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"Hypoglycemia is a reduction in blood glucose level below 60 mg'/o Epidemiologic data report a 0.02/1000 patent/year mortality rate due to hypoglycemia in patients using insulin in the United Kingdom. Reports from Indonesia are still quite rare. Parto Almojo (1993) reported the incidence rate of hypoglycemia in diabetic patients hospitalized at Sardjilo Hospital, Yogyakarta. Conditions are quite different than in Western nations, perhaps due to a smaller population of patients with type I diabetes mellitus in Indonesia"

"Salah satu kelompok penyakit metabolik yang terjadi karena kelainan sekresi insulin, kerja insulin atau keduanya adalah Diabetes Melitus (DM) yang ditandai dengan hiperglikemia. Kondisi hiperglikemia yang berkepanjangan menyebabkan DM menjadi salah satu masalah kesehatan yang besar di seluruh dunia karena komplikasinya dapat muncul secara akut maupun kronik. Perawat berperan penting dalam menurunkan angka morbiditas dan mortalitas melalui Diabetes Self- Management Education (DSME) dan Diabetes Self-Management Support (DSMS) untuk mencegah komplikasi dan membantu meningkatkan perubahan gaya hidup yang penting bagi individu. Penerapan DSME dan DSMS dapat dilakukan perawat dengan mengaplikasikan teori Self Care Dorothea Orem pada proses keperawatan. Penerapan teori ini berfokus pada kemampuan individu dalam melakukan tindakan keperawatan mandiri, mengenali dan mengatur kebutuhan perawatannya. Penerapan evidence based practice sesuai program DSME dan DSMS dalam upaya meningkatkan self care pasien DM adalah melalui penggunaan buku harian Pemantauan Gula Darah Mandiri (PGDM). Proyek inovasi latihan kekuatan otot dan keseimbangan dilakukan pada pasien DM lansia untuk mencegah jatuh, meningkatkan kekuatan otot dan keseimbangan berjalan.

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One of metabolic diseases that occurs due to abnormalities in insulin secretion, insulin action or both is diabetes mellitus (DM). It is characterized by hyperglycemia. Prolonged of hyperglycemia causes various complication become major health problem worldwide. Nurses play an important role in reducing morbidity and mortality through the Diabetes Self-Management Education (DSME) and Diabetes Self-Management Support (DSMS) to prevent the complications and improve lifestyle changes. Framework of DSME and DSMS were applied using Dorothea Orem's Self Care. The application of this theory focuses on the individual's ability to independently perform nursing actions, identify and manage the treatment needs. Evidence-based practice related to DSME and DSMS programs by using Self Monitoring Blood Glucose Diary (SMBG). The inovation project was muscle strengths and balances exercises in elderly diabetic patients with neuropathy, in other to prevent falls and improve the muscle strengths and balances."

"ABSTRAKLatar Belakang: Diabetes Melitus Tipe 1 DM tipe 1 merupakan salah satu jenis diabetes yang menyerang usia anak. Diabetes tipe ini dicirikan dengan riwayat ketoasidosis diabetikum KAD dan penggunaan insulin seumur hidup. Penderita DM tipe 1 rentan terhadap komplikasi mikrovaskular dan makrovaskular. Atherosklerosis merupakan komplikasi makrovaskular yang dapat dideteksi secara dini dengan melihat penebalan tunika intima dan media dari pembuluh darah. Sampai saat ini, belum ada data mengenai prevalensi penebalan pembuluh darah pada pasien diabetes melitus tipe 1 dan apakah penebalan tersebut berhubungan dengan riwayat kejadian KAD di Indonesia. Metode: Terdapat 30 pasien kontrol diabetes melitus tipe 1 yang mengikuti penelitian dengan desain potong lintang ini. Pemeriksaan penebalan Arteri Karotis Komunis AKK yang dilakukan menggunakan alat ultrasonografi resolusi tinggi dengan 2 operator. Dilakukan pula pemeriksaan tekanan darah dan pengukuran antropometri. Riwayat KAD, kadar HbA1c terakhir, dan durasi sakit ditentukan melalui rekam medis. Hasil penelitian dilakukan analisis statistik menggunakan uji Pearson, uji Spearman, dan Uji Chi-Square untuk mendapat nilai kemaknaan. Hasil: Prevalensi Penebalan AKK pada pasien anak dengan DM Tipe 1 sebesar 43,3 IK95 0,343-0,523. Tidak terdapat hubungan antara penebalan AKK dengan riwayat KAD p=0,64 dan frekuensi KAD p= 0,499, r=0,128. Dilakukan pengujian 4 variabel independen yakni durasi sakit p=0,249, nilai IMT p=0,944, nilai Sistolik p=0,077, dan kadar HbA1c terakhir p=0,249 dengan hasil tidak ada hubungan bermakna secara statistik. Kesimpulan: Prevalens penebalan AKK pada pasien anak dengan DM Tipe 1 sebesar 43,3. Durasi sakit,Riwayat KAD, Frekuensi KAD, kadar HbA1c terakhir, nilai sistolik, dan nilai IMT belum dapat disimpulkan karena keterbatasan sampel. K

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ABSTRACTIntroduction Type 1 Diabetes Mellitus T1DM is one of the kind of diabetes whom common in childhood. The characteristics of this disease are the event of Diabetics Ketoacidosis DKA and permanently dependent on insulin therapy. There are several microvascluar and macrovascular complications associated with diabetes mellitus. Atherosclerosis is the macrovascular complications that the progression of plaque from Atherosclerosis can be detected early by knowing the thickness of intima and media layer of vascular. Until now, there is no data about the prevalence of Carotid Intima media thickness CIMT and its relationship with DKA history in Indonesia. Methods thirty consecutive patients with T1DM were registered into this cross sectional study. High resolution ultrasonography scanner performed by 2 operator was used to examine CIMT. There were examination on blood pressure and measurement on BMI. The history of DKA, the last HbA1c, and duration of DM were determined by medical record. Pearson, Spearman, and Chi Square test were used for the statistical analysis. Results the prevalence of the CIMT in patients with T1DM was 4.,3 IK95 0.343 0.523. There was no correlation between CIMT and the history of DKA p 0.64 as well as the frequency of DKA p=0.499, r 0.128. After analyzed the duration of diabetes p 0.249, BMI p 0.944, HbA1c p 0.249, Systolic value p 0.077, the results was not significantly correlated. Conclusion The Prevalence of CIMT in patients with T1DM is 43.3. The history of DKA, duration of diabetes, BMI, Systolic value, HbA1c are not yet concluded due to samples limitiation."

"[ABSTRAKLatar belakang : Hiperglikemia kronik pada pasien Diabetes melitus tipe 1 (DMT1) dihubungkan dengan kerusakan jangka panjang, gangguan fungsi dan kerusakan berbagai organ tubuh lain seperti mata, ginjal, saraf, jantung dan pembuluh kapiler. Salah satu gangguan fungsi organ yang sering diabaikan sebagai akibat hiperglikemia adalah faal paru. Uji fungsi paru dapat membedakan kelainan paru obstruktif, restriktif atau campuran antara obstruktif dn restriktif. Uji fungsi paru dengan spirometri tidak dapat dilakukan dengan baik pada anak dibawah usia 7 atau 8 tahun karena memerlukan koordinasi yang cukup sulit. Penelitian tentang dampak DMT1 terhadap paru di Indonesia belum ada sampai saat ini.Tujuan : Mengetahui gambaran uji fungsi paru pada pasien DMT1 usia 8-18 tahun.Metode : Penelitian potong lintang dilakukan di Poliklinik Endokrinologi dan Respirologi Rumah Sakit Cipto Mangunkusumo (RSCM), serta Laboratorium Prodia Salemba pada bulan Januari 2015. Wawancara orangtua dilakukan dan data kadar HbA1c dalam rentang satu tahun terakhir diambil dari rekam medis subjek atau berdasarkan hasil pemeriksaan sebelumnya. Uji fungsi paru dilakukan sebanyak tiga kali dan diambil salah satu hasil yang terbaik. Kemudian subjek menjalani pengambilan darah untuk pemeriksaan kadar HbA1c dengan metode cation-exchange high pressure liquod chromatography (HPLC) di Laboratorium Prodia.Hasil : Tiga puluh lima subjek berpartisipasi dalam penelitian, terdiri dari 68,6% perempuan. Rerata usia 14 ± 2,7 tahun dan median durasi DM adalah 4 tahun (1,3-10,2 tahun). Rerata parameter FEV1 adalah 86,8 ± 14%, FVC 82,7 ± 12% dan V25 83,1 ± 26,2%. Median FEV1/FVC adalah 92,4 % (77,6-100) dan V50 91,5 % (41,1-204). Fungsi paru normal didapatkan pada 19 subjek (54,3%) dan fungsi paru terganggu sebanyak 16 subjek (45,7%), terdiri dari 10 subjek (28,6%) gangguan restriktif, 2 subjek (5,7%) gangguan obstruktif dan 4 subjek (11,4%) gangguan campuran. Rerata HbA1c dalam 1 tahun terakhir pada subjek dengan gangguan restriktif adalah 10,3%. Simpulan : Nilai parameter uji fungsi paru pasien DMT1 usia 8-18 tahun masih dalam batas normal. Gangguan fungsi paru didapatkan pada 16 subjek (45,7%) dengan gangguan restriksi terbanyak yaitu 10 subjek (28,6%).

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ABSTRACTBackground: Chronic hyperglycemia in patients with type 1 diabetes mellitus (T1DM) is associated with long term functional impairment and damage of several parts of the body, such as eyes, kidneys, nerves, heart, and capillary blood vessels. Among all systems, disorder of pulmonary function due to hyperglycemia is often neglected by physicians. Pulmonary function test could determine whether the lung impairment is obstructive, restrictive, or mixed. Pulmonary function test using spirometry could not be applied to children below 7 or 8 years old because they are not capable to do the test. Until now, research about the effect of T1DM to pulmonary function has never been done in Indonesia.Objective: To obtain pulmonary function test profile in type 1 diabetes mellitus patients aged 8 to 18 years old.Methods: This cross sectional study took place at Endocrinology and Respirology Outpatient Department of Cipto Mangunkusumo Hospital (RSCM) and Prodia Laboratory Service in Salemba in January 2015. Parents of subjects were interviewed for history disease. HbA1c level of recent year was collected from medical records or from previous test results. Pulmonary function test were conducted three times to each subjects and among those three results, the best was chosen as data. Blood samples were collected for HbA1c level measurement. The HbA1c level was measured by cation-exchange high pressure liquod chromatography (HPLC) method in Prodia Laboratory.Results: Thirty five subjects participated in the research, 68.6% of them were female. The average age was 14 ± 2.7 years and the median duration of diabetes melitus was 4 years (1.3-10.2 years). FEV1, FVC, and V25 average was 86.8 ± 14%, 82.7 ± 12%, and 83.1 ± 26.2%, respectively. The median of FEV1/FVC and V50 was 92.4 % (77.6-100) and 91.5% (41.1-204) respectively. Nineteen subjects (54.3%) had normal pulmonary function and among 16 (45.7%) abnormal subjects, 10 (28.6%) had restrictive disorder, 2 (5.7%) had obstructive disorder, and 4 (11.4%) had mixed disorder. Average of HbA1c level of restrictive group was 10.3%.Conclusions: Pulmonary function test parameter profile in type 1 diabetes mellitus patients aged 8 to 18 years old lies in normal range. Pulmonary function disorder was found in 16 subjects (45.7%). Among those 16 subjects, 10 (28.6%) had restriction disorder.;Background: Chronic hyperglycemia in patients with type 1 diabetes mellitus (T1DM) is associated with long term functional impairment and damage of several parts of the body, such as eyes, kidneys, nerves, heart, and capillary blood vessels. Among all systems, disorder of pulmonary function due to hyperglycemia is often neglected by physicians. Pulmonary function test could determine whether the lung impairment is obstructive, restrictive, or mixed. Pulmonary function test using spirometry could not be applied to children below 7 or 8 years old because they are not capable to do the test. Until now, research about the effect of T1DM to pulmonary function has never been done in Indonesia. Objective: To obtain pulmonary function test profile in type 1 diabetes mellitus patients aged 8 to 18 years old. Methods: This cross sectional study took place at Endocrinology and Respirology Outpatient Department of Cipto Mangunkusumo Hospital (RSCM) and Prodia Laboratory Service in Salemba in January 2015. Parents of subjects were interviewed for history disease. HbA1c level of recent year was collected from medical records or from previous test results. Pulmonary function test were conducted three times to each subjects and among those three results, the best was chosen as data. Blood samples were collected for HbA1c level measurement. The HbA1c level was measured by cation-exchange high pressure liquod chromatography (HPLC) method in Prodia Laboratory. Results: Thirty five subjects participated in the research, 68.6% of them were female. The average age was 14 ± 2.7 years and the median duration of diabetes melitus was 4 years (1.3-10.2 years). FEV1, FVC, and V25 average was 86.8 ± 14%, 82.7 ± 12%, and 83.1 ± 26.2%, respectively. The median of FEV1/FVC and V50 was 92.4 % (77.6-100) and 91.5% (41.1-204) respectively. Nineteen subjects (54.3%) had normal pulmonary function and among 16 (45.7%) abnormal subjects, 10 (28.6%) had restrictive disorder, 2 (5.7%) had obstructive disorder, and 4 (11.4%) had mixed disorder. Average of HbA1c level of restrictive group was 10.3%. Conclusions: Pulmonary function test parameter profile in type 1 diabetes mellitus patients aged 8 to 18 years old lies in normal range. Pulmonary function disorder was found in 16 subjects (45.7%). Among those 16 subjects, 10 (28.6%) had restriction disorder., Background: Chronic hyperglycemia in patients with type 1 diabetes mellitus (T1DM) is associated with long term functional impairment and damage of several parts of the body, such as eyes, kidneys, nerves, heart, and capillary blood vessels. Among all systems, disorder of pulmonary function due to hyperglycemia is often neglected by physicians. Pulmonary function test could determine whether the lung impairment is obstructive, restrictive, or mixed. Pulmonary function test using spirometry could not be applied to children below 7 or 8 years old because they are not capable to do the test. Until now, research about the effect of T1DM to pulmonary function has never been done in Indonesia. Objective: To obtain pulmonary function test profile in type 1 diabetes mellitus patients aged 8 to 18 years old. Methods: This cross sectional study took place at Endocrinology and Respirology Outpatient Department of Cipto Mangunkusumo Hospital (RSCM) and Prodia Laboratory Service in Salemba in January 2015. Parents of subjects were interviewed for history disease. HbA1c level of recent year was collected from medical records or from previous test results. Pulmonary function test were conducted three times to each subjects and among those three results, the best was chosen as data. Blood samples were collected for HbA1c level measurement. The HbA1c level was measured by cation-exchange high pressure liquod chromatography (HPLC) method in Prodia Laboratory. Results: Thirty five subjects participated in the research, 68.6% of them were female. The average age was 14 ± 2.7 years and the median duration of diabetes melitus was 4 years (1.3-10.2 years). FEV1, FVC, and V25 average was 86.8 ± 14%, 82.7 ± 12%, and 83.1 ± 26.2%, respectively. The median of FEV1/FVC and V50 was 92.4 % (77.6-100) and 91.5% (41.1-204) respectively. Nineteen subjects (54.3%) had normal pulmonary function and among 16 (45.7%) abnormal subjects, 10 (28.6%) had restrictive disorder, 2 (5.7%) had obstructive disorder, and 4 (11.4%) had mixed disorder. Average of HbA1c level of restrictive group was 10.3%. Conclusions: Pulmonary function test parameter profile in type 1 diabetes mellitus patients aged 8 to 18 years old lies in normal range. Pulmonary function disorder was found in 16 subjects (45.7%). Among those 16 subjects, 10 (28.6%) had restriction disorder.]"

"Diabetes Mellitus tipe 1 di anak merupakan salah satu penyakit metabolik endokrin tersering di dunia, termasuk di Indonesia. Beberapa tahun belakangan ini, angka insidensi anak yang mengalami diabetes mellitus tipe 1 terus bertambah. Dengan fasilitas dan pengobatan yang kurang memadai di Indonesia, hal ini dapat memperburuk efek kadar gula darah yang tinggi dan menimbulkan beberapa komplikasi termasuk penurunan kecerdasan. Riset ini bertujuan untuk mengetahui apakah anak dengan diabetes mellitus tipe 1 yang tidak terkontrol diindikasikan dengan tingkat HbA1c memiliki hubungan dengan penurunan kecerdasan.Dengan menggunakan metode cross sectional, data dalam riset ini diambil dari questionnaire dan juga medical record pasien yang mengikut sertakan anak diabetes mellitus tipe 1 berumur 5-18 tahun di RSUPN Cipto Mangunkusumo dan Brawijaya Clinic pada periode Juni-Juli 2016. Sebelum melakukan pengukuran kecerdasan mengunakan metode CCIDD, semua subjek harus melakukan pemeriksaan tingkat HbA1c maximal 3 bulan sebelumnya. Seluruh data subjek akan di deskripsikan ke dalam tabel. Sedangkan untuk mengetahui hubungan anatara HbA1c dan tingkat kecerdasan anak, peneliti menggunakan simple correlation test dan juga uni-variable non parametric for independent samples of Mann-Whitney. Kemudian dari pada itu linear regression, juga digunakan untuk mementukan risk factor yang berhubungan dengan fungsi kecerdasaan anak diabetes mellitus tipe 1. Terdapat 50 subjek yang berhasil di analisa pada penilitian ini. Sebagain besar anak DM berumur >12-18 tahun dengan ratio perempuan lebih besar. Nilai tengah dari umur saat terdiagnosa 8.4(1.1-14.3) tahun dan menderita diabetes selama 2.8(0.1-13.9) tahun. Rerata HbA1c 9.3(1.94)% dengan sebagian besar pernah mengalami 1 kali DKA. Untuk hubungan antara tingkat HbA1c dan tingkat kecerdasan, ditemukan korelasi lemah (r = -.182) dengan p-value >0.05 yang dapat diartikan tidak adanya hubungan yang signifikan anatara dua variable tersebut. Namun didalam variable risk factors, ditemukan hubungan antara status sosial ekonomi anak DM-1 dengan fungsi kecerdasannya (p<0.05).Tingkat HbA1c yang tinggi tidak memiliki hubungan dengan penurunan kecerdasan pada anak dengan diabetes mellitus tipe 1. Namun, tingkat status sosial ekonomi anak DM-1 dapat menjadi faktor resiko terhadap fungsi kecerdasan anak tersebut. Penilitian lebih lanjut dapat dilakukan untuk mengetahui apakah anak dengan kasus yang lebih berat dikarenakan tingginya kadar gula darah yang tidak terkontrol memiliki hubungan dengan tingkat kecerdasan anak dengan diabetes melitus tipe 1.

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Type 1 diabetes mellitus in children is one of the most prevalent metabolic endocrine disease including in Indonesia. It is known that the number of incidences is increasing for a past couple of years. With inadequate management and facilities in Indonesia, it makes high blood glucose in children with T1D can lead to serious complication such as cognitive dysfunction. This research aim is to know whether the uncontrolled T1D in which indicated by HbA1c is associated with decreased cognitive function.

This research is a cross-sectional study where the data is gathered by questionnaire alongside with medical record which involves type 1 diabetic children aged 5-18 years old from Cipto Mangunkusumo Hospital and Brawijaya Clinic in June-July 2016 period. Prior to the cognitive test using CCIDD method, all the subject must have a record of HbA1c measurement 3 months before. Following that, all subject characteristics are described in baseline data. In addition, a simple correlation test and non-parametric for uni-variable independent samples of Mann-Whitney were used to compare the HbA1c and cognitive function. Moreover, linear regression was also used to know the risk factor for cognitive function in children with type 1 diabetes mellitus.

There were 50 subjects which were analyzed in this research. The majority is children whose age from >12-18 with a larger ratio of female subjects. The median value for the age of onset 8.4(1.1-14.3) years and duration of disease of 2.8(0.1-13.9) years. The mean HbA1c was 9.3(1.94)% with the majority of subject experienced one episode of DKA. Furthermore, HbA1c and cognitive function showed a very weak negative correlation (r=.182) with p-value >0.05 indicates that there is no significant association between these two variables. However, within the risk factor variable, it showed that socioeconomic of the subject was associated with cognitive function (p<0.05).

High level of HbA1c was not associated with a declined performance of children with type 1 diabetes mellitus. However, socioeconomic status of the T1D children was the risk factors to their cognitive performance. Further investigation of this cross-sectional study can be done to analyze the further association between an uncontrolled glycemic state of children with type 1 diabetes mellitus and cognitive function."

"Pada 28 kasus diabetes melitus ( DM ) tipe 2 tanpa kelainan kardiovaskular yang diperiksa di Bagian Metabolik Endokrin, Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Jakarta, mulai Oktober 2001 sampai Desember 2001, dilakukan pemeriksaan ekokardiografi untuk melihat fungsi diastolik ventrikel kiri dan dilakukan pemeriksaan urin mikroalbuminuria. Disfungsi diastolik ditemukan pada 73,7 % pasien DM tipe 2 tanpa mikroalbuminuria dan 66,7% pada DM tipe 2 dengan mikroalbuminuria. Tidak terdapat hubungan bermakna kejadian disfungsi diastolik pada kelompok DM tipe 2 dengan mikroalbuminuria maupun DM tipe 2 tanpa mikroalbuminuria. (Med J Indones 2005; 14: 169-72)

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Twenty-eight cases of type 2 diabetes mellitus (DM) without any cardiovascular disease were recruited from the Department of Metabolic-Endocrine, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta. Recruitment of the study began in October 2001 and was completed by December 2001. Participants were examined for echocardiography and microalbuminuria urinary examination. Diastolic dysfunction was found in 73.7% of type 2 diabetic patients without microalbuminuria and 66.7% in type 2 diabetic patients with microalbuminuria. Neither type 2 diabetic groups with nor without microalbuminuria indicated any significant association to the occurrence of diastolic dysfunction. (Med J Indones 2005; 14: 169-72)"

"Latar Belakang: Diabetes melitus (DM) Tipe 1 merupakan penyakit kronis yang berlangsung seumur hidup dan membutuhkan pendekatan multidisiplin dari profesional kesehatan yang terkait di bidangnya. Edukator diabetes merupakan tenaga kesehatan yang bertugas membantu penderita diabetes mengubah perilaku hidup penderita untuk mencapai status kesehatan yang optimal dengan memberikan edukasi kepada pasien dan keluarga. Saat ini edukator DM tipe 1 pada anak di Indonesia belum terbentuk. Diperlukan model pelatihan yang efektif untuk membentuk edukator DM tipe 1. Tujuan: Untuk membuat model pelatihan edukator DM Tipe 1 dan mengetahui efektifitas model pelatihan dalam membentuk kompetensi edukator DM tipe 1 pada anak. Metode: Penelitian ini menggunakan metode mixed methods yang menggabungkan data kualitatif dan kuantitatif. Penelitian dilaksanakan dalam tiga tahap yaitu perencanaan dengan melakukan focus group discussion (FGD) atau diskusi kelompok terfokus, pelaksanaan pelatihan, dan evaluasi pelatihan dengan pendekatan Kirkpatrics. Hasil: Pelatihan diikuti oleh 31 peserta dari 13 propinsi di Indonesia. Sebagian besar peserta (94,6%) puas dengan pelaksanaan pelatihan, terdapat peningkatan pengetahuan peserta dari nilai rata-rata pretest sebesar 71,6% menjadi 77,8% dan bermakna secara statistik dengan nilai p 0,00. Sebanyak 77,4% peserta lulus dalam ujian OSCE dengan tingkat kelulusan lebih dari 5 stasion. Umumnya peserta dapat menerapkan hasil pelatihan (92,8%) dan memberikan kontribusi nyata dan perbaikan terhadap organisasi (66,7%). Kesimpulan: Telah terbentuk model pelatihan edukator DM tipe 1. Model pelatihan ini dapat membentuk kompetensi edukator diabetes berdasarkan reaksi peserta pelatihan, peningkatan pengetahuan dan keterampilan edukator diabetes, penerapan hasil pelatihan, dan kontribusi terhadap organisasi.

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Background: Type 1 diabetes mellitus (DM) is a lifelong chronic illness which need professional multidiciplinnary approaches. Educators for diabetic patients are medical personnels who help these patients modify their life styles in order to achieve the optimum health status, by giving proper education to patients and their family. Currently, educators for type 1 DM in Indonesia are not available. An effective training model would be needed to create a good educator.

Objective: This study aimed to created a training model for type 1 DM educators and further to evaluate its effectiveness in building a competent type 1 DM educators for children.

Method: This is a mixed methods study which combined both qualitative and quantitative data. This study was done in three steps: (i) planning by doing a focus group discussion, (ii) training, and (iii) training evaluation with Kirkpatrics approach.

Result: Thirty one candidates from 13 province participated in this study. Most candidates (94,6%) were satisfied with the training program. The mean pre-post score were increased from 71,6% to 77,8%, statistically significant (p=0.00). About 77,4% candidates passed the OSCE examinations. Most candidates (92,8%) were able to implement the training program and gave real contribution for the organization progress (66,7%).

Conclusion: A new training model for type 1 DM educators has been established. This model is able to build a competent educators for DM. Evaluation was done based on the participan’s response during training, increase of knowledge and skill, and their implementation, and also their contribution for organization."

"Penyakit metabolik yang sering ditemukan di usia kanak – kanak adalah Diabetes Melitus (DM) tipe 1 dengan defisiensi insulin yang diakibatkan oleh penghancuran sel beta pankreas sehingga meningkatkan kebutuhan metabolisme dan menyebabkan resiko anak mengalami fatigue. Penelitian ini bertujuan untuk menganalisis faktor dominan yang mempengaruhi fatigue pada anak dengan DM tipe 1. Penelitian ini menggunakan cross sectional design dengan melibatkan 233 responden yang dipilih menggunakan non probabilty: consecutive sampling. Hasil penelitian menunjukkan adanya hubungan yang bermakna antara fatigue dengan usia (p value= 0,011), lama didiagnosis (p value= 0,011), gangguan tidur (p value= 0,000), kecemasan (p value= 0,000), dan depresi (p value= 0,000) serta faktor yang paling besar mempengaruhi fatigue pada anak dengan DM tipe 1 adalah gangguan tidur. Hasil penelitian dapat digunakan sebagai asuhan keperawatan khususnya dalam memberikan pendidikan kesehatan untuk menurunkan gejala fatigue.

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Metabolic disease that often found in children is type 1 diabetes mellitus with insulin deficiency which caused by the destruction of pancreatic beta cells, thereby increasing metabolic needs and causing the child’s fatigue risk. This study aims to analyze the dominant factors that affect fatigue in children with type 1 diabetes mellitus. This study used cross sectional design involving 233 respondents selected by non-probabilty: consecutive sampling. The results showed a meaningful relationship between fatigue and age (p value = 0.011), length of diagnosis (p value = 0.011), sleep disorders (p value = 0.000), anxiety (p value = 0.000), depression (p value = 0.000) and the factor that affects fatigue the most in children with type 1 diabetes mellitus is sleep disorders. The results of the study can be used as nursing care, especially in providing health education to reduce fatigue symptoms."

"Penyakit Diabetes Mellitus (DM) tipe 1 saat ini semakin banyak dialami oleh anak. Prinsip perawatan anak yang berfokus family centered care menuntut orang tua untuk aktif berperan serta dalam mengelola DM tipe 1 pada anak. Penelitian dilakukan dengan tujuan mengeksplorasi pengalaman orang tua dalam merawat anak DM tipe 1. Desain penelitian menggunakan fenomenologi deskriptif yang melibatkan 7 orang tua sebagai partisipan.Hasil eksplorasi didapatkan 8 tema, yaitu:1) tiga fase perubahan respon orang tua,2) dua fase perubahan respon anak yang dirasakan orang tua,3) aktivitas orang tua dalam mengelola DM tipe 1 pada anak,4) penilaian orang tua terhadap pengobatan dengan insulin dan herbal,5) pola komunikasi dan ketrampilan yang ditunjukkan mempengaruhi persepsi orang tua terhadap tenaga kesehatan,6) dukungan sosial sebagai salah satu faktor yang mempengaruhi keberhasilan dalam mengelola DM tipe 1 pada anak,7) perubahan yang dialami orang tua sebagai perawat utama anak, dan 8) harapan orang tua terhadap anak, dirinya sendiri dan tenaga kesehatan.Kesimpulan yang didapatkan yaitu kemampuan orang tua dalam berespon adaptif berpengaruh terhadap pengelolaan DM tipe 1 secara efektif pada anak. Selanjutnya perlu dilakukan eksplorasi kemampuan anak dalam beradaptasi terhadap DM tipe 1 untuk memberikan pemahaman dari segi individu yang mengalami penyakit secara langsung.

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Type 1 Diabetes Mellitus (DM) is now increasingly experienced by children. The principle of family centered care requires parents to actively participate in managing diabetes in children and the factors that influence it. Research conducted with the aim to explore the experience of parents in caring for children with type 1 DM. Descriptive phenomenology used in this research design by involving seven parents as participants.The exploration resulted 8 themes, there are:1) three-phases of parent?s response,2) two-phases of children?s response perceived by parents,3) the activity of parents in managing type 1 DM in children,4) perception of parents to insulin and herbs,5) communication patterns and skills shown affected the perception of parents towards health professionals,6) social support as factor that influence the success in managing type 1 diabetes in children,7) the changes of lifestyle which experienced by parents as primary caregivers of children, and 8) the expectations of parents of children, themselves and health professionals.The conclusion is the ability of parents to respond adaptively influence the effectiveness of managing type 1 DM in children. Further exploration about children's adaption to type 1 DM is necessary to provide an understanding from the individual who experience it directly."