HUBUNGAN DURASI DIABETES MELITUS TIPE 2 DENGAN KEJADIAN DIABETIK NEUROPATI DI

P O L I K L I N I K PENYAKIT DALAM RUMAH SAKIT MUHAMMADIYAH PALEMBANG

SKRIPSI

Sebagai salah satu syarat mempen)leh gclar Sarjana Kedokteran (S. Ked)

Oleh : DIDIK AGUS PRAWIRA

NIM: 70 2009 044

FAKULTAS K E D O K T E R A N UNIVERSITAS MUHAMMADIYAH PALEMBANG

2013

HALAMAN PENGESAHAN

HUBUNGAN DURASI DIABETES MEUTUS TIPE 2 DENGAN KEJADIAN DIABETIK NEUROPATI DI

POLIKLINIK PENYAKIT DALAM RUMAH SAKIT MUHAMMADIYAH PALEMBANG

Dipersiapkan dan dtsusun oleh : Didik Agus Pniwira NIM:70 2009 044

Sebagai salah satu syarat memperolch gelar Sarjana Kedokteran (S. Ked)

Padatanggal ISFebruari 2013

Menyetujai:

Pei^bini M m m n 4 , M A R ? ^ DR. Dr. Iiaan Saich. h i Btoaed Pertama PcmbimMag Kcdaa

... Dckaa M f y ^ ' ?^I»lt« Kedokteran

^ P r d t Dr. l O p i ^ W a d . nABK. SiKAad NBM/ IVIDN : M 3 4809 1052253/ 0002 064 803

I

PERIVYATAAN

D e n g a n i n i S a y a m e n e r a n g k a n b a h w a :

1 . K a r y a T u l i s S a y a , s k r i p s i i n i a d a l a h a s l i d a n b c l u m p e m a h d i a j u k a n u n t u k

m e n d a p a t k a n g e l a r a k a d e m i k , b a i k d i U n i v e r s i t a s M u h a m m a d i y a h

P a l e m b a n g , m a u p u n P e r g u r u a n T i n g g i l a i n n y a .

2 . K a r y a T u l i s i n i m u m i g a g a s a n , r u m u s a n d a n p e n e l i t i a n S a y a s e n d i r i , t a n p a

b a n t u a n p i h a k I a i n , k e c u a l i a r a h a n T i m P e m b i m b i n g .

3 . D a l a m k a r y a T u l i s i n i t i d a k t e r d a p a t k a r y a a t a u p e n d a p a t y a n g t e l a h d i t u l i s

a t a u d i p u b l i k a s i k a n o r a n g l a i n , k e c u a l i s e c a r a t e r t u l i s d e n g a n d i c a n t u m k a n

s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n

d i c a n t u m k a n d a l a m d a f t a r p u s t a k a .

4 . P e r n y a t a a n i n i S a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d i a n h a r i

t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e r n y a t a a n i n i , m a k a

S a y a b e r s e d i a m e n e r i m a s a n k s i a k a d e m i k a t a u s a n k s i l a i n n y a d e n g a n n o r m a

y a n g b e r l a k u d i P e r g u r u a n T i n g g i i n i .

P a l e m b a n g , 2 0 F e b m a r i 2 0 1 3

Y a n g m e m b u a t p e r n y a t a a n

( D i d i k A g u s P r a w i r a ) N I M . 7 0 2 0 0 8 0 1 4

ii

PERSEMBAHAN DAN MOTTO

Banyak kegagalan dalam hidup i n i d i k a r e n a k a n orang-orang tidak menyadari betapa dekatnya mereka dengan keberhasilan saat mereka menyerah

(Thomas A l v a Edison)

D e n g a n i z i n m u ya A l l a h K u b u a t k a r y a sederhana i n i dan kupersembahakan k a r y a i n i u n t u k L e l a k i terhebat dalam hidupku,papa ( Z u h e r i a l ) beserta wan i t a yang p a l i n g hebat

d i h i d u p k u , m a m a (Giftiarsyah) yang selama i n i s e l a l u memberikan c u r a h a n kasih sayang dan merawat, membesarkanku serta mendidikku h i n g g a

sekarang. P a p a m a m a , orang t u a terhebat yang selalu memberi semangat, k e b a h a g i a a n , kehangatan k e l u a r g a , dan segala sesuatu u n t u k a n a k n y a , K a r y a

i n i tak sebanding dengan p e r j u a n g a n papa dan m a m a selama i n i , tetapi semoga k a r y a i n i dapat membuat papa dan m a m a tersenyum b a h a g i a membacanya.

Kupersembahkan j u g a k a r y a i n i u n t u k k a k a k - k a k a k k u yang terbaik dan keponakan-keponakanku yang lucu ( P r i h e r t i n o v a , Arstya D e w a n t a r a , D o n i

H e r t a n t o , R a n i , A r a , Sya-sya, dan Q u i n s h a ) .

Dosen pembimbing yang terbaik D r . H . S y a h r u l M u h a m m a d , M A R S , D R . D r . I r s a n S a l e h , M , Biomed dan B a h r u n I n d a w a n , S . K m , M . s L

Sahabat sahabat terkasih (sahabat j a m u r : Bobi, Cecep, u l u m ; Widya G u s t i f a u r i n a ; sahabat petir: wisman, u b a n , tengii, dodo,jaka, l i d a n , r e y k i , f e r i , a a n , dipta, h a r i a d i setengah kromosom, a l m a n , opek, abot, kaisar, n a r n o , a d r i ;

the capilaris: utik, a b a , a m a l , v i k a , dendi, edo, pipit, bagus, u w a h , angga, suber, dedi; sahabat dodol: a i n u l , a r i , d a n i l , Ut, u d i n , odik, ayu, n a r a , i c a , siwi;

sahabat D C : debi coy, d a n i l , r i a n , eng, r e k s a , f i t r a h , hadi; sahabat global: a r i , r u b i , adon; sailormoon; cherry bell; princes; dan n a n d a MZ).

T e m a n sejawat 2008yang selalu memberi masukan, p i n j a m a n buku, d l l (fadil, a l h a m , wieke, d i b a h , m i r a n t i , sinta, adek)

Teman-teman dan teman sejawat tersayang.

iii

UNIVERSITAS MUHAMMADIYAH PALEMBANG FAKULTAS K E D O K T E R A N

SKRIPSI , F E B R U A R I 2013 DIDIK AGUS PRAWIRA Hubungan Durasi Diabetes Melitus Tipe 2 dengan Kejadian Diabetik Neuropati di Poliklinik Penyakit Dalam Rumah Sakit Muhammadiyah Palembang XV + 47 halaman + 12 tsbcl

ABSTRAK

N e u r o p a t i d i a b e t i k m e r u p a k a n k e r u s a k a n p a d a n e r v u s d a l a m t u b u h y a n g t e i j a d i a k i b a t k a d a r g u l a d a r a h t i n g g i d a r i d i a b e t e s . N e u r o p a t i d i a b e t i k m e r u p a k a n k o m p l i k a s i k r o n i s t e r s e r i n g p a d a d i a b e t e s m e l i t u s t i p e 1 d a n t i p e 2 . N e u r o p a t i s e c a r a u m u m d i k l a s i f i k a s i k a n m e n j a d i d u a y a i t u s o m a t i k d a n a u t o n o m i k n e u r o p a t i . P e n e l i t i a n i n i b e r t u j u a n u n t u k m e n g e t a h u i h u b u n g a n d u r a s i D M d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g . P e n e l i t i a n i n i b e r b e n t u k o b s e r v a s i o n a l a n a l i t i k d e n g a n d e s a i n s t u d i p o t o n g l i n t a n g {cross-sectional) d a n d i l a k u k a n u j i chi-square u n t u k m e l i h a t h u b u n g a n a n t a r a v a r i a b e l d e p e n d e n d a n i n d e p e n d e n . S a m p e l p e n e l i t i a n i n i s e b e s a r 3 4 o r a n g d a r i t o t a l 8 7 5 o r a n g p a s i e n D M d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

H a s i l p e n e l i t i a n d i d a p a t k a n 3 4 r e s p o n d e n t e r d i r i d a r i 1 8 o r a n g m e n d e r i t a d i a b e t e s m e l i t u s d a n 1 6 o r a n g m e n d e r i t a d i a b e t i k n e u r o p a t i , d i l a k u k a n analisa bivariat d e n g a n h a s i l b e r m a k n a s e c a r a s t a t i s t i k a d a l a h l a m a m e n d e r i t a D M ( P R : 5 , 8 3 ; 9 5 % C I : 1 , 2 9 8 - 2 6 , 2 2 3 ; p : 0 , 0 4 2 ) . L a m a m e n d e r i t a D M l e b i h d a r i 5 t a h u n a k a n m e n i n g k a t k a n r e s i k o t e r j a d i n y a d i a b e t i k n e u r o p a t i p a d a p e n d e n t a D M t i p e 2 s e b e s a r 5 - 6 k a l i d i b a n d i n g k a n d e n g a n l a m a m e n d e r i t a D M k u r a n g d a r i 5 t a h u n . L a m a m e n d e r i t a D M a d a l a h f a k t o r r e s i k o t e r j a d i n y a d i a b e t i k n e u r o p a t i p a d a p e n d e r i t a D M t i p e 2 , t e r d a p a t h u b u n g a n b e r m a k n a a n t a r a l a m a m e n d e r i t a D M d e n g a n t e r j a d i n y a d i a b e t i k n e u r o p a t i .

Referensi: 33 (1986 - 2012) Kata Kunci: lama menderita DM, DM tipe 2, diabetik neuropati

iv

MUHAMMADIYAH PALEMBANG UNIVERSITY M E D I C A L F A C U L T Y

ESSAY, FEBRUARY 2013 DIDIK AGUS PRAWIRA

The Relationship of Duration of Type 2 Diabetes Mellitus with Genesis Diabetic Neuropathy in Polyclinic of Internal Medicine Muhammadiyah Palembang Hospital. XV + 47 page + 12 table

A B S T R A C T

Diabetic neuropathy is damage to the nerves in body caused by high blood sugar levels of diabetes. Diabetic neuropathy is the most common chronic complications in diabetes mellitus type 1 and type 2. Neuropathy is generally classified into two, somatic and autonomic neuropathy. This study aimed to determine the relationship between duration of diabetes mellitus with diabetic neuropathy in polyclinic of internal medicine Muhammadiyah Palembang Hospital. This research shaped in observational analytic with cross-sectional study design and chi-square test was done to see the relationship betM'cen dependent and independent variables. The sample of 34 people from a total of 875 diabetic patients in polyclinic of internal medicine Muhammadiyah Palembang Hospital.

The result showed 34 respondents consisted of 18 people suffering from diabetes mellitus and 16 people suffer from diabetic neuropathy, performed bivariate analyzes with statistically significant results are long-suffering DM (PR: 5.83, 95% Ci: 1.298 to 26.223, p: 0.042). Long suffered from diabetes for more than five years would increase the risk of diabetic neuropathy in patients with type 2 diabetes by 5-6 times, compared to the long-suffering DM less than five years. Long suffered from diabetes are risk factors for diabetic neuropatlty in patients with type 2 diabetes, there is a significant association between long suffered from diabetes with the diabetic neuropathy.

Reference: 33 (1986 - 2012) Key Words: long suffered f r o m diabetes, type 2 diabetes, diabetic neuropathy

V

KATA PENGANTAR

P u j i s y u k u r p e n u l i s p a n j a t k a n k e p a d a A l l a h S W T a t a s s e g a l a r a h m a t d a n

k a r u n i a - N y a s e h i n g g a d a p a t m e n y e l e s a i k a n p e n u l i s a n s k r i p s i i n i y a n g b e r j u d u l

'^Hubungan Durasi Diabetes Melitus Tipe 2 dengan Kejadian Diabetik

Neuropati di Poliklinik Penyakit Daiam Rumah Sakit Muhammadiyah

Palembang" s e b a g a i s a l a h s a t u s y a r a t u n t u k m e n d a p a t k a n g e l a r s a r j a n a

k e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g .

S a l a w a t b e r i r i n g s a l a m s e l a l u t e r c u r a h k e p a d a j u n j u n g a n k i t a , n a b i b e s a r

M u h a m m a d S A W b e s e r t a p a r a k e l u a r g a , s a h a b a t , d a n p e n g i k u t - p e n g i k u t n y a

s a m p a i a k h i r z a m a n .

P e n u l i s m e n y a d a r i b a h w a s k r i p s i i n i j a u h d a r i s e m p u m a . O l e h k a r e n a i t u ,

p e n u l i s m e n g h a r a p k a n k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n g u n a p e r b a i k a n

d i m a s a m e n d a t a n g .

D a l a m h a l p e n y e l e s a i a n p e n e l i t i a n i n i , p e n u l i s b a n y a k m e n d a p a t b a n t u a n ,

b i m b i n g a n d a n s a r a n . P a d a k e s e m p a t a n i n i , p e n u l i s i n g i n m e n y a m p a i k a n r a s a

h o r m a t d a n t e r i m a k a s i h k e p a d a A l l a h S W T , y a n g t e l a h m e m b e r i k e h i d u p a n

d e n g a n s e j u k n y a k e i m a n a n . K e p a d a k e d u a o r a n g t u a y a n g s e l a l u m e m b e r i

d u k u n g a n m a t e r i l m a u p u n s p i r i t u a l . K e p a d a D e k a n d a n s t a f f F a k u l t a s K e d o k t e r a n

U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g , D r . H . S y a h r u l M u h a m m a d , M A R S , D R .

D r . I r s a n S a l e h , M . B i o m e d , P r o f . D r . P . M . C h a t a r , S p . P K ( K ) , B a h r u n I n d a w a n ,

S . K m , M , S i , d a n t e m a n - t e m a n s e j a w a t a n g k a t a n 2 0 0 9 a t a s s e m a n g a t d a n

k e r j a s a m a n y a s a m p a i s e k a r a n g . S e m o g a A l l a h S W T m e m b e r i k a n b a l a s a n p a h a i a

a t a s s e g a l a a m a l y a n g d i b e r i k a n k e p a d a s e m u a o r a n g y a n g t e l a h m e n d u k u n g

p e n u l i s d a n s e m o g a l a p o r a n i n i b e r m a n f a a t b a g i k i t a d a n p e r k e m b a n g a n i l m u

p e n g e t a h u a n k e d o k t e r a n . S e m o g a k i t a s e l a l u d a l a m l i n d u n g a n A l l a h S W T . A m i n .

P a l e m b a n g , 2 0 F e b m a r i 2 0 1 3

P e n u l i s

vi

DAFTAR ISI

HALAMAN JUDUL

HALAMAN PENGESAHAN i

HALAMAN PERNYATAAN i i

HALAMAN PERSEMBAHAN DAN MOTTO iii

ABSTRAK i v

A B S T R A C T v

KATA PENGANTAR v i

DAFTAR ISI v i i

DAFTAR T A B E L x

DAFTAR LAMPIRAN x i

DAFTAR SINGKATAN x i i

BAB I PENDAHULUAN 1

1 . 1 . L a t a r B e l a k a n g 1

1.2 R u m u s a n M a s a l a h 3

1.3 T u j u a n P e n e l i t i a n 3

1 .3 .1 T u j u a n U m u m 3

1 .3 .2 T u j u a n K h u s u s 4

1.4 M a n f a a t P e n e l i t i a n 4

1.5 K e a s l i a n P e n e l i t i a n 5

BAB I I TINJAUAN PUSTAKA 7

2 . 1 D i a b e t e s M e l i t u s 7

2 . 1 . 1 D e f i n i s i D i a b e t e s M e l i t u s 7

2 . 1 . 2 K l a s i f i k a s i D i a b e t e s M e l i t u s 8

2 . 1 . 3 D i a g n o s i s D i a b e t e s M e l i t u s 9

2 . 1 . 4 K o m p l i k a s i 9

2 . 2 D i a b e t i k N e u r o p a t i 11

2 . 2 . 1 . D e f i n i s i D i a b e t i k N e u r o p a t i 1 1

2 . 2 . 2 . K l a s i f i k a s i D i a b e t i k N e u r o p a t i 1 2

vii

2 . 2 . 3 . D i a g n o s i s D i a b e t i k N e u r o p a t i 13

2 . 2 . 4 . P a t o f i s i o l o g i D i a b e t i k N e u r o p a t i 1 6

2 . 3 K e r a n g k a T e o r i 1 8

2 . 4 H i p o t e s i s 1 9

BAB m M E T O D E PENELITIAN 2 0

3 . 1 J e n i s P e n e l i t i a n 2 0

3 . 2 W a k t u d a n t e m p a t p e n e l i t i a n 2 0

3 . 3 P o p u l a s i d a n S a m p e l P e n e l i t i a n 2 0

3 . 3 . 1 P o p u l a s i 2 0

3 . 3 . 2 S a m p e l P e n e l i t i a n 2 0

3 . 3 . 3 K r i t e r i a I n k l u s i d a n E k s k l u s i 2 1

3 . 3 . 4 . C a r a P e n g a m b i l a n S a m p e l 2 1

3 . 4 V a r i a b e l P e n e l i t i a n 2 2

3 . 4 . 1 V a r i a b e l B e b a s 2 2

3 . 4 . 2 V a r i a b e l T e r i k a t 2 2

3 . 5 D e f i n i s i O p e r a s i o n a l 2 2

3 . 6 C a r a P e n g u m p u l a n D a t a 2 4

3 . 7 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 4

3 . 7 . 1 . P e n g o l a h a n D a t a 2 4

3 . 7 . 2 . A n a l i s i s D a t a 2 5

3 . 8 A l u r P e n e l i t i a n 2 7

BAB I V HASIL DAN PEMBAHASAN 2 8

4 . 1 . H a s i l P e n e l i t i a n 2 8

4 . 1 . 1 . A n a l i s i s U n i v a r i a t 2 8

4 . 1 . 2 . A n a l i s i s B i v a r i a t 2 9

4 . 2 . P e m b a h a s a n 3 2

4 . 3 . K e t e r b a t a s a n P e n e l i t i a n 3 4

v i i i

BAB V KESIMPULAN DAN SARAN 3 5

5 . 1 . K e s i m p u l a n 3 5

5 . 2 . S a r a n 3 5

DAFTAR PUSTAKA x i i i

LAMPIRAN 3 7

BIODATA RINGKAS ATAU RIWAYAT HIDUP 4 4

DAFTAR T A B E L

T a b e l 1 . K l a s i f i k a s i E t i o l o g i D i a b e t e s M e l i t u s 8

T a b e l 2 . K a d a r G u l a D a r a h 9

T a b e l 3 . D i s t r i b u s i R e s p o n d e n B e r d a s a r k a n K a r a k t e r i s t i k n y a 2 5

T a b e l 4 . D i s t r i b u s i f r e k u e n s i d a n p e r s e n t a s e m e n u r u t u s i a d a n d i a g n o s i s 2 6

T a b e l 5 . D i s t r i b u s i f r e k u e n s i d a n p e r s e n t a s e m e n u r u t j e n i s k e l a m i n d a n d i a g n o s i s 2 6

T a b e l 6 . D i s t r i b u s i f r e k u e n s i d a n p e r s e n t a s e m e n u r u t d u r a s i D M d a n d i a g n o s i s 2 6

T a b e l 7 . D i s t r i b u s i R e s p o n d e n B e r d a s a r k a n K a r a k t e r i s t i k n y a 2 8

T a b e l 8 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t u s i a d a n d i a g n o s i s . ^ i . i w 2 9

T a b e l 9 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t j e n i s k e l a m i n d a n d i a g n o s i s 3 0

T a b e l 1 0 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t d u r a s i D M d a n d i a g n o s i s 3 1

X

DAFTAR LAMPIRAN

L a m p i r a n 1 . C o n t o h L e m b a r P e r s e t u j u a n R e s p o n d e n 3 7

L a m p i r a n 2 . C o n t o h K u e s i o n e r P e n e l i t i a n 4 8

xi

DAFTAR SINGKATAN

A D A : American Diabetes Association

P E R K E N I : P e r k u m p u l a n E n d o k r i n I n d o n e s i a

I D F : international Diabetes Federation

C V A : Cerebrovascular accident

D M : D i a b e t e s M e l i t u s

I D D M : Insulin dependent diabetes mellitus

N I D D M : Non-insulin dependent diabetes mellitus

A G E s : Glycosilation end products

P K C : P r o t e i n k i n a s e C

H D L : High density lipoprotein

L A N S S : Leeds assessment of neuropathic symptoms and signs

O R : Odds Ratio

W H O : World Health Organization

M O D Y : Maturity onset Diabetes of the young

Q S T : Quantitative Sensory Testing

c A F T : cardiovascular Autonomic Function Testing

E D S : Electro-diagnosis studies

D N S : Diabetic Neuropathy Symptom

D N E ; Diabetic Neuropathy Examination

N O S : Nitrid oxide synthase

N O : Nitrid oxide

R O S : Reactive oxygen species

N G F : Nerve Growth Factor

x i i

BAB I

PENDAHULUAN

1.1. Latar Belakang

M e n u r u t American Diabetes Association ( A D A ) 2 0 1 0 , d i a b e t e s m e l i t u s

( D M ) m e r u p a k a n s u a t u k e l o m p o k p e n y a k i t m e t a b o l i k d e n g a n k a r a k t e r i s t i k

h i p e r g l i k e m i a y a n g t e r j a d i k a r e n a k e l a i n a n s e k r e s i i n s u l i n , k e r j a i n s u l i n a t a u

k e d u a - d u a n y a ( P E R K E N I , 2 0 1 1 ) .

D M m e n j a d i s a l a h s a t u m a s a l a h k e s e h a t a n t e r p e n t i n g t i d a k h a n y a d i

n e g a r a m a j u , t a p i j u g a d i n e g a r a y a n g s e d a n g b e r k e m b a n g . B e r d a s a r k a n The

International Diabetes Federation Atlas 5'^Edition, 3 6 6 j u t a o r a n g m e n g i d a p

p e n y a k i t D i a b e t e s p a d a t a h u n 2 0 1 1 d a n d i p e r k i r a k a n a k a n m e n i n g k a t s e b a n y a k

5 5 2 j u t a p a d a t a h u n 2 0 3 0 ( I D F , 2 0 1 1 ) . L e b i h d a r i s e t e n g a h p o p u l a s i i n i a k a n

b e r a d a d i A s i a k a r e n a p o p u l a s i s e c a r a k e s e l u r u h a n d a n p r e v a l e n s i p e n i n g k a t a n

t a j a m D M a d a d i b e n u a i n i ( B e t t e r i d g e , D . J , 2 0 0 0 ) . D i I n d o n e s i a a n g k a

p r e v a l e n s i n y a r a t a - r a t a 1 , 5 % . d a n l a p o r a n y a n g t e r a k h i r m e n c a p a i 5 , 9 % d i J a k a r t a

d a n 6 % d i M a n a d o ( I s s e l b a c h e r d k k , 2 0 0 0 ) . D a n l a p o r a n p a d a t a h u n 2 0 0 9

m e n c a p a i 2 8 , 7 2 p e r 1 0 . 0 0 0 d i S u m a t e r a S e l a t a n d a n 2 2 , 7 9 p e r 1 0 . 0 0 0 d i

P a l e m b a n g ( D e p k e s S u m s e l , 2 0 1 0 ) .

H i p e r g l i k e m i a k r o n i k p a d a D M b e r h u b u n g a n d e n g a n k e r u s a k a n j a n g k a

p a n j a n g , d i s f i i n g s i d a n k e g a g a l a n b e b e r a p a o r g a n t u b u h , t e r u t a m a m a t a , g i n j a l ,

s y a r a f , j a n t u n g d a n p e m b u l u h d a r a h ( S o e g o n d o , S , 2 0 0 4 ) . K o m p l i k a s i j a n g k a

p a n j a n g d a r i D M a d a l a h M i k r o a n g i o p a t i d i a b e t i k , M a k r o a n g i o p a t i d i a b e t i k , d a n

N e u r o p a t i d i a b e t i k . M i k r o a n g i o p a t i d i a b e t i k m e l i p u t i N e f r o p a t i d i a b e t i k ,

R e t i n o p a t i d i a b e t i k , K a r d i o m i o p a t i d i a b e t i k . M a k r o a n g i o p a t i d i a b e t i k m e l i p u t i

p e n y a k i t j a n t u n g k o r o n e r , C V A d a n U l k u s a t a u G a n g r e n ( H a z n a m , 1 9 9 1 ) .

T i n g g i n y a a n g k a m o r b i d i t a s d a n m o r t a l i t a s y a n g d i h u b u n g k a n d e n g a n k o m p l i k a s i

D M m e n y e b a b k a n D M m e n j a d i b e b a n b a g i p a s i e n d a n j u g a s o c i a l ( B e t t e r i d g e ,

D . J , 2 0 0 0 ) . K o m p l i k a s i m e n a h u n d i a b e t e s m e l i t u s d i I n d o n e s i a t e r d i r i a t a s

1

2

n e u r o p a t i 6 0 % , p e n y a k i t j a n t u n g k o r o n e r 2 0 , 5 % , u l k u s d i a b e t i k a 1 5 % , r e t i n o p a t i

1 0 % , d a n n e f r o p a t i 7 , 1 % . ( T j o k r o p r a w i r o , 2 0 0 6 ) .

N e u r o p a t i d i a b e t i k a m e r u p a k a n k o m p l i k a s i m i k r o v a s k u l e r t e r s e r i n g

d i a b e t e s m e l i t u s t i p e I (insulin dependent diabetes mellitus-lDDM), m a u p u n t i p e

I I (non-insulin dependent diabetes mellitus-NlDDM). K e j a d i a n n e u r o p a t i

m e n i n g k a t s e j a l a n d e n g a n l a m a p e n y a k i t d a n t i n g g i n y a h i p e r g l i k e m i a .

D i p e r k i r a k a n s e t e l a h m e n d e r i t a d i a b e t e s s e l a m a 2 5 t a h u n , p r e v a l e n s i n e u r o p a t i

d i a b e t i k a 5 0 % . D i l a p o r k a n 8 5 % n e u r o p a t i d i a b e t i k a b e r u s i a d i a t a s 4 0 t a h u n t e t a p i

p e r l u d i i n g a t b a h w a d i a t a s u s i a 6 0 t a h u n a d a l a h n o r m a l b i l a r e f l e k s A c h i l l e s

m e n u r u n d a n r a s a g e t a r h i l a n g ( D y c k d k k , 1 9 8 6 ) . N e u r o p a t i m e r u p a k a n

k o m p l i k a s i d i a b e t e s y a n g k l a s i k . K o m p l i k a s i n e u r o l o g i s d a r i d i a b e t e s s e r i n g k a l i

m e l i b a t k a n s a r a f p e r i f e r . P o l i n e u r o p a t i d i s t a l m e r u p a k a n n e u r o p a t i d i a b e t i k y a n g

p a l i n g s e r i n g y a n g b e r m a n i f e s t a s i p r o g r e s i f l a m b a t , s i m e t r i s d e n g a n p o l a glove

and stocking ( H o w a r d d k k , 2 0 0 4 ) . K i r a - k i r a l i m a b e l a s p e r s e n p a s i e n d e n g a n

d i a b e t e s m e l i t u s m e m p u n y a i t a n d a d a n g e j a l a n e u r o p a t i , h a m p i r 5 0 % j u g a

m e m p u n y a i g e j a l a n y e r i n e u r o p a t i d a n g a n g g u a n h a n t a r a n s a r a f . N e u r o p a t i p a l i n g

s e r i n g d i j u m p a i p a d a p e n d e r i t a d i a b e t e s y a n g b e r u m u r l e b i h d a r i 5 0 t a h u n , j a r a n g

d i j u m p a i p a d a u s i a d i b a w a h 3 0 t a h u n d a n s a n g a t j a r a n g p a d a a n a k - a n a k . ( A d a m s

d a n V i c t o r , 2 0 0 5 ) .

P r o s e s k e j a d i a n D i a b e t i k N e u r o p a t i b e r a w a l d a r i h i p e r g l i k e m i a

b e r k e p a n j a n g a n y a n g b e r a k i b a t t e r j a d i n y a a k t i v i t a s j a l u r p o l i o , s i n t e s i s Advance

Glycosilation end products (AGEs), p e m b e n t u k a n r a d i k a l b e b a s d a n a k t i v a s i

p r o t e i n k i n a s e C ( P K C ) . A k t i v a s i b e r b a g a i j a l u r t e r s e b u t b e r u j u n g p a d a k u r a n g n y a

v a s o d i l a t a s i , s e h i n g g a a l i r a n d a r a h k e s a r a f m e n u n m d a n b e r s a m a r e n d a h n y a

m i o i n o s i t o l d a l a m s e l t e r j a d i l a h d i a b e t i k n e u r o p a t i ( S u b e k t i I m a m , 2 0 0 6 ) . N y e r i

n e u r o p a t i d i a b e t i k a (painful diabetic neuropathy) d i t e m u k a n p a d a 1 1 , 6 % p a s i e n

n e u r o p a t i d i a b e t i k a d e n g a n I D D M d a n 3 2 , 1 % d e n g a n N I D D M ( S a d e l i H A , 2 0 0 8 ) .

N y e r i n e u r o p a t i s e c a r a b e r m a k n a b e r d a m p a k t e r h a d a p k u a l i t a s h i d u p p a s i e n .

B e b e r a p a p e n e l i t i a n y a n g t e l a h d i l a k u k a n m e n u n j u k k a n a d a n y a h u b u n g a n y a n g

s i g n i f i k a n a n t a r a l a m a m e n d e r i t a D M d e n g a n n y e r i n e u r o p a t i d i a b e t i k . D i l a p o r k a n

3

j u g a h u b u n g a n y a n g s i g n i f i k a n a n t a r a n e u r o p a t i d e n g a n u s i a , j e n i s k e l a m i n ,

k u a l i t a s p e n g e n d a l i a n D M d a n l a m a m e n d e r i t a D M ( B o o y a d k k , 2 0 0 5 ) .

P r e v a l e n s i d i a b e t i k n e u r o p a t i s a n g a t b e r h u b u n g a n d e n g a n l a m a m e n d e r i t a

D M , u s i a , d a n p e n g e n d a l i a n m e t a b o l i k . D i l a p o r k a n j u g a f a k t o r risiko d i a b e t i k

n e u r o p a t i s e p e r t i u s i a , k e p e k a a n g e n e t i k , d u r a s i D M , p e n g e n d a l i a n g l u k o s a b u r u k ,

k a d a r t r i g l i s e r i d a d a n k o l e s t e r o l H D L , R e t i n o p a t i d e n g a n m i k r o a l b u m i n u r i a ,

k e t o a s i d o s i s b e r a t , H i p e r t e n s i , p e n y a k i t k a r d i o v a s k u l e r , i n f l a m a s i , s t r e s o k s i d a t i f ,

d a n m e r o k o k ( T e s f a y e , 1 9 9 6 ; T h o m a s , 1 9 9 9 ) . S e k i t a r 2 0 % p a s i e n d e n g a n D M

a k a n m e n g a l a m i d i a b e t i k n e u r o p a t i y a n g s e c a r a k l i n i s s i g n i f i k a n d a l a m 1 0 t a h u n

s e t e l a h o n s e t , d a n f r e k u e n s i i n i m e n i n g k a t m e n j a d i 5 0 % s e t e l a h 1 0 a t a u 1 5 t a h u n

( C a v a n a g h d k k , 2 0 0 8 ) . P a d a s u a t u p e n e l i t i a n m e n y a t a k a n b a h v i n e u r o p a t i

b e r h u b i m g a n d e n g a n l a m a m e n d e r i t a D M , d a n d i d a p a t k a n p a d a 2 0 , 8 % ( 1 9 , 1 -

2 2 , 5 % ) p e n d e r i t a d e n g a n l a m a m e n d e r i t a D M k u r a n g d a r i 5 t a h u n d a n 3 6 , 8 %

( 3 4 , 9 - 3 8 , 7 % ) p e n d e r i t a d e n g a n l a m a m e n d e r i t a D M l e b i h d a r i 1 0 t a h u n ( Y o u n g ,

d k k , 1 9 9 3 ) .

S a m p a i s a a t i n i b e l u m d i k e t a h u i k a p a n n e u r o p a t i d i a l a m i p a d a p e n d e r i t a

D M d i P a l e m b a n g . M a k a d a r i i t u p e r l u d i l a k u k a n p e n e l i t i a n H u b u n g a n D u r a s i

D M d e n g a n K e j a d i a n D i a b e t i k N e u r o p a t i d i P o l i k l i n i k P e n y a k i t D a l a m R u m a h

S a k i t M u h a m m a d i y a h P a l e m b a n g .

1.2. Rumusan Masalah

A p a k a h a d a h u b u n g a n d u r a s i D M d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i d i

p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g ?

13. Tujuan Penelitian

133. Tujuan Umum

M e n g e t a h u i h u b u n g a n d u r a s i D M d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i

d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

4

1.3.2. Tujuan Khusus

a. M e n g i d e n t i f i k a s i k a r a k t e r i s t i k d a r i d i a b e t i k n e u r o p a t i d i p o l i k l i n i k

p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

b . M e n g i d e n t i f i k a s i p r e v a l e n s i p e n d e r i t a D M d e n g a n n e u r o p a t i d i p o l i k l i n i k

p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

c. M e n g i d e n t i f i k a s i p r e v a l e n s i p e n d e r i t a D M t a n p a n e u r o p a t i d i p o l i k l i n i k

p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

d . M e n g a n a l i s i s p e n g a r u h l a m a n y a m e n d e r i t a D M d e n g a n k e j a d i a n d i a b e t i k

n e u r o p a t i d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g .

1.4. Manfaat Penelitian

l A A i Manfaat bagi Peneliti

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n a m b a h w a w a s a n d a n

p e n g a l a m a n s e r t a m e m b u k t i k a n k e s e s u a i a n a n t a r a h a s i l p e n e l i t i a n d e n g a n

t e o r i y a n g d i u r a i k a n , d a n d a p a t m e n j a d i d a t a a w a l a t a u p e n e l i t i a n

p e n d a h u l u a n b a g i p e n e l i t i a n s e l a n j u t n y a y a n g s e j e n i s a t a u t e r k a i t .

1.4.2. Manfaat bagi Masyarakat

U n t u k m e n a m b a h p e n g e t a h u a n t e n t a n g t a n d a - t a n d a k l i n i s d i a b e t i k

n e u r o p a t i .

1.43. Manfaat bagi Institusi RS Muhammadiyah Palembang

M e m b e r i k a n i n f o r m a s i t e n t a n g t a n d a - t a n d a k l i n i s d i a b e t i k n e u r o p a t i

p a d a p e n d e r i t a D M s e h i n g g a d a p a t m e n u r u n k a n d i s a b i l i t a s a k i b a t n y e r i

d i a b e t i k n e u r o p a t i .

5

1,4.4. Manfaat bagi Fakultas Kedokteran Universitas Muhammadiyah

Palembang

S e b a g a i b a h a n d o k u m e n t a s i y a n g b i s a b e r m a n f a a t b a g i F a k u l t a s

K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g .

1.5 Keaslian Penelitian

B e r d a s a r k a n h a s i l p e n e l u s u r a n d a r i b e b e r a p a p e n e l i t i a n y a n g ada« d i j u m p a i

p e n e l i t i a n y a n g b e r h u b u n g a n d e n g a n d i a b e t i k n e u r o p a t i . P e n e l i t i a n t e r s e b u t d a p a t

d i l i h a t p a d a p e n e l i t i a n G o c i k A g u n g P r a s e t i o ( 2 0 1 0 ) d e n g a n j u d u l " L a m a

M e n d e r i t a D i a b e t e s M e l i t u s T i p e 2 S e b a g a i F a k t o r R i s i k o N y e r i D i a b e t i k

N e u r o p a t i " . P e n e l i t i a n i n i m e n g g u n a k a n m e t o d e p e n e l i t i a n r a n c a n g a n k a s u s

k o n t r o l y a n g d i p a d a n k a n {matched case-control study), k a s u s p a d a p e n e l i t i a n i n i

a d a l a h p e n d e r i t a n y e r i d i a b e t i k n e u r o p a t i s e d a n g k a n k o n t r o l a d a l a h p e n d e r i t a

n y e r i n o n n e u r o p a t i p a d a p e n d e r i t a D M t i p e 2 , s u b j e k d i a m b i l d i P o s y a n d u L a n s i a ,

K e c a m a t a n K a l a s a n . D i l a k u k a n a n a m n e s a , p e m e r i k s a a n n e u r o l o g i c p e m e r i k s a a n

f i s i k , d a t a l a b o r a t o r i u m d a r i c a t a t a n m e d i s d i P u s k e s m a s K a l a s a n k e m u d i a n

d i l a k u k a n p e m e r i k s a a n m e n g g u n a k a n s k a l a L A N S S , j u m l a h s u b j e k a d a l a h 4 9

o r a n g p a d a m a s i n g m a s i n g k a s u s d a n k o n t r o l , d i l a k u k a n analisis bivariat d e n g a n

h a s i l b e r m a k n a s e c a r a s t a t i s t i k a d a l a h l a m a m e n d e r i t a D M ( O R : 4 , 2 6 7 ; 9 5 % C I :

1 , 8 3 2 - 9 , 9 3 9 ; p - 0 , 0 0 1 ) , riwayat h i p e r k o l e s t e r o l ( O R : 4 , 9 4 7 ; 9 5 % C I : 1 , 1 0 7 -

5 , 6 3 4 ; p = 0 , 0 2 6 ) . Analisis multivariat d e n g a n h a s i l b e r m a k n a s e c a r a s t a t i s t i k

a d a l a h l a m a m e n d e r i t a D M ( O R : 4 , 3 5 5 ; 9 5 % C I : 1 , 8 2 3 - 1 0 , 4 0 6 ; p - 0 , 0 2 6 ) , a r t i n y a

b a h w a l a m a m e n d e r i t a D M l e b i h d a r i 5 t a h u n a k a n m e n i n g k a t k a n r e s i k o

t e r j a d i n y a n y e r i n e u r o p a t i d i a b e t i k p a d a p e n d e r i t a D M t i p e 2 s e b e s a r 4 - 5 k a l i

d i b a n d i n g k a n l a m a m e n d e r i t a D M k u r a n g d a r i 5 t a h u n . D a n riwayat

h i p e r k o l e s t e r o l ( O R : 2 , 5 7 6 ; 9 5 % C I : 1 , 0 7 8 - 6 , 1 5 3 ; p = 0 , 0 3 3 ) a r t i n y a b a h w a

r i w a y a t h i p e r k o l e s t e r o l a k a n m e n i n g k a t k a n r i s i k o t e r j a d i n y a n y e r i n e u r o p a t i

d i a b e t i k p a d a p e n d e r i t a D M t i p e 2 s e b e s a r 2 , 5 k a l i d i b a n d i n g k a n d e n g a n d e n g a n

t i d a k m e m p u n y a i riwayat h i p e r k o l e s t e r o l p a d a p e n d e r i t a D M t i p e 2 . L a m a

m e n d e r i t a D M d o n ri-vayat h i p e r k o l e s t e r o l a d a l a h f a k t o r risiko i n d e p e n d e n u n t u k

6

t e r j a d i n y a n y e r i d i a b e t i k n e u r o p a t i . L a m a m e n d e r i t a D M a d a l a h f a k t o r r i s i k o

t e r j a d i n y a n y e r i d i a b e t i k n e u r o p a t i p a d a p e n d e r i t a D M t i p e 2 , t e r d a p a t h u b u n g a n

b e r m a k n a a n t a r a l a m a m e n d e r i t a D M d e n g a n t e r j a d i n y a n y e r i d i a b e t i k n e u r o p a t i .

P e n e l i t i a n y a n g a k a n d i l a k u k a n b e r b e d a d e n g a n p e n e l i t i a n y a n g t e l a h a d a

s e b e l u m n y a . P e n e l i t i a n i n i u n t u k m e l i h a t H u b u n g a n d u r a s i D M d e n g a n k e j a d i a n

d i a b e t i k n e u r o p a t i d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g m e n g g u n a k a n m e t o d e p e n e l i t i a n a n a l i t i k d e n g a n p e n d e k a t a n cross

sectional d a n d i t e m p a t y a n g b e r b e d a .

BAB I I

1INJAUAN PUSTAKA

2.1 Diabetes Melitus

2.1.1 Definisi Diabetes Melitus

Menurut American Diabetes Association ( A D A ) t a h u n 2 0 1 0 , D i a b e t e s

M e l i t u s m e r u p a k a n s u a t u k e l o m p o k p e n y a k i t m e t a b o l i k d e n g a n k a r a k t e r i s t i k

h i p e r g l i k e m i a y a n g t e r j a d i k a r e n a k e l a i n a n s e k r e s i i n s u l i n , k e r j a i n s u l i n a t a u

k e d u a r - d u a n y a ( P E R K E N I , 2 0 1 1 ) .

D i a b e t e s m e l i t u s a d a l a h s u a t u ^ e n y a k i t k r o n i k ( m e n a h u n ) y a n g

d i s e b a b k a n o l e h b e r k u r a n g n y a p r o d u k s i i n s u l i n , b a i k k e k u r a n g a n i n i a b s o l u t

m a u p u n r e l a t i f ( H a z n a m , 1 9 9 1 ) .

W o r l d H e a l t h O r g a n i z a t i o n ( W H O ) s e b e l u m n y a t e l a h m e r u m u s k a n

b a h w a D i a b e t e s M e l i t u s m e r u p a k a n s e s u a t u y a n g t i d a k d a p a t d i t u a n g k a n

d a l a m s a t u j a w a b a n y a n g j e l a s d a n s i n g k a t t e t a p i s e c a r a u m u m d a p a t

d i k a t a k a n s e b a g a i s u a t u k u m p u l a n p r o b l e m a a n a t o m i k d a n k i m i a w i a k i b a t

d a r i s e j u m l a h f a k t o r d i m a n a d i d a p a t d e f i s i e n s i i n s u l i n a b s o l u t a t a u r e l a t i f d a n

g a n g g u a n f u n g s i i n s u l i n ( G u s t a v i a n i , 2 0 0 6 ) .

D i a b e t e s M e l i t u s m e r u p a k a n s u a t u s i n d r o m d e n g a n t e r g a n g g u n y a

m e t a b o l i s m e k a r b o h i d r a t , l e m a k , d a n p r o t e i n y a n g d i s e b a b k a n o l e h

b e r k u r a n g n y a s e k r e s i i n s u l i n a t a u p e n u r u n a n s e n s i t i v i t a s j a r i n g a n t e r h a d a p

i n s u l i n ( G u y t o n , H a l l , 2 0 0 7 ) .

D i a b e t e s m e l i t u s a d a l a h s u a t u p e n y a k i t d i m a n a t e r j a d i n y a d e f i s i e n s i

p r o d u k s i , s e k r e s i , d a n a t a u a k s i d a r i i n s u l i n , s u a t u p r o t e i n y a n g d i s e k r e s i o l e h

s e l b e t a d a r i p u l a u L a n g e r h a n s p a n c r e a s d a n m e n y e b a b k a n t e i j a d i n y a

g a n g g u a n m e t a b o l i s m e , t e r m a s u k r e g u l a s i k o n s e n t r a s i g l u k o s a d a r a h ( D a v i d ,

1 9 9 6 ; J u s m a n , 1 9 9 9 ) .

7

8

2.1.2 Klasifikasi Diabetes Melitus

K l a s i f i k a s i D M M e n u r u t F o s t e r 1 9 8 7

A . D i a b e t e s p r i m e r

1 . I n s u l i n d e p e n d e n t D i a b e t e s M e l i t u s ( I D D M , t i p e 1 )

2 . N o n - i n s u l i n d e p e n d e n t D i a b e t e s M e l i t u s ( N I D D M , t i p e 2 )

a . N o n - o b e s e N I D D M ( t i p e 1 I D D M d a i a m e v a l u a s i )

b . O b e s e N I D D M

c . M a t u r i t y o n s e t D i a b e t e s o f t h e y o u n g ( M O D Y )

B . D i a b e t e s s e k u n d e r

1. P e n y a k i t p a n k r e a s

2 . A b n o r m a l i t a s h o r m o n a l

3 . D i s e b a b k a n o b a t a t a u z a t k h e m i s

4 . A b n o r m a l i t a s d a r i r e s e p t o r i n s u l i n

5 . S i n d r o m g e n e t i k

6 . L a i n - l a i n ( H a z n a m , 1 9 9 1 )

T a b e l 1 . K l a s i f i k a s i e t i o l o g i s D i a b e t e s M e l i t u s

T i p e I D e s t r u k s i s e i b e t a , u m u m n y a m e n j u r u s k e d e f i s i e n s i i n s u l i n a b s o l u t • A u t o i m u n • I d i o p a t i k

T i p e 2 B e r v a r i a s i , m u l a i y a n g d o m i n a n r e s i s t e n s i i n s u l i n d i s e r t a i d e f i s i e n s i i n s u l i n r e l a t i f s a m p a i y a n g d o m i n a n d e f e k s e k r e s i i n s u l i n d i s e r t a i r e s i s t e n s i i n s u l i n

T i p e L a i n • D e f e k g e n e t i k f u n g s i s e l b e t a • D e f e k g e n e t i k k e r j a i n s u l i n • P e n y a k i t e k s o k r i n p a n k r e a s • E n d o k r i n o p a t i • K a r e n a o b a t a t a u z a t k i m i a • I n f e k s i • S e b a b i m i m o l o g i y a n g j a r a n g • S i n d r o m g e n e t i k l a i n y a n g b e r k a i t a n d e n g a n d i a b e t e s

m e l l i t u s

D i a b e t e s m e l i t u s I n t o l e r a n s i k a r b o h i d r a t y a n g t e r j a d i a t a u d i k e t a h u i p e r t a m a g e s t a s i o n a l k a J i p a d a s a a t k e h a m i l a n s e d a n g b e r l a n g s u n g

S u m b e r - P E R K E N ' . , 2 0 1 1

9

2.1.3. Diagnosis Diabetes Melitus

B e r b a g a i k e l u h a n d a p a t d i t e m u k a n p a d a p e n d e r i t a d i a b e t e s .

K e c u r i g a a n a d a n y a d i a b e t e s m e l i t u s p e r l u d i p i k i r k a n a p a b i l a t e r d a p a t k e l u h a n

k l a s i k d i a b e t e s m e l i t u s s e p e r t i d i b a w a h i n i :

A . K e l u h a n k l a s i k d i a b e t e s m e l i t u s b e r u p a : p o l i u r i a , p o l i d i p s i a , p o l i f a g i a , d a n

p e n u r u n a n b e r a t b a d a n y a n g t i d a k d a p a t d i j e l a s k a n s e b a b n y a .

B . K e l u h a n l a i n d a p a t b e r u p a : l e m a h b a d a n , k e s e m u t a n , g a t a l , m a t a k a b u r ,

d a n d i s f u n g s i e r e k s i p a d a p r i a , s e r t a p r u r i t u s v u l v a e p a d a w a n i t a .

T a b e l 2 . K a d a r G u l a d a r a h

B u k a n D M B e l u m t e n t u D M D M

K a d a r g l u k o s a P l a s m a d a r a h < 1 1 0 1 1 0 - 1 9 9 > 2 0 0

d a r a h s e w a k t u

( m g / d l ) D a r a h p e r i f e r < 9 0 9 0 - 1 9 9 > 2 0 0

K a d a r g l u k o s a P l a s m a d a r a h < 1 1 0 1 1 0 - 1 2 5 > 1 2 6

d a r a h

( m g / d l )

p u a s a D a f a h p e r i f e r < 9 0 9 0 - 1 0 9 > 1 1 0

S u m b e r : G u s t a v i a n i , 2 0 0 6

2.1.4. Komplikasi

K o m p l i k a s i j a n g k a p a n j a n g p a d a d i a b e t e s a d a l a h

A . M i k r o a n g i o p a t i d i a b e t i k

a . N e f r o p a t i d i a b e t i k

D a l a m b e b e r a p a h a l d i a b e t e s m e l i t u s m e m p e n g a r u h i s t r u k t u r d a n

f u n g s i g i n j a l d a n i s t i l a h n e f r o p a t i d i a b e t i k m e l i p u t i s e m u a k e l a i n a n

y a n g d i s e b a b k a n d i a b e t e s m e l i t u s p a d a g i n j a l p e n d e r i t a .

K e l a i a n a n - k e l a i n a n i n i b e r u p a :

• G l o m e r u l o s k l e r o s i s ( d i f i i s a t a u n o d u l e r )

• A r t e r i o n e f r o s k l e r o s i s

• N e f n t i s i n t e r s t i s i a l k r o n i k

1 0

• N e k r o s i s p a p i l e r

• D a n b e b e r a p a j e n i s k e r u s a k a n t u b u l i

b . R e t i n o p a t i d i a b e t i k

M a n i s f e s t a s i m i k r o a n g i o p a t i d i a b e t i k d i m a t a a d a l a h t e r u t a m a d i

r e t i n a ( r e t i n o p a t i ) t e t a p i b i s a j u g a d i k o n j u n g t i v a . R e t i n o p a t i d i a b e t i k

d i b a g i d a l a m :

1 . B a c k g r o u n d r e t i n o p a t h y

• T i m b u l k e l a i n a n - k e l a i n a n i n t r a v a s k u l e r d i k a p i l e r - k a p i l e r

( m i k r o a n e u r i s m a d a n p e r m e a b i l i t a s d i n d i n g b e r t a m b a h ) , v e n a

( b e r b e n t u k l o o p ) d a n a r t e r i ( i r e g u l e r ) .

• A r t e r i o v e n c j s s h i m t

• H e m o r a g i

• H a r d e x u d a t e s ( b o c o m y a p r o t e i n d a n l i p i d d i k a p i l e r - k a p i l e r

y a n g r u s a k )

• C a t t o n w o o l s p o t s ( m i c r o i n f a r c t s )

• E d e m a

2 . P o l i f e r a t i v e r e t i n o p a t h y

• T i m b u l p e m b u l u h - p e m b u l u h d a r a h b a r u i n l r a r e t i n a l d a n

p e r i r e t i n a l ( n e o v a s k u l a r i s a s i )

• R e n i t i s p r o l i f e r a n s fibreus

• T e r j a d i p a r u t ( s c a r s )

• P e r d a r a h a n d i c o r p u s v i t r e u m

• A b l a s i r e t i n a

c . K a r d i o m i o p a t i d i a b e t i k

P a d a p e n d e r i t a - p e n d e r i t a d i a b e t e s t a n p a g e j a l a - g e j a l a p e n y a k i t

j a n t u n g t e l a h d i t e m u k a n b e r t a m b a h k a k i m y a d i n d i n g j a n t u n g d a n

k o n t r a k t i l i t a s j a n t u n g b e r k u r a n g . P e n e m u a n i n i p a d a p e n d e r i t a d i a b e t e s

m e n y e r u p a i k a r d i o m i o p a t i y a n g d i t e m u k a n p a d a a l k o h o l i s m e .

1 1

B . M a k r o a n g i o p a t i d i a b e t i k

a . P e n y a k i t j a n t u n g k o r o n e r

K e j a d i a n i n f a r k m i o k a r d p a d a p e n d e r i t a d i a b e t e s b a i k y a n g I D D M

m a u p u n N I D D M p a l i n g k u r a n g d u a k a l i l e b i h b a n y a k d a r i n o n - d i a b e t e s .

R e s i k o i n i j e l a s l e b i h b e s a r p a d a p e n d e r i t a d i a b e t e s y a n g m u d a ( I D D M ) .

b . C V A {cerebrovascular accident)

R i s i k o d a r i p e n d e r i t a d i a b e t e s u n t u k m e n d a p a t k a n C V A d u a k a l i

l e b i h b e s a r d a r i p a d a n o n - d i a b e t e s d a l a m h a l t r o m b o s i s , t r o m b o e m b o l i

d a n i n f a r k s e r e b r i .

c. U l k u s / g a n g r e n / o s t e o m i e l i t i s p a d a t x m g k a i

S u a t u p r o b l e m p a d a d i a b e t e s m e l i t u s a d a l a h t i m b u l n y a u l k u s d i

k a k i . U l k u s i n i d i s e b a b k a n :

• P r i m e r o l e h d i s t r i b u s i t e k a n a n y a n g a b n o r m a l d i k a k i

• S e k u n d e r o l e h n e u r o p a t i d i a b e t i k d i t a m b a h l a g i k u r a n g n y a a l i r a n

d a r a h k a r e n a p e n y a k i t v a s k u l e r d a n i n f e k s i .

C . N e u r o p a t i d i a b e t i k

N e u r o p a t i b i s a m e n g e n a i s e l u r u h s i s t e m s a r a f d a l a m t u b u h , k e c u a l i

o t a k . N e u r o p a t i d i a b e t i k a m a t j a r a n g m e n y e b a b k a n k e m a t i a n t e t a p i s e r i n g

m e n j a d i s e b a b u t a m a m e n j a d i s a k i t d a n m e n d e r i t a p e r a s a a n n y e r i

( H a z n a m , 1 9 9 1 ) .

Diabetik Neuropati

2.2.1. Definisi Diabetik Neuropati

N e u r o p a t i d i a b e t i k m e r u p a k a n k e r u s a k a n p a d a n e r v u s d a l a m t u b u h

y a n g t e r j a d i a k i b a t k a d a r g u l a d a r a h t i n g g i d a r i d i a b e t e s ( A . D . A . M , 2 0 1 1 ) .

N e u r o p a t i d i a b e t i k m e r u p a k a n k o m p l i k a s i k r o n i s t e r s e r i n g p a d a d i a b e t e s

m e l i t u s t i p e 1 d a n t i p e 2 . N e u r o p a t i s e c a r a u m u m d i k l a s i f i k a s i k a n m e n j a d i

d u a y a i t u s o m a t i c d a n a u t o n o m i c n e u r o p a t i ( P e r k i n s B A , 2 0 0 1 ; T a s f a y e S ,

2 0 1 0 ) .

S o m a t i k n e u r o p a t i d i t a n d a i o l e h m a t i r a s a , r a s a t e r b a k a r , r a s a

d i t u s u k - t u s u k r e r a t a m a d i j a r i k a k i , t e l a p a k k a k i d a n t u n g k a i b a w a h .

1 2

S e d a n g k a n a u t o n o m i k n e u r o p a t i t i d a k d i d a p a t g e j a l a s a m p a i s t a d i u m l a n j u t .

A u t o n o m i k n e u r o p a t i d i a b e t i k m e n y e b a b k a n g a n g g u a n f u n g s i b e r b a g a i

o r g a n , s e p e r t i : k a r d i o v a s k u l e r , g a s t r o i n t e s t i n a l , s i s t e m u r o g e n i t a l , f u n g s i

s u d o m o t o r , m e t a b o l i k d a n d i s f u n g s i p u p i l . D i a n l a r a h a l - h a l t e r s e b u t ,

k a r d i o v a s k u l e r a u t o n o m i k n e u r o p a t i m e n i n g k a t n y a r e s i k o k e m a t i a n p a d a

p a s i e n d i a b e t e s . D a l a m h a l i n i d i a g n o s a d a n t e r a p i p a d a a u t o n o m i k

n e u r o p a t i p a d a s t a d i u m d i n i s a n g a t p e n t i n g p a d a p e n d e r i t a d i a b e t e s m e l i t u s

( P e r k i n s , 2 0 0 1 ; T a s f a y e S , 2 0 1 0 ) .

D a l a m k o n f e r e n s i n e u r o p a t i p e r i f e r p a d a b u l a n f e b u a r i 1 9 8 8 d i S a n

A n t o n i o , d i s e b u t k a n b a h w a d i a b e t i k n e u r o p a t i a d a l a h i s t i l a h d e s k i i p t i f y a n g

m e n u n j u k k f ^ n a d a n y a g a n g g g u a n , b a i k k l i n i s m a u p u n s u b k l i n i s , y a n g t e r j a d i

p a d a d i a b e t e s m e l i t u s t a n p a p e n y e b a b n e u r o p a t i p e r i f e r y a n g l a i n ( I m a m

S u b e k t i , 2 0 0 6 ) .

2.2.2. Klasifikasi Diabetik Neuropati

D i a b e t i k n e u r o p a t i b i s a m e n g e n a i s i s t e m s e n s o r i k , s i s t e m m o t o r i k ,

d a n o t o n o m . J e n i s - j e n i s d i a b e t i k n e u r o p a t i a d a l a h :

A . Neuropati perifer

• P a l i n g s e r i n g d i t e m u k a n

• B i a s a n y a b i l a t e r a l

• P e r a s a a n t e b a l / p a r e s t e s i a / h i p e r e s t e s i a y a n g h e b a t

• P e r a s a a n n y e r i , s e r i n g t e r a s a s e k a l i p a d a m a l a m h a r i

• N e u r o p a t i p e r i f e r i n i s e r i n g b e r a k h i r s e n d i r i ( s e l f - l i m i t e d ) d a l a m

b e b e r a p a m i n g g u s a m p a i b e b e r a p a t a h u n

B . Mononeuropati

• t i m b u l n y a t i d a k t e r s e r i n g n e u r o p a t i p e r i f e r

• b i s a t i m b u l d e n g a n s e k o n y o n g - k o n y o n g b e r u p a p e r g e l a n g a n t a n g a n

l u m p u h {wrist drop) a t a u p u n p e r g e l a n g a n k a k i l u m p u h {footdrop) a t a u

p a r a l i s i s s u a t u s a r a f k r a n i a l u m p . S a r a f k e - I I I , k e - I V a t a u k - V I .

• B i s a r e v e r s i b e l s e c a r a s p o n t a n s e s u d a h b e b e r a p a m i n g g u

13

C Radiculopathy

• P e r a s a a n n y e r i d i d a e r a h s u a t u / b e b e r a p a s a r a f m e d u l l a s p i n a l i s ,

b i a s a n y a d i d i n d i n g t o r a k s a t a u a b d o m e n .

• N y e r i i n i k a d a n g - k a d a n g m e n y e r u p a i p a d a h e r p e r s z o s t e r a t a u

a b d o m e n a k u t .

• B i a s a n y a s e l f - l i m i t e d

D. Neuropati otonom

• T r a k t u s g a s t o i n t e s t i n a l i s

> D i s f u n g s i e s o f a g u s ( s u k a r m e n e l a n )

> G a s t e r t e r l a m b a t m e n g o s o n g k a n i s i n y a

> K o n s t i p a s i

> d i a r e

• H i p e r t e n s i o r t o s t a t i k d a n s y n c o p e y a n g j e l a s

• C a r d i o r e s p i r a t o r y a r r e s t d a n s u d d e n d e a t h t e l a h d i l a p o r k a n

• K a n d u n g k e m i h : d i s f u n g s i d a n p a r a l i s i s

• I m p o t e n d a n e j a k u l a s i r e t r o g r a d p a d a p r i a

E. Amyotropi diabetik

• S u a t u j e n i s n e u r o p a t i y a n g m e n y e b a b k a n a t r o p i o t o t . a t r o p i d a r i o t o t -

o t o t b e s a r d i t u n g k a i a t a s d a n p i n g g u l m e n y e r u p a i p e n y a k i t o t o t p r i m e r

• B i s a d i s e r t a i a n o r e k s i a d a n d e p r e s i ( H a z n a m , 1 9 9 1 ) .

2.2.3. Diagnosis Diabetik Neuropati

A d a b e b e r a p a k r i t e r i a u n t u k m e n e n t u k a n a d a n y a k o m p l i k a s i

n e u r o p a t i p a d a p e n d e r i t a d i a b e t e s , s a l a h s a t u n y a a d a l a h d e n g a n K o n s e n s u s

S a n A n t o n i o .

Konsensus San Antonio

P e n e g a k a n n e u r o p a t i d i a b e t i k a s e l a i n b e r d a s a r k a n W H O , d a p a t

p u l a d i t e g a k k a n b e r d a s a r k a n k o n s e n s u s S a n A n t o n i o . P a d a k o n s e n s u s

t e r s e b u t t e l a h d i r e k o m e n d a s i k a n b a h w a p a l i n g s e d i k i t 1 d a r i 5 k r i t e r i a

d i b a w a h i n i d a p a t d i p a k a i u n t u k m e n e g a k k a n d i a g n o s i s n e u r o p a t i

1 4

d i a b e t i k a , y a k n i : {\) Symptom scoring; (2) Physical examination scoring:

( 3 ) Quantitative Sensory Testing ( Q S T ) ; ( 4 ) cardiovascular Autonomic

Function Testing ( c A F T ) ; ( 5 ) Electro-diagnostic studies ( E D S ) ( H A S a d e l i ,

2 0 0 8 ; M e i j e r d k k . 2 0 0 3 ) . P e m e r i k s a a n symptom scoring d a n physical

examination scoring y a n g t e l a h t e r b u k t i m e m i l i k i s e n s i t i f i t a s d a n s p e s i f i t a s

t i n g g i u n t u k m e n d i a g n o s i s n e u r o p a t i a t a u p o l i n e u r o p a t i d i a b e t i k a a d a l a h

s k o r Diabetic Neuropathy Symptom ( D N S ) d a n s k o r Diabetic Neuropathy

Examination ( D N E ) ( M e i j e r d k k . 2 0 0 3 ) .

D i a b e t i c Neuropathy E x a m i n a t i o n (DNE)

A l a t i n i m e m p u n y a i s e n s i t i v i t a s s e b e s a r 9 6 % d a n s p e s i f i s i t a s

s e b e s a r 5 1 % . S k o r Diabetic Neuropathy Examinatio ( D N E ) a d a l a h s e b u a h

s i s t e m s k o r u n t u k m e n d i a g n o s a p o l i n e u r o p a t i d i s t a l p a d a d i a b e t e s m e l i t u s .

D N E a d a l a h s i s t e m s k o r y a n g s e n s i t i f d a n t e l a h d i v a l i d a s i d e n g a n b a i k d a n

d a p a t d i l a k u k a n s e c a r a c e p a t d a n m u d a h d i p r a k t e k k l i n i k . S k o r D N E

t e r d i r i d a r i 8 i t e m , y a i t u : A ) K e k u a t a n o t o t : ( 1 ) q u a d r i s e f e m o r i s ( e k s t e n s i

s e n d i l u t u t ) ; ( 2 ) t i b i a l i s a n t e r i o r ( d o r s o f l e k s i k a k i ) . B ) R e l f e k s : ( 3 ) t r i s e p

s u r a e / t e n d o a c h i l e s . C ) S e n s i b i i i t a s j a r i t e l u n j u k : ( 4 ) s e n s i t i v i t a s t e r h a d a p

t u s u k a n j a r u m . D ) S e n s i b i i i t a s i b u j a r i k a k i : ( 5 ) s e n s i t i v i t a s t e r h a d a p t u s u k a n

j a r u m ; ( 6 ) s e n s i t i v i t a s t e r h a d a p s e n t u h a n ; ( 7 ) p e r s e p s i g e t a r ; d a n ( 8 )

s e n s i t i v i t a s t e r h a d a p p o s i s i s e n d i . S k o r 0 a d a l a h n o r m a l ; s k o r 1 : d e f i s i t

ringan a t a u s e d a n g ( k e k u a t a n o t o t 3 - 4 , r e f l e k s d a n s e n s i t i v i t a s m e n u r u n ) ;

s k o r 2 : d e f i s i t b e r a t ( k e k u a t a n o t o t 0 - 2 , r e f l e x d a r i s e n s i t i v i t a s n e g a t i E t i d a k

a d a ) . N i l a i m a k s i m a l d a r i 4 m a c a m p e m e r i k s a a n t e r s e b u t d i a t a s a d a l a h 1 6 .

S e d a n g k a n k r i t e r i a d i a g n o s t i k u n t u k n e u r o p a t i b i l a n i l a i > 3 d a r i 1 6 n i l a i

t e r s e b u t ( M e i j e r d k k . 2 0 0 3 ; H a s t u t i T , 2 0 0 3 ) .

D i a b e t i c Neuropathy Symptom (DNS)

S k o r Diabetic Neuropathy Symptom ( D N S ) m e r u p a k a n 4 p o i n t

y a n g b e m i l a i i m t u k s k o r g e j a l a , d e n g a n p r e d i k s i n i l a i y a n g t i n g g i u n t u k

m e n y a r i n g p o l ' r i c i i r c p a t i p a d a d i a b e t e s . G e j a l a j a l a n t i d a k s t a b i l , n y e r i

15

n e u r o p a t i , p a r a s t e s i a t a u r a s a t e b a l . S a t u g e j a l a d i n i l a i s k o r 1 , m a k s i m u m

s k o r 4 . S k o r 1 a t a u l e b i h d i t e r j e m a h k a n s e b a g a i p o s i t i f p o l i n e u r o p a t i

d i a b e t i k ( M e i j e r d k k . 2 0 0 3 ) .

M e i j e r d k k t a h u n 2 0 0 2 m e n y i m p u l k a n b a h w a s k o r D N S d a p a t

d i g u n a k a n u n t u k d i a g n o s i s k l i n i s p o l i n e u r o p a t i d i a b e t i k a y a n g m u d a h

d i l a k u k a n d a l a m p r a k t e k k l i n i s , t e t a p i h a r u s d i k o m b i n a s i k a n d e n g a n m e t o d e

l a i n .

A s a d d k k t a h u n 2 0 1 0 , d a l a m u j i r e a b i l i t a s n e u r o l o g i k a i s k o r u n t u k

a s s e s s m e n t n e u r o p a t i s e n s o r i m o t o r p a d a p a s i e n D M t i p e 2 m e n d a p a t k a n

s k o r D N S m e m p u n y a i s e n s i t i v i t a s 6 4 , 4 1 % d a n s p e s i f i t a s 8 0 , 9 5 % d a n

m e n y i m p u l k a n b a h w a d a l a m s e m u a s k o r , D N E y a n g p a l i n g s e n s i t i f d a n

D N S a d a l a h p a l i n g s p e s i f i k .

A s a d d k k t a h u n 2 0 0 9 d a l a m p e n e l i t i a n t e n t a n g P e r b a n d i n g a n

s t u d i k o n d u k s i s a r a f d e n g a n s k o r D N E d a n D N S p a d a n e u r o p a t i

d i a b e t e s t i p e - 2 m e n y i m p u l k a n b a h w a S k o r D N E d a n S k o r D N S d a p a t

d i g u n a k a n u n t u k d e t e k s i n e u r o p a t i d i a b e t i k a .

2.2.4. Patofisologi Diabetik Neuropati

P a t o f i s i o l o g i t e r j a d i n y a d i a b e t i k n e u r o p a t i b e l u m j e l a s . N a m u n a d a

b e b e r a p a t e o r i y a n g m e n y e b a b k a n t e r j a d i n y a n e u r o p a t i d i a b e t i k :

A . F a k t o r m e t a b o l i k

P r o s e s t e r j a d i n y a D i a b e t i k N e u r o p a t i b e r a w a l d a r i h i p e r g l i k e m i

k r o n i k d a n p e r s i s t e n m e n y e b a b k a n a k t i v i t a s j a l u r p o l i o l m e n i n g k a t y a i t u

t e r j a d i a k t i v a s i e n z i m a l d o s e - r e d u k t a s e , y a n g m e r u b a h g l u k o s a m e n j a d i

s o r b i t o l , y a n g k e m u d i a n d i m e t a b o l i s m e o l e h s o r b i t o l d e h i d r o g e n a s e

m e n j a d i fi^tosa. A k u m u l a s i s o r b i t o l d a n f r u k t o s a d a l a m s e l s a r a f

m e r u s a k s e l s a r a f m e l a l u i m e k a n i s m e y a n g b e l u m j e l a s . S a l a h s a t u

k e m u n g k i n a n n y a i a l a h a k i b a t a k u m u l a s i s o r b i t o l d a l a m s e l s a r a f

m e n y e b a b k a n k e a d a a n h i p e r t o n i k i n t r a s e l u l a r s e h i n g g a m e n y e b a b k a n

e d e m s a r a f . P e n i n g k a t a n s i n t e s i s s o r b i t o l b e r a k i b a t t e r h a m b a t n y a

m i o i n o s i t o l m a s u k k e d a l a m s e l s a r a f . P e n u i a n a n m i o i n o s i t o l d a n

1 6

a k u m u l a s i s o r b i t o l s e c a r a l a n g s u n g m e n i m b u l k a n s t r e s s o s m o t i c y a n g

m e r u s a k m i t o k o n d r i a d a n m e n s t i m u l a s i protein kinase C ( P K C ) . A k t i v a s i

PKC i n i a k a n m e n e k a n f u n g s i Na-K~ATP-ase, s e h i n g g a k a d a r N A

i n t r a s e l u l a r m e n j a d i b e r l e b i h a n , y a n g b e r a k i b a t t e r h a m b a t n y a m i o i n o s i t o l

m a s u k k e d a l a m s e l s a r a f s e h i n g g a t e r j a d i g a n g g u a n t r a n s d u k s i s i n y a l

s a r a f .

R e a k s i j a l u r p o l i o l i n i j u g a m e n y e b a b k a n t u r u n n y a p e r s e d i a n

N A D P H s a r a f y a n g m e r u p a k a n k o f a k t o r p e n t i n g d a l a m m e t a b o l i s m e

o k s i d a t i f . K a r e n a N A D P H m e r u p a k a n k o f a k t o r p e n t i n g u n t u k glutachon

d a n nitric oxide synthase ( N O S ) , p e g u r a n g a n k o f a k t o r t e r s e b u t

m e m b a t a s i k e m a m p u a n s a r a f u n t u k m e n g u r a n g i r a d i k a l b e b a s d a n

p e n u r u n a n p r o d u k s i nitric oxide ( N O ) .

D i s a m p i n g i t u m e n i n g k a t n y a a k t i v i t a s j a l u r p o l i o l , h i p e r g l i k e m i

k r o n i k a k a n m e n y e b a b k a n t e r b e n t u k n y a advance glycosilation end

products ( A G E s ) . A G E s i n i s a n g a t t o k s i k d a n m e r u s a k s e m u a p r o t e i n

t u b u h , t e r m a s u k s e l s a r a f . D e n g a n t e r b e n t u k n y a A G E s d a n s o r b i t o l , m a k a

s i n t e s i d a n f u n g s i N O m e n u r u n , y a n g b e r a k i b a t v a s o d i l a t a s i b e r k u r a n g ,

a l i r a n d a r a h k e s a r a f m e n u r u n , d a n b e r s a m a r e n d a h n y a m i o i n o s i t o l d a l a m

s e l s a r a f t e r j a d i l a h d i a b e t i k n e u r o p a t i ( I m a m S u b e k t i , 2 0 0 6 ) .

B. K e l a i n a n v a s k u l e r

P e n e l i t i a n m e m b u k t i k a n b a h w a h i p e r g l i k e m i j u g a m e m p u n y a i

h u b u n g a n d e n g a n k e r u s a k a n m i k r o v a s k u l a r . H i p e r g l i k e m i a p e r s i s t e n

m e r a n g s a n g p r o d u k s i r a d i k a l b e b a s o k s i d a t i f y a n g d i s e b u t reactive

oxygen species ( R O S ) . R a d i k a l b e b a s i n i m e m b u a t k e r u s a k a n e n d o t e l

v a s c u l a r d a n m e n e t r a l i s a s i N O , y a n g b e r e f e k m e n g h a i a n g i v a s o d i l a t a s i

m i k r o v a s k u l a r . M e k a n i s m e k e l a i n a n m i k r o v a s k u l a r t e r s e b u t d a p a t

m e l a l u i p e n e b a l a n m e m b r a n b a s a l i s , t r o m b o s i s p a d a a r t e r i o l i n t r a n e u r a l ,

p e n i n g k a t a n a g r e g a s i t r o m b o s i t d a n b e r k t i r a n g n y a d e f o r m a b i l i t a s

e r i t r o s i t , b e r k u r a n g n y a a l i r a n d a r a h s a r a f d a n p e n i n g k a t a n r e s i s t e n s i

v a s c u l a r , s t a s i s a k s o n a l , p e m b e n g k a k a n d a n d e m i e l i n i s a s i p a d a s a r a f

a k i b a t i s k e m i k a k u t . K e j a d i a n n e u r o p a t i y a n g d i d a s a r i o l e h k e l a i n a n

1 7

v a s c u l a r n i a s i h b i s a d i c e g a h d e n g a n m o d i f i k a s i f a k t o r r i s i k o

k a r d i o v a s k u l a r , y a i t u k a d a r t r i g l i s e r i d a y a n g t i n g g i . i n d e k s m a s a t u b u h

m e r o k o k d a n h i p e r t e n s i ( I m a m S u b e k t i , 2 0 0 6 ) .

C. M e k a n i s m e i m u n

S u a t u p e n e l i t i a n m e n u n j u k k a n b a h w a 2 2 % d a r i 1 2 0 p e n y a n d a n g

D M t i p e I m e m i l i k i complement fixing antisciatic nerve antibodies d a n

D M t i p e I I m e m p e r l i h a t k a n h a s i l p o s i t i f . H a l i n i m e n u n j u k k a n b a h w a

a n t i b o d i t e r s e b u t b e r p e r a n p a d a p a t o g e n e s i s D i a b e t i k N e u r o p a t i . B u k t i

l a i n y a n g m e n y o k o n g p e r a n a n t i b o d i d a l a m m e k a n i s m e p a t o g e n i k

D i a b e t i k N e u r o p a t i a d a l a h a d a n y a antineural antibodies p a d a s e r u m

s e b a g i a n p e n y a n d a n g D M . A u t o a n t i b o d i y a n g b e r e d a r i n i s e c a r a

l a n g s u n g d a p a t m e r u s a k s t r u k t u r s a r a f m o t o r i k d a n s e n s o r i k y a n g

d i d e t e k s i d e n g a n i m u n o f l o r e s e n s i n d i r e k . D i s a m p i n g i t u a d a n y a

p e n u m p u k a n a n t i b o d i d a n k o m p l e m e n p a d a b e r b a g a i k o m p o n e n s a r a f

s u r a l i s m e m p e r l i h a t k a n k e m u n g k i n a n p e r a n p r o s e s i m u n p a d a

p a t o g e n e s i s D i a b e t i k N e u r o p a t i ( I m a m S u b e k t i , 2 0 0 6 ) .

D . P e r a n Nerve Growth Faktor (NGF)

N G F d i b u t u h k a n u n t u k m e m p e r c e p a t d a n m e m p e r t a h a n k a n

p e r t u m b u h a n s a r a f . P a d a p e n y a n d a n g d i a b e t e s , k a d a r N G F s e r u m

c e n d e r u n g t u r u n d a n b e r h u b u n g a n d e n g a n d e r a j a t n e u r o p a t i . N G F j u g a

b e r p e r a n d a i a m r e g u l a s i g e n substance P d a n calcitonin-gen-regulated

peptida ( C G R P ) . P e p t i d a i n i m e m p u n y a i e f e k t e r h a d a p v a s o d i l a t a s i ,

m o r t i l i t a s i n t e s t i n a l d a n n o s i s e p t i f , y a n g s e m u a n y a i t u m e n g a l a m i

g a n g g u a n p a d a D i a b e t i k N e u r o p a t i ( I m a m S u b e k t i , 2 0 0 6 ) .

18

2.3. Kerangka Teori D i a b e t e s M e l i t u s

T i p e 1

g u l a d a r a h t i d a k t e r k o n t r o i

T i p e 2 T i p e l a i n

H i p e r g l i k e m i a k r o n i k l a m a n y a D M

A k t i v i t a s j a l u r p o l i o l m e n i n g k a t

S i n t e s i s advance glycosilation end products ( A G E s )

A k u m u l a s i s o r b i t o l

P e n u r u n a n p e r s e d i a n N A P D H

S t r e s s o s m o t i k

M e m b a t a s i k e m a m p u a n s a r a f u n t u k m e n g u r a n g i r a d i k a l b e b a s d a n p e n u r u n p r o d u k s i nitric oxide Q40)

~2 M e r u s a k m i t o k o n d r i a d a n m e n s t i m u l a s i p r o t e i n k i n a s e C ( P K . C )

i

R a d i k a l b e b a s m e n i n g k a t

M e n e k a n f u n g s i N a - K - A T P - A s e

K a d a r N a i n t r a s e l u k i e r m e n i n g k a t

T e r h a m b a t n y a m i o i n o s i t o l m a s u k k e s a r a f

J

M e r a n g s a n g p r o d u k s i r a d i k a l b e b a s o k s i d a t i f ( R O S )

A G E s s a n g a t t o k s i k d a n m e r u s a k p r o t e i n t u b u h t e r m a s u k s e l s a r a f

M e r u s a k e n d o t e l v a s k u l a r

M e n e t r a l i s a s i N O

h i p e r k o l e s t e r o l

h i p e r t e n s i

m e r o k o k

V a s o d i l a t a s i b e r k u r a n g

A l i r a n d a r a h k e s a r a f m e n u r u n

G a n g g u a n t r a n s d u k s i s i n y a l s a r a f • D i a b e t i k N e u r o p a t i

S u m b e r : I m a m S u b e k l i , 2 0 0 6

2,4. Hipotesis

A d a h u b i m g a n d u r a s i D M d e n g a n k e j a d i a n D i a b e t i k N e u r o p a t i

P o l i k l i n i k P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

B A B I I I

METODE PENELITIAN

3.1 Jenis penelitian

P e n e l i t i a n i n i m e r u p a k a n j e n i s p e n e l i t i a n o b s e r v a s i o n a l a n a l i t i k d e n g a n

d e s a i n s t u d i p o t o n g l i n t a n g {cross-sectional).

3.2 Waktu dan tempat penelitian

P e n e l i t i a n d i l a k u k a n d i P o l i k l i n i k R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

p a d a k u r u n w a k t u b u l a n N o v e m b e r 2 0 1 2 s a m p a i d e n g a n J a n u a r i 2 0 1 3 .

3.3 Populasi & sampel penelitian

3.3.1 Populasi

1. Populasi Target

S e l u r u h p a s i e n D i a b e t e s M e l i t u s y a n g a d a d i K o t a m a d y a P a l e m b a n g

2. Populasi Terjangkau

S e l u r u h p a s i e n D i a b e t e s M e l i t u s y a n g m e n g u n j u n g i P o l i k l i n i k P e n y a k i t

D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

3.3.2 Sampel

S a m p e l m e r u p a k a n b a g i a n ( s u b s e t ) d a r i p o p u l a s i y a n g d i p i l i h d e n g a n

c a r a t e r t e n t u h i n g g a d i a n g g a p d a p a t m e w a k i l i p o p u l a s i n y a ( S a s t r o a s m o r o ,

2 0 1 1 ) .

E s t i m a s i b e s a r s a m p e l u n t u k p e n e l i t i a n cross-sectional m e n u r u t

S o p i y u d i n ( 2 0 1 0 ) a d a l a h :

n = ( Z g V 2 P Q + ( Z p VP, 0 , + P 7 0 ; ) ^

( P l - P 2 ) ^

n : U k u r a n m a s i n g - m a s i n g s a m p e l d a r i k e d u a k e l o m p o k s a m p e l

P i : P e r k i r a a n P r o p o r s i s a k i t p a d a p o p u l a s i t e r p a p a r = 0 , 6 9

P 2 : P e r k i r a a n P - o p o r s i s a k i t p a d a p o p u l a s i t a k t e r p a p a r = 0 , 3 4

( A r ^ S G , 2 0 1 0 )

20

2 1

P ( P l + P 2 ) / 2 - 0 , 3 6

D e f i a t b a k u n o r m a l i m t u k a ( 1 , 9 6 u n t u k a s e b e s a r 5 % )

D e f i a t b a k u n o r m a l u n t u k p ( 0 , 8 4 u n t u k p s e b e s a r 2 0 % )

Z a

zp O R O d s r a s i o p a p a r a n p e n y a k i t = 4 , 2 7 ( A g u n g G , 2 0 1 0 )

P | ( l - P 2 ) / P 2 ( l - P l )

l - P - 0 , 4 8

OR

Q

Q i

Q 2

1 - P ] = 0 , 3 1

1 - P 2 = 0 , 6 6

S e t e l a h d i h i t u n g b e r d a s a r k a n r a m u s , d i d a p a t k a n n = 3 0 , 2 9 m a k a

u k u r a n s a m p e l m i n i m a l y a n g d i g u n a k a n p e n e l i t i p a d a p e n e l i t i a n i n i a d a l a h

3 0 o r a n g .

33.3 Kriteria Restriksi

1. Kriteria Inklusi:

a . P a s i e n D M t i p e 2 y a n g b e r o b a t d i p o l i k l i n i k p e n y a k i t d a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

b . B e r s e d i a d i j a d i k a n s a m p e l p e n e l i t i a n

2. Kriteria ekskJusi

P a s i e n D M t i p e 2 d e n g a n r i w a y a t s t r o k e , p a s i e n D M t i p e 1 d a n t i p e

l a i n

33.4 Cara Pengambilan Sampel

S a m p e l d i a m b i l d a r i r e k a m m e d i k R S M u h a m m a d i y a h P a l e m b a n g

d e n g a n t e k n i k s i s t e m a t i k {systematic random sampling), y a n g d i l a k u k a n

d e n g a n c a r a m e n e n t u k a n l e b i h d a h u l u a n g k a k e l i p a t a n ( k ) . A n g k a k e l i p a t a n

d i p e r o l e h d a r i j u m l a h p o p u l a s i p e r j u m l a h s a m p e l , d e n g a n f o r m u l a s e b a g a i

b e r i k u t ( S a s t r o a s m o r o , I s m a e l , 2 0 1 1 ; N o t o a t m o d j o , 2 0 1 0 ) .

n K e t e r a n g a n : k = a n g k a k e l i p a t a n

= j u m l a h p o p u l a s i

= j u m l a h s a m p e l

N

n

2 2

S e h i n g g a b e s a r s a m p e l y a n g d i g u n a k a n d a l a m p e n e l i t i a n i n i a d a l a h

s e b a g a i b e r i k u t .

N n

8 7 5

k = 2 9 , 1 7

D i b u l a t k a n m e n j a d i k = 2 9 . J a d i d a r i s e l u r u h d a t a r e k a p i t u l a s i p e r s a l i n a n

y a n g d i d a p a t d a l a m s a t u t a h u n , u n t u k m e n g a m b i l s a m p e l s e b a n y a k 3 0

o r a n g , s a m p e l y a n g d i a m b i l y a i t u n o m o r u n i t d e n g a n k e l i p a t a n 2 9 .

P e r h i t u n g a n d i m u l a i d a r i a n g k a 2 9 , 5 8 , 8 7 , 1 1 6 , d s t , s a m p a i t e r p e n u h i n y a

j u m l a h s a m p e l m i n i m a l .

3.4 Variabel penelitian

1. Variabel Bebas

V a r i a b e l b e b a s d a l a m p e n e l i t i a n i n i a d a l a l i d u r a s i D M , u m u r , j e n i s

k e l a m i n .

2. Variabel Terikat

V a r i a b e l t e r i k a t d a l a m k a s u s i n i a d a l a h D i a b e t i k N e u r o p a t i .

3.5 Definisi operasional

1. Durasi DM

a . D e f i n i s i

D u r a s i D M a d a l a h b r a p a l a m a m e n d e r i t a D M

b . A l a t u k u r

D a f t a r p e r t a n y a a n

c . C a r a u k u r

W a w a n c a r a

d . H a s i l u k u r

1 ) S k a l a U k u r : o r d i n a l

2 ) H a s i l P e n g u k u r a n D i k a t e g o r i k a n m e n j a d i :

a . < 5 t a h u n

2 3

b . > 5 t a h u n

2 . Umur

a. D e f i n i s i

U m u r r e s p o n d e n p a d a s a a t p e n e l i t i a n s e s u a i d e n g a n K T P y a n g m a s i h

a k t i f .

b . A l a t u k u r

D a f t a r p e r t a n y a a n

c . C a r a u k u r

W a w a n c a r a

d . H a s i l u k u r

1 ) S k a J a u k u r ; o r d i n a l

2 ) H a s i l P e n g u k u r a n D i k a t e g o r i k a n m e n j a d i :

a. < 5 0 t a h u n

b . > 5 0 t a h u n

3 . Jenis kelamin

a. D e f i n i s i

J e n i s k e l a m i n r e s p o n d e n b a i k l a k i - i a k i m a u p u n p e r e m p u a n

b . A l a t u k u r

D a f t a r p e r t a n y a a n

c. C a r a u k u r

W a w a n c a r a

d . H a s i l u k u r

1 ) S k a l a u k u r : n o m i n a l

2 ) H a s i l P e n g u k u r a n D i k a t e g o r i k a n m e n j a d i :

a. l a k i - l a k i

b . p e r e m p u a n

2 4

4. Diabetik Neuropati

a . D e f i n i s i

R e s p o n d e n y a n g m e m i l i k i p e n y a k i t D i a b e t i k N e u r o p a t i b e r d a s a r k a n

d i a g n o s a d o k t e n

b . A l a t u k u r

R e k a m M e d i s

c . C a r a u k u r

M e l i h a t r e k a m m e d i k .

d . H a s i l P e n g u k u r a n

1 ) S k a l a p e n g u k u r a n : o r d i n a l

2 ) H a s i l P e n g u k u r a n d i k a t e g o r i k a n m e n j a d i :

a. m e n d e r i t a D i a b e t i k N e u r o p a t i

b . t i d a k m e n d e r i t a D i a b e t i k N e u r o p a t i

3.6 Cara Kerja/Cara pengumpulan data

D a t a d i k u m p u l k a n d a r i d a t a p r i m e r y a n g d i a m b i l d e n g a n c a r a w a w a n c a r a

t e r s t r u k t u r d e n g a n m e n g g u n a k a n d a f t a r p e r t a n y a a n y a n g t e l a h d i p e r s i a p k a n d a n

d a t a s e k u n d e r d a r i R e k a m M e d i k ;

3.7 Cara Pengolahan Data dan analisis data

3;73 Pengolahan data

D a t a y a n g t e l a h d i k u m p u l k a n m a k a p e n e l i t i a k a n m e l a k u k a n a n a l i s a

d a t a s e h i n g g a d a t a t e r s e b u t d a p a t d i t a r i k k e s i m p u l a n n y a . A d a p u n d a t a

d i a n a l i s i s d e n g a n m e n g g i m a k a n software statistik

L a n g k a h a w a l a d a l a h m e l a k u k a n p e n y u n t i n g a n ( e d i t i n g ) t e r h a d a p d a t a

y a n g a d a . A p a b i l a t e m y a t a t i d a k a d a d a t a y a n g d i r a s a k a n k u r a n g ( d a t a

l e n g k a p / s i a p ) , s e l a n j u t n y a d i l a k u k a n e n t r i k e d a l a m k o m p u t e r . P e m b e r s i h a n

d a t a ( C l e a n i n g ) t e r h a d a p d a t a - d a t a y a n g t i d a k w a j a r d a n d i c e k k e b e n a r a n n y a

p a d a r e k a p i t u l a s i d a t a y a n g t e l a h d i k u m p u l k a n ;

2 5

3.7.2 Analisis data

A n a l i s i s d a t a d i l a k u k a n d e n g a n d u a t a h a p y a i t u a n a l i s i s u n i v a r i a t d a n

a n a l i s i s b i v a r i a t .

1. Analisis Univariat

A n a l i s i s u n i v a r i a t d i l a k u k a n u n t u k m e n d e s k r i p s i k a n v a r i a s i s e l u r u h

v a r i a b e l y a n g d i g u n a k a n d e n g a n c a r a m e m b u a t t a b e l d i s t r i b u s i f r e k u e n s i

m a u p u n m e m b u a t n i l a i r a t a - r a t a , m a u p u n n i l a i t e n g a h u n t u k d a t a k o n t i n y u .

T a b e l 3 . D i s t r i b u s i r e s p o n d e n b e r d a s a r k a n k a r a k t e r i s t i k n y a

K a r a k t e r i s t i k J u m l a h P e r s e n t a s i ( % )

DM

D e n g a n n e u r o p a t i

T a n p a n e u r o p a t i

Lamanya DM

< 5 t a h u n

> 5 t a h u n

Usia

< 5 0 t a h u n

> 5 0 t a h u n

Jenis kelamin

L a k i - l a k i

P e r e m p u a n

2. Analisis Bivariat

A n a l i s i s b i v a r i a t d i l a k u k a n u n t u k m e l i h a t h u b u n g a n a n t a r a v a r i a b e l

i n d e p e n d e n d e n g a n v a r i a b e l d e p e n d e n . A n a l i s i s b i v a r i a t y a n g d i l a k u k a n

p a d a f > e n e l i t i a n i n i a d a 2 y a i t u :

a . A n a l i s i s H u b u n g a n d u r a s i D M d e n g a n D i a b e t i k N e u r o p a t i .

A n a l i s i s y a n g a k a n d i g u n a k a n p a d a m e n g u j i d u a v a r i a b e l y a n g b e r s k a l a

k a t e g o r i k a n a l i s i s a d a l a h d e n g a n u j i chi square, d e n g a n m e l i h a t n i l a i

2 6

fisher exact lest b i l a d i j u m p a i n i l a i < 5 d a n m e l i h a t n i l a i continue

correction a p a b i l a t i d a k d i j u m p a i n i l a i h a r a p a n < 5 .

b . U n t u k m e l i h a t Odds Ratio, s e b a g a i n i l a i u n t u k m e l i h a t s e b e r a p a b e s a r

d u r a s i D M d a p a t m e n j a d i f a k t o r r e s i k o t e r h a d a p k e j a d i a n D i a b e t i k

N e u r o p a t i .

T a b e l 4 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t u s i a d a n d i a g n o s i s

U s i a D i a b e t i k n e u r o p a t i D M P R P

< 5 0 - - - _

> 5 0 - - - .

U j i C h i S q u a r e , b e r m a k n a s e c a r a s t a t i s t i k b i l a p < 0 , 0 5 .

T a b e l 5 . D i s t r i b u s i f r e k u e n s i d a n p e r s e n t a s e m e n u r u t j e n i s k e l a m i n d a n

d i a g n o s i s

J e n i s k e l a m i n D i a b e t i k n e u r o p a t i D M P R P

L a k i - l a k i - - _ .

P e r e m p u a n - - _ .

U j i C h i S q u a r e , b e r m a k n a s e c a r a s t a t i s t i k b i l a p < 0 , 0 5 .

T a b e l 6 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t l a m a m e n d e r i t a D M

d a n d i a g n o s i s

L a m a n y a D M D i a b e t i k n e u r o p a t i D M P R P

< 5 t a h u n - -

> 5 t a h u n - -

U j i C h i S q u a r e , b e r m a k n a s e c a r a s t a t i s t i k b i l a p < 0 , 0 5 .

27

3.8 Alur Penelitian

P a s i e n p e n d e r i t a D M

P a s i e n p e n d e r i t a D M d i R S M P

K - r i t e r i a I n k l u s i K r i t e r i a E k s k l u s i

M e n g a l a m i N e u r o p a t i

T i d a k m e n g a l a m i n e u r o p a t i

< 5 t a h u n > 5 t a h u n < 5 t a h u n > 5 t a h u n

BAB IV

HASIL DAN PEMBAHASAN

4.1. Hasil Penelitian

B e r d a s a r k a n P e n e l i t i a n y a n g d i l a k u k a n d i P o l i k l i n i k P e n y a k i t D a l a m R u m a h

S a k i t M u h a m m a d i y a h P a l e m b a n g m e n g e n a i h u b u n g a n d u r a s i d i a b e t e s m e l i t u s t i p e

2 d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i d e n g a n j u m l a h s a m p e l s e b e s a r 3 4 o r a n g ,

t e r d i r i d a r i 1 8 o r a n g m e n d e r i t a d i a b e t e s m e l i t u s d a n 1 6 o r a n g m e n d e r i t a d i a b e t i k

n e u r o p a t i .

P a d a h a s i l p e n e l i t i a n i n i m e n g g u n a k a n d u a m e t o d e t e k n i s a n a l i s i s d a t a y a i t u

a n a l i s i s u n i v a r i a t d a n a n a l i s i s b i v a r i a t . A n a l i s i s u n i v a r i a t y a n g d i t e l i t i p a d a

p e n e l i t i a n i n i a d a l a h k a r a k t e r i s t i k d a s a r s u b j e k p e n e l i t i a n y a n g d i s a j i k a n d a l a m

b e n t u k t a b e l . P a d a p e n e l i t i a n i n i j u g a m e n g g u n a k a n a n a l i s i s b i v a r i a t y a n g t e r d i r i

d a r i h u b u n g a n d u r a s i D M d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i , h u b u n g a n u s i a

d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i , d a n h u b u n g a n j e n i s k e l a m i n d e n g a n k e j a d i a n

d i a b e t i k n e u r o p a t i y a n g d i s a j i k a n d a l a m b e n t u k t a b e l .

4.1.1. Analisis Univariat

K a r a k t e r i s t i k d a s a r s u b j e k p e n e l i t i a n d i s a j i k a n s e c a r a d e s k r i p t i f

y a n g b i s a d i l i h a t p a d a t a b e l 7 .

T a b e l 7 . D i s t i i b u s i r e s p o n d e n b e r d a s a r k a n k a r a k t e r i s t i k n y a ( n - 3 4 )

K a r a k t e r i s t i k J u m l a h DM D e n g a n n e u r o p a t i 1 6

1 8 4 7 , 1 5 2 , 9 T a n p a n e u r o p a t i

Lamanya DM < 5 t a h u n > 5 t a h u n Usia

2 0 14

5 8 , 8 4 1 . 2

< 5 0 t a h u n > 5 0 t a h u n

11 2 3

3 2 , 4 6 7 , 6

Jenis kelamin 12 2 2

3 5 , 3 6 4 , 7

2 8

29

B e r d a s a r k a n t a b e l 7 d i a t a s d i k e t a h u i b a h w a r e s p o n d e n y a n g

m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k 1 6 o r a n g ( 4 7 , 1 % ) d a n

m e n g a l a m i d i a b e t e s m e l i t u s s e b a n y a k 1 8 o r a n g ( 5 2 , 9 % ) . D a r i v a r i a b e l

l a m a n y a m e n d e r i t a D M d i d a p a t k a n s e b a n y a k 2 0 o r a n g ( 5 8 , 8 % )

r e s p o n d e n d e n g a n l a m a m e n d e r i t a D M < 5 t a h u n d a n 1 4 o r a n g

( 4 1 , 2 % ) r e s p o n d e n d e n g a n l a m a m e n d e r i t a D M > 5 t a h u n .

D a r i v a r i a b e l u s i a d i d a p a t k a n s e b a n y a k 1 1 o r a n g ( 3 2 , 4 % )

b e r u s i a < 5 0 t a h u n d a n 2 3 o r a n g ( 6 7 , 6 % ) b e r u s i a > 5 0 t a h u n s e r t a d a r i

v a r i a b e l j e n i s k e l a m i n d i d a p a t k a n r e s p o n d e n p e r e m p u a n s e b a n y a k 2 2

o r a n g ( 6 4 , 7 % ) d a n r e s p o n d e n l a k i - l a k i s e b a n y a k 1 2 o r a n g ( 3 5 , 3 % ) .

4.1.2. Analisis Bivariat

A . H u b u n g a n U s i a d e n g a n K e j a d i a n D i a b e t i k N e u r o p a t i

A n a l i s i s b i v a r i a t y a n g d i l a k u k a n p a d a p e n e l i t i a n i n i m e n g e n a i

h u b u n g a n u s i a d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i b i s a d i l i h a t p a d a

t a b e l 8 d i b a w a h i n i :

T a b e l 8 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t u s i a d a n

d i a g n o s i s

U s i a D i a b e t i k n e u r o p a t i

( % )

D M ( % )

T o t a l ( % )

P R P ( 9 5 % C I )

< 5 0 t a h u n 4 7 11 1 , 9 ( 0 , 4 3 6 - 0 , 6 1 9 ( 3 6 , 4 ) ( 6 3 , 6 ) ( 1 0 0 ) 8 , 3 5 3 )

> 5 0 t a h u n 12 11 2 3 ( 1 0 0 ) ( 5 2 , 2 ) ( 4 7 , 8 )

U j i C h i S q u a r e , b e r m a k n a s e c a r a s t a t i s t i k b i l a p < 0 , 0 5 .

B e r d a s a r k a n t a b e l 8 d i a t a s d a p a t d i l i h a t b a h w a r e s p o n d e n

d e n g a n u s i a < 5 0 t a h u n y a n g m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k

4 o r a n g ( 3 6 , 4 % ) , d a n t i d a k m e n g a l a m i n e u r o p a t i s e b a n y a k 7 o r a n g

( 6 3 , 6 % ) . S e d a n g k a n r e s p o n d e n d e n g a n u s i a > 5 0 t a h u n y a n g

m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k 1 2 o r a n g ( 5 2 , 2 % ) , d a n y a n g

30

t i d a k m e n g a l a m i n e u r o p a t i s e b a n y a k 1 1 o r a n g ( 4 7 , 8 % ) . D a r i h a s i l

a n a l i s i s b i v a r i a t t a b e l 8 d i d a p a t k a n p v a l u e 0 , 6 1 9 y a n g m e l e b i h i a

0 , 0 5 i n i m e n u j u k k a n t i d a k a d a c u k u p b u k t i u n t u k m e n o l a k H o . M a k a

d a p a t d i s i m p u l k a n b a h w a t i d a k a d a h u b u n g a n u s i a l e b i h d a r i 5 0 t a h u n

d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i .

B . H u b u n g a n J e n i s K e l a m i n d e n g a n K e j a d i a n D i a b e t i k N e u r o p a t i

A n a l i s i s b i v a r i a t y a n g d i l a k u k a n p a d a p e n e l i t i a n i n i m e n g e n a i

h u b i m g a n j e n i s k e l a m i n d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i b i s a

d i l i h a t p a d a t a b e l 9 d i b a w a h i n i :

T a b e l 9 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t j e n i s k e l a m i n

d a n d i a g n o s i s

J en i s D i a b e t i k D M T o t a l P R p k e l a m i n n e u r o p a t i ( % ) ( % ) ( 9 5 % C I )

( % ) L a k i - l a k i 4 8 1 2 ( 1 0 0 ) 2 , 4 ( 0 , 5 5 5 0 , 4 1

( 3 3 , 3 ) ( 6 6 , 7 ) - 1 0 , 3 8 1 ) P e r e m p u a n 12 1 0 ( 4 5 , 5 ) 2 2 ( 1 0 0 )

( 5 4 , 5 ) U j i C h i S q u a r e , b e r m a k n a s e c a r a s t a t i s t i k b i l a p < 0 , 0 5 .

B e r d a s a r k a n t a b e l 9 d i a t a s d a p a t d i l i h a t b a h w a r e s p o n d e n

d e n g a n j e n i s k e l a m i n l a k i - l a k i y a n g m e n g a l a m i d i a b e t i k n e u r o p a t i

s e b a n y a k 4 o r a n g ( 3 3 , 3 % ) d a n t i d a k m e n g a l a m i n e u r o p a t i s e b a n y a k 8

o r a n g ( 6 6 , 7 % ) . S e d a n g k a n r e s p o n d e n d e n g a n j e n i s k e l a m i n

p e r e m p u a n y a n g m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k 1 2 o r a n g

( 5 4 , 5 % ) d a n y a n g t i d a k m e n g a l a m i n e u r o p a t i s e b a n y a k 1 0 o r a n g

( 4 5 , 5 % ) . D a r i h a s i l a n a l i s i s b i v a r i a t t a b e l 9 d i d a p a t k a n p v a l u e 0 , 4 1

y a n g m e l e b i h i a 0 , 0 5 i n i m e n u j u k k a n t i d a k a d a c u k u p b u k t i u n t u k

m e n o l a k H o . M a k a d a p a t d i s i m p u l k a n b a h w a t i d a k a d a h u b u n g a n

j e n i s k e l a m i n d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i .

31

C . H u b u n g a n D u r a s i D M d e n g a n K e j a d i a n D i a b e t i k N e u r o p a t i

A n a l i s i s b i v a r i a t y a n g d i l a k u k a n p a d a p e n e l i t i a n i n i m e n g e n a i

h u b u n g a n d u r a s i D M d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i b i s a d i l i h a t

p a d a t a b e l 1 0 d i b a w a h i n i :

T a b e l 1 0 . D i s t r i b u s i frekuensi d a n p e r s e n t a s e m e n u r u t l a m a m e n d e r i t a

D M d a n d i a g n o s i s

L a m a n y a D i a b e t i k D M T o t a l P R p D M n e u r o p a t i ( ( % ) ( % ) ( 9 5 % C I )

% ) < 5 t a h u n 6 14 2 0 ( 1 0 0 ) 5 .83 0 , 0 4 2

( 3 0 ) ( 7 0 ) ( 1 , 2 9 8 -2 6 , 2 2 3 )

> 5 t a h u n 10 4 1 4 ( 1 0 0 ) ( 7 1 , 4 ) ( 2 8 , 6 )

U j i C h i S q u a r e , b e r m a k n a s e c a r a s t a t i s t i k b i l a p < 0 , 0 5 .

B e r d a s a r k a n t a b e l 1 0 d i a t a s d a p a t d i l i h a t b a h w a r e s p o n d e n

d e n g a n l a m a m e n d e r i t a D M < 5 t a h u n y a n g m e n g a l a m i d i a b e t i k

n e u r o p a t i s e b a n y a k 6 o r a n g ( 3 0 % ) d a n t i d a k m e n g a l a m i n e u r o p a t i

s e b a n y a k 1 4 o r a n g ( 7 0 % ) . S e d a n g k a n r e s p o n d e n d e n g a n l a m a

m e n d e r i t a D M > 5 t a h u n y a n g m e n g a l a m i d i a b e t i k n e u r o p a t i

s e b a n y a k 1 0 o r a n g ( 7 1 , 4 % ) d a n y a n g t i d a k m e n g a l a m i n e u r o p a t i

s e b a n y a k 4 o r a n g ( 2 8 , 6 % ) . D a r i h a s i l a n a l i s i s b i v a r i a t t a b e l 1 0 d i

d a p a t k a n p v a l u e 0 , 0 4 2 l e b i h k e c i l d a r i a 0 , 0 5 i n i m e n u j u k k a n a d a

c u k u p b u k t i u n t u k m e n o l a k H o - M a k a d a p a t d i s i m p u l k a n b a h w a a d a

h u b u n g a n l a m a n y a m e n d e r i t a D M l e b i h d a r i 5 t a h u n d e n g a n k e j a d i a n

d i a b e t i k n e u r o p a t i . N i l a i P R 5 , 8 3 ( 9 5 % C I : 1 , 2 9 8 - 2 6 , 2 2 3 ) b e r a r t i

l a m a m e n d e r i t a D M l e b i h d a r i 5 t a h u n a k a n m e n i n g k a t k a n r e s i k o

t e r j a d i n y a d i a b e t i k n e u r o p a t i p a d a p e n d e r i t a D M t i p e 2 s e b e s a r 5 - 6

k a l i d i b a n d i n g k a n d e n g a n l a m a m e n d e r i t a D M k u r a n g d a r i 5 t a h u n .

32

. Pembahasan

D a r i h a s i l m e l i h a t r e k a m m e d i k d a n w a w a n c a r a y a n g t e l a h d i l a k u k a n

d i P o l i k l i n i k P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g

d i d a p a t k a n d a t a m e n g e n a i j e n i s k e l a m i n , u s i a , d a n d u r a s i D M p a d a

r e s p o n d e n y a n g m e n g a l a m i D i a b e t i k N e u r o p a t i d a n D i a b e t e s M e l i t u s .

43.1.Usia

P e n i l a i a n v a r i a b e l u s i a d i l a k u k a n d e n g a n c a r a m e l i h a t r e k a m m e d i k

d a n w a w a n c a r a k e p a d a 3 4 s a m p e l p a s i e n D M d i P o l i k l i n i k P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g . D a r i p e n e l i t i a n i n i d i d a p a t k a n

r e s p o n d e n d e n g a n u s i a < 5 0 t a h u n y a n g m e n g p i a m i d i a b e t i k n e u r o p a t i

s e b a n y a k 4 o r a n g ( 3 6 . 4 % ) d a n t i d a k m e n g a l a m i n e u r o p a t i s e b a n y a k 7 o r a n g

( 6 3 , 6 % ) . S e d a n g k a n r e s p o n d e n d e n g a n u s i a > 5 0 t a h u n y a n g m e n g a l a m i

d i a b e t i k n e u r o p a t i s e b a n y a k 1 2 o r a n g ( 5 2 , 2 % ) d a n y a n g t i d a k m e n g a l a m i

n e u r o p a t i s e b a n y a k 1 1 o r a n g ( 4 7 , 8 % ) . H a s i l i n i s e s u a i d e n g a n p e n e l i t i a n

y a n g d i l a k u k a n o l e h A g u s M ( 2 0 1 1 ) , A g u n g G ( 2 0 1 0 ) d a n A d a m s ( 2 0 0 5 )

y a n g m e n d a p a t k a n d a t a p e n d e r i t a d i a b e t e s m e l i t u s t i p e 2 y a n g b e r u m u r

l e b i h d a r i 5 0 t a h u n l e b i h b a n y a k m e n g a l a m i n e u r o p a t i .

D a r i h a s i l a n a l i s i s b i v a r i a t d i d a p a t k a n p v a l u e 0 , 6 1 9 > a 0 , 0 5 i n i

m e n u j u k k a n t i d a k a d a c u k u p b u k t i u n t u k m e n o l a k H Q . M a k a d a p a t

d i s i m p u l k a n b a h w a t i d a k a d a h u b u n g a n u s i a l e b i h d a r i 5 0 t a h u n d e n g a n

k e j a d i a n d i a b e t i k n e u r o p a t i . H a s i l i n i t i d a k s e s u a i d e n g a n p e n e l i t i a n y a n g

d i l a k u k a n B o o y a d k k ( 2 0 0 5 ) y a n g m e n y a t a k a n a d a h u b u n g a n s i g n i f i k a n

a n t a r a n e u r o p a t i d e n g a n u s i a p a d a p a s i e n d i a b e t e s m e l i t u s .

4.2.2. Jenis Kelamin

P e n i l a i a n v a r i a b e l j e n i s k e l a m i n d i l a k u k a n d e n g a n c a r a

m e n g o b s e r v a s i s e r t a m e l i h a t r e k a m m e d i k d i P o l i k l i n i k P e n y a k i t D a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g . D a r i p e n e l i t i a n i n i d i d a p a t k a n

r e s p o n d e n d e n g a n j e n i s k e l a m i n l a k i - l a k i y a n g m e n g a l a m i d i a b e t i k

n e u r o p a t i s e b a n y a k 4 o r a n g ( 3 3 , 3 % ) d a n t i d a k m e n g a l a m i n e u r o p a t i

33

s e b a n y a k 8 o r a n g ( 6 6 , 7 % ) . S e d a n g k a n r e s p o n d e n d e n g a n p e r e m p u a n y a n g

m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k 1 2 o r a n g ( 5 4 , 5 % ) d a n y a n g t i d a k

m e n g a l a m i n e u r o p a t i s e b a n y a k 1 0 o r a n g ( 4 5 , 5 % ) . H a l i n i t i d a k s e s u a i

d e n g a n p e n e l i t i a n s e b e l u m n y a y a n g d i l a k u k a n o l e h B a r o n A ( 2 0 0 9 ) y a n g

m e n y a t a k a n d a t a frekuensi d i a b e t i k n e u r o p a t i l e b i h b a n y a k p a d a l a k i - l a k i

d i b a n d i n g p e r e m p u a n . T e t a p i h a s i l i n i s e s u a i d e n g a n p e n e l i t i a n y a n g

d i l a k u k a n A g u s M ( 2 0 1 1 ) d a n A g u n g G ( 2 0 1 0 ) , d i m a n a p r e v a l e n s i p e n d e r i t a

d i a b e t i k n e u r o p a t i l e b i h b a n y a k d i d a p a t k a n p a d a p e r e m p u a n d i b a n d i n g l a k i -

i a k i . P e r b e d a a n i n i k e m u n g k i n a n d i s e b a b k a n o l e h l o k a s i p e n e l i t i a n y a n g

b e r b e d a s e h i n g g a e p i d e m i o l o g i p e n y a k i t n y a j u g a b e r b e d a .

D a r i h a s i l a n a l i s i s b i v a r i a t d i d a p a t k a n p v a l u e 0 , 4 1 > a 0 , 0 5 i n i

m e n u j u k k a n t i d a k a d a c u k u p b u k t i u n t u k m e n o l a k H Q . M a k a d a p a t

d i s i m p u l k a n b a h w a t i d a k a d a h u b u n g a n j e n i s k e l a m i n d e n g a n k e j a d i a n

d i a b e t i k n e u r o p a t i . H a s i l i n i t i d a k s e s u a i d e n g a n p e n e l i t i a n y a n g d i l a k u k a n

B o o y a d k k ( 2 0 0 5 ) y a n g m e n y a t a k a n a d a h u b u n g a n s i g n i f i k a n a n t a r a

n e u r o p a t i d e n g a n j e n i s k e l a m i n p a d a p a s i e n d i a b e t e s m e l i t u s .

4.23. Durasi Diabetes Melitus

P e n i l a i a n v a r i a b e l d u r a s i m e n d e r i t a d i a b e t e s m e l i t u s d i l a k u k a n

d e n g a n c a r a w a w a n c a r a l a n g s u n g k e p a d a 3 4 s a m p e l p a s i e n D M d i P o l i k l i n i k

P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g . D a r i p e n e l i t i a n

i n i d i d a p a t k a n r e s p o n d e n d e n g a n l a m a m e n d e r i t a D M < 5 t a h u n y a n g

m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k 6 o r a n g ( 3 0 % ) d a n t i d a k m e n g a l a m i

n e u r o p a t i s e b a n y a k 1 4 o r a n g ( 7 0 % ) . S e d a n g k a n r e s p o n d e n d e n g a n l a m a

m e n d e r i t a D M > 5 t a h i m y a n g m e n g a l a m i d i a b e t i k n e u r o p a t i s e b a n y a k 1 0

o r a n g ( 7 1 , 4 % ) d a n y a n g t i d a k m e n g a l a m i n e u r o p a t i s e b a n y a k 4 o r a n g

( 2 8 , 6 % ) . H a l i n i s e s u a i d e n g a n p e n e l i t i a n s e b e l u m n y a y a n g d i l a k u k a n A g u s

M ( 2 0 1 1 ) , A g u n g G ( 2 0 1 0 ) , C a v a n a g h d k k ( 2 0 0 8 ) d a n Y o u n g d k k ( 1 9 9 3 ) ,

d i m a n a p r e v a l e n s i p e n d e r i t a d i a b e t i k n e u r o p a t i l e b i h b a n y a k d i d a p a t k a n

p a d a p e n d e r i t a d e n g a n l a m a m e n d e r i t a D M l e b i h d a r i 5 t a h u n .

3 4

D a r i h a s i l a n a l i s i s u n i v a r i a t d i d a p a t k a n p v a l u e 0 , 0 4 2 < a 0 , 0 5 , P R

5 , 8 3 ( 9 5 % C I : 1 , 2 9 8 - 2 6 , 2 2 3 ) i n i m e n u j u k k a n a d a c u k u p buku u n t u k

m e n o l a k H Q . M a k a d a p a t d i s i m p u l k a n b a h w a a d a h u b u n g a n l a m a n y a

m e n d e r i t a D M l e b i h d a r i 5 t a h u n d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i d a n

l a m a m e n d e r i t a D M l e b i h d a r i 5 t a h u n m e r u p a k a n f a k t o r risiko t e r j a d i n y a

d i a b e t i k n e u r o p a t i . H a s i l i n i s e s u a i d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h

A g u n g G ( 2 0 1 0 ) , y a n g m e m b u k t i k a n b a h w a l a m a m e n d e r i t a D M l e b i h d a r i 5

t a h u n m e r u p a k a n f a k t o r r e s i k o y a n g b e r p e r a n t e r h a d a p t i m b u l n y a n e u r o p a t i

p a d a p e n d e r i t a D M t i p e 2 . D a n s e s u a i d e n g a n p e n e l i t i a n B o o y a d k k ( 2 0 0 5 )

y a n g m e n y e b u t k a n a d a h u b u n g a n y a n g s i g n i f i k a n a n t a r a n e u r o p a t i d e n g a n

l a m a m e n d e r i t a D M p a d a p a s i e n D M t i p e 2 .

43. Keterbatasan Penelitian

K e t e r b a t a s a n p a d a p e n e l i t i a n i n i a d a l a h a d a n y a b i a s y a n g d i s e b a b k a n k a r e n a

p e n g a m b i l a n s a m p e l , d i m a n a recall bias d a p a t t e r j a d i k a r e n a f a k t o r risiko, f a k t o r

l u p a , d a l a m h a l i n i a d a l a h k a p a n p e r t a m a k a l i m e n d e r i t a D M . s e h i n g g a p e n e l i t i

d a l a m m e n g a m b i l d a t a f a k t o r risiko t i d a k m e m p e r h i t u n g k a n b a t a s w a k t u

p e n g a m b i l a n . D a n k e k u r a n g a n d a r i p e n e l i t i a n i n i a d a l a h s e m p e l p e n e l i t i a n y a n g

s e d i k i t s e h i n g g a u n t u k v a r i a b e l u m u r d a n j e n i s k e l a m i n b e l u m b i s a d i d a p a t k a n

h u b u n g a n y a n g b e r m a k n a d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i .

P e n e l i t i a n k o h o r t m e r u p a k a n j e n i s p e n e l i t i a n e p i d e m i o l o g i s n o n

e k s p e r i m e n t a l y a n g s e r i n g d i g u n a k a n u n t u k m e m p e l a j a r i h u b u n g a n a n t a r a f a k t o r

risiko d e n g a n e f e k a t a u p e n y a k i t ( S a s t r o a s m o r o S d a n I s m a e l S , 2 0 1 1 ) . P a d a

p e n e l i t i a n i n i p e n e l i t i m e m i l i h r a n c a n g a n p e n e l i t i a n Crossectional a t a u p o t o n g

l i n t a n g k a r e n a p e r t i m b a n g a n w a k t u d a n b i a y a y a n g r e l a t i f l e b i h s e d i k i t

d i b a n d i n g k a n k o h o r t .

BAB V

KESIMPULAN DAN SARAN

5.1. Kesimpulan

D a r i p e n e l i t i a n m e n g e n a i h u b u n g a n d u r a s i d i a b e t e s m e l i t u s d e n g a n k e j a d i a n

d i a b e t i k n e u r o p a t i d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h S a k i t M u h a m m a d i y a h

P a l e m b a n g d a p a t d i s i m p u l k a n b a h w a :

1 . P a s i e n y a n g m e n d e r i t a d i a b e t i k n e u r o p a t i d i p o l i k l i n i k p e n y a k i t d a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g l e b i h b a n y a k p a d a u s i a > 5 0 t a h u n

( 6 7 , 6 % ) , p e r e m p u a n ( 6 4 , 7 5 % ) d a n l a m a m e n d e r i t a D M > 5 t a h u n ( 7 1 , 4 % ) .

2 . P a s i e n y a n g m e n d e r i t a d i a b e t i k n e u r o p a t i d i p o l i k l i n i k p e n y a k i t d a l a m

R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g s e b a n y a k 2 , 5 % .

3 . P a s i e n y a n g m e n d e r i t a d i a b e t e s m e l i t u s d i p o l i k l i n i k p e n y a k i t d a l a m R u m a h

S a k i t M u h a m m a d i y a h P a l e m b a n g s e b a n y a k 2 , 9 7 % .

4 . A d a h u b u n g a n L a m a m e n d e r i t a D M > 5 t a h u n d e n g a n t e r j a d i n y a d i a b e t i k

n e u r o p a t i .

5 . L a m a m e n d e r i t a D M > 5 t a h u n m e r u p a k a n f a k t o r risiko independen

t e r j a d i n y a d i a b e t i k n e u r o p a t i .

5.2. Saran

A d a p u n s a r a n y a n g d a p a t p e n u l i s s a m p a i k a n s e t e l a h d i l a k u k a n n y a p e n e l i t i a n

d a n d a r i m a n f a a t p e n e l i t i a n i n i a d a l a h s e b a g a i b e r i k u t .

5.2.1. Bagi Peneliti Lain

1 . D a p a t d i l a k u k a n p e n e l i t i a n l a n j u t a n m e n g e n a i h u b u n g a n d u r a s i

d i a b e t e s m e l i t u s d e n g a n k e j a d i a n d i a b e t i k n e u r o p a t i d e n g a n

m e n g g u n a k a n d e s a i n p e n e l i t i a n case-control a g a r d a p a t

m e n g e t a h u i h u b u n g a n s e b a b a k i b a t .

2 . P e r l u d i l a k u k a n p e n e l i t i a n l e b i h l a n j u t t e r u t a m a m e n g e n a i

f a k t o r - f a k t o r l a i n y a n g b e l u m d a p a t d i t e l i t i s e p e r t i riwayat

h i p e r t e n s i , riwayat h i p e r k o l e s t e r o l , riwayat m e r o k o k , d a n

35

36

p e n g e n d a l i a n g u l a d a r a h a g a r d i p e r o l e h h a s i l y a n g l e b i h a k u r a t

d a n s i g n i f i k a n .

5.2.2. Bagi Rumah Sakit Muhammadiyah Palembang dan Fakultas

Kedokteran Universitas Muhammadiyah Palembang

1 . D i s a r a n k a n a g a r p i h a k R u m a h S a k i t m e m b e r i k a n e d u k a s i s e d i n i

m u n g k i n m e n g e n a i d i a b e t i k n e u r o p a t i k e p a d a p a s i e n D M

s e h i n g g a m e n c e g a h t e r j a d i n y a d i a b e t i k n e u r o p a t i , g a n g r e n d a n

d i s a b i l i t y .

2. S e b a g a i s a l a h s a t u s u m b e r b a h a n s e m i n a r a t a u e d u k a s i d a r i

F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g

u n t u k k e l o m p o k m a s y a r a k a t y a n g r e n t a n .

5.2.3. Bagi Dokter Umum

D a p a t m e m a n t a u f u n g s i s a r a f d a r i p a s i e n D M u n t u k m e d e t e k s i

s e d i n i m u n g k i n t e r j a d i n y a n e u r o p a t i .

5.2.4. Bagi Masyarakat

D i s a r a n k a n a g a r m a s y a r a k a t y a n g m e n d e r i t a d i a b e t e s m e l i t u s

u n t u k r a j i n k o n s u l t a s i k e d o k t e r d a n m e n g o n t r o l g u l a d a r a h n y a a g a r

b i s a m e n c e g a h t e j a d i n y a n e u r o p a t i .

DAFTAR PUSTAKA

A d a m , R . D . , V i c t o r , M . a n d R o p p e r , A . H . 2 0 0 5 . P r i n c i p l e s o f N e u r o l o g y . 8 n d . E d . M c G r a w - H i l l . N e w Y o r k .

A g u n g , G o c i k . 2 0 1 0 . L a m a M e n d e r i t a D i a b e t e s M e l i t u s T i p e 2 S e b a g a i F a k t o r R i s i k o N y e r i D i a b e t i k N e u r o p a t i . T e s i s . J u r u s a n I l m u P e n y a k i t S a r a f U G M ( t i d a k d i p u b l i k a s i k a n ) . H a l . 4 7 - 4 8 .

A s a d A , d k k . 2 0 0 9 . C o m p a r i s o n o f n e r v e c o n d u c t i o n s t u d i e s w i t h d i a b e t i c n e u r o p a t h y s y m p t o m s c o r e a n d d i a b e t i c n e u r o p a t h y e x a m i n a t i o n s c o r e i n t y p e - 2 d i a b e t i c s f o r d e t e c t i o n o f S e n s o r i m o t o r P o l y n e u r o p a t h y . J P a k M e d A s s o c . H a l . 5 9 4 - 8 .

B a r o n A , 2 0 0 9 . N e u r o p a t h i c p a i n : a c l i n i c a l p e r s p e c t i v e . Hand Exp Pharmacol ( 1 9 4 ) : 3 - 3 0 .

B e t t e r i d g e , D . J . 2 0 0 0 . D i a b e t e s : C u r r e n t P e r s p e c t i v e s . T h e N e w E n g l a n d J o u r n a l o f M e d i c i n e .

B o o y a , P . , B a n d a r i a n . F . , L a r i j a n i . B . , P a j o u h i . M . , N o o r a e i . M . , L o t f i . J . 2 0 0 5 . P o t e n t i a l R i s k F a c t o r s f o r D i a b e t i c N e u r o p a t h y : a ca se c o n t r o l s t u d y . BMC Neurology: 1 -5 .

C a v a n a g h , K . , M i t r a . T . , M a r i a . J . , J o n a t h a n . W . 2 0 0 7 . S u r r u g a t e M a r k e r s o f S m a l l F i b e r D a m a g e i n H u m a n C u r r e n t C o n c e p t s a n d T r e a t m e n t . Northeast Florida Medicine Spring. 3 0 2 - 3 0 4 .

D a v i s , M D . 1 9 9 6 . D i a b e t e s m e l l i t u s . D a l a m : T h e e y e a n d s y s t e m i c d i s e a s e . J P L i p p i n c o t , P h i l a d e l p h i a H a l . 7 9 - 8 5 .

D e p a r t e m e n K e s e h a t a n P r o v i n s i S u m a t e r a S e l a t a n . 2 0 1 0 . P r o f i l K e s e h a t a n P r o v i n s i S u m a t e r a S e l a t a n t a h u n 2 0 1 0 , P a l e m b a n g . H a l . 5 2 - 5 3 .

D y c k P J , d k k . 1 9 8 6 . N e u r o p a t h y S y m t o m P r o f i l e i n H e a l t h , m o t o r n e u r o n d i s e a s e , d i a b e t i c n e u r o p a t h y a n d a m y l o i d o s i s . N e u r o l o g y 1 9 8 6 . H a l . 1 3 0 0 - 0 3 .

G u s t a v i a n i , R e n o . 2 0 0 6 . D i a g n o s i s D a n K l a s i f i k a s i D i a b e t e s M e l i t u s . D a l a m : S u d o y o , A . W , d k k ( E d i t o r ) . B u k u A j a r I l m u P e n y a k i t D a l a m . P u s a t P e n e r b i t a n D e p a r t e m e n I l m u P e n y a k i t D a l a m F K U l , J a k a r t a , I n d o n e s i a . H a l . 1 8 7 9 .

G u y t o n , A r t h u r C . 2 0 0 8 . B u k u A j a r F i s i o l o g i K e d o k t e r a n : " I n s u l i n , G l u k a g o n , D a n D i a b e t e s M e l i t u s " ( E d i s i k e - 1 1 ) . T e r j e m a h a n O l e h : R a c h m a n , L . Y . , d k k F G C , J a k a r t a , I n d o n e s i a . H a h 1 0 2 2 ;

xiii

H a s t u t i , T . 2 0 0 3 . U j i R e a b i l i t a s s k o r D N E u n t u k m e n e n t u k a n D i a g n o s i s K l i n i s N e u r o p a t i D i a b e t i k a . Y o g y a k a r t a ; B a g i a n I l m u P e n y a k i t S a r a f F a k u l t a s K e d o k t e r a n U n i v e r s i t a s G a d j a h M a d a .

H a z n a m , M W . 1 9 9 1 . E n d r o k r i n o l o g i . " D i a b e t e s M e l i t u s " . E d i s i k e - 3 . P e r c e t a k a n A n g k a s a O f f i s e t , B a n d u n g . H a l 4 8 - 6 9 .

H o w a r d , L . W . , L a w r e n c e , P . L . , A l e x a n d e r , R . G . 2 0 0 4 . N e u r o l o g y . 7 ^ e d . L i p p i n c o t t W i l l i a m & W i l k i n s . P h i l a d e l p h i a .

I D F . 2 0 1 1 . T h e I D F D i a b e t e s A t l a s 5"^ E d i t i o n . (HtW://wm\>jd(ors/diahetesatlas/news/iiiih-edition, D i a k s e s 3 0 S e p t e m b e r 2 0 1 2 ) .

I s s e l b a c h e r , K . J , d k k . 2 0 0 0 . H a r r i s o n P r i n s i p - p r i n s i p I l m u P e n y a k i t D a l a m ( H a r r i s o n ' s P r i n c i p l e s o f I n t e r n a l M e d i c i n e ) . J a k a r t a : F G C . H a l . 2 1 9 7 .

J u s m a n , S . W . A . 1 9 9 9 . K o n s e p - k o n s e p d a s a r b i o k i m i a d a l a m d i a b e t e s m e l l i t u s . D a l a m ; u n d e r s t a n d i n g i c u l a r d i a b e t i c - b a s i c s c i e n c e , c l i n i c a l a s p e c t a n d d i d a c t i c c o u r s e . F K U l . H a l . 1 - 1 5 .

M e i j e r L f t T C , d k k . 2 0 0 3 . C l i n i c a l D i a g n o s i s o f D i a b e t i c N e u r o p a t h y S y m p t o m a n d D i a b e t i c N e u r o p a t h y E x a m i n a t i o n S c o r e s . D i a b e t e s C a r e . H a l . 6 9 1 -7 0 1 .

M e i j e r J W K , d k k . 2 0 0 2 . S y s t e m s c o r i n g s y s t e m t o d i a g n o s e d i s t a l p o l y n e u r o p a t h y i n D i a b e t e s : t h e D i a b e t i c N e u r o p a t h y S y m p t o m s c o r e . D i a b e t e s M e d i c i n e . H a l . 9 6 2 - 6 5 .

N o t o a t m o d j o , S . 2 0 1 0 . M e l o d o l o g i P e n e l i t i a n K e s e h a t a n : " M e t o d e P e n g a m b i l a n S a m p e l " . R i n e k a C i p t a , J a k a r t a , I n d o n e s i a , h a l . 1 1 5 - 1 3 0 .

P E R K E N I . 2 0 1 1 . K o n s e s u s P e n g e l o l a a n D a n P e n c e g a h a n D i a b e t e s M e l i t u s t i p e 2 D i I n d o n e s i a , J a k a r t a . H a l . 2 - 2 1 .

P e r k i n s B A . G l y c e m i c c o n t r o l i s r e l a t e d t o t h e m o r p h o l o g i c a l s e v e r i t y o f d i a b e t i c s e n s o r i m o t o r p o l y n e u r o p a t h y . h t t p : / c a r e . d i ^ t e s j u m a l s . o r g / c o n t e n t / 2 1 / 4 / 7 4 . f i i i l p d f . D i a k s e s O k t o b e r 2 0 1 2 .

S a d e l i , H . A . 2 0 0 8 . N y e r i N e u r o p a t i D i a b e t i k a . D a l a m : M e l i a l a L , S u r y a m i h a i j a , W i r a w a n , S a d e l i H A , A m i r D , e d i t o r . N y e r i N e u r o p a t i k . Y o g y a k a r t a : M e d i g a m a P r e s s . H a l . 7 7 - 9 0 .

S a s t r o a s m o r o , S . 2 0 1 1 . D a s a r - d a s a r M e t o d o l o g i P e n e l i t i a n K l i n i s : " P e m i l i h a n S u b y e k P e n e l i t i a n " . E d i s i k e - 4 . S a g ^ u i g S a t o , J a k a r t a , I n d o n e s i a , . H a l . 8 8 -1 0 1 .

xiv

S o e g o n d o , S . 2 0 0 4 . D i a g n o s i s d a n K l a s i f i k a s i D i a b e t e s M e l i t u s T e r k i n i . J a k a r t a : B a l a i P e n e r b i t F K U I .

S o p i y u d i n , M . 2 0 1 0 . B e s a r S m a p e l d a n C a r a P e n g a m b i l a n S a m p e l d a l a m P e n e l i t i a n K e d o k t e r a n d a n K e s e h a t a n . E d i s i k e - 3 . S a l e m b a M e d i k a . J a k a r t a . H a l . 6 9 .

S u b e k t i , i m a m . 2 0 0 6 . N e u r o p a t i D i a b e t i k . D a l a m : S u d o y o , A . W , d k k ( E d i t o r ) . B u k u A j a r I l m u P e n y a k i t D a l a m . P u s a t P e n e r b i t a n D e p a r t e m e n I l m u P e n y ^ t D a l a m F K U I , J ^ a r t a , I n d o n e s i a . H a l . 1 9 2 4 .

T e s f a y e S , d k k . 2 0 1 0 . D i a b e t i c N e u r o p a t i e s : U p d a t e o n D e f i n i t i o n s , D i a g n o s t i c C r i t e r i a , E s t i m a t i o n o f S e v e r i t y , a n d T r e a t m e n t s . h t t p : / w w w . n c b l . n l m . n i h , g o v / p m c / a r t i c i e s / p m c 2 9 4 5 I 7 6 . D i a k s e s O k t o b e r 2 0 1 2 .

T h o m a s P K . 1 9 9 7 . M e t a b o l i c N e u r o p a t h y . J . R C o l l . P h y s . L o n d o n . H a l . 1 5 4 .

T j o k r o p r a w i r o , A . 2 0 0 5 . A n g i o p a t i D i a b e t i k : M a k r o a n g i o p a t i - M i k r o a n g i o p a t i . D a l a m N o e r , d k k . E d i t o r . I l m u P e n y a k i t D a l a m J i l i d I , E d i s i k e - 3 . P e n e r b i t F K U I , J a k a r t a .

Y o u n g , M . , W i l l i a m s . S . , S o n k s e n . F . 1 9 9 3 . A M u l t i c e n t r e S t u d y o f T h e P r e v a l e n c e o f D i a b e t i c P e r i p h e r a l N e u r o p a t h y i n T h e U n i t e d K i n g d o m H o s p i t a l C l i n i c P o p u l a t i o n . D i a b e t o l o g i a , 3 6 : 1 5 0 - 1 5 4 .

Z i e g l e r D , d k k . 1 9 9 2 . T h e E p i d e m i l o g y o f D i a b e t i c N e u r o p a t h y . J D i a b C o m p 1 9 9 2 ; 6 : 4 9 - 5 7 .

XV

LAMPIRAN

Lampiran 1. Contoh lembar persetujuan sebagai responden

L E M B A R PERSETUJUAN SEBAGAI RESPONDEN HUBUNGAN DURASI DIABETES M E L I T U S DENGAN KEJADIAN

D I A B E T I K NEUROPATI DI P O L I K L I N I K PENYAKIT DALAM RUMAH SAKIT MUHAMMADIYAH PALEMBANG

B a p a k / i b u y a n g t e r h o r m a t , M e l a l u i s u r a t i n i s a y a m a h a s i s w a F a k u l t a s K e d o k t e r a n U n i v e r s i t a s

M u h a m m a d i y a h P a l e m b a n g s e d a n g m e l a k u k a n p e n e l i t i a n s e h u b u n g a n d e n g a n p e n u l i s a n s k r i p s i s a y a m e n g e n a i H u b u n g a n D u r a s i D i a b e t e s M e l i t u s D e n g a n K e j a d i a n D i a b e t i k N e u r o p a t i d i P o l i k l i n i k P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

U n t u k i t u s a y a m o h o n d e n g a n k e r e n d a h a n h a t i a g a r k i r a n y a B a p a k / i b u d a p a t m e l u a n g k a n w a k t u u n t u k m e n g i s i b e b e r a p a p e r t a n y a a n d a l a m k u e s i o n e r i n i . M e n j a w a b d e n g a n j u j u r d a n s e s u a i d e n g a n k e n y a t a a n s a n g a t m e m b a n t u d a l a m k e v a l i d a n d a t a y a n g s a y a p e r o l e h .

S e g a l a d a t a y a n g B a p a k / i b u a k a n d i j a g a k e r a h a s i a a n n y a . B i l a B a p a k / i b u b e r s e d i a i k u t s e r t a d a l a m p e n e l i t i a n i n i m o h o n m e n g i s i d a n m e n a n d a t a n g a n i l e m b a r p e r s e t u j u a n i n i . Y a n g b e r t a n d a t a n g a n d i b a w a h i n i , N a m a : A l a m a t : N o . T e l e p o n / H P :

D e n g a n f o r m u i i r i n i m e n y a t a k a n t e l a h m e n d a p a t k a n k e t e r a n g a n s e c a r a j e l a s s e r t a m e n g e t a h u i m a n f a a t s e r t a a k i b a t y a n g m u n g k i n m u n c u l s e l a m a p e n e l i t i a n t e r s e b u t s e c a r a s u k a r e l a . D a n S a y a b e r s e d i a t e r l i b a t d a l a m p e n e l i t i a n H u b u n g a n D u r a s i D i a b e t e s M e l i t u s D e n g a n K e j a d i a n D i a b e t i k N e u r o p a t i d i P o l i k l i n i k P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .

P a l e m b a n g , D e s e m b e r 2 0 1 2

( )

37

3S

Lampiran 2. Contoh kuesioner penelitian

KUESIONER PENELITIAN HUBUNGAN DURASI DIABETES MELITUS DENGAN KEJADIAN

D I A B E T I K NEUROPATI DI P O L I K L I N I K PENYAKIT DALAM RUMAH SAKIT MUHAMMADIYAH PALEMBANG

No. R e s p o n d e n

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4 . J e n i s K e l a m i n L a k i - l a k i / P e r e m p u a n *

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6 . P e n d i d i k a n t e r a k h i r :

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8 . P e k e r j a a n :

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RUMAH SAKIT MUPAMM/HiHi r m y :

Jin. Jend. A. Yani 13 Ulu falp f O / - ' / ; : - ; :.. • G \ e-mail: rsmuL iJIqCwvol^rj c• ,• la f - - ' - .

;i^N0f:>^frl .'

DATA PASIEN DENGAN DIAGNOSA DIABETES MELITUS RS MUHAMMADIYAH PALEMBANG

P E R I O D E JANUARI S/D D E S E M B E R 2011

* Jumlah Pasien Poliklnik Penyakit Dalam per Bnlan : 3271 Pasien

2. Jumlah Pasien Dengan Diagnosa DM (Diabetes Melitus) R J Periode Januari s/d Desember 2011 :2564

3. Jumlah Pasien Dengan Diagnosa DM (Diabetes Melitus) R l Periode Januari s/d Desember 2011 : 139

P a l e m b a n g 13 O k t o b e r 2 0 1 2

' M u k h l i s i n A M . P e r K e s N I P : 1 0 8 6 0 3 9 2

( e-maii ) P a i e f r t •'63

JUMLAH PASIEN OENGAN DIAGNOSA DM DN DM NEORUPATI DI RS MUHAMMADIYAH PALEMBANG

PERIODE 2010 S/D 2012

NO TAHUN DIABETES MELITUS DM NEORUPATI 1 2 0 1 0 1 5 8 1 4 2 2 0 1 1 1 8 7 1 5 3 2 0 1 2 1 3 7 6

DI INSTALASI RAWAT JALAN / P O L I K L I N I K

NO TAHUN DIABETES M E L I T U S DM NEORUPATI 1 2 0 1 0 1 5 4 4 15 2 2 0 1 1 1 6 5 2 1 7 3 2 0 1 2 8 7 5 2 2

SURAT KETERANGAN N o : ' > ' 8 < V / K E T / L - 1 / R S M P / 1 I / 2 0 I 3

Assalamu*alaikum Wr. Wb.

D e n g a n i n i m e n e r a n g k a n b a h w a :

N a m a : D i d i k A g u s P r a w i r a

N P M : 7 0 2 0 0 9 0 4 4 P r o g r a m S t u d i

P e r g u r u a n T i n g g i

: P e n d i d i k a n D o k t e r

: U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g

B e n a r t e l a h m e l a k u k a n p e n e l i t i a n d i R S . M u h a m m a d i y a h P a l e m b a n g d e n g a n j u d u l

p e n e l i t i a n " H u b u n g a n D u r a s i D i a b e t e s M e l i t u s T i p e 2 D e n g a n K e j a d i a n D i a b e t i k

N e u r o p a t i d i P o l i k l i n i k P e n y a k i t D a l a m R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g "

pada t a n g g a l I s.d 7 D e s e m b e r 2 0 1 2 d e n g a n B a i k .

D e m i k i a n i a h s u r a t k e t e r a n g a n i n i d i b u a t u n t u k d i g u n a k a n s e b a g a i m a n a m e s t i n y a .

N a s r u n m i n a l l a h Wafathun Q a r i b , Wassalamu^alaikum Wr. Wb.

P a l e m b a n g , 2 0 R a b i u l A w a l 1 4 3 4 H 0 1 F e b r u a r i 2 0 1 3 M

D i r e k t u r , ' / \ j

Dr. Yudi Fadilah. S P . P D . F I N A S I M ^ N B P . 0 5 . 6 4 . 0 0 6 6 /

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PEMBIMBING

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NO TGLyBLyTH KONSULTASI MATERI YANG DIBAHAS , PARAF PEMBIMBING , KETERANGAN

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C A T A T A N : Dikeluarkan di : Palembang Pada tanggal . / / a.n. Dekan Ketua UPK,

BIODATA

N a m a T e m p a t , T a n g g a l L a h i r A l a m a t

T e l p / H P E m a i l A g a m a

N a m a O r a n g T u a A y a h : H . Z u h e r i a l , S H I b u : D r a . H j . G i f t i a r s y a h . M M .

J u m l a h S a u d a r a : 2 ( d u a ) o r a n g A n a k k e : 3 ( t i g a ) R i w a y a t P e n d i d i k a n : 1 . T a m a n K a n a k - K a n a k P e i t i w i J a m b i , L u l u s 1 9 9 5

2 . S e k o l a h D a s a r N e g e r i 1 7 2 P a l e m b a n g , L u l u s T a h u n 2 0 0 1

4 . S e k o l a h M e n e n g a h P e r t a m a N e g e r i 1 0 P a l e m b a n g , L u l u s T a h u n 2 0 0 4

5 . S e k o l a h M e n e n g a h A t a s N e g e r i 15 P a l e m b a n g , P r o g r a m S t u d i : I l m u A l a m , L u l u s T a h u n 2 0 0 7

D i d i k A g u s P r a w i r a P a l e m b a n g , 1 1 A g u s t u s 1 9 8 9 J l . H . S a n u s i L r . M e s j i d N o . 4 3 6 R t . 3 0 R w . 5 K e i u r a h a n S u k a b a n g u n K e c a m a t a n K e m u n i n g , P a l e m b a n g . 0 7 1 1 - 4 1 3 7 3 7 , 0 8 9 8 4 4 2 1 1 4 4 d i d i t . a p l l @ g m a i l . c o m I s l a m

P a l e m b a n g , 2 0 F e b r u a r i 2 0 1 3

D i d i k A g u s P r a w i r a

4 4