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"Introduction: Diabetes mellitus can cause various complications, including diabetic foot ulcers (DFU). Vitamin D levels are known to be correlated with wound healing and insulin resistance. Method: This cross-sectional study aimed to determine the correlation between the 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 was examined using the chemiluminescent immunoassay method. The correlation between these two variables was analyzed. Results: 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. A significant correlation was found between the serum level of vitamin D and the severity of DFU (r= -0.901, p <0.001)."

"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."

"Penelitian ini bertujuan untuk mengetahui hubungan antara profil lipid darah dengan derajat retinopati diabetik penderita DM tipe-2. Penelitian potong-lintang pada 52 pasien retinopati diabetika dilaksanakan di Poliklinik Mata, Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dikumpulkan meliputi data demografi, gaya hidup, lama menderita DM, pemeriksaan fisik dan antropometrik, asupan lemak, asam lemak dan kolesterol data kadar gula darah puasa, A1C, kolesterol total, kolesterol-LDL, kolesterol-HDL and trigliserida, dan pemeriksaan fundus. Analisis statistik yang digunakan adalah uji chi-square untuk mengetahui hubungan antara profil lipid darah dengan derajat retinopati diabetik. Subyek terdiri dari 20 orang laki-laki dan 32 orang perempuan dengan rerata usia 53,8 ± 5,2 tahun. Sebanyak 53,8% telah didiagnosis DM selama >10 tahun, dengan rerata IMT adalah 24,1 ± 3,3 kg/m2 dan 38,5% diklasifikasikan sebagai obes I dan II. Rerata kadar gula darah puasa 157,5 ± 71,8 mg/dL, dan A1C 9,1 ± 2,4 %. Sebanyak 40,4% subyek mempunyai kadar kolesterol total darah tinggi, 34,6% kadar kolesterol-LDL darah sangat tinggi, dan 65,4% dengan kolesterol-HDL dan trigliserida darah normal. Derajat keparahan retinopati diabetika ditunjukkan dengan adanya 61,6% subyek dengan retinopati diabetika non-proliferasi berat (NPDR) and retinopati diabetika proliferasi (PDR). Kesimpulannya, belum dapat dibuktikan adanya hubungan yang bermakna antara profil lipid dengan derajat retinopati diabetika.

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This study aimed to determine the relationship between plasma lipid profile and the severity of diabetic retinopathy in type 2 diabetes patients. A cross sectional study was done in Ophthalmologic Clinic, Cipto Mangunkusumo General Hospital, Jakarta for 52 diabetic retinopathy (DR) patients. Data collected were demographic, life style, duration of diabetes, physical and antropometric examinations, fat, fatty acid and cholesterol intake, fasting plasma glucose, A1C, total-, LDL-, HDL-cholesterol and triglyceride level, and fundus examination.

Statistical analysis was done using chi-square test to see the associations between plasma lipid profile and DR in type 2 diabetes patients. Subjects comprised of 20 males and 32 females diabetes patients with mean age of 53.8 ± 5.2 years. As much as 53.8% had been diagnosed as DM for >10 years. The mean value of BMI was 24.1 ± 3.3 kg/m2 and 38.5% were classified as obese I and II. The mean value of fasting plasma glucose was 157.5 ± 71.8 mg/dL, and A1C was 9.1 ± 2.4 %.

For lipid profile, 40.4% had high total cholesterol level (>240 mg/dL), 34.6% had high and very high LDL-cholesterol level (≥160 mg/dL), and 65.4% had normal HDL-cholesterol (40-60 mg/dL) and triglyceride level (<150 mg/dL). For the severity of retinopathy, 61.6% had severe non-proliferative diabetic retinopahy (NPDR) and proliferative diabetic retinopahy (PDR). In conclusion, there were no significant associations between plasma lipid profile and the severity of diabetic retinopathy."

"Introduction: Diabetic foot ulcer is one of the most severe complications in a patient with diabetes mellitus because it will lead to with amputation, which results in disability and death. Doppler ultrasound is an easily available and non-invasive modality for evaluating lower limb arteries and can detect the severity of blood flow disorders or peripheral arterial disease (PAD). WHO recommends the classification of perfusion, extent/size, depth/tissue loss, infection, and sensation (PEDIS) as a tool for establishing the diagnosis and helping determine the management of diabetic foot. This study aims to see the correlation of PEDIS scores in assessing impaired lower limb arterial flow with Doppler ultrasound in patients with diabetic foot ulcers. Method: This was a cross-sectional study with subjects who has diabetic foot ulcer treated in the Division of Vascular and Endovascular Surgery, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data of PEDIS scores and spectral ultrasound in the femoral artery, popliteal artery, dorsalis pedis artery, and posterior tibial artery were taken. Results: As many as 81 subjects participated in this study, with 52 people (64%) were male, 29 people (36%) were female, and an average age of 59.8 ± 10.5 years. Pedis cut-off scores were obtained using ROC (receiver operating characteristic) curves, with popliteal arteries scores of >10, dorsalis pedis arteries, and posterior tibial arteries scores of >8 had the best values as diagnostic tools compared to USG as reference standards."

"Ulkus diabetikum merupakan komplikasi Diabetes Mellitus yang membutuhkan perawatan baik dan sesuai agar luka tidak semakin memburuk. Tujuan dari penelitian ini adalah untuk melihat hubungan antara instrument skala Wagner dan instrument BWAT pada pasien dengan ulkus diabetikum. Desain penelitian yang digunakan pada penelitian ini adalah potong lintang dengan bentuk penelitian deskriptif korelasi menggunakan sampel sebanyak 120responden yang terdiri dari grade 1 sampai dengan grade 5. Instrumen yang digunakan pada penelitian ini adalah skala Wagner dan Bates-Jensen Wound Assessment Tool (BWAT) untuk mengukur tingkat keparahan luka pada pasien ulkus diabetikum. Hasil penelitian didapatkan adanya hubungan yang sangat kuat antara instrumen skala Wagner dan BWAT dalam penilaian luka ulkus diabetikum dengan (r = 0,951; p = 0,0005). Berdasarkan hasil penelitian yang telah dilakukan, peneliti merekomendasikan instrumen Bates- Jensen Wound Assessment Tool menjadi instrumen yang lebih tepat untuk digunakan sebagai alat untuk mengevaluasi skala penyembuhan luka ulkus diabetikum karena memiliki karakteristik penilaian yang lebih rinci.

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Diabetic ulcer is a serious complication of Diabetes Mellitus that requires a good and appropriate treatment to prevent the worsening condition of the wound. The study aimed to identify the correlation between Wagner Scale and BWAT in measuring the wound grade. Design of this study was cross-sectional descriptive, involving 120 observers with diabetic ulcer varying from grade 1 to grade 5. The instruments used in this study were the scale of Wagner and Bates-Jensen Wound Assessment Tool (BWAT) whichwere used to measure the severity of injuries in the diabetic ulcer patients. The result showed a very strong correlation between Wagner and BWAT scale instrument to assess (r = 0.951; p = 0.0005). The study strongly suggested to use of Bates-Jensen Wound Assessment Tool to evaluate the scale of wound healing for diabetic ulcers since it has more detail assessment characteristics than Wagner scale."

"Komplikasi ulkus diabetikum pedis (UDP) terjadi pada 15% pasien DM tipe 2. Seluruh kasus UDP dalam serial kasus ini diawali oleh trauma pedis sehingga menyebabkan luka yang tidak menyembuh disertai demam, kelemahan tubuh, mual, anoreksia, dengan atau tanpa disertai gejala klasik DM. Suatu uji klnis mendapatkan sebanyak 69% penderita DM dengan komplikasi UDP menderita malnutrisi. Tata laksana nutrisi pada serial kasus ini adalah pemberian nutrisi optimal, meliputi makronutrien, mikronutrien, dan nutrien spesifik sesuai kebutuhan untuk memperbaiki dan mencegah malnutrisi, komplikasi lainnya, dan kekambuhan serta mendukung penyembuhan ulkus.Rentang usia pasien pada serial kasus ini adalah 52–70 tahun. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict. Kebutuhan energi total didapat dari perkalian kebutuhan energi basal dengan faktor stres. Pemberian nutrisi dilakukan bertahap sesuai toleransi sampai mencapai kebutuhan total.Makronutrien diberikan dengan komposisi sesuai dengan keadaan pasien.Pemberian protein sesuai dengan fungsi ginjal, pembatasan asam lemak jenuh dan kolesterol, karbohidrat terutama jenis kompleks, dan cukup serat.Garam diberikan sesuai tekanan darah.Diusulkan pemberian mikronutrien berupa vitamin dan mineral sesuai Angka Kecukupan Gizi (AKG) serta nutrien spesifik asam lemak omega-3.Pemantauan dilakukan terhadap perkembangan klinis, toleransi asupan makanan, kapasitas fungsional, status ulkus, laboratorium, dan antropometri.Seluruh pasien membutuhkan insulin dengan dosis yang terus meningkat untuk menjaga kadar glukosa darah dan mengalami penurunan berat badan, namun kebutuhan energi total dapat tercapai, luka membaik dan kapasitas fungsional meningkat. Tata laksana nutrisi yang diberikan harus bersifat individual disesuaikan dengan keadaan umum dan klinis pasien.Edukasi nutrisi selama dan pasca rawat penting diberikan dalam meningkatkan motivasi pasien menjalankan diet yang benar untuk menjaga status gizi. Status gizi dan kontrol glikemik yang baik penting dalam penyembuhan luka, mencegah kekambuhan dan timbulnya komplikasi diabetes melitus yang lain.

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Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals. All patients had pedal trauma as an initiation of their non-healing wounds which were then developed to form ulcers. The ulcers presented with febrile, lethargy, nausea, anorexia, with or without diabetes mellitus classical symptoms. A clinical trial found 69% patients of this disease were malnourished. The goal of medical nutrition therapy on type 2 diabetes mellitus with diabetic foot ulcer is to provide the patients with appropriate nutrition containing macronutrient, micronutrient, and specific nutrient according to the requirement, to reverese and prevent malnutrition, other complications and recurrence, and support the wound healing.

Patient’s age range in this case series was 52–70 years old. Basal energy requirements calculated using Harris-Benedict equation and multiplyit by stress factor for the total energy requirements. Diets were gradually given according patient’s tolerance until total energy requirements were achieved.Macronutrients composition were given according to patient’s condition, with protein adjusted to renal function, limiting saturated fat and cholesterol, complex carbohydrate, sufficient fiber and sodium given according to blood pressure. Micronutrient recommendation was vitamin and mineral sejumlah as much as Recommended Dietary Allowance (RDA) and omega-3 fatty acid. Monitoring was done at clinical status, nutrition intake and tolerance, functional capacity, wound/ulcer status, laboratory and anthropometric assessment.

All patients needed increasing dose of insulin in maintainingglucose control and experienced mild weight loss, total energy requirements were achieved by all patients. Patient’s functional capacities were increased, and had improvement wound status. Nutrition therapy for patients should be given individuallyaccording to general and clinical condition. Nutrition education and motivation during and after hospitalization are important part of this disease’s management to keep the patient’s compliance on nutrition intake as recommended to maintain good nutritional status and glycemic control, prevent other complications and re-ulceration."

"Latar Belakang : Pasien Non-Proliferative Diabetic Retinopathy (NPDR), Proliferative Diabetic Retinopathy (PDR) dengan neuropati kornea akan mengalami terganggunya stabilitas air mata. Penurunan sekresi dan konsituen air mata akan menyebabkan gangguan berupa mata kering. Pada pasien Diabetes dengan retinopati diabetik, gangguan kornea ini berpotensi lebih memperburuk gangguan penglihatan yang terjadi. Tujuan : Menilai stabilitas air mata pada pasien NPDR, PDR dengan neuropati kornea sebelum, sesudah diberikan tetes mata Sodium hyaluronat+Vitamin A,E (HA+Vit A,E) atau Sodium Hyaluronat saja (HA). Metodologi : Penelitian ini merupakan uji eksperimental randomisasi acak terkontrol, dengan dua kelompok utama (NPDR, PDR), kedua kelompok mendapatkan tetes mata HA+Vit A,E atau HA selama 28 hari. Sensitivitas kornea, Skoring Ocular Surface Disease Index (OSDI), Non-Invasive Break Up Time (NIBUT), Schirmer I, jumlah sel goblet konjungtiva dinilai pada 0, 2, 4 minggu. Hasil : 96 subyek berpartisipasi, 65.6% wanita, 34.4% laki-laki (rerata usia 54.4 tahun). Skor OSDI memperlihatkan perbaikan signifikan, nilai terbesar pada kelompok PDR HA+Vit A,E dengan -4.86±5.76 (P= 0.000), NIBUT memperlihatkan perbaikan signifikan, nilai terbesar pada kelompok NPDR HA dengan 4.79±2.63 (P= 0.000), Schirmer I memperlihatkan perbaikan signifikan, hasil terbesar pada kelompok NPDR HA dengan 2.41±2.35 (P= 0.000). Sitologi impressi konjungtiva memperlihatkan perbaikan signifikan, terutama pada kelompok NPDR HA+Vit A,E (66% perbaikan). Seluruh kelompok memperlihatkan perbaikan signifikan, tetapi perbaikan antar kelompok tidak bermakna. Kesimpulan : Parameter seluruh kelompok memperlihatkan perbaikan yang signifikan setelah diberikan tetes mata HA+Vit A,E maupun HA saja, Tetapi jika dibandingkan antar kelompok, tidak terdapat perbedaan perbaikan yang signifikan.

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Background : Patient with Non-Proliferative Diabetic Retinopathy (NPDR), Proliferative Diabetic Retinopathy (PDR) with corneal neuropathy will experiencing disruption in tear film stability. Decrease in tear film secretion and constituent will cause dry eyes. In Diabetic patients with diabetic retinopathy, this corneal disorder has the potential to further worsen visual impairment.

Purpose : To Assess tear film stability in NPDR, PDR patients with corneal neuropathy before, after treatment with topical Sodium hyaluronat+Vitamin A,E (HA+Vit A,E) or Sodium Hyaluronat only (HA).

Method : This study was a double blind experimental randomized control trial with two parallel groups (NPDR, PDR), both group receives HA+Vit A,E or HA for 28 days. Corneal sensitivity, Ocular Surface Disease Index (OSDI), Non-Invasive Break Up Time (NIBUT), Schirmer I, conjungtival goblet cells will be assessed on 0, 2, 4 weeks.

Result : 96 subjects participated, 65.6% female, 34.4% male, mean age 54.4 years old. OSDI score shows significant improvement, highest improvement seen on PDR HA+Vit A,E with -4.86±5.76 (P= 0.000), NIBUT hows significant improvement, highest improvement seen on NPDR HA with 4.79±2.63 (P= 0.000), Schirmer I shows significant improvement, highest improvement seen on NPDR HA with 2.41±2.35 (P= 0.000). Conjungtival goblet cells shows significant improvement, highest improvement seen on NPDR HA+Vit A,E (66% improved). All groups shows shows significant improvement, but between groups the improvement was not statistically significant.

Conclusion : Parameters on all groups shows statistically significant improvement after topical HA+Vit A,E or HA. But, if compared between groups, the improvement was not significantly differed."

"Latar belakang: Penelitian analisis gaya jalan sebelumnya menemukan perubahan pada beberapa parameter gaya jalan populasi pengidap diabetes melitus (DM), bahkan sebelum timbulnya komplikasi seperti neuropati perifer. Sayangnya, penelitian-penelitian tersebut masih menggunakan teknologi dengan harga yang tinggi dan obtrusif. Belakangan ini alat analisis gaya jalan yang lebih terjangkau dan praktis yaitu sensor Kinect V2 sudah banyak digunakan, namun belum terdapat penelitian yang mengaplikasikan pada pengidap DM. Penelitian ini bertujuan untuk membandingkan gaya jalan antara pengidap DM dewasa dengan orang dewasa tanpa DM menggunakan sensor Kinect V2. Metode: Penelitian ini melibatkan 10 orang dewasa tanpa DM dan 10 pasien DM. Subjek diminta mengisi kuesioner pendataan, lalu diminta berjalan sebanyak lima kali di hadapan sensor Kinect. Data yang didapat diuji konsistensi antar repetisi, lalu komponen gaya jalan berupa panjang langkah, waktu langkah, panjang stride, waktu stride, dan kecepatan langkah diambil dari setiap pengulangan. Uji T antar kedua populasi subjek dilakukan untuk mengetahui apakah ada perbedaan gaya jalan di antara orang dewasa tanpa DM dan pasien DM. Hasil: Kelima repetisi setiap subjek konsisten. Rerata komponen jalan pada pasien DM cenderung menurun, kecuali pada waktu stride. Terdapat perbedaan signifikan (p<0,05) antara kedua populasi pada panjang langkah dan stride serta kecepatan langkah. Kesimpulan: Hasil ini sesuai dengan penelitian sebelumnya yang menggunakan alat analisis gaya jalan pada pasien DM. Sensor Kinect sebagai alat analisis gaya jalan pada pasien DM, namun masih diperlukan penelitian lebih lanjut.

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Introduction: Prior studies has discovered that some aspects of gait parameters can be altered in patients with diabetes mellitus (DM), even before development of complications such as peripheral neuropathy. However, the studies used high-cost and obtrusive gait analysis tools. Recently, use of a more affordable and practical gait analysis tool, the Kinect V2 sensor, has been increasing but currently there are still no studies using Kinect V2 to analyze gait in DM patients. This study aims to compare gait parameters between adults without DM and adult DM patients using the Kinect V2 sensor. Method: This study compared 10 adults without DM and 10 adult DM patients as subjects. Their demographic data were collected with a questionnaire, while gait parameters were collected recording the subjects walking in front of the Kinect sensor for five repetitions. Inter-repetition consistency is analyzed using ANOVA, then the gait parameters (step length, step time, stride length, stride time, and gait velocity) were extracted from each repetition. Two-sample independent t-test was performed on the data between the two populations to determine the significant changes of gait parameters. Result: All five repetitions from all subjects were consistent. Adult DM patients has lower magnitude of gait parameters except for stride time. Significant differences (p<0,05) were found between populations on step length, stride length, and gait velocity. Conclusion: The results were in accordance with previous gait studies involving DM patients. Kinect is prospective to be a prospective tool to analyze gait parameters in DM patients. However, larger scale studies are still required."

"Ulkus diabetik merupakan komplikasi dari diabetes melitus, lama sembuh dan terjadi berulang sehingga mempengaruhi kualitas hidup penderita. Penelitian ini bertujuan mengidentifikasi hubungan antara tingkat depresi dengan kualitas hidup pasien ulkus diabetes. Desain penelitian ini adalah deskriptif korelasi dengan pendekatan cross-sectional. Pemilihan sampel dengan cara purposive sampling yang melibatkan 30 responden. Hasilnya menunjukkan adanya hubungan yang signifikan antara nilai depresi dengan kualitas hidup dengan p-value 0,000. Hasil penelitian ini diharapkan merekomendasikan program pencegahan dan penanganan depresi pada pasien dengan ulkus diabetik.

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Diabetic ulcers is complications of diabetes mellitus, delayed healing and repeated that affect the quality of life patients. The purpose of this study was to identify the relationship between depression and quality of life patients with diabetic ulcer. The design of this study is a descriptive correlation cross-sectional approach. The selection of samples were done in purposive sampling method and involved 30 respondents. The result are a significant correlation value depression with quality of life with p-value 0,000. The results of this study are expected to recommendation a program of prevention and treatment of depression patients with diabetic ulcers."

"Diabetes mellitus adalah penyakit kronik yang banyak terjadi di perkotaan. Komplikasi yang dapat terjadi pada penderita DM jika tidak teratur mengontrol kadar gula darahnya adalah ulserasi diabetikum. Pasien ulserasi diabetikum mengalami kerusakan integritas kulit dan diperlukan penatalaksanaan luka dengan segera untuk mencegah amputasi. Perawatan luka yang dapat dilakukan adalah operasi debridement kemudian luka dibalut dengan balutan yang lembab. Hasil dari analisis ini adalah diperlukan pula manajemen diabetes yang ketat untuk membantu mengatasi luka ulserasi diabetikum. Rekomendasi penulisan ini adalah perlu adanya pendidikan kesehatan kepada setiap pasien ulserasi diabetikum tentang manajemen diabetes.

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Diabetes mellitus is a chronic disease that commonly happens in urban community. Complication that could happen if blood glucose is uncontrolled is ulcers diabetic foot. Patients with ulcers diabetic foot experience impaired skin integrity and need wound care as soon as possible to prevent amputation. The wound care which we can do is debridement operation, and then wraps the wound with a moist bandage. The result of this analysis is also needed a strict diabetes management to help overcome the ulcers diabetic foot. Recommendation of this writing is that health education is necessary to every patient of ulcers diabetic foot about diabetes management."