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Abstrak :
Tujuan : (1) mengetahui perubahan kadar gala darah dalam 5 hari pasca serangan stroke; (2) rengetahui faktor risiko, status gizi, asupan energi dan karbohidrat serta pemberian insulin selama dirawat; (3) mengetahui hubungan antara perubahan kadar gula darah dengan faktor risiko, indeks massa tubuh, asupan energi dan karbohidrat serta pemberian insulin pada pasien hiperglikemia. Tempat : Ruang rawat inap Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo. Metodologi : Sebanyak 103 pasien diambil dengan diagnosa stroke iskemik dan hemoragik yang memenuhi kriteria penerimaan. Dilakukan pengukuran antropometri yaitu berat badan dan tinggi badan. Pemeriksaan laboratorium yang dilakukan yaitu kadar gula darah sewaktu hari 1 dan kadar gula darah puasa hari 2 - 5. HbA1. diperiksa pada pasien hiperglikemia. Data asupan energi dan karbohidrat melalui oral, enteral dan parenteral selama 24 jam pads hari I diambil secara recall dan hari 2 -- 5 secara record, hasil dianalisis dengan program food processor II. Perubahan kadar gula darah di uji dengan uji Friedman I uji Wilcoxon. Hubungan antara perubahan kadar gula darah dengan faktor risiko diuji dengan uji Mann Whitney. Hubungan antara perubahan kadar gula darah dengan indeks massa tubuh diuji dengan uji Kruskal Wallis. Korelasi antara perubahan kadar gula darah dengan asupan energi dan karbohidrat di uji dengan korelasi Spearman rank. Hasil : Hasil penelitian yang diperoleh 51,5% stroke iskernik dan 49,5% stroke hemoragik. Faktor risiko yang di dapat adalah hipertensi, DM, kelainan jantung dan dislipidernia. Faktor risiko dibagi menjadi DM dan non DM. Median asupan energi dan karbohidrat masih dibawah kebutuhan. Pada stroke non DM kadar gula darah puasa tertinggi hari 2, terjadi penurunan bermakna hari 3, dan stabil hari 4 dan 5 sedangkan pads DM tidak ada perbedaan bermakna. Terdapat perbedaan bermakna kadar gula darah antara kelompok stroke iskemik dan hemoragik pads stroke non DM dan tidak bermakna pads DM. Terdapat perbedaan bermakna kadar gula darah puasa antara penderita stroke dengan DM dan non DM. Tidak terdapat perbedaan bermakna antara kadar gula darah puasa dengan indeks massa tubuh.,Terdapat korelasi lemah sampai sedang negatif antara kadar gula darah dengan asupan energi dan karbohidrat pada penderita non DM dan korelasi lemah sampai sedang positif pada DM. Pemberian insulin sesuai dengan pedoman dapat menurunkan kadar gula darah pada beberapa pasien stroke dengan DM. Kesimpulan Penelitian ini menunjukkan terdapat perubahan kadar gula darah pads pasien stroke. Kadar gula darah puasa tertinggi hari 2 menurun bermakna hari 3 dan stabil hari 4 dan 5. Tidak ada perbedaan bermakna antara kadar gula darah dengan indeks massa tubuh. Terdapat korelasi lemah sampai sedang negatif antara kadar gula darah dengan asupan energi dan karbohidrat pada pasien stroke non DM.

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The Changes Of Fasting Glucose And Associated Factors In Stroke Patiens In Ciptomangunkusumo General Hospital 2002Objective : (1) to investigate the changes of blood glucose within 5 days after stroke, (2) to observe the risk factors, body mass index, energy and carbohydrate intake (3) to analyze the correlation between blood glucose with the risk factors, body mass index, energy and carbohydrate intakes and insulin to hyperglycemia patients. Location: Cipto Mangunkusumo General Hospital, Jakarta. Subject and methods : One hundred and three patients with acute stroke were recruited as the subjects of the study. Antropometric assessments i.e. body weight and height were assessed in the 1 0 day of admission. Laboratory assessment i.e. blood glucose at the time in the 1 °' day and fasting blood glucose in the 2nd - 5th days, HbAic to patients with hyperglycemia. Energy and carbohydrate intakes from parenteral, enteral and oral route were calculated in the 10 day by recall and 2"d - 5th day by record and analyzed by food processor II program. The changes of fasting blood glucose was tested using Friedman I Wilcoxon test The correlation between changes of blood glucose with risk factors was tested using Mann Whitney U test The correlation between changes of blood glucose with body mass index was tested using Kruskal Wallis test. The correlation between change of blood glucose with energy and carbohydrate intake was tested using Spearman rank correlation. Results : The type of stroke determined by clinical diagnosis and CT scan were ischemic stroke 51,5% and hemorrhagic stroke 48,5%. Risk factors found were : hypertension, diabetes mellitus, cardiac disease, dislipidemia and unknown risk factors. The risk factors were grouped into 2 categories : DM and non. DM. The median intake of energy and carbohydrate were below the requirement. Fasting blood glucose higher in the 2nd day, significant decrease in the 3`d day, and constant in the 4t- 5th day in non DM patient whereas in DM not significant There were significant difference in changes of fasting blood glucose between ischemic and hemorrhagic stroke in non DM patient whereas DM no significant There were no significant difference between changes of fasting blood glucose with body mass index. There was weak to moderate negative correlation between of fasting blood glucose and energy and carbohydrate intake using Spearman rank correlation in non DM patient. Insulin to decrease blood glucose for several DM stroke patients. Conclusions : the current study indicates that there was changes of blood glucose in the stroke patients. There were higher in the 2"' day significant decrease in the 3`d day and constant in the 4d' - 5d' day. There was no significant difference in the changes of blood glucose fasting with body mass index. There was weak to moderate negative correlation between fasting blood glucose and energy and carbohydrate intake in non DM stroke patients.

Abstrak :
Latar Belakang: Studi epidemiologi menunjukkan bahwa DM merupakan salah satu faktor dalam proses terjadinya aterosklerosis dan mempengaruhi secara nyata kesaldtan dan kematian akibat PIK. Dibandingkan dengan penderita bukan DM, penderita DM 2-4 kali lebih banyak menderita P3K dan 2-4 kali lebih banyak mengalami kematian jangka pendek setelah menderita serangan infark miokard akut Dewabrata mendapati 23,2% penderita infark miokard akut yang di rawat di RSCM selama periode 1994-1999. Data di Indonesia tersebut belum banyak menggambarkan bagaimana karakteristik penderita DM tersebut saat terbukti menderita infark miokard akut. Dengan demildan, gambaran penderita DM yang mengalami sindrom koroner akut merupakan ha! yang renting untuk diketahui, baik karakteristik klinis maupun komplikasi yang muncul akibat S1CA tersebut. Tujuan. Penelitian ini ingin mengetahui prevalensi SKA pada penderita DM tipe-2. Penelitian ini juga ingin mengetahui karakteristik klinis dan komplikasi SKA pada penderita DM tipe-2 serta perbandingannya dengan penderita bukan DM. Metodologi. Studi potong lintang retrospektif untuk mengetahui prevalensi dan karakteristik klinis serta studi kohort retrospektif untuk mengetahui perbandingan komplikasi SKA pads penderita DM tipe-2 dan penderita bukan DM, terhadap penderita yang dirawat di ICCU RSCM periode 1 Januari 2001 s.d. 31 Desember 2005. Hasil. Didapatkan data: Prevalensi SKA penderita DM tipe-2: 34,2%. Awitan nyeri penderita DM lebih lama, 70,7% vs 53,4%, p=0,001; 1K 95%; DR=2,259 (1,372-3,719). Nyeri dada tidak khas, didapati penderita DM lebih banyak, 17,3% vs 9,8% p~ 0,041; 1K 95%; OR=1,713 (1,019-2,881)_ Komplikasi: Gagal jantung: penderita DM tipe-2 Iebih banyak: 39,35% vs 16,8%, p=0,001; 11(95%; RR-3,213 (1,992-5,182). Untuk komplikasi syok kardiogenik, didapati penderita DM tipe-2 Iebih banyak, 16,2% vs 8,9%, p= 0,031; IK 95%; RR==1,983 (1,057-3,721). Sedangkan komplikasi kematian didapati penderita DM tipe-2 lebih banyak, 17,3% vs 6,3%, dengan p= 0,001; 1K 95%; RR= 3,116 (1,556-6,239). Simpulan. Didapatkan perbedaan karakteristik klinis SKA antara penderita DM tipe-2 dengan penderita SKA bukan DM. Awitan nyeri lebih lama dan keluhan nyeri dada yang tidak khan, Iebih banyak didapati Dada penderita DM tipe-2. Didapatkan juga perbedaan dalam hat komplikasi SKA. Kejadian gagal jantung, syok kardiogenik dan kematian didapatkan lebih tinggi pada penderita DM tipe-2.

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Background. Epidemiologic studies revealed diabetes mellitus (DM) as one of the factors involved in atherosclerosis process. DM also influence morbidity and mortality-related to coronary artery disease (CAD). Compared to non diabetic patients, type -2 DM patients suffer CAD 2-4 times more often and had increased short term mortality rate due to acute myocardial infarction 2-4 times more likely. During 1994-1999, Dewabrata found 23.2% of all acute myocardial infarction patients was diabetic patients treated in ICCU Cipto Mangunkusumo hospital. Unfortunately these data did not describe the clinical characteristic and complication ACS in type -2 DM patients. Therefore it is important to know the clinical characteristics and ACS related complications in type-2 DM patients. Objectives. To know the prevalence of type-2 DM among ACS patients, to learn clinical characteristics and ACS related complications in type-2 DM compared to non diabetic patients. Methods. A cross sectional retrospective study was performed to know the prevalence of ACS in type -2 DM patients and their clinical characteristics_ A retrospective cohort study was performed to compare the differences in ACS related complications in type -2 DM and non diabetic patients who were hospitalized in ICCU Cipto Mangunkusumo hospital during 5 years period (January 1st, 200I December 31st, 2005). Results. Prevalence of Type-2 DM among ACS patients : 34.2%. The onset of chest pain in type-2 DM patients was longer, 70.7% vs 53.4%, p=0.40l; CI 95%; OR=2.259 (1.372-3.719). Aypical chest pain were often in type-2 DM patients, 17.3% vs 9.8%; p= 0.041; CI 95%; OR 1.713 (L019 2.881). Heart failure as complications were more often found in type-2 DM patients, 39.35% vs 16.8%, p=0.001; CI 95%; RR=3.213 (1.992-5.182), cardiogenic shock were more often found in type-2 DM patients, 16.2% vs 8.9%, p= 0.031; CI 95%; RR 1.983 (1.057-3.721), and death were more often found in type-2 DM patients, 17.3% vs 6.3%, p= 0.001; CI 95%; RR= 3.116 (L556-6.239). Conclusions. There are differences in clinical characteristics of ACS between type-2 DM patients and non diabetic patients; which are longer onset of chestpain and atypical chestpain more often in type-2 DM patients. There are also differences in complications related ACS between Type-2 DM patients and non diabetic patients; heart failure, cardiogenic shock, and death more often in Type-2 DM patients.