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"Diabetes melitus Tipe 2 (DMT2) merupakan suatu kelompok penyakit metabolik dengan komplikasi yang sering terjadi adalah ulkus kaki. Salah satu penyebab terjadinya ulkus kaki adalah keterbatasan lingkup gerak sendi (LGS) pada pasien DMT2 akibat kerusakan jaringan ikat tendon yang dipengaruhi oleh produksi Advanced Glycation End Products (AGE) secara cepat pada kondisi hiperglikemia. AGE merupakan zat yang membentuk suatu ikatan dengan kolagen yang dapat merubah struktur tendon. Produksi yang berlebihan dapat menyebabkan penebalan struktur periartikuler seperti tendon, ligamen, dan kapsul sendi, menyebabkan terjadi penyempitan sehingga menimbulkan kekakuan sendi dan kemudian terjadi keterbatasan LGS. Penelitian ini bertujuan Mengetahui hubungan antara LGS pergelangan kaki dengan derajat ulkus kaki pada pasien DMT2 sebagai salah satu dasar tindakan promotif dan preventif terhadap ulkus kaki diabetik.Penelitian menggunakan studi potong lintang. Kami melaporkan ada 34 sampel (laki-laki 55,9% dan perempuan 44,1%)ulkus kaki pada pasien DMT2 yang memiliki ulkus kaki di regio hindfoot (26,5%), midfoot (5,9%) dan forefoot (67,6%).Pengukuran lingkup gerak sendi pada pergelangan kaki menggunakan goniometri digital untuk gerakan dorsifleksi, plantarfleksi, inver­si dan eversi. Kemudian dihubungkan dengan usia, Indeks Massa Tubuh (IMT), level aktivitas fisik, lama ulkus, lama DM. Terdapat korelasi negatif bermakna signifikan antara lingkup gerak sendi dengan indeks masa tubuh (p=0,019; r=-0,401) dan korelasi positif bermakna signifikan dengan level aktivitas fisik (p=0,004; r=0,484). Semakin meningkat IMT, maka akan menurunkan LGS dan semakin rendah level aktivitas fisik maka akan menurunkan LGS.Tidak terdapat hubungan bermakna signifikan antara LGS dengan usia, lama ulkus dan derajat ulkus. Didapatkan hubungan yang bermakna pada semua gerakan LGS dengan lama DM dengan p-value <0.05. Semua sampel tidak memiliki kejadian yang tidak diinginkan selama penelitian. Kesimpulan dari studi ini adalah tidak ada hubungan antara LGS pergelangan kaki dengan derajat ulkus kaki pada penderita DMT2.

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Type 2 diabetes mellitus (T2DM) is a group of metabolic diseases with the most common complication being foot ulcers. One of the causes of foot ulcers is the limited range of joint motion in T2DM patients due to damage of tendons connective tissue which is affected by the rapid production of Advanced Glycation End Products (AGE) in hyperglycemia conditions. AGE is a substance that forms a bond with collagen that can change the structure of the tendon. Excessive production can cause thickening of periarticular structures such as tendons, ligaments and joint capsules, causing narrowing to occur resulting in joint stiffness and then limiting the range of joint motion. This study aims to determine the relationship between the range of motion of the ankle joint and the degree of foot ulcers in T2DM patients as one of the basic promotive and preventive measures for diabetic foot ulcers. This study is a cross-sectional study. We reported that there were 34 samples (55.9% males and 44.1% females) foot ulcers in T2DM patients who had foot ulcers in the hindfoot (26.5%), midfoot (5.9%) and forefoot (67.6%) regions. Measurement of the range of motion at the ankle using digital goniometry for dorsiflexion, plantarflexion, inversion and eversion. It is related to age, body mass index (BMI), level of physical activity, time of ulcer,time of DM.There was a significant negative correlation between range of motion and body mass index (p=0.019; r=-0.401) and a significant positive correlation with the level of physical activity (p=0.004; r=0.484). The higher of BMI, the range of motion of the joints is lower and the lower level of physical activity, the lower the range of motion of the joints. There was no significant relationship between the range of motion of the joints and age, ulcer duration and degree of ulcer. A significant relationship was found in all range of motion range of motion with duration of DM with p-value <0.05. All samples did not have major adverse events. The conclusion of this study is that there is no relationship between the range of motion of the ankle joint and the degree of foot ulcers in T2DM patients."

"Latar Belakang. Pasien diabetes melitus (DM) berisiko mengalami komplikasi pada sistem vaskular dan persyarafan, khususnya pada bagian perifer, yang jika tidak tertangani dengan baik dapat berimbas pada terjadinya luka kaki diabetes. Buerger Allen Exercise (BAE) merupakan salah satu pilihan terapi konservatif yang terbukti efektif dalam menangani Peripheral Artery Disease (PAD). Sayangnya beberpa penelitian sebelumnya belum membuktikan efektivitasnya. Pada penelitian ini akan BAE akan dikombinasikan dengan latihan Range of Motion (ROM) kaki untuk melihat efektivitasnya pada vaskularisasi dan neuropati perifer. Tujuan. Penelitian ini bertujuan untuk mengidentifikasi efektivitas latihan kombinasi BAE dan ROM kaki terhadap perbaikan vaskularisasi dan neuropati perifer pada pasien DM tipe 2. Metode. Desain penelitian yang digunakan adalah quassi experiment with pre test-post test two goups dengan total 72 orang pasien DM tipe 2 sebagai responden. Responden dibagi rata secara acak ke dalam kelompok intervensi dan kelompok kontrol. Kelompok intervensi mendapatkan latihan kombinasi BAE dan ROM kaki, sedangkan kelompok kontrol mendapatkan latihan tunggal BAE. Setiap kelompok melaksanakan latihan kaki selama dua minggu dengan 2 siklus latihan perhari dan total durasi 30 menit. Sebelum dan setelah latihan, responden dikaji nilai Ankle Brachial Index (ABI) untuk menilai vaskularisasi dan nilai Michigan Neuropathy Screening Instruments (MNSI) untuk menilai neuropati. Hasil. Latihan kombinasi BAE dan ROM kaki lebih efektif dalam meningkatkan nilai ABI daripada latihan tunggal BAE (pvalue 0,00). Latihan kombinasi BAE dan ROM kaki juga lebih efektif dalam menurunkan nilai MNSI daripada latihan tinggal BAE (pvalue 0,00). Kesimpulan Latihan kombinasi BAE dan ROM kaki efektif dalam memperbaiki vaskularisasi dan neuropati perifer melalui perbaikan nilai ABI dan MNSI.

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Background. Patients with diabetes mellitus (DM) are at risk of experiencing complications in the vascular and nervous system, especially in the peripheral areas. These complications can lead to even worse complication without proper intervention such as diabetic foot wounds. Buerger Allen Exercise (BAE) is a conservative therapy option that has been proven effective in treating Peripheral Artery Disease (PAD). Unfortunately, the effect of BAE on neuropathy has not been clearly proven. In this study, BAE will be combined with foot Range of Motion (ROM) exercises to see its effectiveness on vascularization and peripheral neuropathy. Objective. This study aims to identify the effectiveness of combined BAE and foot ROM exercises to improve vascularization and peripheral neuropathy in type 2 DM patients. Methods. Quasi experiment with pre test-post test two groups design was conducted on total of 72 type 2 DM patients. Respondents were divided randomly into intervention and control group. The intervention group received a combination of BAE and foot ROM exercises, while the control group received single BAE exercises. Each group carried out leg training for two weeks with 2 training cycles per day and a total duration of 30 minutes. Before and after exercise Ankle Brachial Index (ABI) score and the Michigan Neuropathy Screening Instruments (MNSI) score were assessed. Results. Combination BAE and foot ROM exercise was more effective in increasing ABI score than BAE-only exercise (pvalue 0.00). The combination of BAE and foot ROM combination was also more effective in reducing the MNSI score than BAE-only exercise (pvalue 0.00). Conclusion: Combination exercise of BAE and foot ROM is effective in improving vascularization and peripheral neuropathy as shown by improved ABI and MNSI score."

"Diabetes melitus dapat menyebabkan berbagai komplikasi yang menyebabkan hendaya, salah satunya adalah ulkus kaki diabetikum (UKD). Kadar vitamin D diketahui berhubungan dengan penyembuhan luka dan resistensi insulin. Penelitian potong lintang ini bertujuan untuk menentukan hubungan antara kadar vitamin D serum dan derajat keparahan UKD. Tiga puluh pasien UKD dengan nilai ankle brachial index normal dikelompokkan sesuai derajat keparahannya sesuai klasifikasi Wagner diikutkan dalam studi ini. Kadar vitamin D serum diperiksa menggunakan metode immunoassay. Hubungan antara kedua variabel dianalisis. Pasien terdiri dari 18 orang laki-laki (60%) dan 12 orang perempuan (40%) dengan rerata usia 57 tahun. Rerata kadar vitamin D serum adalah 10,58 ng/mL. Korelasi kuat ditemukan antara kadar vitamin D serum dan derajat keparahan UKD (p<0,001, r=0,901). Pemeriksaan penyaring kadar vitamin D serum pada pasien UKD menunjukkan hasil yang rendah dan berkorelasi kuat dengan derajat keparahan UKD

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Diabetes mellitus can cause various disabilitating complications including diabetic foot ulcer (DFU). Vitamin D levels are known to be correlated with wound healing and insulin resistance. This cross-sectional study aimed to determine the correlation between serum level of vitamin D and the severity degree of DFU. Thirty DFU patients with normal ankle brachial index, grouped into degrees according to the Wagner classification, were included in this study. Their serum level of vitamin D were examined using the chemiluminescent immunoassay method. Correlation between these two variables was analyzed. Patients were 18 males (60%) and 12 females (40%) with an average age of 57 years. The average serum level of vitamin D was 10.58 ng/mL. Strong correlation was found between serum level of vitamin D and the severity of DFU (p<0.001, r=0.901). Serum level of vitamin D screening in DFU patients were low and were strongly correlated with the degree of DFU."

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

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

"Pengkajian faktor risiko ulkus kaki merupakan peran perawat untuk mencegah terjadi ulkus diabetik atau ulkus berulang. Tujuan penelitian mengidentifikasi faktor yang berhubungan dengan kejadian ulkus kaki. Rancangan penelitian case control, dengan sampel 68 responden DM terdiri 34 pasien ulkus dan 34 pasien tidak ulkus. Hasil multivariat menunjukkan faktor perawatan kaki, neuropati motorik, Peripheral Arterial Disease, pengendalian kadar gula darah, dan gangguan penglihatan berhubungan signifikan dengan kejadian ulkus. Neuropati motorik yang paling mempengaruhi kejadian ulkus kaki. Rekomendasi penelitian ini adalah perlu pendidikan kesehatan & early detection risiko ulkus kaki dan penelitian lanjutan pengaruh penyuluhan pada pasien berisiko dengan kejadian ulkus kaki.

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Assessment of risk factors for foot ulcer is the role of nurses to prevent diabetic ulcers or recurrent ulcers. The research aimed to identify factors associated with the incidence of foot ulcers. Case-control study design, recruited 68 respondents diabetic devided into 34 ulcer patients and 34 no ulcer patients. Multivariate results indicated foot care, motor neuropathy, PAD, controlling blood sugar levels, and visual impairment significant associated with the occurrence of ulcers. Motor neuropathy was the most influence incidence of foot ulcers. Recommendations of this study is the need for health education and early detection of its risk foot ulcers and further had explore research effect of counseling for patients at risk with the incidence of foot ulcers."

"Ulkus kaki diabetik (UKD) merupakan luka kronik pada pasien diabetes melitus (DM). Vitamin D dipercaya memiliki peran penting pada diferensiasi, proliferasi, pertumbuhan sel, dan modulasi sistem imunitas sehingga kadar yang optimal dibutuhkan untuk penyembuhan luka. Defisiensi vitamin D juga diduga mengganggu produksi dan sekresi insulin sehingga berkontribusi pada kronisitas UKD. Penelitian bertujuan membandingkan kadar vitamin D pada pasien DM dengan dan tanpa UKD; serta untuk mengetahui korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS (perfusion, extension, depth, infection, sensation) dengan kadar vitamin D. Serum 25-hidroksivitamin D (25(OH)D) dianalisis menggunakan in-vitro chemiluminescent immunoassay (CLIA). Analisis statistik yang sesuai dilakukan untuk membuktikan tujuan penelitian. Perbandingan nilai median (Q1-Q3) kadar vitamin D pada pasien DM dengan dan tanpa UKD secara berurutan adalah 8,90 ng/mL (6,52-10,90) dan 16,25 ng/mL (13-19,59), serta bermakna secara statistik (p<0,001). Tidak ada korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS terhadap kadar vitamin D, serta tidak bermakna secara statistik. Hasil pada penelitian ini menunjukkan bahwa kadar vitamin D pada pasien DM dengan UKD lebih rendah dibandingkan pasien tanpa UKD. Namun belum ada bukti yang cukup untuk menyimpulkan bahwa tidak ada korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS terhadap kadar vitamin D.

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Diabetic foot ulcers (DFU) are chronic wounds in patients with diabetes mellitus (DM). Vitamin D believed have important role in differentiation, proliferation, cell growth, and immune system modulation hence optimal levels are needed for wound healing. Vitamin D deficiency also thought to interfere insulin production and secretion, thereby contributing to DFU chronicity. This study aims to compare vitamin D levels in DM patients with and without DFU; and determine the correlation between DFU duration and severity by PEDIS (perfusion, extension, depth, infection, sensation) score to vitamin D levels. 25-hydroxyvitamin D serum analyzed using in-vitro chemiluminescent immunoassay. Appropriate statistical analysis was done following the study. Comparison of median values ​​(Q1-Q3) vitamin D levels in DM patients with and without DFU were 8.90 ng/mL (6.52-10.90) and 16.25 ng/mL (13-19.59) respectively, and statistically significant (p<0.001). There was no correlation between DFU duration and severity PEDIS score to vitamin D levels, and it was not statistically significant. The results of this study indicate that vitamin D levels in DM patients with DFU are lower than patients without DFU. However, there is not enough evidence to conclude that there is no correlation between DFU duration and severity by PEDIS score to vitamin D levels."

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

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Background: Diabetes mellitus is important risk factor of atherosclerosis.

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

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

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

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

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

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

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

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

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

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

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

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

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

in Patients with type 2 diabetes mellitus (DM)

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

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

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

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

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

each variable was used the Spearman test.

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

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

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

this study found a statistically significant negative correlation with moderate correlation

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

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

also found a statistically significant negative correlation with moderate correlation

coefficient (r = -0.399, p = 0.016)

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

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

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

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

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

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

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

"ABSTRAK Kondisi pasien diabetes mellitus DM tipe 2 dengan peripheral arterial disease PAD yang tidak ditangani dengan tepat dapat memicu terjadinya neuropati, ulkus pedis diabetik, bahkan amputasi. Intervensi latihan ankle range of motion ROM dipercaya dapat mengurangi gejala dan mencegah progresifitas PAD pada pasien DM tipe 2. Namun pada praktiknya, intervensi ini masih jarang dilakukan. Studi kasus dalam Karya Ilmiah Akhir Ners KIAN ini bertujuan untuk mengidentifikasi pengaruh pemberian intervensi ankle ROM pada pasien DM tipe 2 dengan komplikasi PAD. Hasil analisis menunjukkan bahwa terdapat pengurangan gejala PAD dan peningkatan aliran darah ekstremitas yang ditandai dengan peningkatan saturasi oksigen, kekuatan pulsasi, dan penurunan skala nyeri. Edukasi dan pendampingan latihan ankle ROM pada pasien DM tipe 2 dengan PAD diperlukan agar perfusi jaringan perifer pasien dapat tercapai dengan optimal.

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ABSTRACT The conditions of type 2 diabetes mellitus T2DM patient with peripheral arterial disease PAD that is not handled properly can lead to neuropathy, diabetic pedis ulcer, even amputation. Intervention of ankle range of motion ROM exercise is believed to reduce symptoms and prevent the PAD progression. However, in clinical practice, this intervention still rarely done. Therefore, this case report aims to identify the impact of ankle ROM in T2DM patients with PAD complications. The results showed that there was a reduction in PAD symptoms and an increase in limb blood flow characterized by increased oxygen saturation, pulsation, and decreased pain scale. In brief, education and advisory of ankle ROM in T2DM patient with PAD is required to optimize the peripheral perfusion."