Analisis Hubungan Faktor Risiko dengan Derajat Keparahan Ulkus Diabetikum pada Penderita Diabetes Melitus Tipe 2

Marcelino Gultom; Suandy; Iskandar Nasution

doi:10.30867/nasuwakes.v19i1.1322

Authors

Marcelino Gultom Profesi Kedokteran, Fakultas Kedokteran, Kedokteran Gigi, dan Ilmu Kesehatan, Universitas Prima Indonesia
Suandy Profesi Kedokteran, Fakultas Kedokteran, Kedokteran Gigi, dan Ilmu Kesehatan, Universitas Prima Indonesia
Iskandar Nasution Profesi Kedokteran, Fakultas Kedokteran, Kedokteran Gigi, dan Ilmu Kesehatan, Universitas Prima Indonesia

DOI:

https://doi.org/10.30867/nasuwakes.v19i1.1322

Keywords:

Diabetes Melitus Tipe 2, Faktor Risiko, Ulkus Diabetikum

Abstract

Diabetes melitus tipe 2 merupakan penyakit kronis yang sering menimbulkan komplikasi, salah satunya ulkus diabetikum yang berisiko menyebabkan amputasi dan meningkatkan mortalitas. Penelitian ini bertujuan untuk menganalisis hubungan faktor risiko dengan derajat keparahan ulkus diabetikum pada pasien diabetes melitus tipe 2. Penelitian ini menggunakan desain analitik observasional dengan pendekatan cross sectional dan retrospektif. Penelitian dilakukan di RSU Sundari pada bulan Januari–Maret 2026 dengan jumlah sampel sebanyak 86 pasien yang dipilih menggunakan teknik total sampling. Data diperoleh dari rekam medis pasien dan dianalisis menggunakan uji univariat, bivariat (Chi-Square), dan multivariat (regresi logistik). Hasil penelitian menunjukkan bahwa sebagian besar responden berusia 45–59 tahun dan >59 tahun (masing-masing 39,5%), dengan lama menderita DM ≥5 tahun (65,1%), terapi kombinasi (62,8%), HbA1c buruk (44,2%), serta memiliki komorbid (69,8%). Derajat ulkus terbanyak adalah ringan (57,0%). Analisis bivariat menunjukkan bahwa seluruh faktor risiko memiliki hubungan signifikan dengan derajat keparahan ulkus diabetikum (p<0,05). Pasien dengan lama menderita DM ≥5 tahun, terapi kombinasi, HbA1c buruk (>8%), dan adanya komorbid lebih berisiko mengalami ulkus berat. Kesimpulan penelitian ini adalah faktor lama menderita DM, jenis terapi, kadar HbA1c, dan komorbid berhubungan dengan derajat keparahan ulkus diabetikum. Pengendalian faktor risiko secara komprehensif sangat penting untuk mencegah perburukan kondisi pasien.

References

1. Adeleye, O. O., Williams, A. O., Dada, A. O., Ugwu, E. T., Ogbera, A. O., & Sodipo, O. O. (2022). Sequelae of Hospitalization for Diabetic Foot Ulcers at LASUTH Ikeja Lagos: A Prospective Observational Study. Frontiers in Clinical Diabetes and Healthcare, 3. https://doi.org/10.3389/fcdhc.2022.889264

2. Aditya, C., Bukke, S. P. N., Anitha, K., Meeraraje, P., Goruntla, N., Yadesa, T. M., & Onohuean, H. (2025). A Comprehensive Review on Diabetic Foot Ulcer Addressing Vascular Insufficiency, Impaired Immune Response, and Delayed Wound Healing Mechanisms. Frontiers in Pharmacology, 16. https://doi.org/10.3389/fphar.2025.1622055

3. An, J., Nichols, G. A., Qian, L., Munis, M. A., Harrison, T. N., Li, Z., Wei, R., Weiss, T., Rajpathak, S., & Reynolds, K. (2021). Prevalence and Incidence of Microvascular and Macrovascular Complications Over 15 Years among Patients with Incident Type 2 Diabetes. BMJ Open Diabetes Research & Care, 9(1), e001847. https://doi.org/10.1136/bmjdrc-2020-001847

4. Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023). Diabetic Foot Ulcers. JAMA, 330(1), 62. https://doi.org/10.1001/jama.2023.10578

5. Atinafu, B. T., Tarekegn, F. N., Mulu, G. B., Kebede, W. M., Abinew, Y., & Mossie, Y. (2022). The Magnitude and Associated Factors of Diabetic Foot Ulcer Among Patients with Chronic Diabetic Mellitus in Northeast Ethiopia, 2021. Chronic Wound Care Management and Research, Volume 9, 13–21. https://doi.org/10.2147/CWCMR.S364288

6. Azhar, A., Basheer, M., Abdelgawad, M. S., Roshdi, H., & Kamel, M. F. (2023). Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage. The International Journal of Lower Extremity Wounds, 22(3), 518–523. https://doi.org/10.1177/15347346211027063

7. Bedriñana-Marañón, B., Rubio-Rodríguez, M., Yovera-Aldana, M., Garcia-Villasante, E., & Pinedo-Torres, I. (2024). Association Between the Diabetes mellitus Duration and the Severity of Diabetic Foot Disease in Hospitalized Patients in Latin America. The International Journal of Lower Extremity Wounds, 23(3), 436–444. https://doi.org/10.1177/15347346211063266

8. Çakmak, V. S., & Özdemir, S. Ç. (2024). Patients with Diabetic Foot Ulcers: A Qualitative Study of Patient Knowledge, Experience, and Encountered Obstacles. Journal of Tissue Viability, 33(4), 571–578. https://doi.org/10.1016/j.jtv.2024.07.010

9. Dawi, J., Tumanyan, K., Tomas, K., Misakyan, Y., Gargaloyan, A., Gonzalez, E., Hammi, M., Tomas, S., & Venketaraman, V. (2025). Diabetic Foot Ulcers: Pathophysiology, Immune Dysregulation, and Emerging Therapeutic Strategies. Biomedicines, 13(5), 1076. https://doi.org/10.3390/biomedicines13051076

10. Edmonds, M., Manu, C., & Vas, P. (2021). The Current Burden of Diabetic Foot Disease. Journal of Clinical Orthopaedics and Trauma, 17, 88–93. https://doi.org/10.1016/j.jcot.2021.01.017

11. Fitridge, R., Chuter, V., Mills, J., Hinchliffe, R., Azuma, N., Behrendt, C., Boyko, E. J., Conte, M. S., Humphries, M., Kirksey, L., McGinigle, K. C., Nikol, S., Nordanstig, J., Rowe, V., Russell, D., van den Berg, J. C., Venermo, M., & Schaper, N. (2024). The Intersocietal IWGDF, ESVS, SVS Guidelines on Peripheral Artery Disease in People with Diabetes and a Foot Ulcer. Diabetes/Metabolism Research and Reviews, 40(3). https://doi.org/10.1002/dmrr.3686

12. Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275

13. Gallagher, K. A., Mills, J. L., Armstrong, D. G., Conte, M. S., Kirsner, R. S., Minc, S. D., Plutzky, J., Southerland, K. W., & Tomic-Canic, M. (2024). Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association. Circulation, 149(4). https://doi.org/10.1161/CIR.0000000000001192

14. Kim, J. Y., & Kim, N. H. (2024). Initial Combination Therapy in Type 2 Diabetes. Endocrinology and Metabolism, 39(1), 23–32. https://doi.org/10.3803/EnM.2023.1816

15. Lane, K. L., Abusamaan, M. S., Voss, B. F., Thurber, E. G., Al-Hajri, N., Gopakumar, S., Le, J. T., Gill, S., Blanck, J., Prichett, L., Hicks, C. W., Sherman, R. L., Abularrage, C. J., & Mathioudakis, N. N. (2020). Glycemic Control and Diabetic Foot Ulcer Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Journal of Diabetes and Its Complications, 34(10), 107638. https://doi.org/10.1016/j.jdiacomp.2020.107638

16. McDermott, K., Fang, M., Boulton, A. J. M., Selvin, E., & Hicks, C. W. (2023). Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care, 46(1), 209–221. https://doi.org/10.2337/dci22-0043

17. Meloni, M., Izzo, V., Giurato, L., Lázaro-Martínez, J. L., & Uccioli, L. (2020). Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers. Journal of Clinical Medicine, 9(6), 1780. https://doi.org/10.3390/jcm9061780

18. Monami, M., Candido, R., Pintaudi, B., Targher, G., & Mannucci, E. (2021). Improvement of Glycemic Control in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrition, Metabolism and Cardiovascular Diseases, 31(9), 2539–2546. https://doi.org/10.1016/j.numecd.2021.05.010

19. Mostafavi, F., Amini, M. R., Mehrabi, Y., Nasli Esfahani, E., & Nazari, S. S. H. (2025). Machine Learning Insights Into Amputation Risk: Evaluating Wound Classification Systems in Diabetic Foot Ulcers. International Wound Journal, 22(6). https://doi.org/10.1111/iwj.70515

20. Oe, M., Saad, S. S., Jais, S., & Sugama, J. (2024). Impact of Foot Ulcer‐Related Factors on Quality of Life in Patients with Diabetes: Prospective Observational Study. International Wound Journal, 21(5). https://doi.org/10.1111/iwj.14895

21. Schmidt, B. M., Holmes, C. M., Najarian, K., Gallagher, K., Haus, J. M., Shadiow, J., Ye, W., Ang, L., Burant, A., Baker, N., Katona, A., Martin, C. L., & Pop-Busui, R. (2022). On Diabetic Foot Ulcer Knowledge Gaps, Innovation, Evaluation, Prediction Markers, and Clinical Needs. Journal of Diabetes and Its Complications, 36(11), 108317. https://doi.org/10.1016/j.jdiacomp.2022.108317

22. Swoboda, L., & Held, J. (2022). Impaired Wound Healing in Diabetes. Journal of Wound Care, 31(10), 882–885. https://doi.org/10.12968/jowc.2022.31.10.882

23. Tang, W., Zhao, Y., Cheng, Z., Xu, J., Zhang, Y., & Liu, X. (2024). Risk Factors for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Vascular, 32(3), 661–669. https://doi.org/10.1177/17085381231154805

24. Thomason, G., Gooday, C., Nunney, I., & Dhatariya, K. (2024). The Association of HbA1c Variability with 12 Week and 12 Month Outcomes on Diabetes Related Foot Ulcer Healing. Diabetes Therapy, 15(10), 2223–2232. https://doi.org/10.1007/s13300-024-01640-4

25. Tuha, A., Getie Faris, A., Andualem, A., & Ahmed Mohammed, S. (2021). Knowledge and Practice on Diabetic Foot Self-Care and Associated Factors Among Diabetic Patients at Dessie Referral Hospital, Northeast Ethiopia: Mixed Method. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 14, 1203–1214. https://doi.org/10.2147/DMSO.S300275

26. Upadhyay, N., Saoji, A., Saoji, P., Rahuman, A. S. A. A., Sivakumar, S., Kumar, S., Javarashetty, N. J. T., Kothari, U. J., & Arumugam, P. (2025). Socio-Demographic Risk Factors Associated with Diabetic Foot Ulcer in India: A Case Control Study. Journal of Pharmacy and Bioallied Sciences, 17(Suppl 1), S855–S857. https://doi.org/10.4103/jpbs.jpbs_245_25

27. Wang, X., Yuan, C.-X., Xu, B., & Yu, Z. (2022). Diabetic Foot Ulcers: Classification, Risk Factors and Management. World Journal of Diabetes, 13(12), 1049–1065. https://doi.org/10.4239/wjd.v13.i12.1049

28. Xin, J. (2025). Hypertension and the Risk of Diabetic Foot Ulcers: A Mendelian Randomization Analysis. International Journal of Biology and Life Sciences, 10(3), 104–109. https://doi.org/10.54097/8kbvja86

29. Yan, T., Dou, Z., Claire, M., Ellen, K., & Caroline, M. (2025). Risk Factors for First‐Ever Diabetes‐Related Foot Ulcer: A Systematic Review and Meta‐Analysis. International Wound Journal, 22(8). https://doi.org/10.1111/iwj.70728