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"Background: peripheral neuropathy is known as one of most common complication in diabetes mellitus type 2 patient. This complication is caused by uncontrolled condition of blood glucose level in long periode. Regular physical activity in moderate to high intensity is beneficial in management of diabetes mellitus. This report aimed to know the effectiveness of aerobic exercise in causing improved peripheral functions in type 2 diabetes mellitus.Methods: literature searching using several related keywords in Medline, Pubmed,, and Cochrane library, following inclusion and exclusion criteria. Result: Dixit et al suggested that a heart rate intensity of 40-60 percent aerobic exercise of 30-45 min duration per session for eight weeks suggest an important impact in controlling diabetic peripheral neuropathy. Kluding PM et al suggested that significantly improved selected measures of peripheral nerve function (worst, pain levels and MNSI score, glycemic control (HbA1c), and resting heart rate. Conclusion: the studies showed significant benefit of aerobic exercise, despite the short duration of exercise being used as intervention towards improvement in peripheral nerve function. However, further studies with large samples and longer duration of intervention are needed to confirm the finding.

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Latar belakang: neuropati perifer merupakan salah satu komplikasi yang sering dijumpai pada penderita diabetes mellitus tipe 2. Timbulnya komplikasi ini dilatarbelakangi oleh kondisi kadar gula darah tidak terkontrol dalam waktu yang lama. Aktivitas fisik rutin dengan intensitas sedang sampai tinggi bermanfaat dalam pengelolaan diabetes mellitus. Telaah ini bertujuan untuk mengetahui efektivitas latihan aerobik dalam memperbaiki fungsi perifer yang lebih baik pada diabetes melitus tipe 2.

Metode: pencarian literatur menggunakan beberapa kata kunci yang terkait di perpustakaan elektronik Medline®, Pubmed®, dan Cochrane library, mengikuti kriteria inklusi dan eksklusi.

Hasil: studi Dixit et al menunjukkan bahwa 40-60% intensitas denyut jantung latihan aerobik dengan durasi 30-45 menit per sesi selama delapan minggu menunjukkan adanya dampak penting dalam mengontrol diabetes neuropati perifer. Kluding PM et al menunjukkan perbaikan secara signifikan dari pengukuran terpilih fungsi nervus perifer (tingkat keparahan “terburuk” dan skor MNSI), kontrol glikemik (HbA1c), dan denyut jantung istirahat.

Kesimpulan: penelitian ini menunjukkan manfaat latihan aerobik yang signifikan, meski menggunakan latihan singkat sebagai intervensi terhadap perbaikan fungsi saraf perifer. Namun, diperlukan penelitian lebih lanjut dengan sampel besar dan durasi intervensi yang lebih lama untuk mengonfirmasi temuan tersebut."

"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."

"ABSTRAKLatar belakang: Penderita diabetes melitus tipe 2 diprediksi akan semakin bertambah di seluruh dunia. Diabetes melitus merupakan penyakit yang dapat menimbulkan komplikasi di berbagai organ tubuh manusia, termasuk kulit. Kulit kering adalah komplikasi yang sering ditemukan pada penderita diabetes melitus dan berpotensi sebagai faktor predisposisi terjadinya luka yang dapat berkembang menjadi gangren. Terdapat beberapa teori yang diajukan, salah satunya adalah neuropati autonom perifer sebagai faktor etiologi kulit kering diabetes tipe 2. Belum ada penelitian mengenai hubungan antara neuropati autonom perifer dengan kulit kering diabetes melitus tipe 2.Tujuan: Menguji hubungan neuropati autonom perifer dan kulit kering diabetes mellitus tipe 2.Metode: Uji potong lintang. Enam puluh subjek penelitian dibagi menjadi dua kelompok yaitu, kelompok diabetes melitus tipe 2 dengan neuropati dan kelompok diabetes melitus tipe 2 tanpa neuropati. Penilaian neuropati autonom perifer menggunakan skor SSW (stimulated skin wrinkling). Penilaian kekeringan kulit secara subjektif menggunakan specified symptom sum score dan secara objektif menggunakan Scap (skin capacitance) serta TEWL (trans epidermal water loss).Hasil: Nilai specified symptom sum score kelompok yang tidak mengalami neuropati yaitu 4 (1-8) dan kelompok yang mengalami neuropati yaitu 4 (1-9) dengan nilai p > 0,05. Nilai TEWL pada kelompok neuropati lebih tinggi dibandingkan dengan kelompok yang tidak mengalami neuropati yaitu 10,5 (6,9-55,0) vs 9,3 (7,4-13,2) dengan nilai p < 0,05. Nilai scap lebih tinggi pada kelompok neuropati dibandingkan dengan kelompok yang tidak mengalami neuropati yaitu 29,5 + 8,6 vs 27,0 + 7,2 dengan nilai p > 0,05. Kekuatan penelitian untuk ketiga parameter status hidrasi kulit dibawah 80%.Kesimpulan: Tidak ada perbedaan bermakna secara klinis dan statistika terhadap kulit kering pada kelompok pasien diabetes tipe 2 dengan neuropati dan tanpa neuropati dilihat dari penilaian specified symptom sum score. Kelompok pasien diabetes tipe 2 yang mengalami neuropati memiliki nilai TEWL lebih tinggi dibandingkan dengan kelompok yang tidak mengalami neuropati, yang bermakna secara statistika. Nilai scap kelompok pasien diabetes tipe 2 yang mengalami neuropati lebih tinggi dibandingkan dengan kelompok yang tidak mengalami neuropati, walaupun tidak bermakna secara statistika. Kekuatan penelitian dibawah 80% menunjukkan bahwa secara statistika, hasil dari penelitian ini belum cukup kuat untuk menjelaskan hubungan antara kulit kering pasien diabetes melitus tipe 2 dengan neuropati autonom perifer.

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ABSTRACTBackground: Prevalence of type 2 diabetes mellitus is predicted to elevate worldwide. Diabetes mellitus cause complications in many organs, including the skin. Dry skin is common in diabetics and potential to predispose wound that could complicate into gangrene. One of the theory which explain the etiology of dry skin in diabetics is peripheral autonom neuropathy. There is not a study that evaluate association of peripheral autonom neuropathy and dry skin in type 2 diabetes mellitus.Objective: To asses association of peripheral autonom neuropathy and dry skin in type 2 diabetes mellitus.Methods: A cross sectional study. Sixty subjects are divided into 2 groups, group of diabetics with neuropathy and without neuropathy. Evaluation of peripheral autonom neuropathy was using SSW (stimulated skin wrinkling) scoring system. Subjective tool to evaluate dry skin was the Specified Symptom Sum Score (scaling, roughness, redness, cracks fissures) and the objective tool was using Scap (skin capacitance) and TEWL (trans epidermal water loss).Result: Specified Symptom Sum Score mean value in group without neuropathy is 4 (1-8) and with neuropathy is 4 (1-9), p value > 0,05. TEWL mean value in group with neuropathy is higher than group without neuropathy 10,5 (6,9-55,0) vs 9,3 (7,4-13,2) and p value < 0,05. Scap value is higher in group with neuropathy than group without neuropathy 29,5 + 8,6 vs 27,0 + 7,2 and p value > 0,05. The calculation shows below 80% for statistical power. Conclusion: There is no clinically and statistically significant difference in type 2 diabetes dry skin with neuropathy and without neuropathy for Specified Symptom Sum Score. TEWL value in group with neuropathy is higher than group without neuropathy, which statistically significant. Scap value in group with neuropathy in higher than group without neuropathy, there is no statistically significant. Below 80% statistical power shows the low strength of this study."

"Diabetes melitus merupakan penyakit kronis yang dapat mengurangi harapan hidup. Lansia tentunya mengalami proses penuaan sehingga lebih mudah terkena penyakit diabetes. Kurangnya pencegahan faktor risiko diabetes menyebabkan keparahan dan durasi hiperglikemia yang lama, berisiko terjadi komplikasi kronis seperti neuropati diabetik. Latihan senam tangan dan kaki merupakan tindakan keperawatan berbasis bukti yang dapat mengurangi gejala neuropati, serta meningkatkan sensasi dan kemampuan ADL. Penulisan ini bertujuan untuk menjabarkan asuhan keperawatan pada lansia dengan diabetes tipe 2 dengan gejala neuropati melalui latihan senam tangan dan kaki untuk mengurangi keluhan nyeri kronis dan menurunkan risiko kerusakan integritas jaringan pada Nenek L di PSTW Budi Mulia 4 Ciracas. Nenek L berusia 64 tahun mengalami diabetes tipe 2 dengan kadar GDS saat ini 335 mg/dL. Gejala yang dirasakan berupa kesemutan, nyeri (seperti tertusuk), terasa tebal saat berjalan dan beristirahat, serta penurunan sensasi pada tangan dan kaki. Setelah dilakukan intervensi sebanyak 24 kali selama 8 hari, terjadi peningkatan sensasi pada kaki dan tangan, serta penurunan gejala neuropati. Latihan senam tangan dan kaki diharapkan dapat menjadi program harian yang dilaksanakan di PSTW Budi Mulia 4 Ciracas pada lansia dengan diabetes tipe 2 dengan gejala neuropati untuk mengurangi keluhan nyeri kronis dan mencegah risiko kerusakan integritas jaringan.

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Diabetes mellitus is a chronic disease that can reduce life expectancy. The elderly experience an aging process, are susceptible to diabetic. The lack of prevention of diabetic risk factors causes the severity and long duration of hyperglycemia, the risk of chronic complications such as diabetic neuropathy. Hand and foot exercises are evidence-based nursing actions that can reduce neuropathy symptoms and improve ADL sensation and ability. This paper aims to describe nursing care for the elderly with type 2 diabetic with symptoms of neuropathy through exercise of the hands and feet to reduce complaints of chronic pain and reduce the risk of damage to tissue integrity in Nenek L at PSTW Budi Mulia 4 Ciracas. Nenek L, 64 years old, has type 2 diabetes with current GDS level of 335 mg/dL. Symptoms are tingling, pain (like being stabbed), feeling thick when walking and resting, and decreased sensation in the hands and feet. After 24 interventions for 8 days, can increase in sensation in the feet and hands, and reduce in neuropathy symptoms. Hand and foot exercises expected to become a daily program carried out at PSTW Budi Mulia 4 Ciracas in elderly with type 2 diabetes with neuropathy symptoms to reduce chronic pain complaints and prevent the risk of damage to tissue integrity."

"To determine the differences in mean plasma values of von willebrand factor and platelet agregation in type 2 DM patient with or without peripheral artirial disease...."

"Senam diabetes merupakan jenis latihan aerobik yang bermanfaat mengontrol kadar glukosa darah pada pasien diabetes melitus tipe 2. Penelitian ini bertujuan mengetahui perubahan kadar glukosa darah pada pasien diabetes melitus tipe 2 yang melakukan senam diabetes. Pada penelitian ini menggunakan desain deskriptif dengan pengamatan pada serangkaian waktu (Time Series Design) dengan tehnik pengambilan sampel concecutive sampling. Besarnya sampel pada penelitian ini 87 orang, setiap responden mengikuti senam selama 60 menit, 3 kali seminggu, selama 1 minggu. Hasil penelitian didapatkan ada perubahan yang signifikan terhadap penurunan kadar glukosa darah pada pasien diabetes melitus tipe 2 yang melakukan senam diabetes (p value <0.05). Penelitian ini merekomendasikan bahwa senam diabetes dapat menurunkan kadar glukosa darah pada pasien diabetes melitus tipe 2 serta perlu dikembangkan penelitan lebih lanjut.

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Diabetes exercise is an aerobic exercise that help Diabetes Mellitus (DM) type 2 patient in maintaining normal blood sugar level. The purpose of this study is to examine the changes in DM type 2 patient’s blood sugar level when they are having diabetes exercise. This is descriptive quantitative study using time series observation design. Sample of 87 patients were recruited using consecutive sampling. Each participant had 60 minutes exercise and 3 times in a week.

The result shows significant changes in decreasing blood sugar level of DM type 2 patient after diabetes exercise (p value <0.05). This study recommends that diabetes exercise can decrease blood sugar level of DM type 2 significantly, and can be continue to further studies."

"Diabetes mellitus merupakan penyakit degeneratif dengan gejala hiperglikemia kronis akibat defisiensi maupun resistensi insulin. Kejadiannya terus meningkat terutama di perkotaan akibat perubahan gaya hidup seperti pola makan tinggi kalori rendah serat, aktivitas kurang, obesitas, merokok, konsumsi alkohol dan stress. Penulisan ini bertujuan untuk menganalisis asuhan keperawatan yang diberikan pada Tn.S (59th) dengan diabetes, khususnya perawatan kaki untuk mencegah ulkus kaki. Intervensi perawatan kaki yang dilakukan kepada Tn.S selama tujuh hari menunjukkan bahwa kaki bersih, lembab, tidak ada luka, terasa lebih nyaman dan kesemutan sudah berkurang. Dengan demikian, perawatan kaki perlu dilakukan pada pasien diabetes baik saat di rumah sakit maupun di rumah.

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Diabetes Mellitus is a degenerative disease whose symptom chronic hyperglycemia because of deficiency or insulin resistance. The incidence of diabetes rapidly increasing trough years, especially in urban areas due to changes in lifestyle like a high calorie low fiber in diet, less activity, obesity, smoking, alcohol consumption and stress. This paper was made to analyze nursing care that was given to Mr.S (59 yo) with diabetes, especially footcare to prevent foot ulcer. Footcare which given to Mr.S for seven days indicated that the feet clean, moist, no injuries, feels more comfortable and nomb has decreased. Thus, footcare must be done by diabetic patients both in the hospital or at home."

"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."

"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."

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

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