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"The prevalence of coronary heart disease in the adult population with diabetes mellitus (DM) is far greater (55%) than in the general public (2-4%). There is an acknowledged correlation between type I hidden ischemia and the incidence of myocardiac infarct. There needs to be a way to determine the presence or absence of ischemia. An alternative examination method is the Dobutamine Stress Echocardiography (DSE).This study was conducted at the Metabolic-Endocrine and the Cardiology Out-Patient Clinics of the Department of Internal Medicine ofCipto Mangunkusumo Central Public General Hospital, Jakarta, from February to August 2001.The aim of the study is to detect undetected myocardiac ischemia using the electrocardiography among patients with type 2 diabetes mellitus and podiatric abnormality and testing the correlation between certain factors (sex, age, body mass index, lipid profile, fasting blood glucose, post prandial blood glucose, HbAlc, peripheral vascular disease, smoking, retinopathy, and neuropathy) with myocardiac ischemia.Methodology: The study was designed as a comparative study of the incidence of myocardiac ischemia between type 2 diabetes mellitus patients with and without podiatric abnormalities. The sample consisted of 28 patients. Samples underwent the dobutamine stress echocardiographyResults: dobutamine stress echocardiography examination using Apogee on 14 patients with type 2 diabetes mellitus with podiatric abnormality demonstrated a positive ischemic response in 4 people (28.6%). No positive findings were found in type 2 diabetes mellitus patients without podiatric abnormality.Conclusion: 1. DSE could detect myocardiac ischemia in 28.6% of type 2 diabetes mellitus undetected with electrocardiography. 2. Other factors that influenced a positive dobutamine stress echocardiography were autonomic neuropathy, diabetic retinopathy, the duration of diabetes mellitus, fasting blood glucose, and podiatric abnormality."

"The aim of this study was to investigate the increase in neutrophil count and the decrease in both phagocytosis and neutrophil oxidative burst (formation of radical oxygen) among type 2 diabetes mellitus (DM) patients and the normal range of phagocytosis function and oxidative burst in neutrophil from Non-DM control subjects. The aim of this study is also to investigate the factors that influence neutrophil count, phagocytosis function and neutrophil oxidative burst among type 2 diabetes mellitus (DM) patients. The examination was conducted using a flow cytometry. The study subjects were 142 type 2 DM patients and 65 Non-DM control subjects. Statistical analysis was performed using the Mann Whitney test and linear regression analysis. The results of this study indicated that there is impaired neutrophil function among type 2 DM patients. The results of this study also showed a correlation between Hemoglobin level, age, platelet count, and SGPT vs. neutrophil phagocytosis function, as well as a correlation between HDL cholesterol and (fMLP-stimulated) neutrophil oxidative burst. The study also showed a correlation between sex and stroke and (S. sureus-stimulated) neutrophil radical oxygen formation, a correlation between neutrophil count and platelet count, a correlation offibAlc and fasting blood glucose level and (fMLP-stimulated) neutrophil radical oxygen formation. In a multivariate analysis, when adjusted to age and sex, there was a correlation between triglyceride and (baseline) neutrophil radical oxygen formation and between HDL cholesterol and (fMLP-stimulated) neutrophil radical oxygen formation."

"Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients."

"Aim: The purpose of the study was to investigate the prevalence of diastolic dysfunction in patients with type II diabetes mellitus without overt cardiovascular disease, and to investigate whether its presence is associated with age, sex, onset of diabetes, glycemic control and obesity.Patient and methods: We studied 30 patients with type 2 diabetes; II were men and 19 were women; their ages ranged from 40 - 65 years; all patients had no evidence of hypertension, coronary artery disease, congestive heart failure, anatomical disease of heart, arrhythmia; and myocardiac ischemia at maximal treadmill exercise test. Diastolic dysfunction was evaluated using Doppler echocardiography.Results: Diastolic dysfunction was found in 22 subjects (73.3%) of whom 21 (70%) had abnormal relaxation and one (3.3%) had a pseudonormal pattern of ventricular filling. Systolic function was normal in all subjects, and there was no correlation between diastolic dysfunction and age, sex, onset of diabetes, glycemic control and obesity.Conclusion: Diastolic dysfunction is much more common than previously reported. The high prevalence of this phenomenon population suggests the importance of screening for diastolic dysfunction among such high-risk patients."

"Periodontal status is a periodontum condition evaluated by using plaque index, calculus index, gingival index and pocket index. The main mediator of periodontum inflammation is IL-113 examined by ELISA method. There is an evaluation of PMN s in periodontum inflammation, but the leucotoxin as well as the protease in turn lowers the PMN phagocytotic function. Phagocytotic function was measured by flowcytometry. The aim of the study was to evaluate the high risk factors of being type 2 DM. A diagnostic study was conducted by using cross-sectional design on 45 controlled DM (CDM) subjects, 45 uncontrolled DM (UCDM) subjects in the Metabolic Endocrinology Clinic Cipto Mangunkusumo Hospital Jakarta, as compared to 45 non-DM control subjects. The result of multivariate analysis showed that patients of older age (>54 years old), low periodontum status (periodontal index >1.80), high IL-113 level (>23.70 pg/mL), and low PMN phagocytotic function <<53.47%), were significantly at high risk of having DM compared to non-DM (p<0.05). Lower periodontum status showed an increase in IL-113 level, decrease PMN phagocytotic function, and consequently, an increase in the risk of being type 2 DM."

"Latar Belakang: Buruknya manajemen diabetes melitus tipe 2 menyebabkan peningkatan komplikasi dan tingginya morbiditas sehingga diperlukan adanya pendampingan pasien berkelanjutan dalam menjalankan manajemen dirinya. Stres dapat berkaitan timbal balik dengan penurunan manajemen diri. Salah satu intervensi nonfarmakologis untuk menurunkan tingkat stres dan meningkatkan manajemen diri adalah edukasi pasien dengan metode blended menggunakan web apps "diabetacare". Edukasi ini terdiri dari beberapa pendekatan pembelajaran seperti video tutorial, pemantauan diri dan konsultasi, sehingga pasien dapat belajar dan menerapkan pendidikan berkelanjutan dalam kehidupan sehari-hari. Penelitian ini bertujuan untuk menguji pengaruh edukasi blended menggunakan web apps “diabetacare” terhadap tingkat stres dan manajemen diri pasien DM tipe 2. Bahan dan Metode: Penelitian ini menggunakan pendekatan quasi eksperimental pretestposttest control group design terhadap 54 responden yang dibagi rata menjadi 2 kelompok. Program edukasi blended menggunakan web apps “Diabetacare” diberikan selama 3 minggu. Instrumen penelitian ini menggunakan DASS 21 (Depression Anxiety Stress Scale) untuk mengukur tingkat stres dan kuesioner M Tingkat stres dan manajemen diri responden telah diukur pada saat sebelum dan sesudah intervensi, kemudian dianalisis dengan uji wilcoxon dan mann-whitney. manajemen diri. Hasil: Terdapat perbedaan yang signifikan antara rata-rata skor tingkat stres dan manajemen diri antara kelompok intervensi dan kelompok kontrol sesudah diberikan intervensi (p = 0,000 dan p=0,000 ). Kesimpulan: Hasil penelitian ini menunjukkan bahwa edukasi blended menggunakan web apps “Diabetacare” berpengaruh terhadap penurunan tingkat stres dan peningkatan manajemen diri pada pasien DM tipe 2.

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Background: Poor management of type 2 diabetes mellitus causes increased complications and high morbidity, so that ongoing patient assistance is needed in carrying out self-care. Stress can be reciprocally related to decreased self-care. One non-pharmacological intervention to reduce stress levels and increase selfcare is patient education using a blended method using the "diabetacare" web app. This education consists of several learning approaches such as video tutorials, selfmonitoring and consultation, so that patients can learn and apply continuing education in their daily lives. This study aims to test the effect of blended education using the "diabetacare" web app on the stress level and self-care of type 2 DM patients. Materials and Methods: This study used a quasi-experimental Pretest- Posttest Control Group Design approach with 54 respondents who were divided equally into 2 groups . The blended educational program using the "Diabetacare" web app is provided for 3 weeks. This research instrument uses the DASS 21 (Depression Anxiety Stress Scale) to measure stress levels and a self-care questionnaire. The respondents' levels of stress and self-care were measured before and after the intervention, then analyzed using the Wilcoxon and Mann-Whitney tests. Component scores were compared between the two groups. Results: There was a significant difference between the average stress and self-care level scores between the intervention group and the control group after being given the intervention (p = 0.000 and p = 0.000). Conclusion: The results of this study show that blended education using the "diabetacare" web app has an effect on reducing stress levels and increasing self-care in type 2 DM patients."

"Kepatuhan perawatan diri diabetes berdampak positif terhadap peningkatan outcome klinis. Hasil penelitian terdahulu pada penyandang diabetes melitus tipe 2 menunjukkan kepatuhan perawatan diri yang buruk. Inovasi teknologi dapat menjadi alternatif solusi dalam mengatasi masalah ini. Penelitian bertujuan mengetahui pengaruh aplikasi berbasis web terhadap perilaku kepatuhan perawatan diri pada pasien diabetes melitus tipe 2. Penelitian ini berdesain quasi eksperimental pre-posttest dengan kelompok kontrol. Partisipan direkrut di program prolanis di klinik dan persadia. Analisis data menggunakan komputerisasi pada 56 responden. Pada analisis bivariat, terdapat peningkatan skor kepatuhan pada kelompok intervensi di akhir penelitian yang tidak bermakna (p=0,649) dan terjadi penurunan skor kepatuhan yang tidak bermakna pada kelompok kontrol (p=0,490). Tidak ada pengaruh penggunaan aplikasi terhadap perilaku diabetes (p=0,433). Pada analisis multivariat, didapatkan hubungan yang signifikan antara tingkat pendidikan (p=0,007) terhadap skor kepatuhan posttest. Aplikasi peduli diabetes berpotensi meningkatkan skor kepatuhan perawatan diri. Perbaikan desain aplikasi diharapkan dapat meningkatkan efektivitas penggunaan aplikasi.

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Diabetes self-care adherence has a positive impact on improving clinical outcomes. Observations in people with type 2 diabetes mellitus show poor self-care adherence. Technological innovation can be an alternative solution to overcome this problem. The research aims to determine the effect of web-based applications on self-care adherence behavior in type 2 diabetes mellitus patients. This research has a quasi-experimental pre-posttest design with a control group. Participants were recruited in the prolanis program at the clinic and persadia. Data analysis used computerization on 56 respondents. In bivariate analysis, there was an increase in adherence scores in the intervention group at the end of the study which was not significant (p=0.649) and a decrease in adherence scores which was not significant in the control group (p=0.490). There was no effect of application use on diabetes behavior (p=0.433). In multivariate analysis, a significant relationship was found between education level (p=0.007) and posttest adherence scores. The Peduli Diabetes application has the potential to improve self-care adherence scores. Improvements in application design are expected to increase the effectiveness of application use."

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Penyakit komorbid Diabetes Melitus (DM) yang umum dan paling sering adalah hipertensi. DM dan hipertensi terdapat secara bersamaan pada 40%-60% penderita DM tipe 2. Tujuan penelitian ini adalah untuk mengetahui unmodifiable factors dan modifiable factors pada penderita DM tipe 2 sebagai faktor risiko hipertensi. Desain penelitian ini adalah cross sectional. Sampel penelitian adalah pasien DM tipe 2 yang berobat di poli penyakit dalam RSUD dr. Chasbullah Abdulmadjid Kota Bekasi pada tanggal 30 September-19 Oktober 2019 dengan total sampel sebanyak 292 responden. Unmodifiable factors meliputi gender, umur, pendidikan, status perkawinan, lama menderita DM, hereditas DM, hereditas hipertensi dan golongan darah. Sedangkan modifiable factors terdiri dari indeks massa tubuh, pekerjaan, aktifitas fisik dan merokok. Hipertensi adalah keadaan tekanan darah sistolik ≥ 140 mm Hg dan/atau tekanan darah diastolik ≥ 90 mm Hg. Analisis data dengan Cox regression menggunakan Stata versi 15. Persentase hipertensi pada penderita DM tipe 2 adalah 46,57%. Dari analisis multivariat faktor risiko hipertensi yang signifikan untuk unmodifiable factors adalah faktor umur > 50 tahun (Pv= 0,02; PR= 1,93) dan kelompok dengan hereditas DM yang berasal dari kakek/nenek (Pv= 0,04; PR= 1,86) dan orang tua (Pv= 0,04; PR= 1,54). Sedangkan dari modifiable factors, Indeks Massa Tubuh berat badan lebih (Pv= 0,01; PR=1,81) dan obesitas (Pv=0,02; PR=1,81), merupakan faktor risiko hipertensi yang signifikan. Disarankan agar terhadap pasien DM tipe 2 terutama bila disertai dengan berat badan berlebih atupun obesitas perlu diberikan informasi lengkap tentang faktor risiko hipertensi.

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The most common Diabetes Mellitus (DM) comorbid disease is hypertension. DM and hypertension are present simultaneously in 40% -60% of people with type 2 diabetes. The purpose of this study is to know unmodifiable factors and modifiable factors of type 2 DM patients as risk factors for hypertension, The design of this study was cross sectional. The sample of study was type 2 DM patients those seeking treatment at Department of Internal Medicine-dr Chasbullah Abdulmadjid Hospital-Bekasi on September 30-October 19, 2019 with a total of 292 respondents. Unmodifiable factors include gender, age, education, marital status, duration of DM, heredity of DM, heredity of hypertension and ABO blood group. While modifiable factors consist of body mass index, occupation, physical activity and smoking. Hypertension is a state of systolic blood pressure ≥140 mm Hg and /or diastolic blood pressure ≥90 mm Hg, Data were analysed with Cox regression using Stata versi 15.The precentage of hypertension in patients with type 2 DM was 46.57%. Multivariate analysis revealed that the significant hypertension risk factors for unmodifiable factors are age > 50 years (Pv= 0,02; PR= 1,93) and DM heredity from grandfather/grandmother (Pv= 0,04; PR= 1,86) and parents (Pv= 0,04; PR= 1,54). While from modifiable factors, Body Mass Index overweight (Pv= 0,01; PR=1,81) and obesity (Pv=0,02; PR=1,81) were the significant risk factors for hypertension. It is recommended that patients of type 2 diabetes especially when accompanied by overweight or obesity need to be given complete information about risk factors for hypertension

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"ABSTRACTDepresi merupakan gangguan kejiwaan yang banyak terjadi pada pasien Diabetes Mellitus DM . Beberapa penelitian menunjukkan bahwa pasien Diabetes Mellitus Tipe 2 beresiko tinggi mengalami depresi ringan dan depresi berat. Gejala komplikasi diabetes, durasi diabetes, dan perilaku manajemen diri merupakan faktor ndash; faktor yang diduga mempengaruhi depresi pada pasien DM tipe 2. Metode analisis regresi logistik ordinal digunakan untuk menentukan faktor ndash; faktor yang paling mempengaruhi depresi dan mendeteksi tingkat depresi berdasarkan faktor ndash; faktor yang paling mempengaruhi depresi. Hasil dari penelitian ini adalah 43.6 pasien DM tipe 2 di Rumah Sakit Cipto Mangunkusumo mengalami depresi, yang terdiri dari 22.7 mengalami depresi ringan, dan 20.9 mengalami depresi berat. Depresi pada pasien DM tipe 2 di Rumah Sakit Cipto Mangunkusumo hanya dipengaruhi oleh gejala komplikasi diabetes yang tediri dari hipoglikemia, opthalmologi, dan neuropati sensorik, sehingga faktor ndash; faktor tersebut dapat digunakan untuk mendeteksi depresi.

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ABSTRACTDepression is a mental disorder that often exists within patients with diabetes mellitus. Several studies displays that the patients with type 2 diabetes mellitus has an increased risk of minor and major depression. The symptom of diabetes complications, duration diabetes, and the self management behavior are predicted to be the contributing factors that influence depression in the patient with type 2 diabetes mellitus. This research employs ordinal logistic regression method to determine the most prominent factor affecting depression and to detect the level of depression according to the said factors. The result of this research displays that depression occurs in 43.6 of the patient with type 2 diabetes mellitus in Cipto Mangunkusumo hospital, with the following breakdown 22.7 patients that suffer from minor depression and 20.9 patients suffer from major depression. Depression in the patients of Cipto Manungkusumo hospital with type 2 diabetes mellitus is only affected by the symptoms of diabetes complication which constitute of hypoglycemia, ophthalmology, and sensory neuropathy. Thus, these factors can be used to detect depression."