ORIGINAL ARTICLE

Bali Medical Journal (Bali Med J) 2020, Volume 9, Number 1: 172-178

P-ISSN.2089-1180, E-ISSN: 2302-2914

Diabetes mellitus control among elderly patients at

geriatric polyclinic of Karangasem District Hospital, Bali,
Indonesia: a preliminary study

Ni Made Ayu Dwipayanti1, I Wayan Nariata1, I Gusti Putu Suka Aryana2*

ABSTRACT
Background: The increasing number of elderly populations also (DBP), fasting plasma glucose (FPG), postprandial glucose (PPG),
increases the number of chronic degenerative diseases, including and HbA1c levels. Data were analyzed using SPSS version 25 for
diabetes mellitus (DM). Therefore, diabetes control is needed to Windows and depicted descriptively.
prevent various complications and improve the health quality of the Results: Among 46 samples, there were 23 (50.0%) male and 23
elderly patient. This study aims to obtain preliminary information (50.0%) female enrolled in this study. We find median of each, BMI
about diabetes control in elderly patients in the geriatric clinic of was 23.2856 kg/m2, SBP 120 mmHg, DBP 70mmHg, 153.5 mg/
Karangasem District Hospital to provide appropriate management dl for FPG, 238 mg/dl for PPG, and 7.8% for HbA1c. In this study,
to improve diabetes control. patients who met target of diabetes control is 34.8% for BMI,
Method: This research is a cross-sectional study and consecutive 53.8% for SBP, 76.9% for DBP, 43.5% for FPG, 17.4% PPG, and 28.3
sampling of 46 DM patients who seek treatment at the geriatric % for HbA1c levels.
clinic of Karangasem District Hospital in the period May-July Conclusion: In this study, it was found that DM control in elderly
2019. Inclusion criteria were DM patients aged ≥60 years. We patients in our Hospital is not optimal on the parameters of BMI,
exclude diabetes person with acute infection and end-stage renal SBP, DBP, FPG, PPG, and HbA1c levels. Better results were obtained
disease. The criteria for DM control used in this study is body mass in systolic and diastolic blood pressure control.
index (BMI), systolic blood pressure (SBP), diastolic blood pressure

Keywords: diabetes mellitus, control, elderly, geriatric polyclinic

Cite this Article: Dwipayanti, N.M.A.D., Nariata, I.W., Aryana, I.G.P.S.2020. Diabetes mellitus control among elderly patients at geriatric
polyclinic of Karangasem District Hospital, Bali, Indonesia: a preliminary study. Bali Medical Journal 9(1): 172-178. DOI: 10.15562/bmj.
v9i1.1664

1
Internal Medicine Medical Staff,
Karangasem District Hospital, Bali INTRODUCTION aged ≥65 years is around 22-33%. DM in the elderly
Indonesia
is associated with an increase in DM complications,
The success of development in the health sector both acute and chronic.3
2
Geriatric Consultant of Internal has resulted in an increase in life expectancy
Medicine Departement, Faculty DM is a chronic disease that does not cause
due to the increasing population of the elderly death directly but can be fatal if the management
of Medicine, Udayana University,
Sanglah Hospital, Bali Indonesia
population. The life expectancy of the Indonesian is inappropriate. Inappropriate management of DM
population (male and female) rose from 70.1 years causes the patient’s blood glucose to be challenging
in the 2010-2015 period to 72.2 years in the 2030- to control and can lead to various complications,
*Corresponding to: 2035 period. The five provinces with the highest such as diabetic neuropathy, diabetic nephropathy,
I Gusti Putu Suka Aryana; population percentage of 65 years and over in 2035 stroke, blindness, and diabetic ulcers that affect the
Geriatric Consultant of Internal were Central Java at 14.9%, East Java at 14.1%, DI quality of life of the patient.4 Therefore, DM control
Medicine Departement, Faculty Yogyakarta 14.0%, Bali 12.1%, and North Sulawesi is needed in the patient. Diabetes mellitus control
of Medicine, Udayana University, 12 0%. In other words, the population of 65 years criteria used include Body Mass Index (BMI),
Sanglah Hospital, Bali Indonesia; and over in this province has reached more than
suka_aryana@unud.ac.id systolic blood pressure (SBP), diastolic blood
10%. So these five provinces, by 2035, could already pressure (DBP), fasting plasma glucose (FPG),
be categorized as an ageing population province.1 postprandial glucose (PPG), HbA1c levels, LDL
However, the increasing number of elderly cholesterol, HDL, and triglycerides. The definition
populations also increases the amount of chronic of well-controlled DM is when blood glucose, lipid,
Received: 2019-11-06 degenerative diseases including diabetes mellitus
Accepted: 2020-02-16 and HbA1c levels reach the expected level, as well
(DM).2 The prevalence of DM in elderly patients as nutritional status and blood pressure according
Published: 2020-04-01

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 ORIGINAL ARTICLE

to the specified target.5 (OGTT) with a 75-gram glucose load or a plasma

Appropriate DM control is associated with glucose examination. DM was diagnosed If blood
decreased diabetes complications. Diabetes Control glucose was ≥200 mg/dl with classic complaints or
and Complication Trial (DCCT) results show HbA1c examination ≥6.5% using a standardized
that better DM control can reduce DM chronic method by the National Glycohaemoglobin
complications between 20-30%.6 Even the results Standarization Program (NGSP).5 Well-controlled
of The United Kingdom Prospective Diabetes Study DM is assessed when blood glucose, lipid, and
(UKPDS) show that a 1% reduction in HbA1c will HbA1c levels reach the expected level, as well as
reduce the risk of complications by 35%, reduce the nutritional status and blood pressure according to
incidence of DM-related deaths by 21%, myocardial the specific target. The targets were BMI 18.5-23
infarction by 14%, microvascular complications by kg/m2, systolic blood pressure (SBP) <140 mmHg,
37% and vessel disease peripheral blood by 43%.7 diastolic blood pressure (DBP) <90 mmHg, fasting
The absence of study about the diabetes mellitus plasma glucose (FPG) 80-130 mg/dl, postprandial
control in geriatric clinic at Karangasem District glucose (PPG) <180 mg/dl, and HbA1c levels <7%.5
Hospital is the main reason to provide baseline Elderly patients in this study were residents 60 years
data of diabetes especially in elderly. Baseline data or older2
including Body Mass Index (BMI), systolic blood The researcher measured the patient’s blood
pressure (SBP), diastolic blood pressure (DBP), pressure using a calibrated ABN blood pressure
fasting plasma glucose (FPG), postprandial glucose gauge. The measurement of HbA1c was carried out
(PPG), and HbA1c levels. Long term evaluation using a Quo A1c EKF test tool, while examination
needed to implements strategy to achieve optimal of FPG and PPG used an AutolyserDialab at the
diabetes control to reduce future complications. Clinical Pathology Laboratory in Karangasem
District General Hospital.
MATERIALS AND METHODS In this study, the data obtained will then be
analyzed using Statistical Program for Social
This study is a cross-sectional study and sample Science (SPSS) software for windows version
selection by a consecutive sampling of the elderly 25.0, including Kolmogorov-Smirnov to asses the
population suffering from DM aged ≥60 years normality of data, descriptive statistics to calculate
who undergo outpatient treatment at the geriatric the median, minimum, and maximum in numerical
polyclinic at the Karangasem District General data while for categorical data with using frequency
Hospital between May to July 2019. The study calculations.
conduct in these three months only as the initial
research to know how diabetes control among
elderly DM patient. Glycemic control such as A1C
RESULTS
evaluated in next three month to observe its proper In this study we enrolled 46 subjects, 23 person
target reduction. (50%) male and 23 (50%) female. A total of 6 (13%)
Inclusion criteria were DM patients aged ≥60 patients were underweight (BMI <18.5 kg/m2),
years. We exclude diabetes person with acute 16 (34.8%) normal weight (BMI = 18.5 - 22.9 kg/
infection and end-stage renal disease that may alter m2), 12 (26, 1%) excessive weight with risk (BMI =
blood glucose. Data collected by interview using 23 - 24.9 kg/m2), 10 (21.7%) obesity I (BMI = 25 -
comprehensive medical evaluation and assessment 29.9 kg/m2), and 2 (4.3 %) obesity II (BMI ≥30 kg/
based on Standards of Medical Care in Diabetes m2). A total of 13 people from 46 geriatric subjects
2019.8 That instrument contains past medical (28.3%) with diabetes found also had a history of
and family history, lifestyle factors, medications, hypertension. The duration of patients suffering
technology use, behavioural and diabetes self- from DM varies in which 30 (65.2%) patients had
management skills, physical examination, and DM for less than 5 years, 8 (17.4%) for 6-10 years,
laboratory evaluation.8 From that instrument, data and 8 (17.4%) had more than 10 year (Table 1).
obtained including age, sex, duration of illness, Among the subjects, 15 people (32.6%) used
height, weight, body mass index (BMI), blood oral antidiabetic drugs, 1 person (2.2%) used
pressure, FPG, PPG, HbA1c levels, diagnosis and basal insulin injection, 23 people (50%) used a
diabetes treatment. combination of basal-bolus insulin injection, and
The variables in this study were diabetes mellitus the rest 7 people (15.2%) used a combination of oral
(DM), DM control target, and the elderly. DM was antidiabetic drugs and insulin (Figure 1).
described as fasting plasma glucose examination The data collected then assessed for normality
≥126 mg/dl in a condition of no-calorie intake of at using Kolmogorov-Smirnov by SPSS version
least 8 hours or plasma glucose examination ≥200 25.0. The results were the characteristic of elderly
mg/dl 2-hours after the Oral Glucose Tolerance Test DM patients not normally distributed. The

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 ORIGINAL ARTICLE

characteristics of the research subjects can be seen from 1.38-1.67m. The BMI of patient quite varies
in Table 1. between 15.62-30.85kg/m2 (the median 23.2856kg/
We found a median age of the patient is 60 which m2). The median of systolic blood pressure is
vary between 60-90 years old. Diabetes onset varies 120mmHg, while the median of diastolic blood
between 1-33 years (the median 2.5). The median pressure is 70mmHg. The median of fasting plasma
weight of the patient is 56.50 kg starts from 33 kg to glucose is 153.5mg/dl while the median of prandial
78kg. The median height of patient is 1.565m varies plasma glucose is 238mg/dl. The HbA1c varies
among 5.5-15 with the median 7.8% (Table 1).
In this study, the percentage of patients who
Table 1. The characteristics respondents in the geriatric polyclinic of had met the DM control target was 34.8% for the
Karangasem District Hospital during May-July 2019 period. Body Mass Index (BMI). When compared with
Variable Median (Min-Max) all subjects, the number of patients whose systolic
Age (years) 66 (60-90) blood pressure had met the standard was 87%.
However, when compared with DM patients who
Onset of DM (years) 2.5 (1-33)
have comorbid hypertension, the percentage of
Weight (kg) 56.50 (33-78) systolic blood pressure control only reaches 53.8%
Height (m) 1.565 (1.38-1.67) because 6 out of 13 DM people with hypertension
BMI (kg/m ) 2
23.285 (15.62-30.85) have systolic blood pressure ≥ 140mmHg (Table
Blood pressure (mmHg) 2). Patient’s diastolic blood pressure met the target
better where 93.5% of all subjects had diastolic blood
Systolic 120 (95-190)
pressure <90mmHg. However, when compared to
Diastolic 70 (60-100) DM patients who do have comorbid hypertension,
FPG (mg/dl) 153.5 (69-557) the percentage of diastolic blood pressure control is
PPG (mg/dl) 238 (128-528) 76.9% because 3 out of 13 people who suffer from
HbA1c (%) 7.8 (5.5-15) DM and hypertension (23.1%) have diastolic blood
pressure ≥90mmHg (Table 2).
Blood sugar control in subjects in the three
criteria still did not reach the expected results
where the percentage that met the target was only
43.5% for Fasting Plasma Glucose (FPG), 17.4% for
Post Prandial Glucose (PPG), and 28.3% for HbA1c
levels (Table 2).

DISCUSSION
This cross-sectional study was carried out on 46
elderly patients with DM consisting of 23 (50%)
male and 23 (50%) female. This result is slightly
different from the results of DiabCare Asia 2008
study which percentage higher in female 55.16%
compare in male (43.3%), and DiabCare Asia 2012
Figure 1. The characteristic of DM Therapy Type among Geriatric Patients at
with a slight preponderance to the female gender
Karangasem District Hospital during May-July 2019 period
(58.6%). This difference could be due to the different
number of the patient which only 46 in this study
compare with 1,832 patients in DiabCareAsia 2008
Table 2. A DM control target evaluation at Karangasem District study or 1,967 patients inDiabCare Asia 2012. Both
Hospital during May-July 2019 period DiabCare study use sample from several centres
Criteria in Indonesia which represented the population of
Parameter Indonesia.9,10
Good (%) Bad (%)
The longer a person has diabetes, the higher
Body Mass Index (BMI) 16 (34.8) 30 (65.2) the risk of complications. In this study, we found
Systolic Blood Pressure (SBP) 7 (53.8) 6 (46.2) 30 people (65.2%) had DM for less than 5 years, 8
Diastolic Blood Pressure (DBP) 10 (76.9) 3 (23.1) people (17.4%) for 6-10 years, and 8 people (17.4%)
Fasting Plasma Glucose (FPG) 20 (43.5) 26 (56.5)
had more than 10 years. The median duration
of diabetes in this study was 2.5 (1-33) years.
Post Prandial Glucose (PPG) 8 (17.4) 38 (82.6)
Compare with the median duration of diabetes in
HbA1c 13 (28.3) 33 (71.7) DiabCare Asia 2012 was 6.0 (0.1−47.0) years. With

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 ORIGINAL ARTICLE

our findings, if followed by proper management, it these five classes is it can increase the awareness of
could be possible to reduce future complication.9,10 patient, community, and healthcare provider about
Regarding diabetes treatment, 15 people (32.6%) BMI control inpatient to prevent related metabolic
used oral antidiabetic drugs, 1 person (2.2%) disease like DM and improve diabetes control
used basal insulin injection, 23 people (50%) especially in BMI for patient who already had DM.
used multiple basal-bolus insulin injections, and In this study, the percentage of patients who
the 7 people (15.2%) used a combination of oral had met the DM control target was 34.8% for the
antidiabetic drugs and insulin. This finding differs Body Mass Index (BMI), where the expected BMI
from the 2008 Diabcare Asia study where 81.32% target ranged from 18.5 to <23.6. From patients
used oral antidiabetic drugs (± insulin) while who met the BMI target, the ratio between male
37.7% used insulin (±oral antidiabetic drugs), or and female are the same, every 8 people. Likewise,
Diabcare Asia 2012 where 84.2% of patients used for patients who have not met their BMI targets
oral antidiabetic medications while 34.7% used (both BMI less than 18.5 and BMI ≥23) the same
insulin. DiabCare Asia 2008 obtained all samples in number of comparisons between male and female
Indonesia, while DiabCare Asia 2012 obtained the patients (15 each). This result is different from the
majority of samples in Indonesia (99.6%).9,10 What previous study by Pardede et al. in which a better
caused this difference is likely the average age of BMI target was achieved in male patients because
patients who were sampled whereas in DiabCare physical activity in male was more significant than
Asia 2008 the average sample age was 58.93 (± 9.57) in the female.12 This difference may due to subjects
and DiabCare Asia 2012 the average age was 58.4 in that study were not limited to elderly patients,
(± 9.5) years while in this study the elderly subjects while in this study conducted in elderly patients
were taken with a median age of 66 (60-90) years. where the activities of both male and female did not
The characteristics of DM in the elderly are slightly differ much.
different from young adults where beta cell function Obesity has an important relationship with
decreases so insulin resistance increases. This is also DM so that in managing DM, obesity is one of the
accompanied by a decrease in the function of other factors that must be controlled. In obesity, adipose
organs such as the heart and kidneys which have makes and releases adipocytokines to maintain
caused complications in the elderly, causing more energy balance. Tumour necrosis factor α (TNF-α)
therapeutic choices using insulin in this study due is one example of cytokines released as an early
to higher HbA1c in this elderly patient. sign of inflammation that can induce insulin
A total of 6 (13%) patients were underweight resistance in muscle tissue and adipose through
(BMI <18.5 kg/m2), 16 (34.8%) within normal glucose transporter 4 (GLUT 4) so that ​​ it can cause
body weight (BMI = 18.5 - 22.9 kg/m2), 12 (26, an increase in the release of free fatty acids due
1%) overweight with risk (BMI = 23 - 24.9 kg/ to lipolysis that occurs. Increased free fatty acids
m2), 10 (21.7%) obesity I (BMI = 25 - 29.9 kg/m2), for a long time can suppress insulin secretion by
and 2 (4.3%) with obesity II (BMI ≥30 kg/m2). interfering with β cell response to glucose. Besides,
Of the 6 underweight people, 2 were male, and 4 free fatty acids can activate protein kinase (PKC)
were female. While from 16 with normal body which can damage the formation of insulin signals.
weight, the proportion of male and female is the Other adipocytokines that play a role are retinol-
same, respectively 8. Of the 12 people who have binding protein 4 (RBP4) which is thought to
more weight with risk, 9 of them are male and the damage glucose uptake that stimulates insulin in
remaining 3 are female. For type 1 obesity, 3 people the muscles and increases hepatic sugar production,
are male, while 7 are female. For type 2 obesity 1 is causing insulin resistance.12
male and 1 other is female. This is slightly different In addition, insulin resistance is also influenced
from the results of previous studies conducted by by low adiponectin. Adiponectin is an adipokine that
Ludirdja JS, et al who obtained results as follows: has insulin-mimetic properties. Low adiponectin
total of 1 (3.3%) patients underweight (BMI <18.5 counts are also found in obese individuals. The
kg/m2), 12 (40%) normal body weight (BMI = 18.5 - process of lipolysis in obesity is high which causes
25 kg/m2), 13 (43.33%) were overweight (BMI = 25 the amount of oxidative stress produced is also
- 30 kg/m2) and 4 (13.3%) were obese (BMI > 30 kg/ high. Increased Reactive Oxygen Species (ROS)
m2).11 This different may due to the different category can reduce mitochondrial function resulting in
of BMI that used in these two study. In this study we accumulation of fat in muscles and liver. This will
used the guidance of managing diabetes mellitus in generate insulin resistance phenotype which is an
Indonesia (PERKENI 2015)5 which classified BMI initial phase of metabolic abnormalities until the
into 5 classes instead of four classes in the studies occurrence of glucose intolerance.13
conducted by Ludirdja JS, et al. The advantage using Among DM patients who are overweight or

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 ORIGINAL ARTICLE

obese with poor glycemic, blood pressure and 50.6 years, average BMI 33.9 kg/m2), weight loss is
cholesterol control, lifestyle changes that result in obtained with moderate physical activity programs
weight loss, clinically proven to have an impact on at least 2.5 hours/week and a reduction in total fat
reducing blood sugar, HbA1C, and triglycerides. diet to <25% of calories, accompanied by lifestyle
More significant weight loss results in greater counselling every week for 16 curriculum sessions
improvements including decreased blood pressure, followed by 2 times a month. The result is that
improvement in LDL cholesterol and HDL, as well every 1 kilogram of weight loss through diet and
as a decrease in the need for drugs to control blood exercise decreases 16% incidence of DM over 3.2
sugar, blood pressure and fat levels.14 years.17 The moderate physical activity is a physical
But keep in mind, in elderly BMI to determine exercise which reaches 50-70% maximum heart
obesity is a less precise index because it does not rate (maximum heart rate is 220-age patients)
show fat distribution, decreased muscle mass, such as brisk walking, relaxed cycling, jogging, and
and the calculation becomes less accurate due to swimming.
the shortening of the spine or the changing shape In the elderly, the purpose of weight loss is
of the spine. Weaknesses in the elderly also cause to improve physical function and quality of life.
difficulties in measuring the weight and height Lifestyle changes are as effective in older individuals
of the elderly. To predict the health condition of as younger individuals. Weight loss of 5-10 kg with
the elderly, it is more appropriate to use the waist a conventional diet and exercise program, brings
circumference as a reference because it is highly a significant reduction in intra-abdominal fat and
correlated with total and intraabdominal fat which improvement of metabolism. However, weight loss
plays an important role in metabolic disorders programs in the elderly must be adjusted for each
including DM. Obesity in the elderly increases the individual to provide a balanced diet, adequate
risk of metabolism, physical disability, impaired calorie consumption as well as physical activity and
quality of life, sexual dysfunction, decreased duration of therapy.
cognitive impairment and dementia. On the Control of systolic and diastolic blood pressure
contrary, weight loss is done deliberately through are two parameters which results are quite good
lifestyle modification in the form of a combination in the target of DM control in this study, which
of exercise and calorie restriction and not because when compared with all subjects, the number of
of accidental reasons such as illness, bringing many patients whose systolic blood pressure had met the
health benefits for the elderly. Weight loss of 5-10% standard was 87%. However, when compared with
has been shown to improve cardiovascular risk. DM patients who do have comorbid hypertension,
According to the research of Lean et al., There was the percentage of systolic blood pressure control
an increase in life expectancy in weight loss carried only reaches 53.8% because 6 out of 13 DM people
out by the elderly with DM using a simple diet with hypertension still have systolic blood pressure
method.15 ≥ 140mmHg. Patient’s diastolic blood pressure met
However, weight loss does not only have an the target better, where 93.5% of all subjects had
impact on decreasing fat mass but also can reduce diastolic blood pressure <90 mmHg. However,
non-fat mass (muscle) and bone mineral mass. So when compared to DM patients who do have
we need to do weight training and diet exercises comorbid hypertension, the percentage of diastolic
to prevent femoral fractures in obese patients. blood pressure control is 76.9% because 3 out of
However, this weight training is recommended 13 people who suffer from DM and hypertension
in people with DM without contraindications (23.1%) have diastolic blood pressure ≥90 mmHg.
such as osteoarthritis, uncontrolled hypertension, The target blood pressure in DM patients is a
retinopathy, and nephropathy. Systemic analysis by systolic blood pressure of <140 mmHg and diastolic
McTigue et al. showed a weight loss of 3-4 kg over blood pressure of <90 mmHg. The number of DM
1-3.3 years through lifestyle modification resulting patients diagnosed with hypertension in this study
in improvements in glucose tolerance and physical was smaller than the results of DiabCare Asia 2012,
function, reducing the incidence of new DM and where 65.4% of DM patients studied also suffered
combination of hypertension or cardiovascular from hypertension.10 In another study, Pardede
as well as reducing bone density. This can occur et al. obtained blood pressure control on target at
because of the increased sensitivity of insulin 60.8% while those are not on target (either systolic,
receptors in the muscles and the increasing number diastolic or both) amounted to 39.3%.12
of receptors that are active due to capillaries that Management of blood pressure is crucial to
open during exercise.16 be done in DM patients altogether with DM
In the Diabetes Prevention Program where control. Because DM in the long term and being
obese patients up to age 84 years (average age uncontrolled can result in hypertension that can

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 ORIGINAL ARTICLE

have implications for other macroangiopathy falling or hypoglycemia, the HbA1c target is slightly
risks such as coronary heart disease, stroke, and higher at <8.0% (64 mmol/mol), FPG 90-150mg/dL
peripheral Vascular Disease (PVD). Managing (5.0-8.3 mmol/L), blood sugar before going to sleep
blood pressure starts from lifestyle modifications 100-180mg/dL (5.6-10.0 mmol/L), blood pressure
in the form of losing weight, increasing physical <140/90 mmHg, and statin administration unless
activity, stopping smoking and alcohol and reducing there are contraindications or are not tolerated
salt consumption. If the target of blood pressure by the patient. While in elderly DM patients with
has not been achieved with lifestyle modification, poor health conditions in the later stages of chronic
pharmacological therapy can be given in the form illness, moderate-severe cognitive impairment, and
of angiotensin II receptor blockers, ACE inhibitors, dependence on daily living activities the HbA1c
low dose selective beta receptor blockers, low dose target is even higher at <8.5% (69 mmol/mol), FPG
diuretics, alpha-receptor blockers and calcium 100-180 mg/dL(5.6-10.0 mmol/L), blood sugar
antagonists. In patients with blood pressure> 120/80 before bed 110-200mg / dL (6.1-11.1 mmol/L),
mmHg lifestyle changes are required, while patients blood pressure <150/90 mmHg, and considered
with systolic blood pressure> 140 / 80mmHg can be benefits giving statins as secondary prevention.18,19
given direct pharmacological therapy. Combination DM management in the elderly must be
therapy is given if the therapeutic target cannot be individual in which the drug needs, the abilities
achieved with monotherapy.5 and desires of patients are important and main
This study shows that the goal of controlling components in determining choices to achieve
blood sugar is not yet achieved in short-term therapeutic targets. These considerations are
blood glucose monitoring as seen from fasting influenced by several things including patient’s
plasma glucose (FPG) and postprandial glucose age and life expectancy, duration of DM, history
(PPG), and long-term blood glucose control by of hypoglycemia, comorbidities, cardiovascular
examining HbA1c. Examination of HbA1c levels complications, and other supporting components
reflects the average blood glucose control in the (availability of drugs and capability for purchasing).
last 2-3 months. The percentage of achievement However, more optimal monitoring and efforts are
achieved by the target is 43.5% for FPG, 17.4% for needed to control DM parameters so that we can
PPG, and 28.3% for HbA1c levels. All three are provide health services that are in line with DM
still below 50%. Better results were obtained in the control goals and prevent DM complications in the
2012 DiabCare Asia study where the percentage elderly.
of patients with HbA1c <7 reached 30.8%. This
shows that blood sugar control is still not optimal CONCLUSION
in elderly DM patients in the geriatric clinic of
Karangasem District Hospital. But this can also due In this study, it was found that the control of
to the principle of therapy in elderly is starts from diabetes mellitus in elderly patients in the geriatric
a low dose with a slow titration (start low go slow) clinic of Karangasem District Hospital was still not
and the target of HbA1c therapy is more flexible optimal in the parameters of BMI, FPG, PPG, and
because the elderly population is more susceptible HbA1c. Better results were obtained in controlling
to hypoglycemia complications wherein elderly systolic and diastolic blood pressure. More optimal
patients the target of HbA1c therapy is between 7.5 efforts are needed to achieve the DM control goals
-8.5%.6 in the geriatric polyclinic of Karangasem District
DM therapy in the elderly is slightly different, Hospital. Ongoing evaluation is required to assess
wherein the selection of therapy can not only by the effectiveness of DM management in the elderly.
looking at laboratory results but must be assessed Further research with larger sample size is needed
the patient’s characteristics and overall health to determine the relationship between each DM
condition. In the elderly DM patients with little or control parameter and the therapy given.
no comorbidities, with good cognitive status and
good functional status to carry out daily activities, CONFLICT OF INTEREST
as well as expectations of longevity, target HbA1c The authors declare that there is no conflict of
<7.5% (58 mmol/mol), FPG 90-130mg / dL (5.0- interest regarding the manuscript
7.2 mmol / L), blood sugar before sleep 90-150mg
/ dL (5.0-8.3 mmol/L), blood pressure <140/90 ETHICAL CLEARANCE
mmHg, and statin administration unless there are
contraindications or are not tolerated by the patient. This research has followed the ethical rules that
In elderly DM with many comorbid diseases or apply in the Research Ethics Committee of the
disturbances in daily activities or having mild- Faculty of Medicine, Udayana University / Sanglah
moderate cognitive impairment, and having a risk of Hospital.

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 ORIGINAL ARTICLE

FUNDING 10. Cholil AR, Lindarto D, Pemayun TGD, Wisnu W,

Kumala P, Puteri HHS. The DiabCare Asia 2012: diabetes
The authors are responsible for the funding without management, control, and complications in patients with
the involvement of grant, sponsorship, or any other type 2 diabetes in Indonesia. Med J Indones. 2019;28:47–56
11. Ludirdja JS, Kencana J, Kurniawan K, Adnyana MP,
sources of funding. Aryana IGPS. Rerata Durasi Penderita Diabetes Melitus
Terkena Nefropati Diabetik Sejak Terdiagnosis Diabetes
AUTHOR CONTRIBUTION Melitus pada Pasien di Poliklinik Geriatri RSUP Sanglah.
IPTEKMA. 2010; 2(1):15-19.
All authors are contributed equally to the content of 12. Pardede TE, Rosdiana D, Christianto E. Gambaran
the study from data preparation, statistical analysis, Pengendalian Diabetes Melitus Berdasarkan Parameter
Indeks Massa Tubuh dan Tekanan Darah di Poli Rawat
results, and data synthesis.
Jalan Penyakit Dalam RSUD Arifin Achmad Pekanbaru.
JOM FK. 2017;4(1):1-14
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