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"ABSTRAKNeuropati sensori dan perubahan perfusi perifer merupakan jenis komplikasi jangkapanjang pasien DM tipe 2. Kedua masalah ini menyebabkan pasien berisikomengalami trauma pada kaki. Gejala neuropati dapat berupa perubahan sensasiproteksi dan nyeri sedangkan perfusi perifer berupa perubahan akle brachial index(ABI). Berbagai upaya dilakukan untuk mengurangi gejala neuropati sensori danperubahan perfusi perifer, salah satu diantaranya adalah masase kaki secara manualyang sampai saat ini belum ditemukan penelitian terkait. Penelitian ini bertujuanuntuk mengidentifikasi pengaruh masase kaki secara manual terhadap sensasiproteksi, nyeri dan ABI pada pasien DM tipe 2. Penelitian ini merupakan penelitianquasi eksperimen dengan kelompok kontrol dan pengambilan sampelnya dengancara consecutive sampling. Hipotesis yang dibuktikan dalam penelitian ini adalahada perbedaan sensasi proteksi, nyeri dan ABI setelah dilakukan masase kaki secaramanual. Sampel penelitian terdiri dari 30 responden kelompok intervensi dan 30responden kelompok kontrol. Hasil uji independent t test menunjukan adaperbedaan yang bermakna pada sensasi proteksi dan nyeri setelah dilakukan masasekaki secara manual (p= 0.000), tetapi tidak ada perbedaan yang bermakna padaABI setelah dilakukan masase kaki secara manual (p= 0.440). Kesimpulan yangdidapat adalah masase kaki secara manual berpengaruh terhadap peningkatansensasi proteksi dan penurunan nyeri pasien DM tipe 2. Rekomendasi untukperawat spesialis adalah perlunya menerapkan dan mengembangkan masase kakisebagai suatu intervensi mandiri perawat khususnya dalam memberikan asuhankeperawatan pada pasien DM tipe 2.

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ABSTRACTNeuropathy sensory and impaired peripheral perfusion are the long complication on type 2 DM patient. Both problems placed the patient at risk for foot injury. Neuropathy symptoms included loss of protection sensation and pain otherwise peripheral perfusion is change of ankle brachial index (ABI). There are modalities to reduce neuropathy sensory symptoms and impaired peripheral perfusion, one of them is manually foot massage that until this time was not yet being researched. This research aimed to identify influence of manually foot massage on protection sensation, pain and ankle brachial index. The design of this research was a quasi experimental research with control group and the sample was recruited by consecutive sampling. This research try to identify differences between protection sensation, pain and ABI of type 2 diabetes mellitus patient after manual foot massage intervention. That consisted of 30 sample for each group (intervention and control group) in this research. Independent t test indicated that there were significant differences between protection sensation and pain after performing manually foot massage (p= 0.000), however there were no significant differences of ABI after manually foot massage intervention (p= 0,440). The conclusion of this research is manually foot massage had effect on increasing protection sensation and reducing pain level on type 2 DM patient. The recommendation of this study is the importance of implementation and development manually foot massage as an independent nursing intervention for taking care of type 2 DM patient."

"Swedish massage merupakan teknik masase berfokus pada relaksasi dan meningkatkan sirkulasi darah dengan melibatkan otot. Tujuan penelitian untuk mengetahui pengaruh Swedish massage terhadap nilai ankle brakial index pada pasien diabetes tipe 2. Penelitian ini merupakan penelitian quasi eksperiment dengan kelompok kontrol, pemilihan sampel secara purposive sampling. Hasil penelitian menunjukkan ada perbedaan signifikan sebelum dan sesudah diberikan masase selama 3 minggu pada nilai ABI kanan (p = 0.015) dan ABI kiri (p = 0.045) antara kelompok kontrol dengan intervensi. Penelitian ini menyarankan perawat melakukan masase di layanan klinik untuk meningkatkan nilai ABI pada pasien diabetes melitus tipe 2.

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Swedish massage is a massage technique involving the muscles which focuses on promoting relaxation and blood circulation. This research aimed to investigate the effects of Swedish massage on Ankle Brachial Index (ABI) in type 2 diabetes mellitus patients. This study was quasi experimental with a control group and employed purposive sampling. There was a significant difference of intervention group and control on the right side of ABI (p = 0.015) and on the left side of ABI (p = 0.045) in three weeks of massage. This study suggests that nurse should perform massage in clinical practice to increase the ABI score for type 2 diabetes mellitus patients."

"Exercise pada pasien DM selama ini hanya difokuskan pada latihan daerah ankle saja, namun belum ada latihan fisik yang berfokus melatih seluruh otot kaki. Home‑Based Foot–Ankle Exercise (HBFAE) melatih seluruh otot kaki yang menggabungkan empat jenis exercise yang direkomendasikan American Diabetes Association yaitu stretching, strengthening, resistance dan balance exercises. Tujuan dari penelitian ini mengidentifikasi efektivitas HBFAE terhadap ABI pada pasien DM Tipe 2. Metode penelitian ini adalah Randomized Controlled Trial (RCT) double blind sampel 40 responden (20 intervensi dan 20 kontrol). Kelompok intervensi diberikan perlakuan HBFAE, kelompok kontrol diberikan perlakuan senam kaki diabetes. Perlakuan pada kedua kelompok diberikan sebanyak 24 kali (1 kali/hari, 5 kali dalam seminggu). Hasil penelitian menunjukan HBFAE (p value 0,001) dan senam kaki diabetes (p value 0,003) mampu meningkatkan ABI. Uji efektifitas menunjukan HBFAE efektif dalam meningkatkan nilai ABI dengan skor efektivitas 0,72 (72%), dibandingkan senam kaki diabetes hanya 0,14 (14%). Variabel confounding gula darah, lama DM, riwayat merokok, dan riwayat ulkus kaki pada penelitian ini tidak berhubungan dengan perubahan skor ABI (p value > 0,05). HBFAE dapat menjadi standar terapi exercise di rumah (komunitas) maupun di instalasi pelayanan kesehatan untuk mencegah komplikasi vaskularisasi kaki pada pasien DM karena mudah dan mampu dilakukan secara mandiri.

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Exercise in DM patients so far only focused in the ankle area and there is no exercise that focuses on training all leg muscles. Home-Based Foot-Ankle Exercise (HBFAE) trains all leg muscles by combining the four types of exercise recommended by the American Diabetes Association, namely stretching exercises, strengthening exercises, resistance exercises, and balance exercises. The purpose of this study was to identify the effectiveness of HBFAE on the Ankle Brachial Index (ABI) in Type 2 DM patients. The research method was a Randomized Controlled Trial (RCT) with a sample of 40 respondents (20 intervention and 20 control). Respondents in the intervention group were given HBFAE treatment, while the control group was given Diabetic Foot Exercise (standard treatment). The treatment in both groups was given 24 times (1 time/day, 5 times a week). The results showed that HBFAE (p-value 0,001) and diabetic foot exercise (p-value 0,003) were able to increase ABI. The results of the effectiveness test showed that HBFAE was effective in increasing the ABI value an effectiveness score of 0,72 (72%) compared to diabetic foot exercise was only 0,14 (14%). The results analysis of the confounding variables showed blood sugar levels, duration of DM, smoking and foot ulcers history in this study were not associated with changes in ABI (p-value > 0,05). HBFAE can be a standard exercise therapy both at home (community) and health care to prevent foot vascular complications because it’s implementation is easy and can be done independently.

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"Diabetes melitus merupakan salah satu dari penyakit kronis penyebab kematian tertinggi di dunia. Kondisi hiperglikemia akan menyebabkan berbagai komplikasi baik akut maupun kronis mencakup komplikasi mikrovaskuler dan makrovaskuler. Salah satu diantaranya yang paling berbahaya yaitu munculnya peripheral arterial  disease (PAD) yang menyebabkan terjadinya foot ulcers. Penulisan karya tulis ilmiah ini bertujuan untuk menganalisis asuhan keperawatan pada pasien diabetes melitus serta efektivitas pemeriksaan ankle brachial index (ABI) dan senam kaki diabetes untuk mengatasi ketidakefektifan perfusi jaringan perifer. Pemeriksaan ABI dan senam kaki diabetes merupakan intervensi yang dapat digunakan untuk meningkatkan sirkulasi perifer dengan mengidentifikasi terjadinya gangguan pada sirkulasi perifer,  meningkatkan aliran kolateralisasi darah pada kaki dan meningkatkan fungsi insulin. Intervensi pemeriksaan ABI dan senam kaki diabetes dilakukan pada pasien diabetes melitus selama 7 hari perawatan. Hasilnya menunjukkan bahwa penerapan pemeriksaan ABI dan senam kaki diabetes dapat meningkatkan sirkulasi perifer dan mencegah timbulnya luka kaki. Melihat keefektifan pemeriksaan ABI dan senam kaki diabetes untuk meningkatkan sirkulasi perifer maka diharapkan intervensi ini dapat digunakan sebagai perawatan rutin pada pasien diabetes melitus.

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Diabetes mellitus is one of the highest chronic disease causes of death in the world. The condition of hyperglycemia will cause various complications either acute and chronic including microvascular and macrovascular complications. One of the most dangerous is the emergence of peripheral arterial disease (PAD) which causes foot ulcer. The scientific paper aims to analyze nursing care in patient with diabetes mellitus and the effectiveness of measuring the ankle brachial index (ABI) and diabetic foot exercises to overcome the ineffectiveness of peripheral tissue perfusion. The examination of ABI and diabetic foot exercises are interventions that can be used to improve peripheral circulation by identifying disturbances in peripheral circulation, increasing the flow of blood collateralisation in the foot and improving insulin function. Intervention of ABI examination and diabetic foot exercises were carried out in patient with diabetes mellitus for 7 days treatment. The results show that the application of ABI examination and diabetic foot exercises can improve peripheral circulation and prevent foot injuries. Reviewing the effectiveness of ABI examination and diabetic foot exercises to improve peripheral circulation, then it is hoped that this interventions can be used as a routine treatment in patients with diabetes mellitus."

"[ABSTRAKDiabetes melitus (DM) yang telah diderita selama bertahun-tahun dapat mengarahke berbagai komplikasi, diantaranya yaitu terjadinya peripheral arterial disease(PAD). Salah satu indikator terjadinya PAD pada pasien DM tipe 2 yaitu adanyapenurunan nilai ankle brachial index (ABI) pada ekstremitas bawah pasien. Jika halini terus dibiarkan, maka bisa terjadi neuropati yang dapat memicu munculnyaulkus kaki diabetik. Intervensi yang dapat diberikan untuk meningkatkan nilai ABIyaitu dengan melakukan foot massage atau latihan ROM ankle dorsofleksi. Tujuanpenelitian ini adalah untuk mengetahui efektivitas pemberian kombinasi footmassage dan latihan ROM ankle dorsofleksi terhadap nilai ABI pada pasien DMtipe 2. Penelitian ini merupakan penelitian quasi experiment dengan metode pre andpost test without control yang terdiri dari 2 kelompok intervensi dengan besarsampel 20 responden. Hasil penelitian ini menunjukkan bahwa terdapat hubunganyang signifikan antara pemberian kombinasi latihan ROM ankle dorsofleksi danfoot massage terhadap peningkatan nilai ABI (p value = 0,033 untuk ekstremitaskanan dan p value = 0,001 untuk ekstremitas kiri). Rekomendasi penelitian ini yaituagar para perawat dapat memberikan intervensi kombinasi latihan ROM ankledorsofleksi dan foot massage dalam rangka mencegah terjadinya PAD pada pasienDM tipe 2.

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ABSTRACTThe chronic diabetes mellitus has the potential to cause several complicationsincluding peripheral arterial disease (PAD). A parameter indicating PAD amongstType 2 diabetes mellitus patients is the decline in the ankle brachial index (ABI) ontheir lower extremity. Once this condition persists, it can cause neuropathy leadingto the occurrence of leg diabetic ulcer. An intervention believed to overcome thisproblem is conducting foot massage or ankle dorsiflexion range of motion (ROM)exercises. This research aimed at investigating the effectiveness of exercisecombination of foot massage and ankle dorsiflexion ROM on ABI scores amongtype 2 diabetes mellitus patients. This study used quasi-experiment method with preand post-test without control design, and consisted two intervention groupsinvolving 20 participants. The study revealed that there was distinctive correlationbetween the exercise combination of foot massage and ankle dorsiflexion ROM andthe increase of ABI scores of the patients (p value = 0.033 for the right extremitiesand p value = 0.001 for the left extremities).The findings suggest that suchintervention can be considered or even be provided by nurses taking care of type 2diabetes mellitus patients to prevent them from the possible deterioratingcomplication, the peripheral artery disease.;The chronic diabetes mellitus has the potential to cause several complicationsincluding peripheral arterial disease (PAD). A parameter indicating PAD amongstType 2 diabetes mellitus patients is the decline in the ankle brachial index (ABI) ontheir lower extremity. Once this condition persists, it can cause neuropathy leadingto the occurrence of leg diabetic ulcer. An intervention believed to overcome thisproblem is conducting foot massage or ankle dorsiflexion range of motion (ROM)exercises. This research aimed at investigating the effectiveness of exercisecombination of foot massage and ankle dorsiflexion ROM on ABI scores amongtype 2 diabetes mellitus patients. This study used quasi-experiment method with preand post-test without control design, and consisted two intervention groupsinvolving 20 participants. The study revealed that there was distinctive correlationbetween the exercise combination of foot massage and ankle dorsiflexion ROM andthe increase of ABI scores of the patients (p value = 0.033 for the right extremitiesand p value = 0.001 for the left extremities).The findings suggest that suchintervention can be considered or even be provided by nurses taking care of type 2diabetes mellitus patients to prevent them from the possible deterioratingcomplication, the peripheral artery disease., The chronic diabetes mellitus has the potential to cause several complicationsincluding peripheral arterial disease (PAD). A parameter indicating PAD amongstType 2 diabetes mellitus patients is the decline in the ankle brachial index (ABI) ontheir lower extremity. Once this condition persists, it can cause neuropathy leadingto the occurrence of leg diabetic ulcer. An intervention believed to overcome thisproblem is conducting foot massage or ankle dorsiflexion range of motion (ROM)exercises. This research aimed at investigating the effectiveness of exercisecombination of foot massage and ankle dorsiflexion ROM on ABI scores amongtype 2 diabetes mellitus patients. This study used quasi-experiment method with preand post-test without control design, and consisted two intervention groupsinvolving 20 participants. The study revealed that there was distinctive correlationbetween the exercise combination of foot massage and ankle dorsiflexion ROM andthe increase of ABI scores of the patients (p value = 0.033 for the right extremitiesand p value = 0.001 for the left extremities).The findings suggest that suchintervention can be considered or even be provided by nurses taking care of type 2diabetes mellitus patients to prevent them from the possible deterioratingcomplication, the peripheral artery disease.]"

"ABSTRAKPenurunan sensitivitas kaki dan ankle brachial index (ABI) merupakankomplikasi yang sering terjadi pada Diabetisi. Terapi akupresur bermanfaat dalam menstimulasi aliran energi dalam tubuh sehingga memperbaiki aliran sirkulasi tubuh. Penelitian ini bertujuan untuk mengetahui pengaruh akupresur terhadap sensitivitas kaki dan ABI Diabetisi. Desain penelitian ini adalah quasi eksperimen dengan pendekatan pre-posttest design pada 64 responden (kelompok intervensi = 31 orang, kelompok non intervensi = 33 orang). Kelompok intervensi diberikan terapi akupresur selama 7 sesi, 2 hari sekali selama 10 menit. Hasil penelitian menunjukkan adanya pengaruh akupresur terhadap sensitivitas kaki (p=0,001) dan ABI (p=0,001). Akupresur dapat dijadikan salah satu alternatif terapi yang dapat diterapkan perawat di masyarakat untuk mencegah terjadinya komplikasi lanjut Diabetisi sebagai kelompok rentan.

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ABSTRACTDecreased of foot sensitivity and ankle brachial index (ABI) is a complication that often occurs in Diabetes. Acupressure therapy stimulating the flow of energy in the body so that the body's circulatory flow touch ups. This study aimed to determine the effect of acupressure to foot sensitivity and ABI in Diabetes Mellitus patients. This study designed was quasi-experimental with pre-posttest design at 64 responden (intervention group = 31, non-intervention group = 33). The intervention group received acupressure therapy for 7 sessions, each 2 days for 10 minutes. The results showed the effect of acupressure on foot sensitivity (p = 0.001) and ABI (p = 0.001). Acupressure can be used as an alternative therapy that can be applied by nurses in the community to prevent complications in people with diabetes as a vulnerable group."

"Latar belakang: Diabetes melitus merupakan faktor risiko penting terjadinyaaterosklerosis, aterosklerosis merupakan penyakit sistemik yang bisa terjadi di seluruhpembuluh darah baik pada mikrovaskular maupun makrovaskular. Adanya buktiiskemia akibat stenosis yang disebabkan aterosklerosis pada salah satu pembuluh darah,mengharuskan kita lebih waspada akan adanya proses aterosklerosis di tempat lain.NPD di kaki terjadi akibat komplikasi diabetes pada mikrovaskular yang akhirnyamengakibatkan kerusakan pada persarafan di kaki. Maka perlu mewaspadai prosesateroslerosis di tempat lain, baik pada pembuluh arteri makro maupun mikrovaskular dikaki. Pemeriksaan non invasif untuk melihat adanya ganguan makrovaskular di kakimenggunakan ABI dan TBI sedangkan untuk gangguan mikrovaskular dengan TcPO2.Penelitian ini dilakukan untuk dapat menilai hubungan derajat neuropati perifer diabetikyang dinilai dengan TCSS dengan proses ateroskerosis dipembuluh darah kaki, baikyang makrovaskular dengan ABI dan TBI maupun mikrovaskular TcPo2 pada pasienDM tipe 2.Metode: Penelitian potong lintang dilakukan pada pasien DM tipe 2 dengan NPDdengan nilai TCSS >5 di Poliklinik Pelayanan Jantung Terpadu, poliklinik Endokrindan Metabolik dan Poliklinik Ilmu Penyakit Dalam Umum RSCM. Data diperoleh dariwawancara, rekam medik, pemeriksaan ABI, TBI dan TcPO2. Variabel penelitianberupa derajat neuropati perifer, ABI, TBI dan TcPO2. Analisis bivariat terhadapmasing-masing variable dengan menggunakan uji Spearman.Hasil: Sebanyak 36 subjek yang memenuhi kriteria pemilihan diikutkan dalampenelitian, rerata usia 62 tahun dengan 20 (55,6%) di antaranya perempuan dan medianlama diabetes 12 tahun. Berdasarkan analisa bivariat dengan uji spearman penelitian inimendapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasisedang antara derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan ABI(r = -0,475, p = 0,003) dan TBI (r = -0,421, p = 0,010). Dan pada pemeriksaan TcPO2juga di dapatkan korelasi negatif yang bermakna secara statistik dengan koefisienkorelasi sedang ( r = -0,399, p = 0,016)Simpulan : Terdapat korelasi negatif yang bermaksa secara statistik antara derajatneuropati perifer diabetik dengan ABI, TBI dan TcPO2.

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Background: Diabetes mellitus is important risk factor of atherosclerosis.

Atherosclerosis is systemic disease that can occur in all blood vessels both

microvascular and macrovascular. There is evidence of ischemia due to stenosis caused

by atherosclerosis in one blood vessel, which requires us to be more aware with the

process of atherosclerosis in other places. Diabetic peripheral neuropathy (DPN) in the

lower extremity results from complications of diabetes in the microvascular which can

damage nerve in the lower extremity. Then it is necessary to be aware of the process of

aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower

extremity. Non-invasive examination to look macrovascular disorders in the lower

extremity are using ankle brachial index (ABI) and toe brachial index (TBI) while for

microvascular disorders with TcPO2. This study was conducted to assess the

association of the degree of diabetic peripheral neuropathy assessed by toronto clinical

scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the

lower extremity, both macrovascular with ABI and TBI as well as microvascular TcPo2

in Patients with type 2 diabetes mellitus (DM)

Methods: Cross-sectional study was carried out in patients with type 2 DM with DPN

with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic

Polyclinic, and Internal Medicine Polyclinics at RSCM. The Data were obtained from

interviews, medical records, ABI, TBI and TcPO2 examinations. The research variables

are the degree of peripheral neuropathy, ABI, TBI and TcPO2. Bivariate analysis of

each variable was used the Spearman test.

Results: Total of 36 subjects who met the selection criteria were included in the study,

the average age was 62 years with 20 (55.6%) of whom were women and the median

duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test,

this study found a statistically significant negative correlation with moderate correlation

coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with

ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010) . The TcPO2 examination

also found a statistically significant negative correlation with moderate correlation

coefficient (r = -0.399, p = 0.016)

Conclusion : There is a statistically significant negative correlation between the degree of diabetic peripheral neuropathy with ABI, TBI and TcPO2 examinations."

"Latar Belakang. Prevalensi penyakit arteri perifer (PAP) pada pasien diabetes melitus lebih tinggi dibandingkan populasi umum. Penyakit arteri perifer dapat meningkatkan mortalitas dan morbiditas terutama akibat penyakit kardiovaskular pada pasien diabetes melitus tipe 2 (DM tipe 2). Tidak semua pasien dengan PAP dapat terdeteksi dengan pengukuran ankle brachial index (ABI) istirahat, sehingga diperlukan pemeriksaan ABI treadmill. Pemeriksaan ABI treadmill dapat mendeteksi PAP pada fase awal, sehingga profil pasien pada kelompok ini berbeda dengan klompok PAP yang dideteksi dengan ABI istirahat. Diketahuinya profil pasien PAP ini penting untuk membantu meningkatkan kewaspadaan pasien, khususnya pasien DM tipe 2. Tujuan. Mengetahui profil pasien DM tipe 2 dengan PAP yang dideteksi dengan ABI treadmill. Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Metabolik Endokrin dan Kardiologi, Departemen Ilmu Penyakit Dalam, Rumah Sakit Cipto Mangunkusumo pada Februari sampai April 2016 dengan metode sampling konsekutif. Subjek dengan nilai ABI istirahat normal/ perbatasan menjalani treadmill dengan protokol Bruce yang digunakan juga sebagai protokol uji latih jantung treadmill. Diagnosis PAP ditegakkan bila terdapat penurunan nilai ABI lebih dari 20% dibandingkan ABI istirahat. Hasil. Sebanyak 92 subjek dianalisis untuk mengetahui profil pasien DM tipe 2 dengan PAP yang dideteksi dengan ABI treadmill. Lima belas subjek (16,3%) didiagnosis PAP. Kelompok PAP memiliki persentase subjek dengan durasi diabetes ≥ 10 tahun sebanyak 53,3%; dislipidemia sebanyak 73,3%; penyakit ginjal kronik (PGK) sebanyak 33,3%; perokok sebanyak 40%; komplikasi neuropati sebanyak 53,3%; albuminuri sebanyak 53,3%; retinopati sebanyak 40%; dan respons iskemia jantung positif/sugestif positif sebanyak 40% subjek. Sedangkan kelompok tanpa PAP memiliki subjek dengan durasi diabetes ≥ 10 tahun sebanyak 33,8%; dislipidemia sebanyak 57,1%; PGK sebanyak 19,5%; perokok sebanyak 32,5%; komplikasi neuropati sebanyak 37,7%; albuminuri sebanyak 26,4%; retinopati sebanyak 28,6%; respons iskemia jantung positif/sugestif positif sebanyak 28,5% subjek. Kesimpulan. Prevalensi PAP yang dideteksi dengan ABI treadmill pada pasien DM tipe 2 adalah 16,3% (IK 95%: 8-23%). Kelompok PAP yang dideteksi dengan ABI treadmill memiliki subjek dengan durasi DM ≥ 10 tahun, dislipidemia, perokok, PGK, neuropati, albuminuria, retinopati dan respons iskemia jantung positif/sugestif positif lebih banyak daripada subjek tanpa PAP.

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Background. The prevalence of peripheral arterial disease (PAD) among diabetes patients was higher compared to general population. PAD increases morbidity and mortality, especially due to cardiovascular disease, in type 2 diabetes mellitus patients (T2DM). Not all patients having PAD could not be detected by resting ankle brachial index (ABI) measurement, hence it is required treadmill ABI examination. The examination enable to detect PAD in the earlier phase, therefore patients profile would different with PAD patient detected from resting ABI examination. The profiles are important to raise the awareness of T2DM patients.

Aim. To identify profile T2DM patients with PAD detected by treadmill ABI.

Methods. A cross-sectional study was carried out in Metabolic Endocrine and Cardiology Outpatient Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital during February-April 2016. The study used consecutive sampling method. Subject having normal or borderline resting ABI value is examine using Bruce protocol treadmill. The protocol is also used as a cardiac treadmill exercise test protocol. The patients diagnose as PAD if there is a reducing ABI value more than 20% compared to resting ABI.

Result. The profile of PAD patients detected by treadmill ABI were obtain from 92 subjects. Fifteen subjects (16,3%) were diagnosed having PAD. In the group with PAD, the percentage of subject with diabetes duration ≥ 10 years was 53,3%; dyslipidemia was 73.3%; chronic kidney disease (CKD) was 33.3%; smokers was 40%; complications of neuropathy was 53.3%; albuminuri was 53.3%; retinopathy was 40%; positive / positive suggestive cardiac ischemia response was 40% . Meanwhile the group without PAD, the percentage of subjects with diabetes duration ≥ 10 years was 33.8%; dyslipidemia was 57.1%; CKD was 19.5%; smokers was 32.5%; complications of neuropathy was 37.7%; albuminuri was 26.4%; retinopathy was 28.6%; positive / positive suggestive cardiac ischemia response was 28.5%.

Conclusion. The prevalence of PAD that detected by treadmilll ABI in T2DM patients is 16,3% (95% CI: 8-23%). The Group with PAD detected by ABI treadmill which have duration of diabetes ≥ 10 years, dyslipidemia, smokers, CKD, neuropathy, albuminuria, retinopathy, and the positive result on treadmill exercise test have more subjects than group without PAD."

"Latar Belakang: Penyakit arteri perifer (PAP) adalah manifestasi aterosklerosis sistemik, yang seringkali melibatkan penyandang diabetes melitus (DM) tipe 2. Tes ankle brachial index (ABI) telah digunakan sebagai penapis PAP, tetapi ABI normal belum menyingkirkan PAP. USG dupleks (UD) lebih sensitif namun lebih mahal daripada tes ABI, sehingga perlu diketahui karakteristik penyandang DM tipe 2 yang paling diprioritaskan untuk menjalani pemeriksaan UD.Tujuan: Tujuan penelitian ini adalah untuk membuktikan bahwa UD dapat mendeteksi PAP pada penyandang DM tipe 2 dengan ABI normal, mengenali gambaran UD PAP, dan mengenali karakteristik penyandang DM tipe 2 yang paling diprioritaskan untuk menjalani pemeriksaan UD.Bahan dan Cara Kerja: Penelitian ini menggunakan desain potong lintang dengan mengikutsertakan 40 tungkai. Setiap subyek menjalani roc ABI, pemeriksaan UD dan pen ilaian faktor-faktor risiko. Arteri-arteri ekstremitas bawah d iperiksa, dengan penilaian terhadap ketebalan kompleks intima media (KIM) arteri femoralis, adanya plak, dan evaluasi spektrum Doppler.Hasil: Dari pemeriksaan UD ditemukan PAP pada 50% (20 dari 40) tungkai. Gambaran UD PAP yang didapatkan berupa penebalan KIM arteri femoralis (20%, 4 dari 20 tungkai) dan adanya plak dengan spektrum Doppler yang masih normal di arteri-arteri ekstremitas bawah (100%, 20 dari 20 tungkai). Terdapat hubungaxi bermakna antara obesitas dan kejadian PAP (Rasio Odds = 22,45). Kesimpulan: Dari penelitian ini, kami menyimpulkan bahwa: 1) UD dapat mendeteksi PAP pada penyandang DM tipe 2 dengan A131 normal; 2) Gambaran UD PAP pada pasien-pasien tersebut berupa penebalan KIM arteri femoralis dan adanya plak dengan spektnim Doppler normal di arteri-arteri ekstremitas bawah; 3) Obesitas merupakan karakteristik penyandang DM tipe 2 yang paling diprioritaskan untuk menjalani pemeriksaan UD.

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Background: Peripheral arterial disease (PAD) is a manifestation of atherosclerosis disease, which commonly involves the non insulin dependent diabetes mellitus (NIDDM) patients. Ankle brachial index (A13I) test has been used as a screening test for PAD, but a normal ABI does not exclude PAD. Duplex ultrasonography (DU) is more sensitive but more expensive than ABI, so it is neccessaty to assess the characteristics q f NIDDM patiens who are mostly indicated to undergo DU examination.

Objectives: The objectives of this study are to prove that DU can detect PAD in NIDDM patients with normal ABI, to assess DU appearances of PAD, and to assess the characteristics of NIDDM patiens who are mostly indicated to undergo DU examination.

Materials and Methods: This study was conducted in a cross sectional design, which involved 40 legs. Every subject underwent ABI and DU examinations. Lower extremity arteries were examined, with assessment for femoral intitnal medial thickness (IMT), the presence of plaque, and evaluation of Doppler spectrum .1-or each artery. The risk factors were evaluated by anamnesis, physical examination and laboratory examination.

Results: From DU examination, as many as 50% (20 _ from 40 legs) are found to have PAD. The DU appearances q f PAD include increase_ femoral artery LMT (20%, 4 from 20 legs) and the presence of plaques with normal Doppler spectrums in the lower extremity arteries (100%, 20 from 20 legs). There was a significant relationship between obesity and the evidence of PAD (Odds ratio = 2 2, 45).

Conclusions: From this study, we conclude that: I) DU can detect PAD in NIDDM patients with normal ABI, 2) 7Tie DUI appearances of PAD in those patients include increase femoral arrey IMT and the presence of plaques with normal Doppler spectntras in the lower extremity arteries: 3) Obesity is the characteristic of NIDDM patients who are mostly indicated to undergo DU examination."

"ABSTRAKLatar belakang. Diabetes mellitus DM merupakan salah satu penyakit kronis yang komplikasinya masih menjadi masalah besar di Indonesia. Salah satu komplikasi DM yang paling sering dan sering berakhir dengan kecacatan adalah kaki diabetik. Angka amputasi di Indonesia khususnya di RSUPN dr. Cipto Mangunkusumo RSCM masih cukup tinggi dibandingkan dengan negara lain di Asia. Salah satu faktor predisposisi amputasi kaki diabetik adalah perfusi jaringan yang dapat diukur dengan ankle brachial index ABI . Studi sebelumnya menunjukkan hubungan signifikan antara ABI dengan kejadian amputasi. Penelitian ini bertujuan untuk mengetahui hubungan nilai ABI dengan besarnya risiko terjadinya amputasi minor dan mayor pada penderita kaki diabetic dalam populasi kami.Metode. Kami melakukan studi retrospektif pada 84 subjek dengan kaki diabetik yang diamputasi di RSCM selama periode 1 Januari 2013 sampai dengan 31 Desember 2014. Karakteristik subjek dan vaskular termasuk diantaranya ABI dianalisa secara statistik.Hasil. Kami dapatkan sepsis dengan adjusted OR 95 CI : 0,023 0,004 sampai 0,157 dan nilai ABI yang memiliki adjusted OR 95 CI : 2,89 1,33 sampai 6,29 merupakan variabel yang bermakna dengan kejadian amputasi pada pasien kaki diabetik.Kesimpulan. Subjek dengan nilai ABI 1,3 secara independen.

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AbstractBackgroundhr>ABSTRACT. Diabetes mellitus is one of the chronic diseases in which the complication is still a major problem in Indonesia. One of the most frequent complications of diabetes mellitus and often ends up with a disability is diabetic foot. The number of amputation in Indonesia, especially in dr. Cipto Mangunkusumo Hospital RSCM is quite high compared to other countries in Asia. One of predisposing factors of diabetic foot amputation is the tissue perfusion that can be measured by the ankle brachial index ABI . All the studies carried out abroad and in RSCM show a significant relationship between ABI and the incidence of amputation. This study aims to determine the relationship of ABI score with the magnitude of minor and major amputation risks in patients with diabetic foot.Method. The retrospective study was conducted in 84 patients with diabetic foot that were amputated at the RSCM during the period of January 1, 2013 to December 31, 2014. Samples were taken consecutively. Statistical analysis is done to find out a relationship between predisposing factors with the incidence of minor and major amputations in patients with diabetic foot. Chi Square test or Fisher, as well as multivariate analysis using logistic regression is used. The significance if p was "