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"Latar Belakang: Akumulasi lemak viseral pada pasien Diabetes Mellitus (DM) Tipe 2 dapat menyebabkan komplikasi metabolik dan risiko penyakit kardiovaskular. Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh latihan dalam bentuk kombinasi High Intensity Interval Training (HIIT) dan latihan beban terhadap perubahan lemak viseral pada pasien DM Tipe 2. Metode: Analisis sekunder dari Randomized Controlled Trial (RCT) pada bulan Juli 2017 sampai Januari 2018. Subjek berjumlah 18 orang yang diambil dari kelompok eksperimen. Subjek melakukan HIIT sebanyak 3x/minggu dan latihan beban 2x/minggu dengan durasi 12 minggu latihan. Protokol HIIT dengan perbandingan 1 menit intensitas tinggi dan 4 menit intensitas lebih rendah, sedangkan latihan beban terdiri dari 9 jenis latihan meliputi ekstrimitas atas, batang tubuh, dan ekstrimitas bawah. Hasil: 18 pasien (72% perempuan) dengan rerata usia 50,94 tahun. Seluruh subjek berada pada kategori overweight (17%), dan obese (83%), serta obesitas sentral (100%). Tidak didapatkan perubahan lemak viseral yang signifikan (p>0.05) dengan pengukuran menggunakan Bioelectrical Impedance Analysis (BIA). Kesimpulan: Didapatkan seluruh subjek berada pada kategori overweight dan obese serta memiliki obesitas sentral. Tidak didapatkan perubahan lemak viseral yang bermakna dari kombinasi HIIT dan latihan beban selama 12 minggu pada pasien DM Tipe 2.

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Background: The accumulation of visceral fat in Type 2 Diabetes Mellitus patient can cause metabolic complications and risk of cardiovascular disease. Goals: This study aims to determine the effect of combined High Intensity Interval Training (HIIT) and Resistance training on the Changes in Visceral Fat in Type 2 Diabetes Mellitus Patient. Methods: Secondary analysis of the Randomized Controlled Trial (RCT) on July 2017 and completed January 2018. Eighteen participants were taken from the experimental group. Participants did HIIT three times a week and resistance training twice a week with the duration of 12 weeks. HIIT protocol was comprised of one minute of high intensity and 4 minutes of lower intensity. Resistance training was comprised of nine exercises for upper extremities, core, and lower extremities. Results: 18 patients (72% female) with an average age of 50.94 years. All subjects were in the overweight (17%), obese (83%), and central obesity (100%). There were no significant changes in visceral fat (p>0,05) with measurements using Bioelectrical Impedance Analysis (BIA). Conclusion: All participants are overweight, obese and have central obesity. There were no changes in visceral fat from a combination of HIIT and resistance training in

Type 2 DM patients in 12 weeks."

"Diabetes Mellitus tipe-2 (DM tipe-2) merupakan suatu kelainan yang ditandai dengan adanya resistensi insulin. Salah satu faktor risiko DM tipe-2 pada otot rangka yakni terjadi penurunan massa otot rangka yang disebabkan oleh degradasi protein otot yang berlebihan. Jalur degradasi otot rangka diregulasi 2 sistem yakni ubiquitin proteosom dan autofagi. Terdapat faktor transkripsi pada ubiquitin proteosom yakni KLF15. Sedangkan pada autofagi terdapat P62 sebagai protein multifungsi. Pada kondisi DM, peran 2 biomarker ini belum sepenuhnya diketahui dalam pengaturan degradasi otot. Dimasa ini, terdapat suatu intervensi yang populer dan terbukti efektif untuk homeostasis otot rangka yakni High Intensity Interval Training (HIIT). Tipe latihan ini menggabungkan latihan berintensitas tinggi dengan periode istirahat berinterval. Pengaruh HIIT terhadap DM pada jalur degradasi masih harus dikaji lebih lanjut. Pada penelitian ini diberikan perlakuan HIIT selama 6 minggu pada tikus yang dbuat DM tipe-2 dibandingkan dengan kelompok DM tanpa perlakuan dan kelompok kontrol dengan melihat perubahan massa otot gastroknemius yang ditinjau dengan menimbang massa otot gastrocnemius yang didekapitasi. Ekspresi KLF15 dianalisis menggunakan qRT-PCR dan p62 menggunakan western blot. Hasil data statistik menunjukkan bahwa tidak ada perbedaan signifikan pada peningkatan massa otot, tidak ada perbedaan signifikan pada peningkatan ekspresi relatif KLF15 dan tidak ada perbedaan signifikan pada penurunan p62 pada perlakuan HIIT terhadap DM tipe-2.

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Type-2 Diabetes Mellitus (Type-2 DM) is a disorder characterized by insulin resistance. One of the risk factors for type-2 DM in skeletal muscle is a decrease in skeletal muscle mass caused by excessive degradation of muscle protein. Skeletal muscle degradation pathway is regulated by 2 systems namely ubiquitin proteosome and autophagy. There is a transcription factor in the proteosome ubiquitin, namely KLF15. Whereas in autophagy there is P62 as a multifunctional protein. In DM conditions, the role of these 2 biomarkers is not fully understood in regulating muscle degradation. At this time, there is an intervention that is popular and proven effective for skeletal muscle homeostasis, namely High Intensity Interval Training (HIIT). This type of exercise combines high-intensity exercise with intermittent rest periods. The effect of HIIT on DM in the degradation pathway still needs to be studied further. In this study, rats treated with HIIT for 6 weeks were given type-2 DM compared to the DM group without treatment and the control group by looking at changes in gastrocnemius muscle mass which was reviewed by weighing the mass of the decapitated gastrocnemius muscles. KLF15 expression was analyzed using qRT-PCR and p62 using western blot. The results of the statistical data showed that there was no significant difference in increasing muscle mass, there was no significant difference in increasing the relative expression of KLF15 and there was no significant difference in decreasing p62 in the HIIT treatment of type-2 DM."

"Asupan serat dalam menu harian penyandang diabetes masih rendah. Tujuan penelitian ini adalah mengetahui pengaruh penambahan serat dalam makanan selingan penyandang diabetes melitus (DM) 2 terhadap kadar glukosa darah. Penelitian ini merupakan studi eksperimental dengan desain menyilang alokasi acak pada 7 laki-laki dan 13 perempuan di Klinik Dokter Keluarga Kayu Putih Jakarta. Subyek penelitian dibagi dalam dua kelompok: kelompok kontrol mendapat anjuran diet DM dan kelompok perlakuan mendapat anjuran diet DM dan pemberian makanan selingan yang mengandung serat 6 gram/hari selama 3 minggu. Pemeriksaan kadar glukosa darah puasa dan 2 jam postprandial dilakukan pada awal dan akhir perlakuan. Status gizi obes didapatkan pada 55% subyek. Sebagian besar subyek tidak mematuhi anjuran diet DM: asupan lemak tinggi sedangkan asupan serat 7,0–13,7 g/hari. Pada awal penelitian, kadar glukosa darah puasa dan 2 jam postprandial serum kedua kelompok perlakuan tidak berbeda bermakna. Setelah periode perlakuan, perubahan kadar glukosa darah tidak bermakna, namun terlihat cenderung menurun pada kelompok perlakuan. Kesimpulan: pada penyandang DM tipe 2, pemberian makanan selingan yang mengandung serat 6 gram selama 3 minggu tidak menurunkan kadar glukosa darah puasa dan 2 jam postprandial serum.

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Fiber intake in the daily menu of diabetes patients was observed to be lower than recommendation. The aim of this study was to evaluate the effect of fiber supplementation as snack on blood glucose levels in type 2 diabetic subjects. This randomized, cross-over controlled clinical trial involved 7 men and 13 women, who visited to Family Doctor Clinic Kayu Putih in Jakarta. Subjects were assigned into two groups: control group who got diabetic diet recommendation, while treatment group got diabetic diet recommendation and snack containing 6 grams fiber/day for three weeks. Fasting blood glucose (FBG) and 2 hours postprandial blood glucose (PPBG) levels were assessed before and after intervention. Fifty five percent of the subjects were obese. Majority of subjects could not comply with diabetic regiment: high in fat, while fiber intakes was around 7.0–13.7 g/day. At baseline, FBG and PPBG levels were comparable. After intervention period, blood glucose level did not changed significantly, but tend to decrease in the treatment group. In conclusion: snack containing 6 grams of fiber for three weeks did not decrease FBG and PPBG of type 2 diabetic subjects."

"Asupan serat pada penyandang DM tipe 2 maupun orang sehat di Indonesia rendah, meskipun berbagai penelitian membuktikan bahwa serat bermanfaat dalam memperbaiki profil lipid. Uji klinis acak menyilang ini bertujuan mengetahui pengaruh penambahan serat makanan terhadap profil lipid penyandang DM tipe 2 usia 20−64 tahun, dengan kadar serum kolesterol total >150 mg/dL, atau kolesterol LDL >100 mg/dL, atau kadar HDL < 45 mg/dL, atau trigliserida >150 mg/dL. Setiap subyek penelitian menjalani dua macam perlakuan diet selama 3 minggu, dengan wash out selama 1 minggu: diet DM sesuai rekomendasi PERKENI dengan makanan selingan berserat 5,88 g/hari. Dilakukan wawancara karakteristik demografi, pengukuran tinggi dan berat badan, penilaian asupan zat gizi dengan metode food record 3 x 24 jam serta pemeriksaan profil lipid sebelum dan setelah perlakuan. Rentang usia subyek penelitian 47-61 tahun, sebagian besar subyek adalah perempuan, dan tingkat pendidikan rendah, serta tingkat aktivitas fisik ringan, dengan status gizi obes I sebanyak 66%. Subyek dapat mengonsumsi makanan selingan berserat sebanyak 90% dari anjuran. Makanan selingan berserat dapat ditoleransi dengan baik, tanpa ada keluhan yang berarti. Sebagian besar subyek penelitian tidak dapat mengikuti anjuran diet DM nya, terutama dalam hal asupan protein, lemak, dan serat. Terlihat penurunan yang bermakna pada kadar serum kolesterol total (p=0,03) dan trigliserida (p=0,04) setelah konsumsi makanan selingan berserat. Kesimpulan: diet DM dengan konsumsi serat sebagai makanan selingan sebesar 5,88 g/hari menurunkan kadar serum kolesterol total dan trigliserida serum dibandingkan dengan diet DM pada penyandang DM tipe 2. Penelitian lanjutan dianjurkan dengan menambah serat dalam makanan selingan.

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Dietary fiber intake of type 2 Diabetes Mellitus (T2DM) patients and general Indonesian population were lower than recommendation, despite proven beneficial effect of dietary fiber on serum lipid profile. This randomized cross-over clinical trial aims to investigate the effect of 5,88 g/day fiber snack supplementation for 3 weeks on serum lipid profile among 20−64 years old T2DM patients with either serum concentration cholesterol total >150 mg/dL, cholesterol LDL >100 mg/dL, cholesterol HDL <45 mg/dL, or triglyceride >150 mg/dL.

Every subject underwent two treatments for 3 weeks with 1 week wash out: 5.88 g/day dietary fiber in snack bars integrated in diabetic diet recommended by Indonesian Diabetic Association (PERKENI). Assessments of sociodemographic, body height and weight, dietary intake using food record 3x24 hours method during study period, and lipid profile before and after intervention were performed.

Subjects age ranged 47-61 years, majority was female, low educational level, sedentary physical activity, and 66% obese. Subjects managed to consume 90% of the dietary fiber snack bars, without experiencing any side effects. Majority of subjects could not follow their diabetic dietary regimen, especially consumption of protein, fat and fiber. There were significant decreases total cholesterol (p=0.03) and triglyceride (p=0.04) serum concentrations after consumption of dietary fiber in snack bars.

Conclusion : diabetic diet with 5.88 g/day fiber snack decreases total cholesterol and triglyceride serum concentrations compared to diabetic diet alone in patients with T2DM. Further study to increase the amount of fiber in snack is proposed."

"Obat antidiabetes yang paling banyak diresepkan di Puskesmas Indonesia adalah metformin atau kombinasi metformin dan sulfonilurea. Studi tentang metformin telah menunjukkan berbagai dampak penurunan kognitif pada pasien dengan diabetes mellitus tipe 2, sedangkan sulfonilurea telah terbukti mengurangi dampak ini. Penelitian ini bertujuan untuk membandingkan dampak metformin dan metformin-sulfonilurea pada fungsi kognitif dan menentukan faktor apa yang mempengaruhinya. Studi potong lintang ini dilakukan di Puskesmas Pasar Minggu dengan melibatkan 142 pasien diabetes melitus tipe 2 yang mengonsumsi metformin atau metformin-sulfonilurea selama >6 bulan dan usia >36 tahun. Fungsi kognitif dinilai menggunakan kuesioner Montreal Cognitive Assessment versi bahasa Indonesia. Efek dari metformin dan metformin-sulfonylurea pada penurunan kognitif tidak menunjukkan perbedaan yang signifikan, bahkan setelah mengontrol kovariat (aOR = 1,096; 95% CI =  13.008px;">0,523–2,297; nilai-p = 0,808). Analisis multivariat menunjukkan usia (OR = 4,131; 95% CI = 1,271–13,428; nilai-p = 0,018) dan pendidikan (OR = 2,746; 95% CI = 1.196–6.305; nilai-p = 0,017) mempengaruhi fungsi kognitif. Pendidikan yang lebih rendah dan usia yang lebih tua cenderung menyebabkan penurunan kognitif, tenaga kesehatan didorong untuk bekerja sama dengan ahli kesehatan masyarakat untuk mengatasi faktor risiko fungsi kognitif ini.

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The most prescribed antidiabetic drugs in Indonesian primary health care are metformin or a combination of metformin and sulfonylurea. Studies on metformin have shown various impacts on cognitive decline in patients with type 2 diabetes mellitus, whereas sulfonylurea has been shown to reduce this impact. This study aimed to compare the impacts of metformin and metformin-sulfonylurea on cognitive function and determine what factors affected it. This crosssectional study was conducted at Pasar Minggu Primary Health Care involving 142 type 2 diabetes mellitus patients taking metformin or metformin-sulfonylurea for >6 months and aged >36 years. Cognitive function was assessed using the validated Montreal Cognitive Assessment Indonesian version. The effects of metformin and metformin-sulfonylurea on cognitive decline showed no significant difference, even after controlling for covariates (aOR = 1.096; 95% CI = 0.523–2.297; p-value = 0.808). Multivariate analysis showed age (OR = 4.131; 95% CI = 1.271–13.428; p-value = 0.018) and education (OR = 2.746; 95% CI = 1.196–6.305; p-value = 0.017) affected cognitive function. Since a lower education and older age are likely to cause cognitive decline, health professionals are encouraged to work with public health experts to address these risk factors for cognitive function."

"ABSTRAKProgram latihan untuk penatalaksanaan Diabetes Melitus DM tipe 2 harus dipastikan aspek keamanannya, selain juga efektif dan bermanfaat. Melalui penelitian dua tahap dilakukan perancangan latihan fisik yang dievaluasi dengan randomized controlled trial RCT .Program latihan 12 minggu mengombinasikan high intensity interval training HIIT dan latihan beban tiga dan dua kali per minggu dengan peningkatan intensitas bertahap. HIIT terdiri atas perbandingan 1 : 4 menit high intensity exercise HIE dan low intensity exercise LIE . Latihan beban terdiri atas sembilan latihan untuk batang tubuh, ekstremitas atas, dan bawah. RCT diikuti 42 penyandang DM tipe 2 berusia 35 ndash;64 tahun, yang dialokasikan menjadi kelompok eksperimen dengan latihan sesuai rancangan dan kelompok kontrol dengan continuous cardiorespiratory training. Pemeriksaan tingkat kebugaran VO2max , kontrol glikemik HbA1c , dan stres oksidatif MDA dan SOD dilakukan di awal dan akhir program.Pasca latihan didapatkan nilai rerata VO2max kelompok eksperimen 38,13 5,93 mL/kg.min lebih tinggi dibandingkan kontrol 32,09 5,24 mL/kg.min , p = 0,004, serta stres oksidatif menurun MDA eksperimen ? -0,14 0,39 nmol/mL dibandingkan kontrol ? 0,18 0,26 nmol/mL , p = 0,011; SOD eksperimen median ? 0,47 U/mL IQR 0,08-0,74 U/mL dibandingkan kontrol ? 0,14 0,35 U/mL , p = 0,036 . HbA1c kelompok eksperimen menunjukkan penurunan ? -0.43 1.01 , namun tidak bermakna. Skor komposit efek latihan lebih tinggi pada kelompok eksperimen 8,72 1,27 dibandingkan kontrol 7,20 1,08 , p = 0,001.Dengan demikian disimpulkan bahwa program latihan pada penelitian ini memberi manfaat dan dapat diimplementasikan dengan aman. Kata kunci: HIIT dan latihan beban; program latihan berbasis pasien; stres oksidatif; T2DM

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ABSTRACTExercise programs for patients with Type 2 Diabetes Mellitus T2DM must be demonstrably safe, effective, and beneficial. Objectives. In this two-step study, a training program was designed and implemented in a randomized controlled trial RCT to meet the above criteria.The 12-week exercise program combined high intensity interval training HIIT three times per week and resistance training twice weekly , with gradually increased intensity. The HIIT element comprised 1 minute of high intensity exercise HIE and 4 minutes of low intensity exercise LIE . The resistance training element comprised nine exercises for core, upper, and lower extremities. The 42 T2DM patients who participated in the RCT were aged 35 ndash;64 years. Participants were randomly allocated to the experimental EXP group for the new training program and to the control KTR group for continuous cardiorespiratory training. Fitness level VO2max , glycemic control HbA1c , and oxidative stress MDA and SOD were measured before and after the exercise program.VO2max was higher in EXP 38.13 5.93 mL/kg.min than in KTR 32.09 5.24 mL/kg.min; p = 0.004 . Overall oxidative stress decreased in EXP MDA EXP ? -0.14 0.39 nmol/mL as compared to KTR ? 0.18 0.26 nmol/mL; p = 0.011 and SOD EXP median ? 0.47 U/mL IQR 0.08-0.74 U/mL as compared to KTR ? 0.14 0.35 U/mL; p = 0.036 . EXP HbA1c also decreased, although not significantly ? -0.43 1.01 . EXP composite effects score was significantly higher 8.72 1.27 than for KTR 7.20 1.08; p = 0.001 .The exercise program for T2DM patients was shown to be safe, with significant benefits.Keywords: glycemic control; HIIT and resistance training; oxidative stress; patient-based training program; physical fitness; T2DM"

"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."

"Diabetes mellitus tipe 2 adalah penyakit kronis dimana tubuh tidak bisa menggunakan insulin untuk metabolisme glukosa. Penyakit ini terus menerus bertambah setiap tahun baik pada masyarakat perkotaan maupun pedesaan. Disayangkan, penyakit diabetes mellitus tidak dapat disembuhkan, hanya bisa dikendalikan.Penelitian ini bertujuan mengetahui faktor dominan terhadap kejadian pre DM dan DM tipe 2 pada Staf Kependidikan FKM UI, Depok. Variabel independen yang diteliti adalah umur, jenis kelamin, riwayat keluarga, asupan zat gizi (energi, karbohidrat, lemak, dan serat), aktivitas fisik, status gizi lebih, lingkar pinggang, dan pengetahuan gizi. Desain studi penelitian yaitu cross sectional dengan analisis chi square. Penelitian dilakukan pada 122 responden dan pada bulan April 2014.Hasil penelitian menunjukkan 26,2% penderita pre DMDM (Pre DM (17,2%) dan DM (9%)). Variabel yang memiliki perbedaan proporsi yang bermakna dengan kejadian pre DM-DM adalah umur. Faktor dominan adalah riwayat keluarga dan umur. Staf kependidikan FKM UI diharapkan meningkatkan kesadaran untuk melakukan pola hidup sehat baik makan-makanan seimbang maupun olahraga rutin, dan melakukan pengecekan glukosa darah.

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Diabetes mellitus type 2 is a chronic disease which the body can not use insulin for glucose metabolism. The disease is constantly increasing every year both in urban and rural communities. Unfortunately, diabetes mellitus can not be cured, only controlled.

This study aims to determine the dominant factor on the incidence of pre-diabetes and type 2 diabetes mellitus in Education Staff at FKM UI, Depok. The independent variables studied were age, sex, family history, the adequacy of nutrients (energy, carbohydrates, fats, and fiber), physical activity, BMI, waist circumference, and nutrition knowledge. The study design is a crosssectional study with a chi-square analysis. The study was conducted on 122 respondents, on April 7 to 25, 2014.

Results showed 26.2% of patients with pre-DM - DM (Pre DM (17.2%) and DM (9%)). Variables that had significant differences in the proportion of the incidence of pre-DM and DM is age. Dominant factor is family history ang age. Education Staff at FKM UI is expected to raise awareness for do healthy lifestyle such as eat balanc meals and exercise regularly, and do a blood sugar check."

"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."