes mellitus. Both groups can also reduced blood pressure and body weight. Current studies show that ET-1 antagonists and nonsteroidal mineralocorticoid receptor antagonists also have the potential to treat diabetic kidney disease because of their effect on reducing albuminuria in patient with type 2 diabetes mellitus. However, to ensure efficacy and safety of the drug further clinical trials must be carried out."

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Ulkus diabetik merupakan komplikasi diabetes melitus berupa neuropati dan  iskemik.Klien ulkus diabetik mengalami luka di  kaki yang penyembuhannya membutuhkan waktu yang lama sehingga rentan mengalami ansietas dan gangguan citra tubuh. Ansietas merupakan rasa takut yang tidak jelas disertai dengan perasaan ketidakpastiandan ketidaknyamanan sedangkan gangguan citra tubuh merupakan persepsi yang tidak jelas terhadap bentuk, struktur dan fungsi tubuh.Tujuan penelitian adalah untuk mengetahui pengaruh tindakan keperawatan ners, terapi penerimaan komitmen(TPK) dan psikoedukasi keluarga terhadap ansietas dan citra tubuh klien ulkus diabetik. Metode penelitian menggunakan desain kuantitatif dengan pendekatan Quasy Experimental Pre-Post with Control Group. Responden sejumlah 20 orangdengan total samplingwithpurposive sampling. Peneliti menggunakan kuesioner.Hasil penelitian menunjukkan bahwa kondisiansietas, citra tubuh, kondisi ulkus mengalami penurunan. Kemampuan menerima dan berkomitmenserta kemampuan keluarga merawat menjadi meningkat secara signifikan. Kesimpulan penelitian ini adalah ada pengaruh tindakan keperawatan ners, terapi penerimaan komitmen (TPK) dan psikoedukasi keluarga terhadap ansietas dan citra tubuh klien ulkus diabetik. Diharapkan penelitian ini dapat diaplikasikan dalam mengatasi penyakit  komplikasi fisik dengan gangguan psikososial.

 

 

 

Kata kunci : Ulkus Diabetik, Ansietas, Citra Tubuh, Tindakan Keperawatan Ners, Terapi Penerimaan Komitmen(TPK) dan Psikoedukasi keluarga

 

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Diabetic ulcers are complications of diabetes mellitus in the form of neuropathy and ischemia. Diabetic ulcer clients experience wounds on the legs which healing takes a long time so they are prone to experiencing anxiety and body image disorders. Anxiety is an unclear fear accompanied by a feeling of uncertainty and discomfort while body image disturbance is an unclear perception of the shape, structure and function of the body. anxiety and body image of diabetic ulcer client. The research method used a quantitative design with a Quasy Experimental Pre-Post with Control Group approach. There were 20 respondents with total sampling with purposive sampling. Researchers used a questionnaire. The results showed that the condition of anxiety, body image, and ulcer conditions decreased. The ability to accept and commit and the ability of the family to care for them is significantly improved. The conclusion of this study is that there is an effect of nursingaction,acceptance commitment therapy (ACT) and family psychoeducation on anxiety and body image of diabetic ulcer clients. It is hoped that this research can be applied in dealing with physical complications and psychosocial disorders.

Keywords :Diabetic Ulcers, Anxiety, Body Image, Effects of Acceptances and Commitment Therapy( ACT) and family psychoeducation

 

 

 

 

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"ABSTRAKLuka kaki diabetik (LKD) merupakan komplikasi kronik diabetes yang meningkatkan mortalitas danmorbiditas, serta menurunkan kualitas hidup. Komplikasi makro dan mikrovaskular/mikrosirkulasimempunyai pengaruh besar terhadap kejadian LKD dan proses penyembuhannya. Kondisimikrosirkulasi dapat dinilai melalui pemeriksaan transcutaneous perfusion oxygen (TcPO2). Kondisimikrosirkulasi dipengaruhi oleh HbA1c, glukosa darah sewaktu, neuropati, fibrinogen, PAI-1,hsCRP, indeks MMP-9, indeks TcPO2, dan indeks TcPCO2, yang akan memengaruhi terbentuknyajaringan granulasi.Penelitian ini bertujuan untuk mengetahui peran HbA1c, GDS, neuropati, fibrinogen, PAI-1, hsCRP,indeks MMP-9, terhadap indeks TcPO2, indeks TcPCO2, dan indeks granulasi, serta mengetahuiperan serta indeks TcPO2 dan indeks TcPCO2 terhadap indeks granulasi pada luka kaki diabetik.Sebanyak 68 subjek LKD tanpa penyakit arteri perifer di RS dr. Cipto Mangukusumo dan beberaparumah sakit jejaring, pada Desember 2015?Desember 2016, diberikan perawatan standar dandipantau setiap minggu sebanyak 4 kali. Pada pemantauan ke-1, ke-2, dan ke-3, dilakukandokumentasi LKD, pengambilan darah vena sebanyak 7,7 mL untuk pemeriksaan fibrinogen, PAI-1,hsCRP, MMP-9, dan TIMP-1, darah arteri sebanyak 2 mL untuk pemeriksaan analisis gas darah,serta pemeriksaan TcPO2 dan TcPCO2 dengan menggunakan TCM TOSCA/CombiM monitoringsystems buatan Radiometer. Pada pemantauan ke-4, hanya dilakukan dokumentasi LKD.Pengukuran luas luka dan jaringan granulasi dinilai berdasarkan hasil dokumentasi fotografi denganmenggunakan program ImageJ. Penilaian neuropati menggunakan pemeriksaan interval RR dankecepatan hantar saraf. Data laboratorium lainnya diperoleh dari data sekunder rekam medis.Kemudian dilakukan analisis data dengan menggunakan path analysis (analisis lajur) pada datarepetitif dan SPSS pada data nonrepetitif.Berdasarkan analisis didapatkan hubungan antara peningkatan glukosa darah sewaktu, fibrinogen,dan PAI-1 dengan penurunan indeks TcPO2. Didapatkan juga hubungan antara beratnya neuropatimotorik dan sensorik, peningkatan glukosa darah sewaktu, fibrinogen, PAI-1, dan hsCRP denganpenurunan indeks granulasi. Tetapi, indeks granulasi tidak dipengaruhi oleh indeks TcPO2. IndeksTcPCO2 tidak memiliki hubungan terhadap semua variabel tersebut, kecuali hsCRP dan indeksTcPCO2 tidak memengaruhi indeks granulasi.Indeks TcPO2 pada LKD dipengaruhi oleh kadar glukosa darah sewaktu, fibrinogen, dan PAI-1,tetapi tidak memengaruhi tumbuhnya jaringan granulasi. Tumbuhnya jaringan granulasi dipengaruhioleh glukosa darah sewaktu, neuropati motorik dan sensorik, peningkatan kadar fibrinogen, PAI-1,dan hsCRP. Selain itu, indeks TcPCO2 tidak memengaruhi indeks granulasi

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ABSTRACTDiabetic foot wounds/ulcer (DFU) is chronic complication of diabetes, which increasesmortality and morbidity, and lower quality of life. Macro and microvascular/microcirculationcomplications has a great influence on DFU and healing process. Microcirculation condition canbe seen from transcutaneous perfusion oxygen (TcPO2). The growth of granulation tissue in thehealing process is determined by microcirculation condition, among others influenced byHbA1c, random blood glucose, neuropathy, fibrinogen, PAI-1, hsCRP, MMP-9 index, TcPO2index, and TcPCO2 index.This study aimed to investigatethe role of HbA1c, random blood glucose, sensory, motoric, andautonomy neuropathy, fibrinogen, PAI-1, hsCRP, MMP-9 index, TcPO2 index, TcPCO2 index,and granulation index, as well as the relationship between TcPO2 index, TcPCO2 index andgranulation index in diabetic foot wounds.As much as 68 subjects DFU without peripheral arterial disease, in Cipto MangunkusumoReferral National Hospital, on December 2015?December 2016, were given standardmanagementof diabetic foot ulcer and monitored once a week for four times. In the 1st, 2nd, and3rd monitoring, DFU was documented, then 7.7 mL of venous blood was taken for fibrinogen,PAI-1, hsCRP, MMP-9, and TIMP-1 examination, also 2 mL arterial blood for blood gasanalysis, and then examination of TcPO2 and TcPCO2was performed using TCM4TOSCA/CombiM monitoring systems made by Radiometer. In the 4th monitoring, only DFUwas documented. Wound and granulation size was measured through photographicdocumentation using ImageJ program. Neuropathy was diagnosed based on RR interval andnerve conduction velocity study. Other laboratory data were obtained from medical records. Thedata were analysed by path analysis for repetititive data and SPSS for nonrepetitive data.From analysis, there is a significant correlation between the increasing random blood glucose(RBG), fibrinogen, and PAI-1 with the decreasing of TcPO2, also found a significantrelationship between the severity of sensory and motoric neuropathy, the increasing levels ofRBG, fibrinogen, PAI-1, and hsCRP with the decreasing of granulation index. But, TcPO2 indexdoes not influence granulation index. TcPCO2 index does not have significant correlation withall these variables, except hsCRP. Moreover, TcPCO2 index also does not influence granulationindex.TcPO2 index of DFU is affected by RBG, fibrinogen, PAI-1, but does not affect the growth ofgranulation tissue. Granulation tissue?s growing is influenced by the sensory and motoricneuropathy, increased levels of fibrinogen, PAI-1, and hsCRP. Furthermore, TcPCO2 index doesnot influence granulation?s growth."