Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that requires lifelong therapy to control blood glucose. The long term use and different mechanism of action antidiabetic have the potential cause side effects and discomfort that affects the quality of life. This study aimed to determine differences in the quality of life of patients with T2DM based on antidiabetic prescribed and complications at the Outpatient of Panembahan Senopati Bantul Yogyakarta Hospital in September 2017. This research is observational with a cross-sectional design. Quality of life data is taking concurrently using the Diabetes Quality of Life Clinical Trial Questionnaire and patient's medical record. This study involved 200 T2DM patients who received antidiabetic at least 3 months before study, aged ≥18 years and agreed to inform concent. Sociodemographic data, antidiabetic prescribed and complications were described descriptively. Differences in the quality of life based on antidiabetic prescribed and complications using the Kruskal Wallis test which was further analyzed using the post hoc by Mann Whitney test. The results showed the majority of patients received oral combination with insulin (48.5%) and dominated by macrovascular complications (19.5%). The average value of patient's quality of life is 65.7. There was difference quality of life based on antidiabetic prescribed in the domain of treatment satisfaction (p=0.000) between oral monotherapy with combination of oral and insulin (p=0.000) and insulin monotherapy with combination of oral and insulin (p=0.002). There were differences in quality of life based on complications in the mental health domain (p=0.003) between macrovascular and microvascular (p=0.011) and between microvascular and without complications (p=0.001).
Diabetes Melitus (DM) tipe 2 merupakan penyakit kronis yang membutuhkan terapi untuk mengontrol glukosa darah. Pengontrolan glukosa darah yang buruk berdampak pada penurunan kualitas hidup dan peningkatan biaya. Tujuan penelitian adalah menganalisis perbedaan outcome klinis yaitu kadar Glukosa Darah Sewaktu (GDS) selama 3 bulan berdasarkan kualitas hidup dan biaya medis langsung. Outcome klinis dikatakan terkontrol apabila GDS <200 mg/dL dan tidak terkontrol apabila GDS ≥200 mg/dL. Rancangan penelitian ini adalah cross sectional dengan jenis observasional. Kriteria inklusi mencakup pasien DM tipe 2 yang memperoleh antidiabetik yang sama minimal 3 bulan di Instalasi Rawat Jalan RSUD Panembahan Senopati Bantul pada September 2017. Kriteria eksklusi meliputi kondisi hamil atau menyusui. Pengambilan data dilakukan melalui pengisian kuesioner, rekam medis dan bagian keuangan. Data demografi dianalisis secara deskriptif sedangkan outcome klinis diolah menggunakan uji Kruskal Wallis. Hasil penelitian menunjukkan sebanyak 129 dari 200 pasien menunjukkan outcome klinis tidak terkontrol (64,5%) dengan rata-rata nilai kualitas hidup yang baik (65,7±7,7) serta mengeluarkan biaya medis langsung sebesar Rp 489.005. Terdapat perbedaan outcome klinis berdasarkan kualitas hidup (p=0,000) pada domain fungsi fisik (p=0,034), kepuasan pribadi (p=0,000), kepuasan pengobatan (p=0,000) dan frekuensi gejala penyakit (p=0,012) serta berdasarkan biaya medis langsung (p=0,012). Pasien dengan outcome klinis terkontrol menunjukkan kualitas hidup yang lebih tinggi dan mengeluarkan biaya lebih rendah.
Knowledge is important to control blood sugar and prevent complications and subsequently have an impact on the quality of life (QOL) of type 2 diabetes mellitus (T2DM) patients as a response to their health. This study aimed to determine the correlation between level of knowledge and QOL in type 2 DM (T2DM) patients, also its related factors. This cross-sectional study was conducted in a Public Hospitals, Buleleng, Bali on September 2020. Inclusion criteria included T2DM outpatients who ≥aged 18 years, get similar therapy for at least 3 months, filling out the questionnaire completely, able to communicate well, and not in a pregnant/breastfeeding condition. Data were obtained by medical records, questionnaires DKQ-24 (knowledge) and EQ-5D-5L (QOL). Correlation between knowledge and QOL of T2DM patients and its related factors were analyzed using bivariate statistical tests. Finding of 150 respondents demonstrated mostly were ≥60 years old (53.3%), female (50.7%), first educational level (64%), not working (54%), low income (49.3%), >5 years of T2DM duration (44%), no complications (75.3%), taking 4-6 item medicines (66.7%), moderate knowledge level (70.7%) with QOL based on the utility score was 0.892±0.154 and VAS was 59.73±20.07. Statistical tests showed there was a significant correlation between knowledge and QOL based on utility value (p=0.01), but not with VAS value (p=0.165). These was reinforced by age has a significant correlation with knowledge (p=0.042), also employment status and complications condition has a significant correlation with QOL (p<0.05). Patients with a higher level of knowledge have a better QOL, despite different backgrounds.
Type 2 Diabetes mellitus (T2DM) is a chronic disease that requires long-term treatment. There were problems related to antidiabetic medication adherence. Medication adherence directly affects patient’s blood glucose level. The aim of this study was to analyze the association between the medication adherence and glycemic control among T2DM patients. The study was an observational with cross sectional design. Participants were 90 of T2DM outpatient at “X” Buleleng General Hospital in July-September 2020. T2DM patients were included if age ?18 years, received the same antidiabetic for three months before the study, sign informed consent, fill out the questionnare and have fully medical record data. Patient are excluded if having weak general condition, were pregnant or breastfeeding. Data was collected through interview using the Probabilistic Medication Adherence Scale (ProMAS) questionnaire and based on patient’s medical records. Data were analyzed with Kruskall-Wallis test. The results showed that most of patients were male (55.6%), aged 46-65 years (61.1%), had DM for 5-10 years (46.7%), elementary school (37.8%), with comordbidities (50%) and without complications (77.8%). Majority of patients (42.2%) showed moderate-high medication adherence and the majority of patients (66.7%) has uncontrolled blood glucose. Based on statistical tests, there was no association between medication adherence with patient’s glycemic control (p=0.168). In dispite of it, finding showed that the level of medication adherence had an impact on glycemic control. Patients with high medication adherence showed better glycemic control.
End-Stage Renal Disease (ESRD) is a condition of severe renal damage associated with a higher incidence of hypertension that requires antihypertensive therapy to prevent the worsening disease. Therefore, patients who received more than two types of antihypertensives have affected medication adherence. This study aimed to analyze relationship between the number of antihypertensives and medication adherence in ESRD patients. The study was a cross-sectional design involving 77 participants selected by a purposive sampling technique at Outpatient Private Hospital Buleleng Bali in July-September 2020. Data were collected based on patient’s medical records and the Probabilistic Medication Adherence Scale (ProMAS) questionnaire. The inclusion criteria were ESRD patients aged ≥18 years, with hypertension history, taking the same antihypertensive for three months before the study, sign informed consent, and completed medical record data. Those who were a weak general condition and cognitive impairment were excluded from the study. Data were analyzed using a Kruskal-Wallis test. The results showed that overall, of patients were <65 years old (80.52%), male (70.13%), duration of ESRD <5 years (89.61%), primarily high school (57.14%), and without complications (57.1%). Most patients used a combination of two antihypertensives (35.07%), and 61.04% has a high medication adherence. There was no significant relationship between the number of antihypertensives and medication adherence (p=0.847). Nevertheless, it was still shown that the higher number of antihypertensives in ESRD patients was directly proportional to the lower medication adherence.
End-Stage Renal Disease (ESRD) is a severe kidney disorder that contributes to an increased risk of mortality in the world. This condition is often related with hypertension. Low medication adherence was affecting uncontrolled blood pressure in ESRD. The research aimed to analyze the association between medication adherence and blood pressure control in ESRD patients. This cross-sectional study with 77 respondents was conducted in September 2020 at the Dialysis Unit of the Private Hospital “X” Buleleng Bali by purposive sampling technique. The respondents must be ≥18 years, diagnosed with ESRD and hypertension, underwent hemodialysis (HD) twice a week, received the same antihypertensive for 3 months, have complete medical record data, and signed the informed consent form. Patients with cognitive impairment, unable to communicate, pregnant or breastfeeding, and received the Erythropoiesis Stimulating Agent (ESA) treatment were excluded. Kruskal-Wallis test was used in data analysis. Most of the patients were <65 years (80.52%), male (70.13%), primary education (57.14%), without complications (57.1%), and duration of illness <5 years (89.61%). Patients were in the high adherence (61.04%) and 66.23% of patients had uncontrolled blood pressure. The association between medication adherence and blood pressure control was not significant (p=0.478). However, these results show that high medication adherence could impact on good blood pressure control.
Resistensi insulin pada pasien diabetes melitus (DM) tipe 2 dapat meningkatkan risiko terjadinya komplikasi kardiovaskuler yang selanjutnya dapat berkontribusi sebagai penyebab utama kematian. Resistensi insulin meningkatkan kerentanan pasien mengalami aterosklerosis dan menimbulkan gangguan pada fungsi platelet di pembuluh darah yang dapat berdampak pada peningkatan risiko komplikasi kardiovaskuler. Sebagai salah satu upaya untuk mencegah dan mengurangi risiko tersebut, Canadian Cardiovascular Society Guidelines tahun 2011 dan American Diabetes Association tahun 2019 merekomendasikan penggunaan golongan statin dan antiplatelet sebagai upaya pencegahan sekunder komplikasi kardiovaskuler pada pasien DM tipe 2. Penelitian ini bertujuan untuk mengetahui gambaran penggunaan statin dan antiplatelet sebagai pencegahan sekunder pada pasien DM tipe 2 dengan komplikasi kardiovaskuler. Penelitian ini bersifat observasional dengan desain cross sectional yang dilakukan pada 110 pasien di RSU Puri Raharja Denpasar Bali periode November 2019. Hasil penelitian menunjukkan bahwa dari 110 pasien yang memenuhi kriteria penggunaan statin, hanya 42 pasien (38,1%) yang menggunakan statin (simvastatin 20 mg; 95,2%). Selain itu, dari total 96 pasien yang memenuhi kriteria penggunaan antiplatelet, hanya 52 pasien (47,3%) yang menggunakan antiplatelet (aspirin 80 mg; 82,7%). Penelitian ini merefleksikan penggunaan statin yang masih rendah dalam upaya pencegahan sekunder komplikasi kardiovaskuler pada pasien DM tipe 2. Meskipun terdapat kecenderungan tingkat penggunaan antiplatelet aspirin yang lebih tinggi daripada statin dalam penelitian ini, pemberian aspirin selanjutnya masih perlu ditingkatkan lagi bersama-sama dengan peningkatan pemberian statin.
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