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Abstrak :
Latar belakang: Diabetes melitus merupakan faktor risiko penting terjadinya aterosklerosis, aterosklerosis merupakan penyakit sistemik yang bisa terjadi di seluruh pembuluh darah baik pada mikrovaskular maupun makrovaskular. Adanya bukti iskemia akibat stenosis yang disebabkan aterosklerosis pada salah satu pembuluh darah, mengharuskan kita lebih waspada akan adanya proses aterosklerosis di tempat lain. NPD di kaki terjadi akibat komplikasi diabetes pada mikrovaskular yang akhirnya mengakibatkan kerusakan pada persarafan di kaki. Maka perlu mewaspadai proses ateroslerosis di tempat lain, baik pada pembuluh arteri makro maupun mikrovaskular di kaki. Pemeriksaan non invasif untuk melihat adanya ganguan makrovaskular di kaki menggunakan ABI dan TBI sedangkan untuk gangguan mikrovaskular dengan TcPO2. Penelitian ini dilakukan untuk dapat menilai hubungan derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan proses ateroskerosis dipembuluh darah kaki, baik yang makrovaskular dengan ABI dan TBI maupun mikrovaskular TcPo2 pada pasien DM tipe 2. Metode: Penelitian potong lintang dilakukan pada pasien DM tipe 2 dengan NPD dengan nilai TCSS >5 di Poliklinik Pelayanan Jantung Terpadu, poliklinik Endokrin dan Metabolik dan Poliklinik Ilmu Penyakit Dalam Umum RSCM. Data diperoleh dari wawancara, rekam medik, pemeriksaan ABI, TBI dan TcPO2. Variabel penelitian berupa derajat neuropati perifer, ABI, TBI dan TcPO2. Analisis bivariat terhadap masing-masing variable dengan menggunakan uji Spearman. Hasil: Sebanyak 36 subjek yang memenuhi kriteria pemilihan diikutkan dalam penelitian, rerata usia 62 tahun dengan 20 (55,6%) di antaranya perempuan dan median lama diabetes 12 tahun. Berdasarkan analisa bivariat dengan uji spearman penelitian ini mendapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasi sedang antara derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan ABI (r = -0,475, p = 0,003) dan TBI (r = -0,421, p = 0,010). Dan pada pemeriksaan TcPO2 juga di dapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasi sedang ( r = -0,399, p = 0,016) Simpulan : Terdapat korelasi negatif yang bermaksa secara statistik antara derajat neuropati perifer diabetik dengan ABI, TBI dan TcPO2. ......Background: Diabetes mellitus is important risk factor of atherosclerosis. Atherosclerosis is systemic disease that can occur in all blood vessels both microvascular and macrovascular. There is evidence of ischemia due to stenosis caused by atherosclerosis in one blood vessel, which requires us to be more aware with the process of atherosclerosis in other places. Diabetic peripheral neuropathy (DPN) in the lower extremity results from complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. Non-invasive examination to look macrovascular disorders in the lower extremity are using ankle brachial index (ABI) and toe brachial index (TBI) while for microvascular disorders with TcPO2. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ABI and TBI as well as microvascular TcPo2 in Patients with type 2 diabetes mellitus (DM) Methods: Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at RSCM. The Data were obtained from interviews, medical records, ABI, TBI and TcPO2 examinations. The research variables are the degree of peripheral neuropathy, ABI, TBI and TcPO2. Bivariate analysis of each variable was used the Spearman test. Results: Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, this study found a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010) . The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016) Conclusion : There is a statistically significant negative correlation between the degree of diabetic peripheral neuropathy with ABI, TBI and TcPO2 examinations.

Abstrak :
Diabetic neuropathy is a complication of diabetes mellitus that is often overlooked, since there are often no subjective complaints during initial stages, and sensory deficit is often only found after objective examination. Diabetic neuropathy is defined by the San Antonio Concensus of 1988 as "clinical or subclinical neural disturbance that occurs in diabetes mellitus, with no signs of other peripheral neuropathy. Neuropathy may manifest on the somatic, peripheral, as well as autonomicic nervous systems." The incidence rate of diabetic neuropathy is reported to be 10-90%. Such high variation is due to differences in the diagnostic criteria or method to establish the diagnosis. Reports of peripheral neuropathy from various hospitals in Indonesia are as follows: Cipto Mangunkusumo Hospital / Jakarta (1989) 68.16%, Hasan Sadikin Hospital (1989) 12.2%, Dr. Sutomo Hospital / Surabaya (1990) 52.21%, Dr. Pirngadi Hospital / Medan (1996) 18.05%, Dr. Wahidin Sudirohusodo Hospital / Ujung Pandang (1997) 57.81%. Asril Bahar, Jakarta (1985), reported an incidence rate for parasympathetic autonomicic neuropathy of 11.9%, while Harsinen Sanusi, Ujung Pandang (1989) reported an incidence rate of 66.7%.

Abstrak :
Pendahuluan: Neuropati diabetik merupakan komplikasi diabetes yang paling sering ditemukan dalam praktik sehari-hari. Gejala terutama dikeluhkan rasa nyeri atau baal pada kedua tungkai. Penyakit arteri perifer (PAP) juga merupakan komplikasi diabetes dengan manifestasi nyeri pada tungkai. Adanya neuropati dan PAP akan mempengaruhi gejala satu sama lain sehingga umumnya pasien akan datang dalam keadaan yang lebih berat. Penelitian ini bertujuan untuk mengetahui gambaran klinis dan hasil pemeriksaan elektrodiagnostik neuropati diabetik dengan atau tanpa PAP. Metode: Studi ini bersifat deskriptif dengan metode potong lintang pada pasien diabetes melitus tipe 2 dengan neuropati berdasarakan Toronto clinical neuropathy score (TCNS). Pasien kemudian dilakukan pemeriksaan elektrofisiologi (Kecepatan hantar saraf (KHS) dan sympathetic skin response (SSR)) untuk membuktikan adanya neuropati serta pemeriksaan ankle brachial index (ABI) dan toe brachial index (TBI) untuk mendiagnosis adanya PAP. Hasil: Sebanyak 46 subjek penelitian yang terdiri dari 22 laki-laki dan 24 perempuan. Rerata usia subjek penelitian adalah 63,09 (±9,98) tahun dengan rerata lama menderita diabetes 13,57 (±10,43) tahun. Kebanyakan pasien memiliki kontrol glikemik yang kurang baik dengan median HbA1C of 7,35 (min-max: 5,6-12,2). Didapatkan sebanyak 22 orang terdiagnosis PAP berdasarkan pemeriksaan TBI. Berdasarkan analisis bivariat didapatkan kemaknaan secara statistik antara adanya keluhan nyeri, rasa kram, lokasi nyeri, klaudikasio intermiten serta riwayat penyakit jantung koroner dengan adanya PAP (masing-masing p < 0,05). Kesimpulan: Adanya keluhan nyeri, rasa kram, lokasi nyeri, klaudikasio intermiten, serta riwayat penyakit jantung koroner dapat menunjukkan adanya kemungkinan PAP pada pasien neuropati diabetik. Kata kunci: neuropati diabetik, penyakit arteri perifer, kecepatan hantar saraf, respon kulit simpatetik

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Background: Diabetic neuropathy (DN) is a common complication of diabetes. Symptoms can be tingling, pain or numbness in the leg.(1) Peripheral arterial disease (PAD) is also a complication of diabetes which can cause pain in the leg. The presence of DN and PAD affect each other, resulting in worse patient condition. The aim of this study to evaluate clinical characteristics and electrodiagnostic findings in diabetic neuropathy with and without PAD. Method: a descriptive cross-sectional study in type 2 diabetes mellitus patient with neuropathy based on Toronto clinical neuropathy score (TCNS). Patients were evaluated with electrodiagnostic study (nerve conduction study (NCS) and sympathetic skin response (SSR)) to confirm neuropathy and also ankle brachial index (ABI) and toe brachial index (TBI) to evaluate PAD. Results: a total of 46 subjects consisted of 22 male and 24 females include in this study. The mean age of the study population was 63,09 years (±9,98). The mean duration of diabetes in the study population was 13,57 years (±10,43). Most of the patients had poorly controlled diabetes with a median HbA1C of 7,35 (min-max: 5,6-12,2). Ten patients have PAD based on TBI examination. From bivariate analysis, there is statistically significant association between pain, cramp, pain location, intermittent claudication, and history of coronary arterial disease with the presence of PAD (p < 0,05). Kesimpulan: The presence of pain, cramp, pain location, intermittent claudication, and history of coronary arterial disease can predict the presence of PAD in DN patients. Keywords: diabetic neuropathy, peripheral arterial disease, nerve conduction study, sympathetic skin response

Abstrak :
ABSTRAK
Deformitas kaki dapat menyebabkan perubahan mobilitas sendi, luas kontak kaki ke permukaan, kemampuan neuromuskular untuk menstabilkan kaki serta mempertahankan posisi berdiri tegak. Perubahan ini akan berdampak pada penurunan fungsi ekstremitas bawah. Tujuan dari penelitian ini adalah untuk mengatahui hubungan deformitas kaki dengan fungsi ekstremitas bawah pada pasien neuropati diabetik. Desain penelitian ini adalah penelitian kuantitatif dengan pendekatan studi cross-sectional dengan jumlah sampel 105 orang responden yang mengalami neuropati diabetik dengan deformitas kaki. Analisis data menggunakan Chi Square, Anova, dan regresi logistik etiologik. Hasil penelitian menunjukkan adanya hubungan antara deformitas kaki dengan fungsi ekstremitas bawah p = 0,000, OR = 10,857 . Penelitian ini diharapkan dapat dijadikan acuan bagi perawat dalam melakukan pengkajian keperawatan untuk memprediksi penurunan fungsi ekstremitas bawah pada pasien neuropati diabetik dengan deformitas kaki sehingga bisa mencegah terjadinya resiko cedera atau jatuh pada pasien.

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ABSTRACT
Foot deformity can cause various of changes in joint mobility, extent of foot contact to the surface, neuromuscular ability to stabilize the legs and maintain an upright standing position. These changes will have an impact on lower limb function. The purpose of this study was to determine the correlation of foot deformities with the lower extremity functions in diabetic neuropathy patients. The design of this study was a quantitative research with a cross sectional study approach with sample size of 105 respondents who has foot deformity with diabetic neuropathy. Data were analysed using a Chi Square, Anova, and etiologic logistic regression. The results showed a significant correlation between foot deformities with lower extremity function p 0,000, OR 10,857 . This study is expected to be used as a reference for nurses in conducting nursing assessments to predict lower extremity function in diabetic neuropathy patients with foot deformities in order to prevent the risk of injuries or falls in patients.