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"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."

"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."

"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."

"Diabetes Melitus adalah penyakit menahun yang membutuhkan penggunaan obat dalam jangka panjang untuk mengontrol glukosa darah dalam tubuh. DM dapat menyebabkan komplikasi sehingga obat seringkali digunakan bersamaan untuk menangani kondisi tersebut. Untuk itu, terapi yang digunakan harus dipantau agar memberikan manfaat klinis yang optimal. Pemantauan Terapi Obat (PTO) adalah suatu kegiatan untuk memastikan terapi obat yang aman, efektif, dan rasional bagi pasien. Kegiatan dalam PTO meliputi pengkajian pilihan obat, dosis, cara pemberian obat, respons terapi, reaksi obat yang tidak dikehendaki (ROTD), dan rekomendasi perubahan atau alternatif terapi. Penelitian ini dilakukan untuk mengkaji pengobatan yang diterima pasien dengan diagnosis diabetes melitus di salah satu rumah sakit umum daerah untuk mengidentifikasi dan mengevaluasi masalah terkait obat yang kemungkinan terjadi, serta menentukan langkah yang perlu diambil selanjutnya. Pemantauan terapi obat dilakukan secara prospektif dengan data yang diperoleh dari rekam medis dan kegiatan visite. Masalah terkait obat dikaji menggunakan metode SOAP (Subjective, Objective, Assesment, dan Plan). Kesimpulan dari penelitian ini yaitu pasien sudah menerima terapi sesuai dengan kondisi klinis pasien. DRP yang terjadi adalah perlunya penyesuaian dosis obat pada pasien gangguan ginjal.

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Diabetes Mellitus is a chronic disease requiring long-term treatment to control blood glucose in the body. DM can cause several complications, often involving multiple medications being used simultaneously. Drug Therapy Monitoring is needed to ensure safe, effective, and rational drug therapy for patients, including assessing drug selection, dosage regimens, drug administration, therapeutic responses, adverse drug reactions (ADR), and recommendations or alternative therapies, if needed. This research aimed to review the treatment received by a patient diagnosed with diabetes mellitus at a public regional hospital by identifying and evaluating drug-related problems that might occur and suggesting the next step be taken. Monitoring drug therapy is carried out prospectively with data obtained from patient's medical records and visits. Drug-related problems were assessed using the SOAP (Subjective, Objective, Assessment, and Plan) method. This study concludes that the patient has received appropriate treatment corresponding to the patient's clinical condition. The observed drug-related problem was the need for drug dosage adjustments in patients with chronic kidney disorders."

"Latar belakang: Ketoasidosis diabetik (KAD) merupakan komplikasi DM tipe-1 yangdapat mengakibatkan kematian atau kecacatan neurologis permanen. Data IDAI tahun2017 menyatakan sebanyak 71% anak DM tipe-1 pertama kali terdiagnosis denganKAD yang meningkat dari tahun sebelumnya. Cedera otak merupakan komplikasi KADberkaitan dengan kerusakan struktural dan fungsional otak sehingga menyebabkankerusakan fungsi neurokognitif. Anak-anak DM tipe-1 dengan riwayat KADmenunjukkan kesulitan dalam waktu merespon, penalaran abstrak, fleksibilitas kognitifdan memori verbal. Pemeriksaan tingkat kecerdasan intelektual berupa pemeriksaan IQdiperlukan untuk menilai fungsi kognitif. Penelitian ini bertujuan untuk mengetahuigambaran fungsi kognitif berupa nilai IQ pada pasien DM tipe-1 usia sekolah denganriwayat KAD.Metode: Dilakukan studi potong lintang deskriptif pada pasien DM tipe-1 denganriwayat KAD yang dilaksanakan pada bulan Februari-Maret 2020 di RSUPN dr. CiptoMangunkusumo, Jakarta. Sampel penelitian adalah pasien anak berusia 7-18 tahun yangpernah mengalami KAD sejak pertama kali terdiagnosis DM tipe-1 dan kooperatifuntuk dilakukan pemeriksaan. Subyek melakukan tes IQ kemudian hasilnya dilaporkan.Hasil: Sebanyak 27 subyek memenuhi kriteria inklusi dengan 14 subyek perempuandan 13 subyek lelaki. Rerata usia subyek adalah 13,5 tahun dengan rerata usia saatterdiagnosis adalah 8 tahun dan lama menderita DM adalah 48 bulan. Median nilai IQyang didapatkan 91 (62-120), median verbal IQ 90 (67-113) dan median performanceIQ 94 (61-118). Frekuensi KAD  2x, riwayat KAD < 18 bulan dan lama menderitaDM tipe-1 5 tahun, usia saat terdiagnosis 7 tahun memiliki kecenderungan nilai IQlebih rendah dibandingkan kondisi sebaliknya yaitu termasuk dalam kategori IQ dibawah rata-rata skala Wechsler.Kesimpulan: Nilai IQ pasien DM tipe-1 usia sekolah dengan riwayat KAD termasukdalam kategori IQ rata-rata skala Wechsler.

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Background and aim: Diabetic ketoacidosis (DKA) is a complication of type-1 diabetes

that results in death or permanent neurological disability. IDAI data for 2017 stated

that 71% of patients with type-1 diabetes were first diagnosed as DKA which increased

from the previous year. Brain injury is a complication of DKA associated with

structural and functional damage to the brain and causes neurocognitive function

impairment. Children with type-1 diabetes with history of DKA show difficulties in

response time, abstract reasoning, cognitive flexibility and verbal memory. An

examination for the level of intelligence as an IQ examination is needed to assess

cognitive function. This study aims to determine the description of cognitive function as

IQ scores in school age patients of type-1 diabetes with history of DKA.

Method: A cross-sectional descriptive study was performed to type-1 diabetic patients

with history of DKA started from February-March 2020 at the RSUPN Dr. Cipto

Mangunkusumo, Jakarta. The study subjects were pediatric patients aged 7-18 years

who had experienced DKA since they were first diagnosed as type-1 diabetes and were

cooperative for examination. Subjects performed an IQ test then the results were

reported.

Results: A total of 27 subjects met the inclusion criteria with 14 females and 13 males.

The mean age was 13.5 years with the average age at diagnosis was 8 years and the

duration of diabetes was 48 months. The median IQ score was 91 (62-120), verbal IQ

IQ 90 (67-113) and performance IQ 94 (61-118). Frequency of DKA twice or more,

history of DKA <18 months, length of suffering of type-1 diabetes 5 years or more and

age at diagnosis 7 years or more have a tendency of lower IQ scores which is included

in the IQ category below the average for Wechsler scale.

Conclusion: The IQ score of type-1 diabetes school-age patients with history of DKA is

categorized as the average of Wechsler scale"

"ABSTRAKDiabetes melitus DM merupakan suatu epidemik global. Obesitas merupakan faktor risiko tersering pada terjadinya DM tipe 2. Salah satu komplikasi yang sering dialami oleh penderita DM ialah kaki diabetik. Pada pasien DM dengan obesitas dan kaki diabetik, terapi medik gizi penting untuk mencapai target berat badan, menjaga kadar glikemik, serta mencegah komplikasi DM. Selain itu pemberian nutrisi yang adekuat juga penting untuk mendukung penyembuhan luka. Pasien pada serial kasus ini berusia antara 41 ndash;59 tahun dengan dengan proporsi yang sama antara laki-laki dan perempuan. Keempat pasien memiliki status gizi obes dengan IMT sebesar 26-54,4 kg/m2. Awitan DM pada keempat pasien diketahui bervariasi antara 1-13 tahun. Terapi medik gizi diberikan sesuai dengan klinis, hasil laboratorium, dan asupan terakhir masing-masing pasien. Dari hasil pemantauan didapatkan bahwa dengan terapi nutrisi yang diberikan terjadi penurunan berat badan sebesar 3,2-4,8 kg 3,2-5,8 dan penurunan nilai HbA1c sebanyak 0,3-0,7. Selain itu juga didapatkan ukuran luka yang mengecil dan gejala neuropati berkurang. Pada pasien DM tipe 2 dengan obesitas dan kaki diabetik, terapi medik gizi yang adekuat berkaitan dengan penurunan berat badan, perbaikan kontrol glikemik, dan penyembuhan luka yang baik.

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ABSTRACT<>br>Diabetes mellitus is now a global epidemic. Obesity is a common risk factor in the occurrence of type 2 diabetes. One of the complications that are often experienced by people with diabetes is diabetic foot. In diabetic patients with obesity and diabetic foot, medical nutrition therapy is important to achieve targeted body weight, maintain glycemic levels, and prevent diabetes complications. Good nutrition is also essential for wound healing. This case series consists of four patients who are between 41-59 years old and obese with BMI of 26-54.4 kg/m2. The onset of DM in all four patients is known to vary between 1-13 years. Nutritional therapy is given in accordance with the clinical, laboratory outcomes, and patients' daily intake. It was found that medical nutrition therapy can lead to weight loss of 3.2-4.8 kg (3.2-5.8%) and decreased HbA1c by 0.3-0.7%. It was also observed that the wound size and neuropathy symptoms are reduced. Adequate medical nutrition therapy in type 2 DM patients with obesity and diabetic foot is associated with weight loss, improved glycemic control, and good wound healing."

"Latar Belakang : Pasien Non-Proliferative Diabetic Retinopathy (NPDR), Proliferative Diabetic Retinopathy (PDR) dengan neuropati kornea akan mengalami terganggunya stabilitas air mata. Penurunan sekresi dan konsituen air mata akan menyebabkan gangguan berupa mata kering. Pada pasien Diabetes dengan retinopati diabetik, gangguan kornea ini berpotensi lebih memperburuk gangguan penglihatan yang terjadi. Tujuan : Menilai stabilitas air mata pada pasien NPDR, PDR dengan neuropati kornea sebelum, sesudah diberikan tetes mata Sodium hyaluronat+Vitamin A,E (HA+Vit A,E) atau Sodium Hyaluronat saja (HA). Metodologi : Penelitian ini merupakan uji eksperimental randomisasi acak terkontrol, dengan dua kelompok utama (NPDR, PDR), kedua kelompok mendapatkan tetes mata HA+Vit A,E atau HA selama 28 hari. Sensitivitas kornea, Skoring Ocular Surface Disease Index (OSDI), Non-Invasive Break Up Time (NIBUT), Schirmer I, jumlah sel goblet konjungtiva dinilai pada 0, 2, 4 minggu. Hasil : 96 subyek berpartisipasi, 65.6% wanita, 34.4% laki-laki (rerata usia 54.4 tahun). Skor OSDI memperlihatkan perbaikan signifikan, nilai terbesar pada kelompok PDR HA+Vit A,E dengan -4.86±5.76 (P= 0.000), NIBUT memperlihatkan perbaikan signifikan, nilai terbesar pada kelompok NPDR HA dengan 4.79±2.63 (P= 0.000), Schirmer I memperlihatkan perbaikan signifikan, hasil terbesar pada kelompok NPDR HA dengan 2.41±2.35 (P= 0.000). Sitologi impressi konjungtiva memperlihatkan perbaikan signifikan, terutama pada kelompok NPDR HA+Vit A,E (66% perbaikan). Seluruh kelompok memperlihatkan perbaikan signifikan, tetapi perbaikan antar kelompok tidak bermakna. Kesimpulan : Parameter seluruh kelompok memperlihatkan perbaikan yang signifikan setelah diberikan tetes mata HA+Vit A,E maupun HA saja, Tetapi jika dibandingkan antar kelompok, tidak terdapat perbedaan perbaikan yang signifikan.

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Background : Patient with Non-Proliferative Diabetic Retinopathy (NPDR), Proliferative Diabetic Retinopathy (PDR) with corneal neuropathy will experiencing disruption in tear film stability. Decrease in tear film secretion and constituent will cause dry eyes. In Diabetic patients with diabetic retinopathy, this corneal disorder has the potential to further worsen visual impairment.

Purpose : To Assess tear film stability in NPDR, PDR patients with corneal neuropathy before, after treatment with topical Sodium hyaluronat+Vitamin A,E (HA+Vit A,E) or Sodium Hyaluronat only (HA).

Method : This study was a double blind experimental randomized control trial with two parallel groups (NPDR, PDR), both group receives HA+Vit A,E or HA for 28 days. Corneal sensitivity, Ocular Surface Disease Index (OSDI), Non-Invasive Break Up Time (NIBUT), Schirmer I, conjungtival goblet cells will be assessed on 0, 2, 4 weeks.

Result : 96 subjects participated, 65.6% female, 34.4% male, mean age 54.4 years old. OSDI score shows significant improvement, highest improvement seen on PDR HA+Vit A,E with -4.86±5.76 (P= 0.000), NIBUT hows significant improvement, highest improvement seen on NPDR HA with 4.79±2.63 (P= 0.000), Schirmer I shows significant improvement, highest improvement seen on NPDR HA with 2.41±2.35 (P= 0.000). Conjungtival goblet cells shows significant improvement, highest improvement seen on NPDR HA+Vit A,E (66% improved). All groups shows shows significant improvement, but between groups the improvement was not statistically significant.

Conclusion : Parameters on all groups shows statistically significant improvement after topical HA+Vit A,E or HA. But, if compared between groups, the improvement was not significantly differed."

"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."

"Kaki diabetik merupakan komplikasi pada diabetes melitus (DM) tipe 2 tersering yang menyebabkan pasien menjalankan perawatan di rumah sakit. Penyulit lain pada DM tipe 2 berkontribusi terhadap peningkatan morbiditas dan mortalitas pasien. Terapi medik gizi pada pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit berperan penting dalam kontrol glikemik, mencegah perburukan status gizi, serta perbaikan penyembuhan luka. Serial kasus ini melibatkan empat pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit yang diberikan terapi medik gizi berupa asupan energi, makronutrien, mikronutrien, nutrien spesifik, dan edukasi gaya hidup. Pasien dilakukan pemantauan selama 19 hari sesuai fase proliferasi penyembuhan luka. Satu pasien dengan ketoasidosis diabetikum, satu pasien dengan hipertensi, dan dua pasien dengan diabetic kidney disease. Kontrol glikemik keempat pasien tercapai pada akhir perawatan di rumah sakit dan tidak didapatkan penurunan berat badan yang bermakna selama masa pemantauan. Penyembuhan luka berupa luka mengering, edema berkurang, dan timbulnya jaringan granulasi didapatkan pada tiga diantara empat pasien. Satu pasien tidak didapatkan penyembuhan luka yang signifikan karena adanya stenosis multipel pembuluh darah arteri di tungkai kiri. Terapi medik gizi pada pasien DM tipe 2 dan kaki diabetik dengan berbagai penyulit berperan pada perbaikan kontrol glikemik, mencegah perburukan status gizi, dan penyembuhan luka.

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The most common cause of complication and hospitalization in type 2 diabetes mellitus (T2DM) patients are those associated with diabetic foot (DF). Complication of T2DM contribute to increasing morbidity and mortality. Medical nutrition therapy in patients with T2DM and DF with various complication plays an important role in management of glycemic control, worsening nutritional status, and repair wound healing. This case series include four patients T2DM and DF with various complication that given nutritional medical therapy consisting of energy intake, macronutrients, micronutrients, spesific nutrient, and healthy lifestyle education. Patients was monitored for 19 days according to the proliferation phase of wound healing. One patient with diabetic ketoacidosis, one patient with hypertension, and two patients with diabetic kidney disease. All patients got glycemic control during hospitalization. No significant weight loss was observed during monitoring period. Wounds in three of the four patients appeared to heal with dry wound, reduced edema, and formation of granulation tissue. One patient found insignificant wound healing due to multiple arterial stenosis in the left leg. Medical nutrition therapy with type 2 diabetes and diabetic foot with various complications plays an important role in management of glycemic control, preventing worsening nutritional status, and repair wound healing."

"Latarbelakang: Praktik Spesialis Keperawatan Medikal Bedah Kekhususan Endokrin di RSUPN dr. Cipto Mangunkusumo Jakarta merupakan kegiatan pembelajaran dalam mengaplikasikan peran dan fungsi Ners Spesialis. Belum ada Karya Ilmiah Akhir Spesialis (KIAS) yang menelaah pasien diabetes melitus dengan komplikasi selulitis dan Chronic Kidney Disease (CKD) dengan penerapan teori adaptasi Roy. Tujuan: KIAS ini bertujuan untuk menganalisis asuhan keperawatan pada pasien diabetes melitus yang mengalami selulitis dan CKD maupun resume 30 kasus. Metode: KIAS ini terdiri dari analisis kasus utama, resume 30 kasus, penerapan evidence based nursing dan proyek inovasi. Teori model keperawatan yang dipakai adalah teori adaptasi Roy. Hasil: Ners spesialis berperan tidak hanya dalam memberikan asuhan keperawatan langsung tetapi menerapkan intervensi berbasis bukti ilmiah pada area endokrin yaitu memberikan aplikasi pelembab mengandung urea, gliserin dan petrolatum untuk mengatasi xerosis dan fisura tumit kaki pasien diabetes melitus tipe 2. Selain itu, Ners spesialis juga melakukan inovasi melalui analisis situasi dan kajian literatur untuk mencegah kejadian hipoglikemia berat pada pasien diabetes melitus tipe 2 melalui penerapan Hy-Newss bundle. Kesimpulan: Teori model adaptasi Roy sesuai untuk diaplikasikan pada pasien dengan gangguan endokrin. Pemberian pelembab mengandung urea, gliserin dan petrolatum efektif untuk menurunkan skor derajat xerosis pada pasien diabetes melitus tipe 2. Hy- Newss dapat diterapkan sebagai alat skrining risiko terjadi hipoglikemia berat pada pasien diabetes melitus tipe 2.

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Background: Medical surgical nursing specialist practice in endocrine specific at RSUPN dr. Cipto Mangunkusumo Jakarta is a learning activity in applying the role and function of nurse specialist. There is no KIAS that examines diabetes mellitus patients with complications of cellulitis and Chronic Kidney Disease (CKD). Aim: This KIAS aims to analyze nursing care in patients with diabetes mellitus who have cellulitis and CKD or resume 30 cases. Method: This KIAS consists of main case analysis, 30 case resumes, application of evidence based nursing and innovation projects. The nursing model theory used is Roy’s adaptation theory. Results: Nurse specialist play a role not only in providing direct care but applying scientific evidence-based practice in the endocrine area, which is providing moisturizing applications containing urea, glycerin and petrolatum to treat xerosis and heel fissures in patient with type 2 diabetes mellitus. In addition, nurse specialist innovate through situation analysis and literature review to prevent the incidence of severe hypoglycemia in patients with type 2 diabetes mellitus through the application of Hy-Newss bundle. Conclusion: Roy’s adaptation model theory is suitable for application in patients with endocrine disorders. Moisturizers containing urea, glycerin and petrolatum are effective in reducing the degree of xerosis score in patient with type 2 diabetes mellitus. Hy-Newss bundle can be applied as a screening tool for the risk of severe hypoglycemia in patients with type 2 diabetes mellitus."