HUBUNGAN ANTARA 4 PILAR PENGELOLAAN DIABETES MELITUS DENGAN KEBERHASILAN PENGELOLAAN DIABETES MELITUS TIPE 2
ASSOCIATION BETWEEN 4 PILLARS OF THE MANAGEMENT OF DIABETES MELLITUS WITH SUCCESS OF THE MANAGEMENT OF DIABETES MELLITUS TYPE 2
ARTIKEL KARYA TULIS ILMIAH
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PROGRAM PENDIDIKAN SAR.ANA KEDOKTERAN /AKULTAS KEDOKTERAN UNI0ERSITAS DIPONEGORO TAHUN 2,))
HUBUNGAN ANTARA 4 PILAR PENGELOLAAN DIABETES MELITUS DENGAN KEBERHASILAN PENGELOLAAN DIABETES MELITUS TIPE 2
Achmad Yoga S.U 1 Ha!" P#$" %&'"a$("2) Dod"* P!amo$o + ABSTRAK
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2) +
ASSO+IATION BET3EEN 4 PILLARS O/ THE MANAGEMENT O/ DIABETES MELLITUS 3ITH SU++ESS O/ THE MANAGEMENT DIABETES MELLITUS TYPE 2 Achmad Yoga S.U 1 Ha!" P#$" %&'"a$("2) Dod"* P!amo$o + ABSTRA+T
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Undergraduate Undergraduate student, Medical Faculty of Diponegoro University Lecturer, Lecturer, Department of Public ealt! "cience, Medical Faculty Faculty of Diponegoro University 2,3
LATAR LATAR BELAKANG
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LATIHAN .ASMANI
7#g"a(a 7#g"a(a$ $ 3ama$" 3ama$" #ha!"< #ha!"
m#$"(0 m#$"(0 m#!&1a m#!&1a*a$ *a$ a'ah a'ah a(& 1"'a! da'am da'am 1#$g#'o'aa$ d"a-#(# ("1# 2. La("ha$ 3ama$" da1a( m#$&!&$*a$ -#!a( -ada$ /3a' /3a'a$ a$)) -#!# -#!#1# 1#da da a$(a" a$(a")) 3ogg 3ogg"$ "$g) g) -#!# -#!#$a $a$g $g0. 0. La("h La("ha$ a$ 3ama 3ama$" $" #-a #-a"* "*$ $aa d"#&a"*a$ d#$ga$ &m&! da$ (a(& *##ga!a$ 3ama$". P#!'& d"-a(a" a(a& 3a$ga$ (#!'a'& 'ama m#'a*&*a$ *#g"a(a$ a$g *&!a$g g#!a* /m#$o$(o$ (#'#""0.
INTER0ENSI /ARMAKOLOGIS
I$(#!#$" 5a!ma*o'og"* d"(am-ah*a$ 3"*a aa!a$ g'&*oa da!ah -#'&m (#!ca1a" d#$ga$ 1#$ga(&!a$ ma*a$ da$ 'a("ha$ 3ama$".
OBAT HIPOGLIKEMIK ORAL 6OHO7
B#!daa!*a$ ca!a *#!3a$a) OHO d"-ag" m#$3ad" + go'o$ga$ , a. P#m"c& #*!#" "$&'"$ / "$&'"$ #c!#(agog&# 0 , &'5$"(&!#a da$ g'"$"d b. P#$am-ah #$"(""(a (#!hada1 "$&'"$ , m#(5o!m"$) ("a@o'"d"$d"o$ c. P#$gham-a( a-o!- g'&*oa , 1#$gham-a( g'&*o"da# a'5a
a. Pemi%u Sek#esi Insuin . Su8*ni#e O-a( go'o$ga$ go'o$ga$ "$" m#m1&$a" m#m1&$a" #5#* &(ama m#$"$g*a(*a m#$"$g*a(*a$ $ #*!#" "$&'"$ "$&'"$ o'#h #' -#(a 1a$c!#a) da$ m#!&1a*a$ 1"'"ha$ &(ama &$(&* 1a"#$ d#$ga$ -#!a( -ada$ $o!ma' da$ *&!a$g) $am&$ ma"h -o'#h d"-#!"*a$ *#1ada 1a"#$ d#$ga$ -#!a( -ada$ '#-"h. U$(&* m#$gh"$da!" h"1og'"*#m"a -#!*#1a$3a$ga$ 1ada -#!-aga" *#adaa$ #1#!(" o!a$g (&a) ga$gg&a$ 5aa' g"$3 g"$3a' a' da$ da$ ha(" ha(")) *&!a *&!a$g $g $&(!" $&(!"" " #!(a #!(a 1#$ 1#$a*" a*"(( *a!d *a!d"o "oa a* *&' &'#! #! ("da ("da* * d"a$3&!*a$ 1#$gg&$aa$ &'5o$"'&!"a *#!3a 1a$3a$g #1#!(" *'o!1am"d. 29 Gini&
G'"$"d G'"$"d m#!&1a*a$ m#!&1a*a$ o-a( g#$#!a" g#$#!a" -a!& a$g ca!a *#!3a$a *#!3a$a ama d#$ga$ d#$ga$ &'5o$"'&!"a) d#$ga$ m#$"$g*a(*a$ #*!#" "$&'"$ 5a# 1#!(ama. O-a( "$" d"a-o!-" d#$ga$ c#1a( #(#'ah 1#m-#!"a$ #ca!a o!a' da$ d"#*!#"$#ca!a c#1a( m#'a'&" ha(".
b9 Penmbh Sensiti:its Te#h&" Insuin )9 Met8*#min
O-a( O-a( "$" "$" m#m1 m#m1&$ &$a" a" #5#* #5#* &(ama &(ama m#$g m#$g&!a &!a$g" $g" 1!od&* 1!od&*" " g'&* g'&*oa oa ha(") ha(") d" am1"$g 3&ga m#m1#!-a"*" am-"'a$ g'&*oa 1#!"5#!) da$ (#!&(ama d"1a*a" 1ada 1a"#$ DM g#m&*.
29 Ti;*i&in&i*n
T"a@o'"d "a@o'"d"$d "$d"o$ "o$ /co$(o /co$(oh h , !o"g'" !o"g'"(a@ (a@o$ o$ da$ 1"og'" 1"og'"(a@o (a@o$0 $0 -#!"*a -#!"*a(a$ (a$ 1ada 1ada 1#!o"om# 1!o'"5#!a(o! ac("a(#d !#c#1(o! gamma /PPAR /PPAR ý), &a(& !##1(o! "$(" d" #' o(o( da$ #' '#ma*. Go'o$ga$ "$" m#m1&$a" #5#* m#$&!&$$*a$ !#"( !#"(#$ #$" " "$& "$&'" '"$ $ d#$g d#$ga$ a$ m#$"$ m#$"$g* g*a( a(*a *a$ $ 3&m'a 3&m'ah h 1#$( 1#$(!a$ !a$1 1o! o! g'&* g'&*o oa) a) #h"$ #h"$gg ggaa
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d"*o$(!a"$d"*a"*a$ 1ada 1a"#$ d#$ga$ gaga' 3a$(&$g *'a I IJ *a!#$a da1a( m#m1#!-#!a( #d#ma!#"(#$" ca"!a$ da$ 3&ga 1ada ga$gg&a$ 5aa' ha(". %. Pen!hmbt Guk*si&se A8 6 A%#b*se 7
O-a( "$" -#*#!3a d#$ga$ m#$g&!a$g" a-o!- g'&*oa d" && ha'&) #h"$gga m#m1&$a" #5#* m#$&!&$*a$ *ada! g'&*oa da!ah #&dah ma*a$. Aca!-o# ("da* m#$ga*"-a(*a$ #5#* am1"$g h"1og'"*#m"a. E5#* am1"$g a$g 1a'"$g #!"$g d"(#m&*a$ "a'ah *#m-&$g da$ 5'a(&'#$.
/AKT AKTOR
YANG
MENENT NENTU UKAN KAN
KEB EBER ERH HASIL ASILAN AN
PENANGANAN DIABETES MELITUS
Da!" -#!-aga" 1#$#'"("a$ (#$(a$g DM ("1# 2) d"*#(ah&" -#!-aga" 5a*(o! a$g m#m1#$ga!&h" *#-#!ha"'a$ 1#$a$ga$a$ DM ("1# 2 a$(a!a 'a"$, a) 7a!a*(#!"("* "$d""d&a' /("$g*a( 1#$d"d"*a$) da$ (a(& #*o$om"* 4 a"(& ,
Da'am (&d" a$g d"'a*&*a$ o'#h H## L## d** m#$#m&*a$ -ah6a !#1o$ (#!hada1 -#!-aga" &1aa (#!a1#("* da1a( d"1#$ga!&h" o'#h !a) 3#$" *#'am"$ da$ gaa h"d&1
/ (#!ma&* -&daa 0. 7#-#!ha"'a$ 1#m-#!"a$
(#!a1" 3&ga (#!ga$(&$g 1ada ("$g*a( 1#$d"d"**a$ 1a"#$) d&*&$ga$ o"a' da$ *#'&a!ga. D&*&$ga$ oc"a' m#!&1a*a$ a'ah a(& 5a*(o! 1#$("$g (#!*a"( 1#!a6a(a$ d"a-#(# a$g 'aa*. S(a(& #*o$om"* a$g a$g !#$dah m#!&1a*a$ a'ah a(& 5a*(o! 1!og$o("c "$d#1#$d#$K 3ad" 1!og!am 1#$d&*&$g oc"a' ha!& d"#!(a*a$ &$(&* m#$da1a(*a$ ha"' a$g -a"*.
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B#-#!a1 B#-#!a1aa (&d" (&d" m#$&$3 m#$&$3&** &**a$ a$ #5#* da!" da!" a*(""( a*(""(a a 5""* 5""* (#!had (#!hada1 a1 co$(!o co$(!o'' g'"*#m g'"*#m"* "* 1ada 1ada &-# &-#* * d#$ga$ d#$ga$ d"a-#(# d"a-#(#. . A*("" A*(""(a (a 5""* 5""* (#!-&*( (#!-&*("" da1a( da1a( m#$"$g*a(*a$ #$"(""(a "$&'"$) m#$&!&$*a$ '##' H-Ac) m#m1#!-a"*" 1!o5"' '"1"d) da$ m#$g&!a$g" *ada! '#ma* 1#!&( / abdominal fat 0. Pada (&d" DA "$g d" C"$a) a*(""(a 5""* #ca!a !#g&'a! da1a( m#$g&!a$g" !""*o -#!*#m-a$g$a d"a-#(# am1a" 49 ; Pada N&!# H#a'(h S(&d) 1#$g&!a$ga$ RR #-#a! ++ ; 3&ga d"da1a(*a$ 1ada 6a$"(a 6a$"(a a$g m#m"'"*" a*(""(a 5""* a$g (#$aga #("da*$a a(& *a'" da'am #m"$gg& . A*("" A*(""(a (a 5""* 5""* #ha!& #ha!&$ $aa m#$3ad m#$3ad"" -ag"a$ -ag"a$ "$(#!g "$(#!g!a' !a' da!" da!" ma$a3#m ma$a3#ma$ a$ o-#"(a #ca!a *om1!#h#$"5 da$ ha!& d"!a$ca$g *h&& #&a" d#!a3a( o-#"(a$a. A*(""(a 5""* ("da* ha$a m#$"$g*a(*a$ 1#m-a*a!a$ #$#!g da$ '#ma*) '#ma*) $am&$ $am&$ 3&ga 3&ga m#'"$d& m#'"$d&$g" $g" (#!hada (#!hada1 1 h"'a$g h"'a$g$a $a maa maa (&-&h) (&-&h) m#$"$g*a(*a m#$"$g*a(*a$ $ *#-&ga!a$ *#-&ga!a$ *a!d"o!#1"! *a!d"o!#1"!a") a") m#$&!&$*a$ m#$&!&$*a$ !""*o *##ha(a$ *##ha(a$ m#(a-o m#(a-o'"* '"* a$g a$g (#!*a" (#!*a"(( o-#"(a o-#"(a) ) da$ m#m"c& m#m"c& 1#!aaa 1#!aaa$ $ #ha( #ha( 1ada 1ada d"!" d"!"
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.
SAMPEL PENELITIAN
Sam1#' Sam1#' 1#$#'" 1#$#'"("a$ ("a$ ada'ah ada'ah 1#$d#! 1#$d#!"(a "(a DM ("1# ("1# 2 a$g a$g d"d"ag d"d"ag$o $o" " do*(#! do*(#! a$g a$g -#!(&ga d" Po'"*'"$"* P#$a*"( da'am RSD7 #-aga" *a& da$ 1#$d#!"(a a$g -#!o-a( *# Po'"*'"$"* P#$a*"( Da'am a$g a$g ("da* m#$d#!"(a DM #-aga" *o$(!o'. Ca!a 1#$gam-"'a$ am1#' m#$gg&$a*a$ purposive m#$gg&$a*a$ purposive sampling d#$ga$ -#a! am1#' a$g d"am-"' ada'ah -#a! am1#' m"$"ma' a"(&,
D"ma$a, $ ? B#a! am1#' ? 7#a'aha$ ("1# I ? :; ? )9 ? 7#a'aha$ ("1# II ? 2>; ? >)42 ! ? P#!*"!aa$ *o#5""#$ *o!#'a" ? >):
B#a B#a!! am1# am1#'' m"$" m"$"ma ma'' da!" da!" 1#!h 1#!h"( "(&$ &$ga ga$ $ !&m& !&m& d" a(a a(a a$g a$g d"1a d"1a*a" *a" da'am da'am 1#$#'"("a$ "$" #-a$a* 2 !#1o$d#$ Ksus a.
7a& ada'ah 1a"#$ !a6a( 3a'a$ d" Po'"*'"$"* P#$a*"( P#$a*"( Da'am RSD7 S#ma!a$ S#ma!a$g g a$g a$g (#'ah (#'ah d"d"ag d"d"ag$o $o" " do*(#! do*(#! #-aga #-aga"" 1a"#$ 1a"#$ DM ("1# ("1# 2 #("da*$a da'am 9 -&'a$ (#!a*h"!) a$g -#!daa!*a$ ha"' 1#m#!"*aa$ H-AC 9 -&'a$ (#!a*h"!) (#!a*h"!) d#$ga$ H-Ac H-Ac 8 9): mgd' mgd'
b.
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B#!#d"a m#$3ad" !#1o$d#$ d#$ga$ m#$a$da(a$ga$" informed consent+
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K#ite#i ekskusi
Pa"#$ Pa"#$ Po'"*' Po'"*'"$" "$"* * !a6a( !a6a( 3a'a$ 3a'a$ P#$a*" P#$a*"(( Da'am Da'am
RSD7 RSD7 S#ma!a$ S#ma!a$g g
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d"d"ag$o" do*(#! #-aga" 1a"#$ DM ("1# 2 $am&$ -#'&m 1#!$ah) m#'a*&*a$ 1#m#!"*aa$ H-Ac.
0ARIABEL PENELITIAN 0#ibe De"en&en
Ja!"a-#' d#1#$d#$ ada'ah 7#-#!ha"'a$ P#$g#'o'aa$ DM
0#ibe In&e"en&en
Ja!"a-#' Ja!"a-#' I$d#1#$d#$ a$g d"(#'"(" a$(a!a 'a"$ ada'ah , .P#$g#(ah&a$ (#$(a$g 1#$g#'o'aa$ DM 2. 7#1a(&ha$ m"$&m o-a( +. Po'a ma*a$ 4. 7#(#!a(&!a$ -#!o'ah!aga
ANALISIS BI0ARIAT BI0ARIAT = ANALISIS ANALITIK 1. Hubun!n Pen!ethun &en!n Kebe#hsin Pen!e*n DM Ti"e
29
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Pen!e*n DM ti"e 29
Ha"' Ha"' a$a' a$a'"" "" d"da d"da1a 1a(* (*a$ a$ odds odds rasio rasio /OR0 /OR0 #-#a! #-#a! 4)>+ 4)>+ d#$ga$ d#$ga$ :; confidence interval /CI0 /CI0 , )+4)4 da$ $"'a" P ? >)> />)>:0. Ha' "$" m#$&$3 m#$&$3&** &**a$ a$ -ah6a -ah6a o!a$g o!a$g a$g a$g m#m1&$ m#m1&$a a"" *#1a(& *#1a(&ha$ ha$ m"$&m m"$&m o-a( o-a( m#m1&$a" !""*o 4 *a'" &$(&* -#!ha"' da'am 1#$g#'o'aa$ DM ("1# 2 d"-a$d"$g*a$ d#$ga$ a$g ("da* 1a(&h da$ #ca!a (a("("* -#!ma*$a. 3. Hubun!n nt# P* Mkn &en!n Kebe#hsin Pen!e*n DM
Ti"e 2
Ha"' Ha"' a$a'"" a$a'"" d"da1a d"da1a(*a (*a$ $ odds odds ratio ratio /OR0 /OR0 #-#a! #-#a! 4)2 d#$ga$ d#$ga$ :; confidence interval /CI0 /CI0 , )44)2+)>9 da$ $"'a" P ? >)>> />)>:0. Ha' "$" m#$&$3&**a$ -ah6a o!a$g a$g m#m1&$a" 1o'a ma*a$ -a"* -#!""*o 4 *a'" &$(&* -#!ha"' da'am 1#$g#'o'aa$ DM ("1# 2 d"-a$d"$g*a$ d#$ga$ a$g ("da* -a"* da$ #ca!a (a("("* -#!ma*$a. 4. Hubun!n nt# Oh R! &en!n Kebe#hsin Pen!e*n DM
Ti"e 2
Da!" 1#$#'"("a$ "$" d"da1a(*a$ -ah6a !#1o$d#$ a$g m#'a*&*a$ o'ah!aga #ca!a #ca!a (#!a(& (#!a(&!! da$ da$ -a"* -a"* m#m" m#m"'" '"*" *" h&-& h&-&$g $ga$ a$ a$g a$g "g$" "g$"5" 5"*a *a$ $ (#!h (#!had ada1 a1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 / P ? >)>>2 0. 7#g"a(a$ 5""* #ha!"< ha!" da$ 'a("ha$ 3ama$" (#!a(&! (#!a(&! / + < 4 *a'" #m"$gg& #'ama *&!a$g *&!a$g '#-"h +> m#$"( 0 a$g "5a($a #&a" CRIPE / continous continous , r!yt!mical, r!yt!mical, interval, interval, endurance endurance training 0 m#!&1a*a$ a'ah a(& 1"'a! da'am 1#$g#'o'aa$ DM ("1# ("1# 2. La("ha La("ha$ $ 3ama$" 3ama$" a(a& o'ah!a o'ah!aga ga "$" (#!-&*( (#!-&*("" da1a( da1a( m#$"$g m#$"$g*a( *a(*a$ *a$ #$"(""(a !##1(o! d" 3a!"$ga$ 1#!"5#! (#!hada1 "$&'"$) #h"$gga glucose #h"$gga glucose update m#$"$g*a( update m#$"$g*a( da$ (a(& g'"*#m"* m#m-a"*.
ANALISIS MULTI0ARIAT
R#g!#" R#g!#" 'og"( 'og"("* "* / Logistic Logistic &egression0 &egression0 d"g&$a d"g&$a*a$ *a$ da'am da'am 1#$#'"( 1#$#'"("a$ "a$ "$" &$(&* &$(&* m#$g#( m#$g#(ah& ah&"" 1#$ga! 1#$ga!&h &h a!"aa!"a-#' #' (#!"*a( (#!"*a( (#!had (#!hada1 a1 a!"aa!"a-#' #' -#-a$ -#-a$a) a) a(a& d#$ga$ *a(a 'a"$ !#g!#" 'og"("* da'am 1#$#'"("a$ "$" d"g&$a*a$ &$(&* m#$g#(ah&" 1#$ga!&h 1#$g#(ah&a$ 1#$g#'o'aa$$ DM) *#1a(&ha$ m"$&m o-a() 1o'a ma*a$) da$ *#(#!a(&!a$ -#!o'ah !aga (#!hada1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2. N"'a" R S&a!# #-#a! >)4>.Ha"' 1#$#'"("a$ "$" m#m-&*("*a$ -ah6a #'&!&h a!"a-#'
"$d#1#$d#$ *#(#!a(&!a$ -#!o'ah !aga da1a( m#$3#'a*a$ *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 #-#a! 4>.;) #da$g*a$ "a$a a"(& #-#a! :); d"3#'a*a$ o'#h a!"a-#' 'a"$ a$g ("da* d"3#'a*a$ da'am 1#$#'"("a$ "$". Ha" Ha"''
1#$# 1#$#'"( '"("a "a$ $
"$" "$" m#m m#m-& -&*(" *("*a *a$ $ -ah -ah6a 6a 1#$ 1#$g# g#(a (ah& h&a$ a$ (#$ (#$(a (a$g $g
1#$g#'o'aa$ DM ("da* -#!1#$ga!&h "g$"5"*a$ "g$"5"*a$ (#!hada1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 /P ? >.290. D"am1"$g "(&) ha"' 1#$#'"("a$ "$" 3&ga m#$#m&*a$ ada$a &a(& &a(& -&*(" -&*(" -ah6a -ah6a *#1a(& *#1a(&ha$ ha$ m"$&m m"$&m o-a( o-a( #ca!a #ca!a (#!a(&! (#!a(&! -#!1#$ -#!1#$ga! ga!&h &h 1o"(" 1o"("55 (#!hada1 (#!hada1 *#-#!ha"'a$ *#-#!ha"'a$ 1#$g#'o'aa$ 1#$g#'o'aa$ DM ("1# 2) (#(a1" ("da* m#m-#!"*$ ha"' a$g "g$"5 "g$"5"*a "*a$ $ #ca!a #ca!a (a("( (a("("c "c
/P ? >.>:0. >.>:0. S#'a$3& S#'a$3&($ ($a) a) ha"' 1#$#'"("a 1#$#'"("a$ $ "$" 3&ga
m#mm#m-&* &*(" ("*a *a$ $ -ah6 -ah6aa 1o'a 1o'a ma*a$ ma*a$ ("da* ("da* -#!1 -#!1#$ #$ga ga!& !&h h "g$" "g$"5"* 5"*a$ a$ (#!h (#!had ada1 a1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 /P ? >.490. S#-a'"*$a) ha"' 1#$#'"("a$ "$" m#mm#m-#!" #!"*a *a$ $ &a( &a(& & -&*( -&*("" a$g a$g c&*& c&*&1 1 *&a( *&a( -ah6 -ah6aa *#(# *#(#!a( !a(&! &!a$ a$ -#!o -#!o'ah 'ah !aga !aga -#!1#$ga!&h "g$"5"*a$ (#!hada1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 /P ? >.>>0.
PEMBAHASAN Hubun!n
nt#
Pen!ethun
tentn!
Pen Pen!e*n
DM
&en!n
Kebe#hsin Pen!e*n DM Ti"e Ti"e 29
P#$# P#$#'"( '"("a "a$ $ "$" "$" m#m-& m#m-&*( *("* "*a$ a$ -ah6 -ah6aa 1#$g 1#$g#(a #(ah& h&a$ a$ (#$( (#$(a$ a$g g 1#$g 1#$g#' #'o' o'aa$ aa$ DM -#!h&-&$ga$ #ca!a "g$"5"*a$ d#$ga$ *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1#2 / P ? >)>:0. >)>:0. Ha' "$" m#$&$3&**a$ m#$&$3&**a$ -ah6a -ah6a o!a$g a$g m#m1&$ m#m1&$a" a" 1#$g#(ah&a$ 1#$g#(ah&a$ -a"* m#m1 m#m1&$ &$ a" !"" !""*o *o 4 *a'" *a'" &$(& &$(&* * -#!h -#!ha a"' "' da'a da'am m 1#$g 1#$g#' #'o' o'aa aa$ $ DM ("1# ("1# 2 d"-a$d"$g*a$ d#$ga$ a$g -#!1#$g#(ah&a$ *&!a$g da$ #ca!a (a("("* -#!ma*$a. P#"-#! da$ No!!" m#$a(a*a$ -ah6a DM ("1# 2 &m&$$a (#!3ad" 1ada aa( 1o'a ga gaa h"d& h"d&1 1 da$ da$ 1#!" 1#!"'a 'a*& *& (#'a (#'ah h (#!(#!-#$ #$(& (&* * d#$g d#$ga$ a$ *o*o *o*oh) h) o'#h o'#h *a!# *a!#$a $a "(& "(& *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 m#m-&(&h*a$ 1a!(""1a" a*("5 da!" 1#$d#!"(a da$ 3&ga *#'&a!ga$a +) 4. Ed&*a" a$g -a"* #("da*$a m#'"1&(" 1#mahama$ (#$(a$g , . P#$a*"( DM ("1# 2K E("o'og") Pa(o5""o'og" da$ G#3a'a 7'"$"* 2. Ma*$a da$ 1#!'&$a 1#$g#$da'"a$ da$ 1#ma$(a&a$ DM ("1# 2 +. 7om1'"*a" a*&( ma&1&$ *!o$"* DM ("1# 2 da$ (a$da (a$da$a
4. P!og!am 1#$go-a(a$K (#!ma&* "$(#!#$" 5a!ma*o'og"* da$ $o$ 5a!ma*o'og"* :. "elf management ) (#!ma&* mo$"(o!"$g mo$"(o!"$g m#(a-o'"m / *ada! g&'a da!ah) &!"$# 0 da$ mo$"(o!"$ mo$"(o!"$g g g#3a'a g#3a'a ga$gg&a$ ga$gg&a$ !#g&'a" !#g&'a" g'&*oa g'&*oa da$ #5#* am1"$g o-a( 9. P#!&-aha$ gaa h"d&1 a(a& / life style 0) m"a'$a K -#!h#$(" m#!o*o*) 1o'a ma*a$ #ha( da$ a*("5"(a 5""*. Hubun!n Ke"tuhn Minum Obt &en!n Kebe#hsin Pen!e*n DM Ti"e2
Da!" 1#$#'"("a$ "$" d"(#m&*a$ d"(#m&*a$ -ah6a *#1a(&ha$ m"$&m o-a( -#!h&-&$g -#!h&-&$ga$ a$ #ca!a "g$"5"*a$ d#$ga$ *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 /P /P ? >)>0. >)>0. Ha' "$" #&a" d#$ga$ 1#$#'"("a$ a$g #-#'&m$a) #1#!(" a$g d"*#m&*a*a$ o'#h T&!$#! #( a'.:) a$g m#m-a$d"$g*a$ m#m-a$d"$g*a$ 1#$ga!&h 1#$ga!&h -#-#!a1a (#!a1" (#!hada1 kontr kontrol ol g'&*oa 1ada DM ("1# 2 a$g m#'a1o!*a$ -ah6a *o$(!"-&" d"#() &'1ho$'&!#a) m#(5o!m"$ da$ "$&'"$ (#!hada1 kontrol g&'a g&'a da!ah ada'ah #-#a! ;) 24;) ; da$ 42;. Ha' "$" m#$&$3&**a$ -ah6a (#!a1" 1#$go-a(a$ DM ("1# 2 m#m-#!"*a$ *o$(!"-&" a$g '#-"h -#a! da'am *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2. Sa!a5 a!a5"$ "$o o
da$ da$
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m#$d m#$d#5 #5"$ "$" ""*a "*a$ $
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/compli complianc ancee ad!er ad!erenc encee- #-ag #-aga", a", Q T"$g* "$g*a( a( 1a" 1a"#$ #$ m#'a* m#'a*a a$a $a*a *a$ $ ca!a ca!a 1#$go-a(a$ da$ 1#!"'a*& a$g d"a!a$*a$ o'#h do*(#!$a a(a& o'#h a$g 'a"$.. d#5"$"" *#("da*(aa($a "$" &'"( d"a$a'"a) *a!#$a &'"( &$(&* d"d#5"$""*a$ ) &'"( &$(&* &$(&* d"&*&! d"&*&! da$ (#!ga$(&$g (#!ga$(&$g 1ada -a$a* 5a*(o!. 5a*(o!. L#-"h 'a$3&( La G!#ca S(o$# m#$a(a*a$ m#$a(a*a$ -ah6a m#$(aa(" m#$(aa(" !#*om#$da" !#*om#$da" 1#$go-a(a$ 1#$go-a(a$ a$g d"a$3&!*a$ d"a$3&!*a$ do*(#! do*(#! m#!&1a*a$ maa'ah a$g a$ga( 1#$("$g. T"$g*a( *#("da*(aa(a$ (#!-&*(" c&*&1 ("$gg" da'am #'&!&h 1o1&'a" m#d" a$g *!o$". Sa!a5"$o m#$ga(a*a$ -ah6a ("$g*a( *#(aa(a$ *##'&!&ha$ ada'ah 9>;. : Hubun!n P* Mkn &en!n Kebe#hsin Pen!e*n DM Ti"e29
P#$#'"("a$ "$" m#$&$3&**a$ -ah6a 1#$ga(&!a$ 1o'a ma*a$ m#m1&$a" h&-&$ga$ a$g S"g$"5"*a$ d#$ga$ *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 /P ? >)>>0. Ha' "$"
#3a'a$ #3a'a$ d#$ga$ d#$ga$ ha"' ha"' < ha"' ha"' 1#$#'"( 1#$#'"("a$ "a$ a$g a$g (#'ah (#'ah d"1&-' d"1&-'"*a "*a"*a "*a$ $ #-#'&m #-#'&m$a $a.. P#$#'"( P#$#'"("a$ "a$ P" S1&$ S1&$#! #! d** #-aga #-aga"ma "ma$a $a d"*&(" d"*&("1 1 %a@"'ah %a@"'ah m#1#!'" m#1#!'"ha( ha(*a$ *a$ -ah6a -ah6a 1a"#$ DM ("1# 2 a$g m#'a*&*a$ 1#!#$ca$aa$ d"#( DM d#$ga$ *om1o"" #"m-a$g /7a!-oh"d!a( ? :: < 9>;) 1!o(#"$ : < 2>;) da$ '#ma* 2> < +>;0 (#!$a(a m#$&$3&**a$ ada$a 1#!-a"*a$ a$g S"g$"5"*a$ / 1 >)> 0 (#!hada1 *ada! g'&*oa 1'ama 1&aa) H-Ac) "$d#* maa (&-&h da$ *o'#(#!o'. Hubun!n Kete#tu#n Be#*h#! &en!n Kebe#hsin Pen!e*n DM Ti"e2
Da!" 1#$#'"("a$ "$" d"da1a(*a$ -ah6a !#1o$d#$ a$g m#'a*&*a$ o'ah!aga #ca!a (#!a( (#!a(&! &! da$ da$ -a"* -a"* m#m" m#m"'" '"*" *" h&-& h&-&$g $ga$ a$ a$g a$g "g$ "g$"5 "5"*a "*a$ $ (#!h (#!had ada1 a1 *#-# *#-#!h !ha" a"'a 'a$ $ 1#$g#'o'aa$ DM ("1# 2 / P ? >)>>2 0. 7#g"a(a$ 5""* #ha!" m#$"(0 a$g "5a($a "5a($ a #&a" CRIPE /continous /continous , r!yt!mical, interval, endurance training 0 training 0 m#!&1a*a$ a'ah a(& 1"'a! da'am 1#$g#'o'aa$ DM ("1# 2. La("ha$ 3ama$" a(a& o'ah!aga "$" (#!-&*(" (#!-&*(" da1a( m#$"$g*a(*a$ m#$"$g*a(*a$ #$"(""(a #$"(""(a !##1(o! !##1(o! d" 3a!"$ga$ 3a!"$ga$ 1#!"5#! (#!hada1 "$&'"$) #h"$gga glucose #h"$gga glucose update m#$"$g*a( update m#$"$g*a( da$ (a(& g'"*#m"* m#m-a"*. M#$&!&( M#$&!&( Cha#a& da$ 7a&5ma$ 7a&5ma$ o'ah!aga o'ah!aga 1ada 1#$d#!"(a 1#$d#!"(a DM ("1#2 da1a( m#$#-a-*a$ (#!3ad"$a 1#$"$g*a(a$ 1#ma*a"a$ g'&*oa o'#h o(o( a$g a*("5) #h"$gga da1a( #ca!a 'a$g&$g m#$&!&$*a$ *ada! g&'a da!ah. S#'a"$ -#!ma$5aa( -ag" glycemic kontrol ) o'ah!ag o'ah!agaa 1ada 1ada DM ("1#2 ("1#2 3&ga 3&ga -#!ma$ -#!ma$5aa( 5aa( m#$g&! m#$g&!a$g a$g"" *#'#*#'#-"h "ha$ a$ -#!a -#!a(( da$ da$ m#m1 m#m1#! #!-a" -a"*" *" 1!o5 1!o5"' "' '"1" '"1"d) d) #h"$ #h"$gg ggaa -#!* -#!*#m #m-a -a$g $g$ $aa *om1'"*a" a*&'#! da1a( d"ham-a(. O'ah!aga a$g (#!a(&!) d#$ga$ ada$a *o$(!a*" o(o() m#m"'"*" "5a( #1#!(" "$&'"$ / insulin like effect 0 , 1#!m#a-"'"(a , 1#!m#a-"'"(a m#m-!a$# (#!hada1 g'&*oa m#$"$g*a( 1ada o(o( a$g -#!*o$(!a*". Pada aa( -#!o'ah!aga !#"(#$" "$&'"$ -#!*&!a$g) #-a'"*$a #$"(""(a "$&'"$ m#$"$g*a() #h"$gga m#$#-a-*a$ -#!*&!a$g$a *#-& *#-&(& (&ha ha$ $ "$& "$&'" '"$. $. Nam& Nam&$ $ !#1o !#1o$ $ "$" "$" ha$ ha$aa (#!3a (#!3ad" d" #m#$ #m#$(a (a!a !a #("a1 #("a1 *a'" *a'" -#!o'ah!aga ("da* m#$#(a1. O'#h *a!#$a "(& o'ah!aga "$" ha!& d"'a*&*a$ (#!& m#$# m#$#!& !& da$ da$ (#!a( (#!a(&! &!.. M#$& M#$&!& !&(( A''# A''#$) $) o'ah o'ah!ag !agaa a#!o a#!o-" -"* * a$g a$g (#!a( (#!a(&! &! a*a$ a*a$ m#$g&!a$g" *#-&(&ha$ "$&'"$ #-#a! +> < :>; 1ada 1#$d#!"(a DM ("1# a$g
(#!*o$(!o' d#$ga$ -a"*) #da$g*a$ 1ada d"a-#(# T"1# 2 a$g d"*om-"$a"*a$ d#$ga$ 1#$&!&$a$ -#!a( -ada$ a*a$ m#$g&!a$g" "$&'"$ h"$gga >>;. 2>)2 S#(#'ah S#(#'ah d"'a*&*a$ d"'a*&*a$ a$a'"" '#-"h 'a$3&( d#$ga$ d#$ga$ !#g!#" 'og"("* d"da1a(*a$ d"da1a(*a$ -ah6a o'ah !aga -#!1#$ga!&h #ca!a #ca!a "g$"5"*a$ (#!hada1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 da$ 1#$ga!&h$a #-#a! 4>;. SIMPULAN
S#(# S#(#'a 'ah h d"'a* d"'a*&* &*a$ a$ 1#$# 1#$#'"( '"("a$ "a$ (#$( (#$(a$ a$g g h&-& h&-&$g $ga$ a$ #m1a #m1a(( 1"'a! 1"'a! DM d#$g d#$ga$ a$ *#-#!ha"'a$ 1#$g#'o'aa$ DM) da1a( d""m1&'*a$ -ah6a 5a*(o! a$g -#!h&-&$ga$ d#$ga$ *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 ada'ah 1#$g#(ah&a$) *#(#!a(&!a$ o'ah !aga) 1o'a ma*a$ da$ *#1a(&ha$ m"$&m o-a(. Fa*(o! a$g -#!1#$ga!&h (#!hada1 *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 ada'ah *#(#!a(&!a$ o'ah !aga. 7#(#!a(&!a$ o'ah !aga m#m1#$ga!&h" *#-#!ha"'a$ 1#$g#'o'aa$ DM ("1# 2 #-#a! 4>;.
SARAN 1. Bag" 1#$d#!"(a DM .
P#$g#'o'aa$ DM m#'"1&(" #m1a( 1"'a! &(ama a"(& #d&*a") 1#!#$ca$aa$ ma*a$) 'a("ha$ 'a("ha$ 3ama$" 3ama$" da$ ada$ ada$aa "$(#! "$(#!#$ #$"" 5a!ma*o 5a!ma*o'og 'og") ") d"ma$a d"ma$a *##m1a( *##m1a( 1"'a! 1"'a! (#!#-&( ha!&'ah d"(#!a1*a$ #ca!a *o$("$& da$ m#$#'&!&h. S#!(a 1#!'&$a mo(" mo("a a"" d"!" d"!" a$g a$g *&a( *&a( da$ da$ "*a "*a1$ 1$o1 o1("m ("m" "(" (" da!" da!" 1#$d 1#$d#!" #!"(a (a m#$g m#$g#$ #$a" a" *#-#!ha"'a$ 1#$go-a(a$ DM. 2. Bag" I$("(&" / Po'" P#$a*"( Da'am RSD7 0.
P#!'&$a 1#$"$g*a(a$ &aha &$(&* m#'a*&*a$ #d&*a" a$g #ca!a c#!ma( da$ '#-"h (#'"(" *#1ada 1#$d#!"(a DM m#$g#$a" 1#$("$g$a #m1a( 1"'a! (#!#-&( da'am da'am *#-#!h *#-#!ha"' a"'a$ a$ 1#$g#' 1#$g#'o'a o'aa$ a$ 1#$d#! 1#$d#!"(a "(a DM. P#!'&$ P#!'&$a a m#$"$g m#$"$g*a( *a(*a$ *a$ 1#$3#'aa$ a$g '#-"h '# -"h d#(a"' da$ #ca!a '#-"h #d#!ha$a *#1ada 1#$d#!"(a DM m#$g#$a" *##m1a( 1"'a! (#!#-&( #h"$gga 1#$d#!"(a DM '#-"h m#$g#!(" da$ m&dah &$(&* m#$ga1'"*a"*a$$a. 3. Bag" 1#$#'"("a$ -#!"*&($a.
D"ha!a1*a$ D"ha!a1*a$ mam1& mam1& &$(&* &$(&* m#$3ad" m#$3ad" daa!) daa!) 1o$da") 1o$da") da$ -aha$ !&3&*a$ !&3&*a$ &$(&* &$(&* d"'a*&*a$ d"'a*&*a$ 1#$#'"("a$ 1#$#'"("a$ < 1#$#'"(a$ 'a"$$a 'a"$$a a$g mam1& mam1& m#m-#!"*a$ m#m-#!"*a$ ma$5aa( ma$5aa( -ag" 1#$d#!"(a DM ("1# 2.
DA/TAR PUSTAKA 1.
P.B. .B. PER7 PER7EN ENII . 7o$ 7o$#$ #$& & P#$g P#$g#' #'o' o'aa aa$ $ D"aD"a-#(# #(# M#'"( M#'"(& & T"1# "1# 2 d" I$do$#"a) 2>>2.
2.
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