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ABSTRAK

Latar belakang: Tujuan penelitian ini adalah untuk mengetahui pengaruh minyak zaitun dan minyak bekatul  terhadap kontrol glikemik dan profil lipid pada pasien dengan diabetes mellitus tipe 2.

Metode: 10 subjek menerima 15 ml / hari minyak zaitun dan minyak bekatul. Kadar glukosa darah puasa, glukosa postprandial, kolesterol total, low-density lipoprotein (LDL), high-density lipoprotein (HDL), dan trigliserida (TG) diukur. Subjek dicross over setelah periode wash out. Data dianalisis menggunakan uji-t berpasangan atau uji Wilcoxon yang sesuai dalam kelompok minyak bekatul dan minyak zaitun.

Hasil: perubahan glukosa darah puasa, glukosa postprandial, kolesterol total, LDL, dan TG tidak berbeda secara signifikan pada kedua kelompok. Namun, secara signifikan menurunkan kadar HDL diamati pada dua kelompok.

Kesimpulan: Minyak bekatul dan minyak zaitun tidak berpengaruh signifikan terhadap kadar glukosa darah puasa dan glukosa postprandial.

 

Kata kunci: DM tipe 2; minyak bekatul; minyak zaitun; kontrol glikemik; profil lipid

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ABSTRACT

Background: The aim of this study was to determine the effect of extra virgin olive oil (EVOO) and rice bran oil (RBO) on glycemic control and lipid profile in patients with type 2 diabetes mellitus (DM).

Methods: 10 subjects received 15 ml/day of EVOO and RBO. Fasting blood glucose, postprandial glucose, total serum cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) were measured. Subjects were cross-covered after wash out. Data were analyzed using paired t-test or Wilcoxon test as appropriate in the group RBO and EVOO.

Results: the changes of fasting blood glucose, postprandial glucose, total cholesterol, LDL, and TG were not significantly different in the two groups. However, significantly decreased the levels of HDL were observed in two groups.

Conclusion: RBO and EVOO no significant influence on the levels of fasting blood glucose and postprandial glucose.

 

Keywords: type 2 DM; EVOO; RBO; glycemic control; lipid profile

 

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"ABSTRAK Latar belakang: Tujuan penelitian ini adalah untuk mengetahui pengaruh minyak zaitun dan minyak bekatul terhadap kontrol glikemik dan profil lipid pada pasien dengan diabetes mellitus tipe 2.Metode: 10 subjek menerima 15 ml / hari minyak zaitun dan minyak bekatul. Kadar glukosa darah puasa, glukosa postprandial, kolesterol total, low-density lipoprotein (LDL), high-density lipoprotein (HDL), dan trigliserida (TG) diukur. Subjek dicross over setelah periode wash out. Data dianalisis menggunakan uji-t berpasangan atau uji Wilcoxon yang sesuai dalam kelompok minyak bekatul dan minyak zaitun.Hasil: perubahan glukosa darah puasa, glukosa postprandial, kolesterol total, LDL, dan TG tidak berbeda secara signifikan pada kedua kelompok. Namun, secara signifikan menurunkan kadar HDL diamati pada dua kelompok.Kesimpulan: Minyak bekatul dan minyak zaitun tidak berpengaruh signifikan terhadap kadar glukosa darah puasa dan glukosa postprandial.

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ABSTRACT

Background: The aim of this study was to determine the effect of extra virgin olive oil (EVOO) and rice bran oil (RBO) on glycemic control and lipid profile in patients with type 2 diabetes mellitus (DM).

Methods: 10 subjects received 15 ml/day of EVOO and RBO. Fasting blood glucose, postprandial glucose, total serum cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) were measured. Subjects were cross-covered after wash out. Data were analyzed using paired t-test or Wilcoxon test as appropriate in the group RBO and EVOO.

Results: the changes of fasting blood glucose, postprandial glucose, total cholesterol, LDL, and TG were not significantly different in the two groups. However, significantly decreased the levels of HDL were observed in two groups.

Conclusion: RBO and EVOO no significant influence on the levels of fasting blood glucose and postprandial glucose."

"Peran apoteker dalam upaya peningkatan kepatuhan pengobatan dan perbaikan luaran klinis pasien di Indonesia perlu dievaluasi. Penelitian bertujuan mengevaluasi pengaruh konseling apoteker terhadap peningkatan kepatuhan pengobatan, mengontrol kadar kontrol glikemik, profil lipid dan tekanan darah pasien DM tipe 2 di RSUD Kota Depok dari April-Oktober 2018. Penelitian dilakukan dengan desain kuasi-eksperimental dengan pretest-posttest pada 77 responden terdiri atas kelompok intervensi (KI) (n=39 orang) mendapatkan konseling dan buklet dari apoteker dan kelompok kontrol (KK) (n=38 orang) yang hanya diberikan buklet saja, dengan alat ukur Medication Adherence Questionnaire (MAQ) untuk kepatuhan, pemeriksaan darah untuk gula darah puasa (GDP), gula darah dua jam post prandial (GDPP), glycosylated hemoglobin A1 (HbA1c) dan profil lipid serta pengukuran tekanan darah. KI mengalami perbaikan parameter kepatuhan, HbA1c dan profil lipid sedangkan pada KK tidak ada perubahan yang bermakna pada parameter klinis bahkan mengalami peningkatan ketidakpatuhan (p=0,008) posttest dibandingkan pretest. Hasil uji beda rerata antara KI dan KK menunjukkan perbedaan bermakna pada parameter kepatuhan, GDP, GDPP dan HbA1c. Berdasarkan uji kai kuadrat, KI menunjukkan perubahan signifikan pada GDP (p=0,05) dan HbA1c (<0,0001) terkontrol dibandingkan KK. Hasil analisis multivariat, konseling apoteker memberikan pengaruh 2,0 kali (95% CI: 0,603-7,059) dan 3,5 kali (95% CI: 0,880-14,045) pada kondisi terkontrol GDP dan HbA1c. Hasil penelitian ini dapat disimpulkan konseling apoteker merupakan faktor yang mempengaruhi perubahan GDP dan HbA1c menjadi lebih terkontrol.

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The role of the pharmacist to improve medication adherence and clinical outcome of patients in Indonesia needs to be evaluated. The study aimed to evaluate the effect of pharmacist counseling on improving medication adherence, controlling the level of glycemic control, lipid profile and blood pressure of type 2 DM outpatient at RSUD Kota Depok from April-October 2018. The study was conducted with quasi-experimental design with pretest-posttest on 77 respondents divided into intervention groups (IG) (n = 39 people) getting counseling and booklets from pharmacists and control groups (CG) (n = 38 people) who were given booklets only, with a MAQ questionnaire for medication adherence, blood tests for fasting blood glucose (FBG), post prandial blood glucose (PPBG), glycosylated hemoglobin A1 (HbA1c) and lipid profiles and blood pressure measurements. IG improved adherence parameters, HbA1c and lipid profile whereas in CG there were no significant changes in clinical parameters and even increased non-adherence (p = 0.008) on posttest. Mean Whitney test between IG and CG showed significant differences in parameters of medication adherence, fasting blood glucose (FBG), post prandial blood glucose (PPBG) and glycosylated hemoglobin A1 (HbA1c). Based on the chi square test, IG shows a significant change in controlled GDP (p = 0.05) and HbA1c (<0,0001) compared to CG. Based on multivariate analysis, counseling of pharmacists had an effect of 2,0 times (95% CI: 0,603-7,059) and 3,5 times (95% CI: 0,880-14,045) on changes in FBG and HbA1c. Pharmacist counseling is a factor that affects changes in FBG and HbA1c to be more controlled. "

"ABSTRAKLatar Belakang: Puasa selama bulan Ramadhan adalah perubahan dalam gaya hidup untuk periode sebulan penuh yang rutin tiap tahunnya. Sejumlah penelitian menunjukkan terjadinya perubahan biokimia tubuh saat berpuasa baik pada pasien diabetes dan juga nondiabetes yang dapat mempengaruhi metabolisme glukosa dan sensitivitas insulin.Tujuan: Menilai pengaruh berpuasa selama Ramadhan terhadap perubahan kontrol glikemia, kadar Fetuin A, dan TNF-α dibandingkan sebelum dan sesudah puasa RamadhanMetode: Penelitian prospektif terhadap dua kelompok (diabetes dan non diabetes). Parameter kontrol glikemik, Fetuin A, dan TNF-α diukur 2-4 minggu sebelum berpuasa Ramadhan, minimal 14 hari puasa Ramadhan dan 4 minggu setelah puasa Ramadhan.Hasil: Puasa Ramadhan menurunkan glukosa darah puasa (GDP) secara signifikan pada kelompok Diabetes (D) (p=0,013) dan pada kelompok Non Diabetes (ND) (p=0,047), sedangkan serum Fetuin A turun tidak signifikan pada kelompok D (p=0,217) dan secara signifikan pada kelompok ND (p=0,009). Dan tidak ada perubahan yang signifikan kadar TNF-α pada kedua kelompok dibandingkan sebelum puasa Ramadhan (p=0,248, p=0,789). Pada 4 minggu setelah puasa Ramadhan,GDP kembali ke nilai yang tidak berbeda dari nilai dasar pada kedua kelompok, sementara Fetuin A secara signifikan lebih rendah pada kelompok diabetes (p=0,039) dan TNF-α lebih rendah secara signifikan pada kelompok ND (p=0,042) dari dari nilai dasar.Kesimpulan: Puasa selama Ramadahan memperbaiki kontrol glikemia pada kedua kelompok. Puasa Ramadhan juga mampu menurunkan nilai Fetuin A pada kedua kelompok, dan TNF-α pada kelompok ND

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ABSTRACTBackground: Fasting during Ramadan is a anually change in lifestyle for the period of a lunar month. Numerous studies have mentioned the biochemical alterations while fasting among both in nondiabetic patients and diabetic patients which can affect glucose metabolism and insulin sensitivity.Objective: to assess the impact of fasting during Ramadan on glycemic control, Fetuin A l, and TNF-a compared to before and after Ramadhan fastingMethods: Prospective Study of diabetic patients (D group) and non-diabetic subjects (ND group). Parameters of glycemic control, Fetuin A, and TNF-a were measured 2-4 weeks before Ramadan fasting, at least 14 days of Ramadan fasting and 4 weeks after Ramadan fasting.Results: Ramadan fasting reduced fasting blood glucose (FBG) significantly in D groups (p=0,013) and in the (ND) groups (p=0,047) , respectively, serum Fetuin A were lowered insignificantly in D groups (p=0,217) dan significantly in ND groups (p=0,009). And no significant differences of TNF-α level ini both group compared to before Ramadhan fasting (p=0,248, p=0,789). At 4 weeks post-Ramadhan fasting FBG returned to levels indistinguishable from their baseline values in both groups, while Fetuin A was maintained significantly lower in D groups (p=0,039) and TNF-α significantly lower in ND groups (p=0,042) from their baseline.Conclusions: Fasting during Ramadan improves glycemic control in both groups, Ramadan fasting was also able to reduce Fetuin A level in both groups, and TNF-α in the ND group."

"Diabetes Mellitus Gestasional (DMG) adalah setiap derajat intoleransi karbohidrat yang terjadi atau diketahui pertama kali pada saat kehamilan. Definisi ini meliputi spektrum klinis yang luas; tidak memandang apakah digunakan insulin atau cukup hanya digunakan modifikasi diet saja dalam mengontrol gula darah, tidak memandang apakah kondisi bertahan setelah kehamilan, dan termasuk pula kondisi intoleransi glukosa dalam berbagai tingkat dari ringan sampai berat yang terjadi sebelum kehamilan namun tidak dikenali sebelumnyalbaru diketahui pada saat hamil.Sekitar 1-14% kehamilan mengalami komplikasi DMG setiap tahun di AS. Di Indonesia. dilaporkan prevalensi DMG antara 1.9-3.6e% dari seiuruh kehamilan setiap tahun.Kontrol gula darah pada DMG berhubungan dengan morbiditas dan mortalitas- pada ibu maupun bayi berupa preeklampsia. polihidramnion, infeksi saluran kemih, persalinan seksio sesarea dan trauma persalinan akibat bayi besar. DMG berhubungan dengan angka kejadian preeklampsia, induksi persalinan, distosia bahu, seksio sesarea, bayi besar, dan Erb's Palsy yang lebih tinggi. Hiperblikemia juga berhubungan dengan peningkatan risiko kematian janin infra uteri (IUFD) pada 4-8 minggu terakhir kehamilan, meningkatnya mortalitas perinatal dan angka kejadian makrosomia, dan pada neonatus terjadi peningkatan kejadian hipoglikemia, ikterus. polisitemia dan hipokaisemia. Dalam jangka panjang pasien DMG memiliki risiko terjadinya diabetes tipe 2 setelah kehamilan. Bayi-bayi yang dilahirkan dari ibu DMG memiliki risiko lebih tinggi akan kejadian sindroma metabolik, obesitas, intoleransi glukosa dan diabetes pada masa muda/dewasa.Langkah awal penanganan DMG yang dianut saat ini adalah pemberian konseling dan terapi diet selama 1 minggu dengan target tes toleransi glukosa darah normal. Apabila tidak berhasil maka diberikan insulin, yang sampai saat ini masih mcrupakan terapi pilihan pada DMG. Ternyata hingga 60% penderita akan memerlukan insulin untuk mempertahankan kontrol glikemiknya.7 Insulin diberikan secara suntikan subkutan sehingga bagi pasien dirasakan sulit dan tidak praktis digunakan, yang mempengaruhi penerimaan pasien dan akhirnya kcberhasilan terapi. Penggunaan obat hipoglikemik oral (OHO) dalam kehamilan dahulu diduga menyebabkan kelainan kongenital. "

"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"

"ABSTRAKLatar Belakang: Hipertrofi jantung dapat timbul akibat stres patologis misal hipoksia yang merupakan respon jantung sebagai mekanisme homeostatis yang diperlukan untuk menormalkan stres dinding ventrikel kiri dan mempertahankan curah jantung. Hipoksia sistemik kronik merupakan stres lingkungan yang berat. Respon spesifik jantung terhadap stres jantung terlihat pada peningkatan kadar peptida di dalam plasma, yang membantu jantung dalam menghadapi beban yang meningkat. Menurut sejumlah peneliti, kadar Apelin berhubungan erat dengan disfungsi ventrikel. Apelin merupakan preproprotein dengan 77 asam amino yang disekresikan dari keluarga adipokine, berperan dalam mempertahankan performa jantung pada beban tekanan kronik. Pada tingkat molekular, respons adaptasi diperantarai oleh perubahan ekspresi gen. Tujuan penelitian: Menganalisis pola ekspresi gen Apelin dan gen BNP pada hipertrofi ventrikel akibat induksi hipoksia sistemik kronik dengan mengukur konsentrasi Apelin-13 dan konsentrasi BNP-45. Penelitian bersifat eksperimental menggunakan 28 ekor tikus Sprague-Dawley jantan, umur 8-12 minggu yang dibagi dalam 7 kelompok n=4 ekor/kelompok , terdiri dari kelompok kontrol normoksia, O2 atmosfir dan kelompok perlakuan hipoksia dalam sungkuphipoksia, 8 O2, masing-masing selama 6 jam, 1, 3, 5, 7 dan 14 hari . Parameter stres oksidatif akibat hipoksia jantung, dilakukan dengan pengukuran kadar malondialdehid MDA dan histopatologi dengan pewarnaan HE. Selain itu juga dilakukan pengukuran protein Apelin-13 dan BNP-45 menggunakan metoda ELISA dan pengukuran ekspresi relatif mRNA Apelin dan BNP-45 jantung, menggunakan real time RT-PCR kuantitatif dengan rumus Livak. Hasil penelitian: ekspresi relatif Apelin-13 di jantung menurun pada awal hipoksia dan kemudian meningkat mulai hari ke-3 sampai hari ke-14. Peningkatan kadar MDA yang signifikan terjadi sejak hipoksia 7 hari. Korelasi MDA terhadap peningkatan ekspresi relatif Apelin adalah kuat r=0.750 dan signifikan p=0.000 . Korelasi BNP-45 terhadap Apelin-13 adalah sangat kuat r=0.943 dan signifikan p=0.000 . Dapat disimpulkan bahwa adanya peningkatan MDA, peningkatan ekspresi relatif dan protein Apelin-13 dan peningkatan ekspresi relatif dan protein BNP-45 pada jaringan jantung mempunyai korelasi yang signifikan dan kuat, sesuai dengan peningkatan lamanya perlakuan hipoksia.

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ABSTRACTBackground: Cardiac hypertrophy can result from pathological stress eg hypoxia as a response to ventricular wall stress and to maintain cardiac output. Chronic systemic hypoxia is a severe environmental stress. During cardiac stress certain peptides are release by the heart into the plasma, which help the heart to compensate the increased myocardial load. According to several authors, apelin levels are increased during cardiac dysfunction. Apelin is a preproprotein with 77 amino acids from adipokine, which contributes to maintaining cardiac performance at chronic stress loads. At the molecular level, the adaptation response is mediated by changes in gene expression. Objective: To analyze the expression pattern of Apelin-13 and BNP-45 on ventricular hypertrophy due to induction of chronic systemic hypoxia by measuring Apelin-13 and BNP-45 concentrations. The experimental study used 28 male Sprague-Dawley rats, 8-12 weeks old divided into 7 groups 4 per group , consisting of control group normoxia, atmospheric O2 and 4 hypoxia treatment groups, which underwent systemic hypoxia in hypoxic chamber containing 8 oxygen, respectively for 6 hours, 1, 3, 5, 7 and 14 days . The presence of oxidative stress due to cardiac hypoxia was determined by malondialdehyde MDA and cardiac structural alteration was examined by HE staining. Apelin-13 and BNP-45 proteins were determined using the ELISA method and the relative expression of cardiac Apelin and BNP-45 mRNA were determined using quantitative RT-PCR real time with Livak formula. Results: Relative expression of Apelin-13 in the heart decreased early in hypoxia and then increased from day 3 to day 14. Significant increases in MDA levels occurred after 7 days hypoxia. There was a strong and significant correlation between MDA levels and Apelin relative expression r = 0.750, p = 0.001 . Similar results were obtained for of BNP-45 and Apelin-13 r = 0.943, p = 0.001 . From the results, it can be concluded that during chronic systemic hypoxia there was an increase in oxidative stress, relative expression and Apelin-13 proteins and relative expression and BNP-45 protein of the rat cardiac tissue."

"Latar belakang Diabetes Mellitus (DM) merupakan salah satu masalah kesehatan utama di negara berkembang maupun negara maju.1 Pada tahun 2007, sekitar 23,6 juta orang Amerika menderita DM, dimana sebagian besar adalah pekerja.2 Penelitian oleh Poulsen (2014) menemukan bahwa 3,5% petugas kesehatan menderita DM selama periode pengamatan 7 tahun.3 Informasi mengenai dampak kerja shift terhadap kontrol glikemik pada pada pekerja yang memiliki DM tipe 2 masih belum banyak diketahui. Metode Kasus wanita berusia 52 tahun bekerja sebagai perawat di rumah sakit, mengikuti jadwal shift malam dan telah didiagnosis DM tipe 2 sejak 7 tahun lalu. Pencarian literatur dilakukan melalui pencarian elektronik (PubMed dan ProQuest) serta hand searching dengan kata kunci “kontrol glukosa darah”, “diabetes mellitus tipe 2”, “kerja shift” dan “kerja shift malam” yang memenuhi kriteria inklusi dan eksklusi. Hasil Hasil pencarian didapatkan 92 studi dan 3 studi yang relevan ditemukan dengan desain potong lintang. Studi oleh Manodpitipong (2017) menunjukkan bahwa kerja shift malam dikaitkan dengan HbA1c yang lebih tinggi (p = 0,044) dibandingkan dengan kerja siang hari. Studi oleh Chalernvanichakorn (2008) memberikan hasil kontrol glikemik yang baik secara signifikan lebih tinggi pada pekerja harian dibandingkan pekerja shift (28,3% vs 15,8%) dengan p = 0,02. Studi oleh Ghazawy (2013) menunjukkan bahwa HbA1c lebih tinggi di antara pekerja dengan diabetes yang melakukan kerja shift dibandingkan dengan pekerja yang hanya bekerja siang hari (p = 0,01). Kerja shift sendiri berpengaruh signifikan terhadap pengendalian diabetes (p = 0,04), dengan OR = 3,83 (1,02 – 14,34). Kesimpulan Bukti penelitian menunjukkan adanya hubungan antara kerja shift malam dengan kontrol glikemik yang buruk pada pekerja dengan DM tipe 2. Pekerja shift malam berisiko 2-3 kali memiliki kontrol glikemik yang buruk daripada pekerja non-shift. Bukti yang ditemukan dalam studi Manodpitipong dan Chalernvanichakorn dapat diterapkan pada pasien ini karena karakteristik subjek penelitian yang sama.

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Background Diabetes Mellitus (DM) is considered to be one of a major problem in both developing and industrialized countries.1 As of 2007, approximately 23.6 million Americans have diabetes, most of whom are or wish to be participating members of the workforce.2 Research by Poulsen et al., (2014) found that 3.5% of health workers had diabetes during the 7-year observation period.3 A person with diabetes should be individually assessed to determine whether or not that person can safely and effectively perform the particular duties of the job in question.2 Shift work is considered to be disruptive to normal diurnal biological rhythms and has been associated with many health problems.4 Observational studies revealed that night-shift work is associated with increased risk of prevalent diabetes and incident diabetes.7 Information regarding the impact of shift work on blood glucose control or glycemic state in workers who have a history of type 2 diabetes is still not widely known. Method The case is about a 52-year-old female who worked as a nurse in non-intensive ward of government hospital and performed night shift work. She has been diagnosed with type 2 Diabetes Mellitus for seven years . A literature search was conducted through PubMed and ProQuest and also performed with the hand searching method. The inclusion criteria of this search strategy were systematic review, cohort study, worker with type 2 DM, shift work, blood glucose control and glycemic control. The exclussion criteria were articles not in english and inaccessible full text article. Then, they were critically appraised based on Center of Evidence- Based Medicine, Oxford University, Critical Appraisal for Etiology. Result Three relevant studies were found through literature searching and all of those studies were cross sectional design. The first study by Manodpitipong, et al.(2017) showed that night shift work was associated with significantly higher haemoglobin A1c (p = 0.044) compared with day work. While there were no differences between unemployed participants and day workers (p = 0.572). The second study conducted by Chalernvanichakorn, et al.(2008) give result that good glycemic control was significantly higher in day workers versus shift workers (28.3% vs 15.8%) with p = 0.02. A higher proportion of shift workers had hypoglycemic symptoms compared to day workers (42.5% vs. 26.7%). The third study by Ghazawy, et al.(2013) showed that HbA1c was significant higher levels among diabetic shift workers compared to diabetic day-time workers (p=0.01), where mean of current shift workers and former shift workers were 7.8±1.9 and 8.4±2.6, compared to 6.3±1.1. Shift work itself has a significant effect on control of diabetes (p = 0.04), with an OR = 3.83 (1.02 – 14.34), whereas age, duration of diabetes, BMI and waist circumference had no significant effect. Conclusion The research evidence found from the three studies above shows that there is association between night shift work and poor glycemic control in workers with type 2 DM. But the causation effect between the two variables cannot be determined yet, because there are many confounding factors that influence it. Night shift workers are two to three times more likely to have poor glycemic control than non-shift workers. The evidence found in the two study (Manodpitipong and Chalernvanichakorn) can be applied to our patient because of the same characteristic: female, diabetic worker, involved in night shift work. For future studies, cohort research should be conducted to find causality between shift work and glycemic control. Recommendation to our patient is to pay more attention to diet and adhere to treatment. It is necessary to inform the doctor that she is involved in shift work so that the doctor will provide a suitable regimen and diet for the patient."

"[ABSTRAK Diabetic Kidney Disease (DKD) pada Diabetes Melitus Tipe 2 (DMT2) merupakan komplikasi kronik yang dapat dicegah dan ditunda progresifitasnya dengan pengontrolan glikemik yang baik dan penatalaksanaan yang tepat dari komorbid lainnya. Pengontrolan glikemik menjadi tanggung jawab bersama antara multidisiplin profesi kesehatan di ruang rawat (dokter, perawat, dietisien, farmasis) dengan pasien (serta keluarga). Model Self care Orem sangat sesuai untuk diaplikasikan dan dikembangkan di ruangan pada asuhan keperawatan pasien dengan penyakit kronik. Pasien dapat bersinergi secara aktif sesuai kemampuannya dalam mencapai tujuan dari setiap intervensi keperawatan. Disamping itu pendekatan model self care Orem sesuai untuk mempersiapkan pasien dalam meningkatkan kemampuan self care untuk pasca rawat. Pelaksanaan praktek berbasis pembuktian, pengukuran suhu kaki dengan termometer infrared dapat menjadi perangkat tambahan untuk menilai adanya gejala inflamasi lokal sehingga upaya deteksi dini menjadi lebih komprehensif. Pelaksanaan kegiatan inovasi pemantauan dan pemeriksaan kesehatan mandiri pada pasien DM dapat meningkatkan upaya promosi kesehatan pada pasien DM.ABSTRACT Diabetic Kidney Disease (DKD) in Type 2 Diabetes Mellitus (T2DM) is a chronic complication that can be prevented and delayed its progresivity with a good glycemic control and appropriate treatments. Glycemic control is a shared responsibility between the multidisciplinary health professions in the ward (doctors, nurses, dietisien, pharmacists) and patients (and families). Orem?s Self care model is appropriate to be applied and developed in the acute care of patients with chronic diseases. Patients can actively work together within its capabilities in achieving the objectives of each nursing intervention. Besides, Orem?s self care model approach appropriate to prepare the patient to improve the ability of self care for post-hospitalization. Implementation of evidence-based practice, the measurement of foot temperature with an infrared thermometer may be enhancements to assess the presence of local inflammatory symptoms so that early detection efforts become more comprehensive. Implementation of innovation activity monitoring and self health assesment can improve health promotion efforts in diabetic patients. ;Diabetic Kidney Disease (DKD) in Type 2 Diabetes Mellitus (T2DM) is a chronic complication that can be prevented and delayed its progresivity with a good glycemic control and appropriate treatments. Glycemic control is a shared responsibility between the multidisciplinary health professions in the ward (doctors, nurses, dietisien, pharmacists) and patients (and families). Orem?s Self care model is appropriate to be applied and developed in the acute care of patients with chronic diseases. Patients can actively work together within its capabilities in achieving the objectives of each nursing intervention. Besides, Orem?s self care model approach appropriate to prepare the patient to improve the ability of self care for post-hospitalization. Implementation of evidence-based practice, the measurement of foot temperature with an infrared thermometer may be enhancements to assess the presence of local inflammatory symptoms so that early detection efforts become more comprehensive. Implementation of innovation activity monitoring and self health assesment can improve health promotion efforts in diabetic patients. , Diabetic Kidney Disease (DKD) in Type 2 Diabetes Mellitus (T2DM) is a chronic complication that can be prevented and delayed its progresivity with a good glycemic control and appropriate treatments. Glycemic control is a shared responsibility between the multidisciplinary health professions in the ward (doctors, nurses, dietisien, pharmacists) and patients (and families). Orem’s Self care model is appropriate to be applied and developed in the acute care of patients with chronic diseases. Patients can actively work together within its capabilities in achieving the objectives of each nursing intervention. Besides, Orem’s self care model approach appropriate to prepare the patient to improve the ability of self care for post-hospitalization. Implementation of evidence-based practice, the measurement of foot temperature with an infrared thermometer may be enhancements to assess the presence of local inflammatory symptoms so that early detection efforts become more comprehensive. Implementation of innovation activity monitoring and self health assesment can improve health promotion efforts in diabetic patients. ]"