DAFTAR ISI
HALAMAN JUDUL ......................................................................................................... i HALAMAN PENGESAHAN ........................................................................................... ii HALAMAN PERNYATAAN ........................................................................................... iii HALAMAN PERSEMBAHAN ....................................................................................... iv KATA PENGANTAR ....................................................................................................... v DAFTAR ISI ...................................................................................................................... vi DAFTAR TABEL ............................................................................................................. ix DAFTAR GAMBAR ......................................................................................................... x DAFTAR LAMPIRAN ..................................................................................................... xi INTISARI .......................................................................................................................... xii ABSTRACT ....................................................................................................................... xiii BAB I Pendahuluan .......................................................................................................... 1 A. Latar Belakang Masalah ..................................................................................... 1 B. Rumusan Masalah ............................................................................................... 3 C. Tujuan Penelitian ................................................................................................ 3 D. Manfaat Penelitian .............................................................................................. 4 BAB II Studi Pustaka ....................................................................................................... 5 A. Tinjauan Pustaka ................................................................................................ 5 I.
Diabetes Melitus .......................................................................................... 5 a. Definisi ................................................................................................... 5 b. Epidemiologi........................................................................................... 5 c. Klasifikasi ............................................................................................... 6 d. Manifestasi Klinis ................................................................................... 9 e. Diagnosis ................................................................................................ 10
II. Penatalaksanaan Diabetes Melitus .............................................................. 12 III. Manajemen Diet .......................................................................................... 14 IV. Terapi Farmakologi Diabetes Melitus ......................................................... 19 1. Sulfoilurea............................................................................................... 19 2. Biguanida ................................................................................................ 21 3. Inhibitor α-Glukosidase .......................................................................... 22
4. Tiazolidindion ......................................................................................... 23 5. Insulin ..................................................................................................... 25 VI. Komplikasi Diabetes .................................................................................... 26 B. Landasan Teori ................................................................................................... 26 C. Hipotesis ............................................................................................................. 29 BAB III Metodologi Penelitian ........................................................................................ 30 A. Rancangan Penelitian ......................................................................................... 30 B. Tempat dan Waktu Penelitian ............................................................................ 31 C. Populasi dan Sampel........................................................................................... 32 1. Populasi Target ............................................................................................ 32 2. Populasi Terjangkau .................................................................................... 32 3. Sampel ......................................................................................................... 32 D. Definisi Batasan Operasional ............................................................................. 33 E. Bahan dan Alat ................................................................................................... 34 1. Bahan ........................................................................................................... 34 2. Alat .............................................................................................................. 34 F. Pengumpulan Data.............................................................................................. 34 1. Observasi ..................................................................................................... 34 2. Wawancara .................................................................................................. 34 3. Pengumpulan Data Melalui Rekam Medik ................................................. 34 G. Pengolahan dan Analisis Hasil ........................................................................... 35 BAB IV Hasil dan Pembahasan ....................................................................................... 36 A. Profil Karakteristik Pasien .................................................................................. 36 1. Distribusi Jumlah Pasien DM Tipe 2 Berdasarkan Jenis Kelamin .............. 36 2. Distribusi Jumlah Pasien DM Tipe 2 Berdasarkan Usia ............................. 37 3. Distribusi Jumlah Pasien Berdasarkan DM tipe 2 dengan Komplikasi Dan Tanpa Komplikasi ............................................................ 38 4. Profil Durasi Diabetes Melitus Tipe 2 ......................................................... 39 5. Diagnosis DM Tipe 2 dan Komplikasinya .................................................. 40 6. Parameter Long of Stay ................................................................................ 42 B. Profil Penggunaan Obat ...................................................................................... 43 1. Sulfonilurea ................................................................................................. 44
2. Insulin .......................................................................................................... 44 3. Kombinasi Sulfonilurea dengan Insulin ...................................................... 45 4. Profil golongan dan Macam Obat yang Digunakan Sebagai Pengatasan Komplikasi DM Tipe 2 ............................................................ 45 5. Kesesuaian Cara Pemberian Terapi Antidiabetik ........................................ 46 C. Profil Manajemen Diet Pasien ............................................................................ 48 1. Profil Asupan Jumlah Kalori Pasien DM tipe 2 .......................................... 48 2. Profil Pengontrolan Manajemen Diet Pasien .............................................. 49 D. Pengendalian Diabetes Melitus Tipe 2 ............................................................... 50 1. Parameter Kadar Glukosa Darah................................................................. 50 2. Parameter HbA1c ........................................................................................ 51 E. Hubungan antara diet dengan pengendalian kadar glukosa darah pasien diabetes melitus tipe 2 yang mendapatkan terapi antidiabetik (Insulin dan atau sulfonilurea) ......................................................................................... 52 F. Analisa Faktor Risiko yang Mempengaruhi pengendalian kadar glukosa darah pasien diabetes melitus tipe 2 yang mendapatkan terapi antidiabetik (Insulin dan atau sulfonilurea) ........................................................ 54 G. Keterbatasan Penelitian ...................................................................................... 59 BAB V Kesimpulan dan Saran ........................................................................................ 60 A. Kesimpulan ......................................................................................................... 60 B. Saran ................................................................................................................... 60 Daftar Pustaka ..................................................................................................................... 62 Lampiran ............................................................................................................................ 65
DAFTAR TABEL
Tabel I.
Klasifikasi Etiologis Diabetes Melitus .......................................................... 78
Tabel II.
Mekanisme Kerja, Efek Samping Utama, dan Pengaruh Terhadap Penurunan A1C (Hb-Glikosilat) .................................................................... 13
Tabel III.
Kebutuhan Kalori orang dengan diabetes ...................................................... 16
Tabel IV.
Obat Hipoglikemik Oral ................................................................................ 24
Tabel V.
Farmakokinetik insulin eksogen berdasar waktu kerja (time course of action) ............................................................................................................ 26
Tabel VI.
Profil Durasi Penyakit Diabetes Melitus Tipe 2 di Instalasi Rawat Inap RS. PKU Muhammadiyah Yogyakarta.................................................. 39
Tabel VII.
Persentase komplikasi yang terjadi pada pasien diabetes melitus tipe 2 di Instalasi Rawat Inap RS. PKU Muhammadiyah Yogyakarta ................. 40
Tabel VIII. Relevansi antara Durasi Penyakit dengan Komplikasi yang Terjadi pada Paisen Diabetes Melitus Tipe 2 di Instalasi Rawat Inap RS. PKU Muhammadiyah Yogyakarta................................................................. 41 Tabel IX.
Profil Long of Stay Pasien DM Tipe 2 di Instalasi Rawat Inap RS. PKU Muhammadiyah Yogyakarta................................................................. 42
Tabel X.
Profil Penggunaan Obat Antidiabetik Pada Pasien DM Tipe 2 di Instalasi Rawat Inap Rumah Sakit PKU Muhammadiyah Yogyakarta ......... 43
Tabel XI.
Profil Golongan dan Macam Obat yang Digunakan Sebagai Pengatasan Komplikasi DM Tipe 2 di Instalasi Rawat Inap Rumah Sakit PKU Muhammadiyah Yogyakarta ....................................................... 46
Tabel XII.
Pengendalian Diabetes Melitus Tipe 2 Terhadap Parameter KGD. .............. 50
Tabel XIII. Tabel Pengendalian Diabetes Melitus berdasarkan parameter HbA1c .......... 51 Tabel XIV. Hubungan Antara Diet dengan Pengendalian Kadar Glukosa Darah Pasien DM Tipe 2 di Instalasi Rawat Inap RS. PKU Muhammadiyah Yogyakarta ..................................................................................................... 53 Tabel XV.
Tabel Pengendalian Kadar Glukosa Darah Pasien Berdasarkan Faktor Risiko Diabetes Melitus Tipe 2 .......................................................... 55
DAFTAR GAMBAR
Gambar 1.
Langkah-langkah diagnostik DM dan gangguan ........................................... 11
Gambar 2.
Algoritma pengontrolan glukosa untuk diabetes melitus tipe 2 pada anak-anak dan dewasa ................................................................................... 18
Gambar 3.
Skema Penelitian............................................................................................ 30
Gambar 4.
Distribusi Jumlah Pasien DM Tipe 2 Berdasarkan Jenis Kelamin ................ 37
Gambar 5.
Distribusi Jumlah Pasien Dewasa dan Lanjut Usia DM Tipe 2 Rawat Inap RS. PKU Muhammadiyah Yogyakarta.................................................. 37
Gambar 6.
Distribusi Jumlah Pasien DM Tipe 2 Berdasarkan Usia................................ 38
Gambar 7.
Distribusi Jumlah Pasien Berdasarkan DM tipe 2 dengan Komplikasi Dan Tanpa Komplikasi .................................................................................. 39
Gambar 8.
Profil Cara Pemberian Antidiabetik Pada Pasien DM tipe 2 Rawat Inap di RS. PKU Muhammadiyah Yogyakarta ............................................. 47
Gambar 9.
Distribusi Asupan Jumlah Kalori Pasien DM Tipe 2 di Instalasi Rawat Inap Rumah Sakit PKU Muhammadiyah Yogyakarta ....................... 48
Gambar 10. Distribusi Pengontrolan Manajemen diet Pasien DM Tipe 2 di Instalasi Rawat Inap Rumah Sakit PKU Muhammadiyah Yogyakarta ......... 49
DAFTAR LAMPIRAN Lampiran 1. Lembar Wawancara Pasien ............................................................................ 63 Lampiran 2. Catatan Rekam Medik Pasien ........................................................................ 64 Lampiran 3. Input Data SPSS 12.0..................................................................................... 103 Lampiran 4. Hasil Output Chi Square ................................................................................ 104 Lampiran 5. Hasil Output Regresi Binary Logistik ........................................................... 105 Lampiran 6. Surat Izin Penelitian ....................................................................................... 113
