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"The International Textbook of Diabetes Mellitus has been a successful, well-respected medical textbook for almost 20 years, over 3 editions. Encyclopaedic and international in scope, the textbook covers all aspects of diabetes ensuring a truly multidisciplinary and global approach. Sections covered include epidemiology, diagnosis, pathogenesis, management and complications of diabetes and public health issues worldwide. It incorporates a vast amount of new data regarding the scientific understanding and clinical management of this disease, with each new edition always reflecting th."

"Diabetes melitus tipe 2 merupakan penyakit metabolik kronik dengan komplikasi yang dapat menyebabkan disabilitas hingga kematian. Upaya pencegahan komplikasi diabetes yaitu menerapkan perilaku self-management. Penelitian ini bertujuan untuk mengidentifikasi korelasi antara kualitas edukasi yang dilakukan perawat terhadap perilaku self-management pasien diabetes melitus tipe 2. Data diperoleh dari 126 responden di Puskesmas Cimanggis, Tapos, Sukmajaya, dan Persadia Cabang Kota Depok dengan teknik purposive sampling. Instrumen penelitian yang digunakan telah diuji untuk mengukur Kualitas Edukasi yang Dilakukan Perawat dan self-management diabetes (SDSCA). Hasil analisis korelasi Pearson menunjukkan terdapat hubungan positif yang bermakna antara kualitas edukasi yang dilakukan perawat terhadap perilaku self-management pasien diabetes melitus tipe 2 (p=0,000). Hasil penelitian ini dapat dijadikan evaluasi bagi pelayanan keperawatan untuk meningkatkan kualitas edukasi dengan harapan meningkatkan self-management pasien diabetes melitus tipe 2.

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Type 2 diabetes mellitus is a long-life chronic metabolic disease with  accompanying complications that could lead to disability or death. Diabetes self-management has been considered as an effort to reduce the complications. This study aimed to identify the correlation between the quality of nurse-led education with type 2 diabetes self-management behavior. A total  of 126 subjects with T2DM were recruited from Puskesmas Cimanggis, Tapos, Sukmajaya, and Persadia Cabang Kota Depok with purposive sampling. Previously validated scales were used to measure the quality of nurse-led education and diabetes self-management (SDSCA). The result of Pearson Correlation analysis showed that there is significantly-positive correlation between nurse-led education with self-management of type 2 diabetes mellitus patients (p=0,000; r=0,436). The result of this research could be a suggestion for further nursing care to educate diabetician to improve their self-management."

"Diabetes Melitus DM penyakit kronis yang membutuhkan terapi jangka panjang dan intervensi untuk adaptasi perubahan gaya hidup dan pengobatan untuk meningkatkan target terapi. Penelitian bertujuan mengetahui pengaruh konseling oleh apoteker pada perbaikan kepatuhan, kadar HbA1c dan kualitas hidup pasien DM tipe 2 di RSUD Kota Depok. Penelitian dilakukan dengan desain pretest-posttest control group design pada 81 responden dengan alat ukur pill count untuk kepatuhan, pemeriksaan darah untuk kadar HbA1c dan kuesioner EQ-5D-5L untuk kualitas hidup. Karakteristik sosiodemografi dan klinis responden DM tipe 2 di RSUD Kota Depok antara kelompok uji dan kontrol tidak terdapat perbedaan yang signifikan p>0,05 . Pasien kelompok uji menunjukkan peningkatan kepatuhan terapi, penurunan kadar HbA1c dan peningkatan kualitas hidup secara signifikan, sementara pada kelompok kontrol hanya kadar HbA1c peningkatan yang signifikan sementara kepatuhan dan kualitas hidup tidak menunjukkan perubahan yang signifikan. Kepatuhan terapi responden dipengaruhi oleh konseling apoteker secara signifikan. Kadar HbA1c responden dipengaruhi oleh kepatuhan terapi dan pola makan secara signifikan. Kualitas hidup responden berdasarkan nilai deskriptif dan nilai VAS dipengaruhi oleh kadar HbA1c secara signifikan. Hasil penelitian ini dapat disimpulkan konseling oleh apoteker menyebabkan perbaikan pada kepatuhan, kadar HbA1c dan kualitas hidup responden pasien DM tipe 2 di RSUD Kota Depok.

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Diabetes Mellitus DM a chronic disease requiring long term therapy and interventions for the adaptation of lifestyle changes and medications to improve therapeutic targets. The aim of this research is to know the influence of counseling by pharmacist on improvement of adherence, HbA1c level and quality of life of DM type 2 patient in RSUD Kota Depok. The research was done by pretest posttest control group design design on 81 respondents with pill count methods for adherence, blood tests for HbA1c levels and EQ 5D 5L questionnaires for quality of life. Sociodemographic and clinical characteristics of DM type 2 respondents in RSUD Kota Depok between test and control group were not significantly different p 0,05 . Patients in the test group showed improved adherence to therapy, decreased HbA1c levels and improved quality of life significantly, while in the control group only HbA1c levels were a significant increase while adherence and quality of life did not show significant change. Adherence of respondents influenced by pharmacist counseling significantly. HbA1c levels of respondents is influenced by adherence of therapy and diet significantly. The quality of life of respondents based on descriptive value and VAS value influenced by HbA1c level significantly. The results of this study can be concluded by the pharmacist counseling led to improvements in adherence, HbA1c levels and quality of life of DM type 2 patients in Depok City Hospital. "

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Kelainan kulit kering banyak ditemukan pada penyandang DMT2. Patogenesis kulit kering pada DMT2 dipicu oleh kondisi hiperglikemia kronik yang meningkatkan Advanced glycation end products (AGE) N(6)-carboxymethyl-lysine (CML), sitokin proinflamasi dan stres oksidatif.  Kombinasi Centella asiatica  oral  (CAo) dan topikal (CAt) diduga dapat meningkatkan efektivitas tatalaksana kulit kering DMT2. Penelitian bertujuan menganalisis efektivitas dan keamanan kombinasi CAo + CAt dalam memperbaiki kulit kering DMT2.

 

Penelitian merupakan uji klinis acak tersamar ganda di Poliklinik Metabolik Endokrin Departemen Penyakit Dalam RSCM dan 5 puskesmas di Jakarta pada bulan Juli 2018–Maret 2019. Subjek dibagi menjadi 3 kelompok, yaitu kelompok CAo + CAt, plasebo oral (Plo) + CAt, dan Plo + Plasebo topikal (Plt) masing-masing berjumlah 53 orang. Perbaikan kulit kering secara klinis diukur dengan Specified Symptom Sum Score (SRRC) dan Skin Capacitance (SCap). Perbaikan secara molekular diukur  CML, IL-1a, dan aktivitas superoksida dismutase (SOD). Keamanan kombinasi CAo + CAt dilakukan melalui penilaian efek simpang oral dan topikal.

 

Pada ketiga kelompok, median HbA1c > 7%. Glukosa darah sewaktu (GDS) kelompok CAo + CAt hari ke-15 dan 29 semakin menurun. Efektivitas kombinasi CAo + CAt dinilai melalui analisis subgrup berdasarkan nilai HbA1c dan GDS. Pada glukosa darah terkontrol baik, persentase penurunan SRRC lebih besar pada kelompok CAo + CAt vs Plo + Plt (p = 0,04). Peningkatan SCap kelompok CAo + CAt lebih besar dibandingkan Plo + Plt (p = 0,01). Pada glukosa darah terkontrol kurang baik peningkatan SOD kelompok CAo + CAt lebih besar dibandingkan Plo + Plt  (p = 0,01). Tidak terdapat korelasi antara CML, IL-1α dan SOD dengan SRRC atau SCap. Terdapat korelasi sedang sampai kuat dan arah korelasi sesuai antara CML dengan SOD (r = 0,58, p < 0,05)  dan  IL-1α dengan SOD (r = 0,70, p < 0,05) pada glukosa darah terkontrol baik. Tidak terdapat efek simpang oral dan topikal yang bermakna pada penggunaan CAo + CAt dibandingkan 2 kelompok.

 

Simpulan: Pada glukosa darah terkontrol baik, perbaikan SRRC dan SCap  kelompok CAo + CAt lebih besar dibandingkan Plo + Plt.  Pada glukosa darah terkontrol kurang baik peningkatan SOD kelompok CAo + CAt lebih besar daripada Plo + Plt. Terdapat korelasi sedang sampai kuat antara CML atau IL-1α dengan SOD pada glukosa darah terkontrol baik. Tidak terdapat efek simpang oral dan topikal yang bermakna pada kelompok CAo + CAt dibandingkan 2 kelompok.

 

Kata kunci: CML, DMT2, IL-1a, kulit kering, SCap, SOD, SRRC

 

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Dry skin is a common findings in type 2 diabetes mellitus (T2DM). The pathogenesis of dry skin in T2DM rises from chronic hyperglycemic condition which causes an increase in levels of Advanced glycation end products (AGEs)  N(6)-carboxymethyl-lysine (CML), pro-inflammation cytokines and oxidative stress. Combination of oral and topical Centella asiatica (CA) is expected to ameliorate dry skin in T2DM patients more effectively.

 

This study was a double blinded randomized clinical trial in T2DM patients with dry skin in outpatients clinic of Metabolic Endocrine, Internal Medicine Department, dr. Cipto Mangunkusumo Hospital, and 5 primary health cares in Jakarta from July 2018 to March 2019. The subjects were divided into three groups, CA oral (CAo) + CA topical (CAt) group, oral placebo (Plo) + CAt group, and Plo + topical placebo (Plt) which included 53 subjects respectively. Dry skin improvement was evaluated clinically using Specified Symptom Sum Score (SRRC) and Skin Capacitance (SCap). The molecular improvement was evaluated using levels of CML, inflammation interleukin 1-α (IL-1α) concentration, and oxidative stress superoxide dismutase (SOD).

 

In the three groups, median of HbA1c > 7%. Random blood glucose (RBG) in CAo + CAt group in day-15 and 29 were further decreased. Effectivity of CAo + CAt combination were assessed via subgroup analysis based on HbA1c and RBG. In well controlled blood glucose, on day-29, percentage of SRRC decrement was greater in  CAo + CAt compared to control group without CA (p = 0,04). SCap value in CAo + CAt group was greater than control group (p = 0,01). In the partially controlled blood glucose, increment of SOD activity of CAo + CAt group was greater than control group (p = 0,01). There was no correlation found between CML, IL-1α and SOD with SRRC nor SCap. There were medium to strong correlation between CML with SOD (r = 0,58, p < 0,05)  and IL-1α with SOD (r = 0,70, p < 0,05)  in well controlled blood glucose. Systemic and topical adverse events were not found significantly in CAo or CAt usage compared to the other two groups.

 

Conclusion: In well controlled blood glucose, improvement of SSRC and SCap in CAo + CAt were greater than Plo + Plt.  In partially controlled blood glucose,  increment of SOD in CAo + CAt was greater than Plo + Plt.  There was moderate to strong correlation between CML or IL-1 and SOD in well controlled blood glucose. There were no significant adverse events found due to CAo + CAt compared to the other 2 group in the study.

 

Keywords: CML, diabetes mellitus, dry skin, IL-1a, SCap, SOD, SRRC

 

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"ABSTRAKAnalisis Biaya Pelayanan Diabetes Melitus denganKomplikasi dan faktor penentu inefisiensi penangananDiabetes Melitus di Rawat Inap RSUD Banyuasin Tahun2015Mulai 1 januari 2014 diberlakukannya JKN di rumah sakit maka terjadi perubahansistem pembayaran dari pembayaran secara retrospektif fee for service menjadisistem pembayaran prospektif INA-CBG?s .Direncananakn pada 2019 Indonesiaseluruh penduduk Indonesia terdaftar di BPJS Universal Heath Coverage .Sebagaisalah satu fasilitas pelayanan kesehatan milik pemerintah RSUD Banyuasinmempunyai peranan untuk memberikan pelayanan yang berkualitas namun tetapmemperhatikan efisiensi karena makin berkurangnya subsidi pemerintah.Penelitianini bertujuan untuk menganalisis biaya dan mengidentifikasi faktor-faktor penentuinefisiensi layanan Diabetes Melitus Komplikasi sehingga bisa dijadikan pedomanpengendalian biaya dalam melayani pasien.Jenis penelitian ini bersifat analisisdeskriptif dengan menggunakan data primer pengamatan dan wawancara dan datasekunder berupa data dari RSUD Banyuasin tahun 2015.Analisis biaya menggunakanpendekatan Activity Based Costing ABC .Metode ABC untuk mengalokasikan biayadengan mengidentifikasi pemicu biaya cost driver penyebab terjadinya biayalayanan Diabetes Melitus Komplikasi.Hasil penelitian menunjukkan komponen obatpada pelayanan Diabetes Melitus Komplikasi merupakan faktor penentu inefisiensi.Usaha yang dapat dilakukan oleh rumah sakit untuk mengatasi inefisiensi denganpembuatan Panduan Praktek Klinik, Revisi Formularium RS, Klinisi secara konsistenmenggunakan obat e-cataloqKata kunci: Analisis biaya, metode ABC, inefisiensi.

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ABSTRACTAnalyzing the cost of services of Diabetes Melitus andidentifying determinant factor in handling diabetes melitus atImpatient at Banyuasin General Hospital RSUD Banyuasi in 2015Since JKN was offiacially administered in general hospital on January 1st, 2014, therehas been changing in hospital administration payment from the restrospective system free for services to the prospective system INA CBG s . It is planned in 2019 thatall the people in Indonesia is registered in BPJS Universal Heath Coverage as oneof the facilities for public healt services provided by Banyuasin general hospital RSUD Banyuasin which ains to provide qualified services, yet still consideringeffiencies due to the lach of the government subsidies. This study aimed to analyzethe cost and identify determinant factor in handling Diabetes Melitus withcomplications, so that it can be a reference to handle the cost in taking care of patientswith Diabetes Melitus. This study applied descriptif analysis which using primarydata observation and interview and secondary data from Banyuasin general hospital RSUD Banyuasin in 2015 meanwhile. The cost analysis was appliyng ActivityBased Costing ABC method. The ABC method was applied to allocated the cost byidentifying the cost driver which was the major cause for cost for financing servicesfor Diabetes Melitus with complication. The result of this study showed that medicalcomponent was the determinant factor of the inefficiencies for Diabetes Melitus withcomplication services. There are many efforts that can be done by the hospital toovercome the ineficiencies, for instance, making quidance for clinical practies,making revision for hospital formulation, and using e cataloq medicine consistentlyKeywords the cost analysis, ABC method, ineficiency."

"Prevalensi DM di Kota Bogor yakni sebesar 2,1% hal ini masih lebih tinggi dibandingkan dengan prevalensi DM di Indonesia menurut data Riskesdas 2013 yakni sebesar 2,0%. Tujuan penelitian ini adalah untuk mengetahui pengaruh aktivitas fisik terhadap kontrol kadar Glukosa darah penderita diabetes mellitus tipe 2 pada studi kohort PTM di Kota Bogor tahun 2011-2016. Menurut uji Log-rank survival berdasarkan aktivitas fisik tidak berbeda bermakna dengan nilai signifikansi 0,941. Bahwa survival antara kelompok aktivitas fisik cukup dan kurang tidak berbeda survival-nya terhadap event kontrol glukosa darah buruk. Penderita DM tipe 2 yang cukup beraktivitas fisik memiliki HR sebesar 0,788 kali (95%CI: 0,456-1,360) dengan p value 0,392. Artinya, penderita DM tipe 2 yang cukup beraktifitas fisik maupun yang kurang tidak menunjukkan perbedaan yang bermakna terhadap kontrol glukosa darah. Tidak ditemukan pengaruh aktivitas fisik terhadap kontrol Glukosa darah penderita diabetes mellitus tipe 2 pada studi kohort PTM di Kota Bogor tahun 2011-2016. Hal ini dikarenakan banyak terjadi sensor dan lost to follow up juga titik pengamatan yang cukup jauh rentangnya yakni 2 tahun. Diperlukan upaya promosi kesehatan yang berkelanjutan dan bagi peneliti lain dapat melakukan studi dengan titik pengamatan dengan rentang waktu yang lebih singkat agar efek dari aktivitas fisik terhadap kontrol glukosa darah penderita DM tipe 2 dapat diukur lebih tepat.

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The prevalence of DM in Bogor City which is equal to 2.1%, this is still higher than the prevalence of DM in Indonesia according to Riskesdas 2013 data which is equal to 2.0%. The purpose of this study was to determine the effect of physical activity on blood glucose level control in patients with type 2 diabetes mellitus in the PTM cohort study in Bogor City in 2011-2016. According to the Log-rank survival test based on physical activity there was no significant difference with a significance value of 0.941. That survival between groups of physical activity is sufficient and the survival of the blood glucose control event is not different. Patients with type 2 DM who have enough physical activity have HR of 0.788 times (95% CI: 0.456-1.360) with p value 0.392. That is, patients with type 2 diabetes who have sufficient physical activity or those who do not show significant differences in blood glucose control. There was no effect of physical activity on blood glucose control in patients with type 2 diabetes mellitus in the PTM cohort study in Bogor City in 2011-2016. This is because there are a lot of sensors and lost to follow-up as well as a far enough observation point, which is 2 years. Continuous health promotion efforts are needed and other researchers can conduct studies with observation points with a shorter time span so that the effects of physical activity on blood glucose control in patients with type 2 diabetes can be measured more precisely."

"Penanganan diabetes melitus yang tidak baik dapat menimbulkan berbagai komplikasi. Monitoring keberhasilan terapi dan tingkat keparahan pada pasien diabetes melitus dilakukan dengan pemeriksaan kadar glukosa darah puasa dan HbA1c secara rutin. Pemeriksaan HbA1c jarang dilakukan karena terkait biaya yang relatif mahal. Penelitian ini bertujuan untuk menganalisis hubungan kadar glukosa darah puasa dengan HbA1c pada pasien diabetes melitus tipe 2. Penelitian ini menggunakan desain potong lintang yang dilanjutkan dengan analisis korelasi. Data diperoleh dari rekam medis pasien diabetes melitus rawat jalan yang berkunjung pada bulan November di RSUD Depok. Data yang dianalisis sebanyak 111 pasien dengan 38 laki-laki dan 73 perempuan, 27,3 pasien murni DM dan selebihnya memiliki penyakit penyerta yang bervariasi. Terapi DM yang paling banyak digunakan adalah kombinasi obat golongan biguanida dan sulfonilurea. Hasil analisis dengan korelasi spearman menunjukkan adanya hubungan kadar glukosa darah puasa dengan HbA1c pada pasien diabetes melitus tipe 2 r = 0,480, p = 0,020 dengan arah hubungan positif yang berarti bahwa kadar glukosa darah puasa linear dengan kadar HbA1c. Usia dan jenis kelamin merupakan faktor yang mempengaruhi hubungan glukosa darah puasa dengan HbA1c.

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The bad management of diabetes mellitus can cause various complications. Monitoring the success of therapy and severity of diabetes mellitus patients is done by examination the level of fasting blood glucose and HbA1c on a regular basis. HbA1c examination is rarely done because of the relatively high cost. This study aims to analyze the correlation of fasting blood glucose levels and HbA1c in type 2 diabetes mellitus patients. This study used a cross sectional design followed by correlation analysis. Data were obtained from medical records of diabetes mellitus outpatient visited in November at Depok Regional Public Hospital. Data were analyzed on 111 patients consisted of 38 men and 73 women, 27.3 were pure DM patients and the rest had various comorbidities. The most widely used DM therapy is a combination of Biguanida and sulfonylurea. The results of spearman correlation analysis showed a correlation of fasting blood glucose level and HbA1c in type 2 diabetes mellitus patient r 0,480, p 0,020 in positive association which means that fasting blood glucose level linear with HbA1c level. Age and sex are the factors that affect the association of fasting blood glucose and HbA1c."

"Analisis resep merupakan kegiatan pengkajian resep yang diterima oleh instalasi farmasi untuk di cek secara administratif, farmasetis, dan pertimbangan klinis, serta di lakukan pengkajian masalah terkait obat (DRP) dan cara pengatasannya. Tujuan analisis resep penyakit diabetes ini yaitu untuk mengetahui pengobatan diabetes yang sering diresepkan dalam dunia pekerjaan, serta mengetahui adanya komplikasi dengan penyakit lainnya atau tidak. Melakukan pengkajian/analisis resep pengobatan diabetes agar tercapai terapiyang aman, rasional, dan efektif. Metode yang digunakan Studi literatur obat-obatan yang digunakan pada penyakit diabetes. Mengumpulkan resep yang mengandung obat-obat antidiabetes di Apotek Roxy Depok. Skrining dan analisa obat-obat dalam resep serta ketersediaan obat di apotek. Berdasarkan resep-resep yang ditemui umumnya pengobatan diabetes sudah sesuai dengan lini pengobatan yang ada dan pada umumnya pasien diabetes mengalami komplikasi dengan penyakit lainnya. Berdasarkan pengkajian skrining dan analisis resep/copy resep, secara administratif masih terdapat beberapa informasi yang kurang lengkap. Untuk aspek kesesuaian farmasetis dan pertimbangan klinis (analisis DRP) secara umum dapat diakatakan sesuai, aman, rasional, dan efektif.

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Prescription analysis is an activity of reviewing prescriptions that are accepted by pharmaceutical installations for administrative, pharmaceutical, and clinical considerations, as well as an assessment of drug-related problems (DRP) and how to overcome them. The purpose of this diabetes prescription analysis is to determine the diabetes treatment that is often prescribed in the world of work, as well as to find out whether there are complications with other diseases or not. Conducting assessment/analysis of diabetes medication prescriptions in order to achieve safe, rational, and effective therapy. Methods used Literature study of drugs used in diabetes. Collecting prescriptions containing antidiabetic drugs at Apotek Roxy Depok. Screening and analysis of prescription drugs and drug availability in pharmacies. Based on the prescriptions found, generally diabetes treatment is in accordance with existing treatment lines and in general diabetes patients experience complications with other diseases. Based on screening studies and analysis of prescriptions/copies of prescriptions, administratively there are some incomplete information. For aspects of pharmaceutical suitability and clinical considerations (DRP analysis) in general, it can be said that it is appropriate, safe, rational, and effective."