Aims: As the country with the seventh largest number of People with Diabetes (PWD) in the world, the Coronavirus disease 2019 (COVID-19) pandemic, and the Large Social Scale Restriction (LSSR) policy taken by the Indonesian government to reduce the number of COVID-19 transmissions is estimated to interfere diabetes management and will increase the incidence of diabetes complications. This study aims to determine the difficulties of diabetes management and its impact on diabetes morbidity during the COVID-19 pandemic in Indonesia. Methods: This study is a cross-sectional study using a national scale web survey. This research was conducted in Indonesia enrolling 1124 PWD aged 18 years or older. Diabetes complications are defined as self-assessed incidence of hypoglycemia, or Diabetic Foot Ulcer (DFU), or hospital admission experienced by PWD in Indonesia during the COVID-19 pandemic. The correlation between diabetes management difficulties and diabetes-related complications was measured using a modified cox regression test. Results: Diabetes management difficulties were experienced by 69.8% of PWD in Indonesia. The difficulties include attending diabetes consultation 30.1%, access to diabetes medication 12.4%, checking blood glucose levels 9.5%, controlling diet 23.8%, and performing regular exercise 36.5%. Diabetes-related complications occurred in 24.6% of subjects. Those who had diabetes management difficulties during the COVID-19 pandemic are prone to have diabetes complications by 1.4 times greater (PR: 1.41, 95% CI: 1.09-1.83) than those who did not. Conclusion: The COVID-19 pandemic and LSSR have impact on diabetes management and diabetes-related complications as assessed by PWD in Indonesia.

BackgroundAs the country with the 7th largest number of People with Diabetes (PWD) in the world, the COVID-19 pandemic, and the Large Social Scale Restriction (LSSR) policy taken by the Indonesian government to reduce the number of COVID-19 transmissions is estimated to interfere diabetes management and will increase the incidence of diabetes complications. This study aims to determine the difficulties of diabetes management and its impact on diabetes morbidity during the COVID-19 pandemic in Indonesia.MethodologyThis study is a cross-sectional study using a national scale web survey. This research was conducted in Indonesia enrolling 1,124 PWD aged 18 years or older. Diabetes complications are defined as any incidence of hypoglycaemia, or Diabetic Foot Ulcer (DFU), or hospital admission experienced by PWD in Indonesia during the COVID-19 pandemic. The correlation between diabetes management difficulties and diabetes-related complications was measured using a modified cox regression test.ResultsDiabetes management difficulties were experienced by 69.8% of PWD in Indonesia. The difficulties include attending diabetes consultation 30.1%, access to diabetes medication 12.4%, checking blood sugar levels 9.5%, controlling diet 23.8%, and performing regular exercise 36.5%. Diabetes-related complications occurred in 24.6% of subjects. Those who had diabetes management difficulties during the COVID-19 pandemic are prone to have diabetes complications by 1.4 times greater (PR: 1.41, 95% CI: 1.09-1.83) than those who did not.ConclusionThe COVID-19 pandemic and LSSR have a substantial impact on diabetes management and indirectly increased diabetes morbidity in Indonesia.

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Background: The utilization of technology in diabetes management, especially self-monitoring blood glucose (SMBG), is growing rapidly. However, the effectiveness of SMBG applications on the smartphone is not yet known. This study aims to assess the effectiveness of using a smartphone-based SMBG application in type 2 diabetes mellitus (T2DM) patients in the Indonesian population.Methods: This is a quasi-experimental (before and after) study conducted at three tertiary hospitals in Jakarta and Malang, Indonesia. Inclusion criteria were T2DM patients aged 18 years and above who have been familiar with performing SMBG  and manually record the results. All subjects were asked to use a smartphone-based SMBG application named Teman Diabetes application for six months, and patients' SMBG performance was assessed at the end of the study Bivariate analysis using T-test or with the Mann Whitney U test performed. Chi-square test is used to analyze the categorical with Risk Ratio (RR) and 95% Confidence Interval (CI). The p-value <0.05 (two-tailed) is considered statically meaningful.Results: From 100 patients enrolled in the study, 78 patients completed the follow-up. We found that the use of the SMBG application helped the subject overcome the difficulty in remembering to perform SMBG (p=0.004), helped change the subject's perception of the benefits of SMBG (p=0.049), improved the subject's diet pattern (p=0.006), and decreased the number of subjects who stopped performing SMBG due to self-perception of lack of benefit SMBG activity (p=0.049).Conclusions: The study found that using the SMBG application helps manage diabetes in T2DM patients.

Introduction:This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM). Methods: This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020. We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12.2%) or pre-existing T2DM (16, 17.8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital. Results: Critical conditions occurred in 50% of T2DM and 54.55% of the in-hospital hyperglycemia group. Mortality was documented in 68.75% of T2DM and 81.82% of in-hospital hyperglycemia group. Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12.5%, 25%, 18.75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate. Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group. However, respiratory failure (45.45% vs. 6.25%) and septic shock (27.27% vs. 6.25%) were more frequent than in the T2DM group. Conclusion:In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia. In T2DM subjects, diabetes relatedcomplications contributed to a higher mortality rate, while inhospital hyperglycemia group, respiratory failure and septic shock were more frequent.

Background and aim: The awareness and practice of diabetes foot prevention by internist through routine examination and patient education remains less than optimal. This study aimed to evaluate the quality of care of internist in performing foot care in high-risk patients. Methods: A cross sectional study was conducted in a tertiary care hospital in Jakarta, Indonesia. Type 2 diabetes mellitus subjects with high-risk foot complication were included in this study. Each subject filled-in a questionnaire investigating whether they had received information about proper foot care practice and whether they have ever had their feet examined by an internist at their present consultation. Multivariate logistic regression were performed. Results: 368 patients were recruited, 130 of them (35.3%) treated by endocrinologists. 71.20% patients did not received any information on foot care and 54.08% patients did not received any foot examination. Foot care information was 1.6 times more frequently provided to patient with longer diabetes duration and 2 times more frequently provided to those who had history of diabetic foot ulcer. Meanwhile, foot examination was 1.5 times more frequently provided to those with longer diabetes duration and had a history of Lower Extremity Amputation. Compare to non-endocrinologist internist, endocrinologists tend to provide foot education and perform foot examination 2.2 to 2.5 times more frequently than non-endocrinologists. Conclusion: Most of patients with high risk foot problems were not offered adequate foot care. It is necessary to develop strategies to improve the care and awareness among health professionals treating patients with diabetes especially internist.

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Recurrent Abortion in Multigravid Type 1 Diabetes Mellitus Woman With Subclinical Hypothyroidism Hashimoto’s Thyroiditis and Antiphospholipid Syndrome as a Manifestation of Type III Autoimmune Polyglandular Syndrome: A Case Report Background: Type 1 Diabetes Mellitus, Antiphospholipid Syndrome, and autoimmune thyroid disease such as Hashimoto’s Thyroiditis had been reported for increasing risk of miscarriages. Meanwhile, the type III Autoimmune Polyglandular Syndrome comprises of autoimmune hypothyroidism and immune mediated diabetes mellitus. Here we report a manifestation of the syndrome presented as a recurrent pregnancy loss in newly diagnosed subclinical hypothyroidism phase of Hashimoto’s Thyroiditis and Antiphospholipid Syndrome, in multigravid woman with long standing Type 1 Diabetes Mellitus. Clinical Case: A 31 years old woman, 20 weeks pregnant, with previously known Type 1 Diabetes Mellitus since the age of 11 years old, came to the Emergency Room with diabetic ketoacidosis. She complained of having nausea, vomiting, and diarrhea two days before hospital admission. She also had history of six spontaneous abortions which all occurred at below 20 weeks of gestation, but no further examination was done to find the cause. The patient was examined with fetal ultrasound and showed good fetal condition, fetal heart rate 143 bpm, estimated fetal weight 562 grams, polyhidramnion, and single umbilical artery. The patient denied any symptoms regarding hair loss, cold intolerence, slow movement, slow speech, or constipation. From physical examination, we found normal vital signs, no abnormalities in thyroid physical examination, but dry hyperpigmented skin in both legs. The patient was examined for thyroid function and found elevated TSH (5.625 IU/mL, n = 0,48 - 4,17 mIU/L) and normal free T4 (1,3 ng/dL, n = 0,89 - 1,76 ng/dL). The TPO antibody was 549,59 IU/mL (n&lt;5.61 IU/mL) and lupus anticoagulant was weakly positive (1.2 - 2.5, n&lt;1.2). The patient was finally diagnosed as Hashimoto’s Thyroiditis and Antiphospholipid Syndrome, which was unrecognized at previous medical care, and in addition to previously known Diabetes Mellitus Type 1 could be manifested as Type III Autoimmune Polyglandular Syndrome. The likely cause of recurrent pregnancy loss in this case could be the Hashimoto’s Thyroiditis and Antiphospholipid Syndrome. Conclusion: Type III Autoimmune Polyglandular Syndrome could be manifested as recurrent pregnancy loss in patient with Type 1 Diabetes Mellitus, therefore the examination of thyroid function and other autoimmune disease such as Antiphospholipid Syndrome should be conducted.