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"Komplikasi ulkus diabetikum pedis (UDP) terjadi pada 15% pasien DM tipe 2. Seluruh kasus UDP dalam serial kasus ini diawali oleh trauma pedis sehingga menyebabkan luka yang tidak menyembuh disertai demam, kelemahan tubuh, mual, anoreksia, dengan atau tanpa disertai gejala klasik DM. Suatu uji klnis mendapatkan sebanyak 69% penderita DM dengan komplikasi UDP menderita malnutrisi. Tata laksana nutrisi pada serial kasus ini adalah pemberian nutrisi optimal, meliputi makronutrien, mikronutrien, dan nutrien spesifik sesuai kebutuhan untuk memperbaiki dan mencegah malnutrisi, komplikasi lainnya, dan kekambuhan serta mendukung penyembuhan ulkus.Rentang usia pasien pada serial kasus ini adalah 52–70 tahun. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict. Kebutuhan energi total didapat dari perkalian kebutuhan energi basal dengan faktor stres. Pemberian nutrisi dilakukan bertahap sesuai toleransi sampai mencapai kebutuhan total.Makronutrien diberikan dengan komposisi sesuai dengan keadaan pasien.Pemberian protein sesuai dengan fungsi ginjal, pembatasan asam lemak jenuh dan kolesterol, karbohidrat terutama jenis kompleks, dan cukup serat.Garam diberikan sesuai tekanan darah.Diusulkan pemberian mikronutrien berupa vitamin dan mineral sesuai Angka Kecukupan Gizi (AKG) serta nutrien spesifik asam lemak omega-3.Pemantauan dilakukan terhadap perkembangan klinis, toleransi asupan makanan, kapasitas fungsional, status ulkus, laboratorium, dan antropometri.Seluruh pasien membutuhkan insulin dengan dosis yang terus meningkat untuk menjaga kadar glukosa darah dan mengalami penurunan berat badan, namun kebutuhan energi total dapat tercapai, luka membaik dan kapasitas fungsional meningkat. Tata laksana nutrisi yang diberikan harus bersifat individual disesuaikan dengan keadaan umum dan klinis pasien.Edukasi nutrisi selama dan pasca rawat penting diberikan dalam meningkatkan motivasi pasien menjalankan diet yang benar untuk menjaga status gizi. Status gizi dan kontrol glikemik yang baik penting dalam penyembuhan luka, mencegah kekambuhan dan timbulnya komplikasi diabetes melitus yang lain.

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Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals. All patients had pedal trauma as an initiation of their non-healing wounds which were then developed to form ulcers. The ulcers presented with febrile, lethargy, nausea, anorexia, with or without diabetes mellitus classical symptoms. A clinical trial found 69% patients of this disease were malnourished. The goal of medical nutrition therapy on type 2 diabetes mellitus with diabetic foot ulcer is to provide the patients with appropriate nutrition containing macronutrient, micronutrient, and specific nutrient according to the requirement, to reverese and prevent malnutrition, other complications and recurrence, and support the wound healing.

Patient’s age range in this case series was 52–70 years old. Basal energy requirements calculated using Harris-Benedict equation and multiplyit by stress factor for the total energy requirements. Diets were gradually given according patient’s tolerance until total energy requirements were achieved.Macronutrients composition were given according to patient’s condition, with protein adjusted to renal function, limiting saturated fat and cholesterol, complex carbohydrate, sufficient fiber and sodium given according to blood pressure. Micronutrient recommendation was vitamin and mineral sejumlah as much as Recommended Dietary Allowance (RDA) and omega-3 fatty acid. Monitoring was done at clinical status, nutrition intake and tolerance, functional capacity, wound/ulcer status, laboratory and anthropometric assessment.

All patients needed increasing dose of insulin in maintainingglucose control and experienced mild weight loss, total energy requirements were achieved by all patients. Patient’s functional capacities were increased, and had improvement wound status. Nutrition therapy for patients should be given individuallyaccording to general and clinical condition. Nutrition education and motivation during and after hospitalization are important part of this disease’s management to keep the patient’s compliance on nutrition intake as recommended to maintain good nutritional status and glycemic control, prevent other complications and re-ulceration."

"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."

"Ketoasidosis diabetik (KAD) merupakan komplikasi akut dari diabetes melitus (DM) tak terkontrol, ditandai dengan hiperglikemia, ketosis, dan asidosis metabolik. Pemberian nutrisi sering menjadi masalah, namun menunda pemberian nutrisi dini menyebabkan peningkatan kadar keton darah dan morbiditas pasien. Tujuan penulisan serial kasus ini adalah memulihkan ketosidosis dan memenuhi kebutuhan makro- dan mikronutrien. Pasien berusia antara 18?65 tahun, mengalami KAD dengan DM, dirawat 5?12 hari di Rumah Sakit Umum Tangerang. Pencetus KAD adalah infeksi, ketidakpatuhan pengobatan, dan diet yang tidak tepat. Keempat orang pasien menderita DM dengan penyakit penyerta yang berbeda. Terapi nutrisi diberikan berdasarkan kondisi klinis pasien. Energi diberikan mulai dari kebutuhan basal yang dihitung dengan persamaan Harris-Benedict, atau dimulai dari 20?25 kkal/ kg BB pada kondisi sakit kritis. Makronutrien diberikan sesuai rekomendasi American Diabetes Association dan mikronutrien sesuai dengan kondisi dan kebutuhan pasien. Pemantauan yang dilakukan meliputi toleransi asupan, imbang cairan, antropometri, dan laboratorium (kadar glukosa darah, keton darah, dan elektrolit). Edukasi dan konsultasi nutrisi diberikan setiap hari. Selama pemantauan semua pasien menunjukkan perbaikan klinis dan penurunan kadar keton darah. Semua pasien dapat mencapai kebutuhan energi total dan kadar glukosa darah mendekati normal. Sebelum pulang pasien diberikan edukasi tentang cara mengetahui faktor yang dapat mencetuskan KAD dan mengatasinya, serta edukasi nutrisi untuk mencapai kontrol glikemik optimal dan mencegah KAD.

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Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes, characterized by hyperglycemia, ketosis, and metabolic acidosis. Nutrition intervention may often cause some problems, unfortunately, withholding early nutrition may increase blood ketones concentration and patient morbidity. Aims of this case series are resolve ketoacidosis dan meet macro and micronutrient requirement. Patients aged between 18 to 65 years old, presented DKA with diabetes mellitus, and hospitalized from 5 to 12 days at Tangerang General Hospital. Precipitating factors of DKA include infection, noncompliance to medication, and inproper diet. All patients suffered from DM with different comorbidities. Nutritional therapy was given according to patients clinical condition. The energy was given begin with basal requirement, which calculated using Harris-Benedict equation, or begin with 20?25 kcal/kg body weight (BW) in critically ill condition. Macronutrients were given according to American Diabetes Association recommendation and micronutrients based on patients? condition and requirement. Monitoring includes food intake tolerance, fluid balance, anthropometric, and laboratory results (blood glucose levels, blood ketone, and electrolytes). Education and nutrition consultation were given everyday. During monitoring all patients showed clinical improvements in general condition and blood ketone concentration?s reduction. All patients can meet total energy requirement with blood glucose levels close to normal. Before discharge, patients received education to identify and manage risk factors that may precipitate DKA. Nutrition education was also given to achieve optimal glycemic control and prevent DKA."

"Komplikasi kronis pada diabetes melitus berupa ulkus kaki diabetik dapat dicegah dengan melakukan perawatan kaki mandiri. Salah satu faktor yang berperan dalam perilaku perawatan kaki adalah efikasi diri.Tujuan penelitian ini adalah untuk mengetahui hubungan efikasi diri dengan perilaku perawatan kaki pada individu dengan diabetes melitus tipe 2 (DMT2).Penelitian ini menggunakan metode kuantitatif observasional analitik dengan pendekatan crossectional, melibatkan 74 individu dengan DMT2. Alat ukur yang digunakan berupa kuesioner karakteristik demografi, Foot Care Confidence Scale, Nottingham Assessment of Functional Footcare, dan pengetahuan perawatan kaki.Hasil penelitian menunjukkan terdapat hubungan positif yang bermakna antara efikasi diri dengan perilaku perawatan kaki (r = 0.303; p = 0.009). Hasil analisis multivariat didapatkan efikasi diri menjadi prediktor terhadap perilaku perawatan kaki setelah dikontrol oleh pengetahuan dan tingkat pendidikan.Kesimpulan dari penelitian ini adalah perlunya upaya untuk memperbaiki perilaku perawatan kaki pada individu dengan DMT2 dengan meningkatkan efikasi diri menggunakan sumber-sumber efikasi diri yang ada.

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Chronic complications of type 2 diabetes mellitus such as diabetes foot ulcer could be prevented by performing foot self care. Self efficacy is the most important role in foot care.

This study aims to investigate the relationship between self efficacy and foot care behavior.

This study was observational analytic with cross-sectional approach, recruited 74 people with type 2 diabetes mellitus using consecutive sampling method. Data collection was done using demographic questionnaire, Foot Care Confidence Scale, Nottingham Assessment of Functional Foot-care and diabetic foot self care knowledge.

The result showed that there was a positive relationship between self efficacy and foot care behavior (r = 0.303; p = 0.009). Multivariate analysis showed that self efficacy became a strong predictor of foot self care behavior along with knowledge and educational level.

In conclusion, it is needed to improve foot self care in people with type 2 diabetes mellitus through increasing self efficacy."

"Diabetes mellitus adalah salah satu penyakit tidak menular yang banyak terjadi di masyarakat perkotaan. Karakteristik masyarakat perkotaan yang heterogen rentan terhadap perubahan gaya hidup sehat yaitu pola makan tinggi kalori dan pola aktivitas rendah yang menyebabkan terjadinya diabetes mellitus tipe 2. Diabetes yang tidak terkontrol dapat menyebabkan munculnya komplikasi mikrovaskuler, salah satunya adalah ulkus kaki diabetik. Ulkus kaki diabetik yang tidak ditangani dengan baik dapat mengalami proses penyembuhan yang lama bahkan dapat muncul dampak lanjut yaitu amputasi kaki. Penyembuhan ulkus kaki memerlukan sirkulasi yang adekuat pada kaki untuk menyalurkan nutrisi ke sel-sel. Tujuan dari penulisan karya ilmiah ini adalah untuk melakukan analisis keperawatan kesehatan masyarakat perkotaan dikaitkan dengan asuhan keperawatan pada pasien diabetes mellitus tipe 2 dengan intervensi ROM ankle dalam mengatasi masalah sirkulasi pada pasien dengan ulkus kaki diabetik. Rekomendasi penulisan ini adalah perawat perlu mengajarkan dan menerapkan ROM ankle pada pasien dengan ulkus kaki diabetik untuk meningkatkan sirkulasi ke kaki sehingga mendukung percepatan proses penyembuhan luka.

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Diabetes mellitus is one of non-communicable disease that happens in urban people. The heterogeneous urban people are susceptible to health behavior changes such as high calorie eating and low level activity pattern which can cause type 2 diabetes mellitus. Uncontrolled diabetes can cause micro vascular complication named diabetic foot ulcer. Diabetic foot ulcer with poor management promotes delayed of healing process even can cause foot amputation. The healing process of diabetic foot ulcer needs adequate circulation to distribute nutrition into cells. This study aimed to analyze urban health nursing linked to nursing care of type 2 diabetes mellitus patient with intervention of ankle ROM to accelerate wound healing process in diabetic foot ulcer. This study recommends nurses to teach and apply ankle ROM in diabetic foot ulcer patients due to increase foot circulation so that support acceleration of wound healing process."

"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: Hipomagnesemia berhubungan dengan kejadian pre-diabetes, konversi ke diabetes tipe 2 dan juga komplikasi kronik diabetes, termasuk albuminuria. Hasil studi hubungan antara kadar magnesium dengan kejadian albuminuria pada diabetes melitus tipe 2 masih kontroversial. Untuk itu perlu dilakukan penelitian hubungan tersebut. Metode: Potong lintang dengan consecutive sampling pada pasien DM tipe 2 yang sudah terdiagnosis nefropati diabetes. Dilakukan anamnesis faktor risiko, pemeriksaan fisik, kadar magnesium, albumine creatinine ratio dan A1C. Hasil: Tiga puluh delapan subjek ikut dalam penelitian yang sebagian besar berusia lebih 50 tahun dan memiliki kontrol glikemik yang buruk (81,6%). Pada subjek penelitian yang memiliki kadar Mg <1,7 mg/dl 80% mengalami albuminuria, sementara subjek yang memiliki kadar Mg ≥ 1,7 mg/dl didapat 63,6% subjek penelitian yang mengalami albuminuria. Pada penelitian ini didapatkan koefisien korelasi sebesar 0,006 yang menunjukkan hubungan yang lemah antara kadar magnesium dalam darah dengan albuminuria. Kesimpulan: Secara statistik tidak ditemukan korelasi antara kadar magnesium dengan albuminuria.

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Background: Hypomagnesemia associated with occurance of prediabetes, convertion to type 2 diabetes and also chronic complication of diabetes, including albuminuria. Studies that look for correlation magnesium concentration with albuminuria in type 2 diabetes still controvensial that?s why we need to do this research.

Method: Cross sectional study done in type 2 diabetes who have been diagnosed with nephropathy. Correlation Pearson test used to prove correlation between magnesium level with albuminuria.

Result: Thirty eight subjects follow this study, majority of them age more than 50 years old, mostly having bad glycemic control (81,6%).There are 80 % subject with hypomagnesemia (Mg <1,7 mg/dl) suffered from albuminuria while subject with normomagnesia (Mg ≥ 1.7 mg/dl) only 63.6% suffered from albuminuria. This study result in no correlation between magnesium level in type 2 diabetes.

Conclusion: No correlation between serum magnesium concentration with albuminuria."

"Masyarakat perkotaan memiliki pola hidup yang mengutamakan kemudahan dalam banyak kegiatan. Pola hidup yang mencerminkan hal tersebut seperti dalam pengkonsumsian makanan atau minuman cepat saji dan aktifitas fisik yang rendah. Pola hidup seperti yang telah dijelaskan dapat memicu terjadinya peningkatan faktor risiko penyebab diabetes mellitus tipe 2. Lamanya proses perawatan pada klien yang telah mengalami komplikasi, dapat memicu terjadinya masalah psikososial seperti ketidakberdayaan. Ketidakberdayaan merupakan persepsi seseorang tentang kegiatannya atau tindakan yang dilakukan tidak akan mempengaruhi apapun. Intervensi yang dapat dilakukan pada klien dengan ketidakberdayaan seperti menanamkan pikiran positif, dan melatih afirmasi positif. Intervensi yang dilakukan pada klien dapat mengontrol ketidakberdayaan yang dialami.

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Urban people have a lifestyle that focuses on ease, such as the consumption of fast food or drinks high carbohydrate and low physical activity. This life style can lead to an increase in risk factors associated with type 2 diabetes mellitus. The length of the treatment process in clients with complications can lead to psychosocial problems such as powerlessness. Powerlessness is one's perception of its activities or actions do not affect anything. Interventions that can be performed on the client with the powerlessness such as practice of positive thinking and positive affirmations. Interventions were performed on the client can control the powerlessness experienced."

"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."

"Sambiloto (Andrographis paniculata Nees.) secara empiris telah digunakan sebagai obat alternatif untuk berbagai penyakit termasuk diabetes mellitus. Penelitian ini dilakukan untuk menganalisis efek hipoglikemik kapsul sambiloto sebagai terapi tambahan pada penyandang diabetes melitus tipe 2. Double-blind randomized controlled trial cross-over desain pada 34 subyek dibagi menjadi dua kelompok. Kelompok pertama sambiloto mendapat 2 kali 2 kapsul sehari selama 14 hari, dan kelompok kedua mendapat plasebo selama 14 hari. Kedua kelompok tetap menggunakan metformin sebagai terapi standar kemudian dievaluasi kadar glukosa darah pasca terapi 14 hari. Pada pemberian kapsul sambiloto selama 14 hari tampak penurunan kadar glukosa darah puasa lebih besar dibandingkan plasebo, tetapi tidak bermakna. Kapsul sambiloto bermakna menurunkan kadar glukosa darah 2 jam setelah makan. Kesimpulan: Kapsul sambiloto dapat menurunkan kadar glukosa darah namun bermakna secara statistik hanya 2 jam setelah makan.

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Sambiloto (Andrographis paniculata Nees.) is empirically used as an alternative medicine for various diseases including diabetes mellitus, but the scientific evident for treatment in humans is still limited. This study analyze the effects of hypoglycemic sambiloto capsules as additional therapy in patients with type 2 diabetes mellitus. Double-blind randomized controlled trial, cross-over design in 34 subjects who were divided into two groups. The first groups sambiloto received 2 capsules 2 times daily for 14 days, and the second groups received placebo for 14 days. Both groups kept taking metformin as standard therapy with an the evaluation of blood glucose levels on day 14. The results showed that administration of sambiloto capsules for 14 days, the blood glucose levels is greater compared to placebo but not significantly. Sambiloto capsules significantly reduced blood glucose 2 hours after eating. Conclusions: sambiloto capsules shown to reduced blood glucose levels, but statistically significant only in 2 hours after eating."