Basis Bukti Terkini

Manajemen Luka Diabetik

Dr. Suriadi, RN, AWCS, CHb
Chairman of International Affair: The Muhammadityah Institute of
Nursing - Pontianak
Independent Practice: PKU Muhammadiyah Kitamura Wound Clinic
The Head of Nurse Education Program, Faculty of Medicine, The
University of Tanjung Pura-Pontianak

Prevalensi
Komplikasi diabetes: Infeksi, Perlukaan
dan atau gangren.
Di USA, 45% -83% dari 120.000 pasien
di amputasi dengan kasus Diabetes
(Baranoski, S & Ayello, E.A, 2002).

Amputasi; 15 - 46 kali > pasien yang

bukan diabetes (Reiber, 1995 dan Lavery, 1996).
Tiga faktor penyebab utama
neuropati, buruknya sirkulasi dan
menurunnya resistensi terhadap infeksi.

Cont
Penyebab utama amputasi adalah perlukaan
pada kaki
Negara berkembang : 1 dari 6 klien diabetes
akan mengalami luka di kaki
Statistik pada negara berkembang: buruk
Masalah kaki menyebabkan paling sering
masuk RS
Masalah di kaki 15% - 40% di negara
berkembang
sumber : Diabetes & foot care the facts. Jan 2006 Diabetes NZ

Manajemen Luka Diebetik

Evidence Based

Vibration therapy accelerates healing of

Diabetic Foot Ulcer patients
Design
Prospective randomized control trial was used

Subjects
Patients with DFU (Neuropathic Ulcer grade II)

Intervention
Vibration was applied for 15 minutes three times a day

Outcome
Healing rate and healing period

Analysis
KaplanMeier curves were used to assess the time from the
start of study treatment to the time of reporting of healing events

Sitty S, Elly Nurahmah, Suriadi, 2013

Results
Healing Rate (n=80)
Variables

Experimental
Group (n= 40)

Control Group
(n = 40)

Healed Time
25% Percentiles, (day, SE)
50% Percentiles, (day, SE)
75% Percentiles, (day, SE)

13 (2.58)
15 (7.00)
27 (2.51)

25 (3.42)
34 (4.83)
56 (5.71)

Relative change per day,

Mean (SD), %/day
Area

6.41 (3.65)

2.72 (1.31)

.003

0.07 (0.36)

0.03 (0.13)

.003

Delta

.002

The Wilcoxon for continuous variables and Fisher Exact Test for
categorical variables were used.

COMPARISON OF HEALING RATE DURING THE STUDY PERIOD (n=80)

0.00

0.25

0.50

0.75

1.00

Kaplan-Meier survival estimates, by GROUP

20

40
analysis time

GROUP = control

60

80

GROUP = experiment

A significant difference between the 2 groups confirmed by the log-rank test

(P = .002)

Comparison of Nitric Oxide between two groups (n=80)

Groups
Control

*Pre
intervention

*Post
intervention

1,12 (0,19-4,84) 0,86 (0,36-2,60)

Intervention 0,92 (0,03-2,97) 2,91 (0,96-6,60)

P-Value

0,502

<0,001

P-value

Delta

0,065 -0,29 ((-4,16)- 2,60)

<0,001 1,39 (0,10-6,60)
<0,001

*)median (min-mak), Wilcoxon test, # Mann-Whitney test

There was significant difference between pre & post

intervention of NO values for both.

Application for the DFU patients

Use in clinical setting

The Comparative Study on Stress And No Stress Toward Acceleration

of Wound Healing in DFU Patients

Design : Comparative study

Samples : Quota sampling
Procedures :
1. Identified patients stress and no stress using DASS
42 (Depression Anxiety and Stress Scale).
2. Analysis cortisol serum using COBAS ELEXYCE 411

Rangga Saputra & suriadi .2014 ( STIK Muhammdiyah)

RESULT
Comparison of the reduction wound area and cortisol level with &
no stress DFU patients (N=13)

Parameters

Stress
No Stress
Mean (SD) Mean (SD) Statistic P. Value
n=7
n=6

Reduction of
88.0244.3 261.59123. t = 3.253
Wound %
9
36
t=
Cortisol serum
18.036.56 8.711.90
There was significant difference between two groups (p = < -3.608
0.05).
level

0.008
0.004

This study postulated that patients who had stress showed high cortisol levels
than patient without stress. Then patients no stress had faster in reduction of
wound area.

PERBEDAAN EFEKTIFITAS PENCUCIAN LUKA ANTARA

PENGGUNAAN NACL 0,9% DENGAN AIR KANGEN PH 9,5
TERHADAP PENURUNAN JUMLAH BAKTERI PADA
PENDERITA DIABETIC FOOT ULCER DI KLINIK SPESIALIS
PERAWATAN LUKA KITAMURA KALIMANTAN BARAT

RIZAL MUSTAKIM & Suriadi,

2014
12

No

Umur

Jumlah

36- 45 tahun

25

46 - 55 tahun

35

56 - 65 tahun

40

Jumlah

20

100

14

Perbedaan Jumlah Bakteri

Antarr Group
Variab
el

P Value

1,24
1

,246

pH 9,5 22.997.00010.265.088,088 7.493.4005.596.003,908 2,43

,038

NaCl

Sebelum
Mean SD

Sesudah
Mean SD

13.552.0008.575.634,476 9.868.0007.503.991,234

15

NaCl 0,9%

16

NaCl 0,9%

17

NaCl 0,9%

18

Air Kangen pH 9,5

19

Air Kangen pH 9,5

20

Air Kangen pH 9,5

21

Kesimpulan
Pencucian luka dengan menggunakan NaCl 0,9%
didapatkan rata-rata mengalami penurunan jumlah
bakteri secara angka. Namun tidak berbeda
secara signifikan pada perhitungan uji statistik.
Pencucian luka dengan menggunakan Air Kangen
pH 9,5 didapatkan rata-rata mengalami penurunan
jumlah bakteri secara angka dan signifikan pada
perhitungan uji statistik.
Ada perbedaan efektivitas pencucian luka antara
penggunaan NaCl 0,9% dengan Air Kangen pH
9,5 terhadap peurunan jumlah bakteri..p =0,038.
22

PENGARUH PENGGUNAAN ELECTRO

MUSCULAR STIMULATION (VEINOPLUS
ARTERIAL) TERHADAP PENYEMBUHAN
LUKA KAKI DIABETES

SUKARNI & SURIADI, 2014

Kelompok n

Rata-rataSB

Intervensi

0.21130.16239

Kontrol

16
16

0.02940.10649

Uji t tidak berpasangan

Uji t tidak berpasangan

Perbedaan rata-rata
(IK 95%)

0.18188 (0.28102-0.08273)

0.010

Variabel

Rata-rataSB

IK 95%

8.8137.556

12.8394.786

0.000

27.259.504

Sebelum
16
Setelah

Perbedaan
Rata-rataSB

18.447.211

Uji t berpasangan

Variabel

Sebelum

Rata-rataSB
27.638.951

16
Setelah

Perbedaan
Rata-rataSB

IK 95%

21.142-12.608

0.000

Uji t berpasangan

16.8758.007
10.755.905

Uji Wilcoxon

Variabel Kelompok

Intervensi

Rata-rataSB

16

27.638.951

Sebelum
Kontrol

16

27.259.504

Intervensi

16

10.755.905

Setelah
Kontrol

16

18.447.211

Perbedaan rata-rata
(IK 95%)

0.375 (7.041-(6.291))

0.970

-7.688 (-2.929-(12.446))

0.003

FACTORS AFFECTING THE OCCURENCE

OF DIABETIC FOOT ULCER IN TYPE 2
DIABETES MELLITUS PATIENTS IN
KITAMURA SPECIALIST CLINIC OF
WOUND, STOMA, AND INCONTINENCE
CARE, PONTIANAK, 2014
Author

Adam Astrada, S. Kep

Suriadi, MSN, AWCS, PhD
Ns. Arina Nurfianti, M. Kep

FACTORS AFFECTING THE OCCURENCE OF DIABETIC FOOT

ULCER IN TYPE 2 DIABETES MELLITUS PATIENTS IN
KITAMURA SPECIALIST CLINIC OF WOUND, STOMA, AND
INCONTINENCE CARE, PONTIANAK IN 2014
Diet
pattern

DF
U

Medicatio
n
Smoking
behaviour
Physical
activity
Followup
Foot care

Psychological
aspect
Social
interaction
Spiritual
aspect
Race/ethnicity

Design: Cross-sectional
approach
Sampling method:
Accidental
Data collection:
Physical
examination
and Interview
(questionnaire)

Data analysis: SPSS 16.0

Univariate,
Bivariate(Chi-square), &
Multivariate (binary logistic
regression)

Sample

Total: 88
respondents

DFU: 42 respondents

Without DFU: 46 respondents

Inclusion criteria:
Age
: 30
69 y/o
Diagnose
:
type 2 DM +
DFU
Wound history : 120 days

Inclusion criteria:
Age
: 30
69 y/o
Diagnose
:
type 2 DM
Wound history : >120 days

Exclusion criteria:
Comorbidity involving 3 main
organs
Patients with mental illness,
conciousness alteration, or
cognitive problems.

Instrument 2: Questionnaire
(face and construct validities, Cronbach 0.6)
Diet
pattern Medication

DF
U

Smoking
behaviour
Physical
activity
Followup
Foot care

Psychological
aspect
Social
interaction
Spiritual
aspect
Race/ethnicity

The Cancer Council Victoria: Food Frequency

Questionnaire
Morisky 8-item Medication Adherence
Questionnaire
Glover Nilsson Smoking Behavioral
Questionnaire
Global Physical Activity
Questionnaire
Schmitt et al.
2013
Desalu et al,
2011
Self-Efficacy Assessment Tool and
Assessing Psychosocial Distress in
Diabetes
Interpersonal Support Evaluation List
(short version)
Multidimentional Measurement of
Religiousness/Spirituality for Use in Health
Research
Included in demographic form

Multivariate
Variabel
Smoking
behaviour

p
0,007

OR
0,110

95% CI
0,22 0,542

Foot care

0,028

5,566

Psychological
aspect

0,008

0,110

1,202
25,783
0,021 0,568

Social
interaction
Malays
Javanese

0,018

7,807

0,001
0,001

0,029
0,021

1,419
42,960
0,004 0,225
0,002 0,206

Trends:
Diabetic patients with less social interaction and lack of foot care
are 7 8 times and 5 6 times more prone to experience DFU,
respectively, after influenced by smoking, psychological aspect,
and ethnicity.

Translation of Evidence: wound

healing
Here is where the scientific evidence is
considered in the context of clinical
expertise and values, thus resulting in
clinical practice guidelines, best practices,
protocols, standards or clinical pathways.

KITAMURA WOUND CLINIC

Protocol for Diabetic Foot Ulcer

(Advanced wound care management)
DFU Classification (1-IV)

Basic DM Management

Five Vilar of DM Management: BP, B. Glucose,

Type
Diet, Activity, Health Education
Screening Diabetic Foot Assessment

of DFUs

Advanced wound care management

Physical /foot assessment

Mild tissue damage

Conservative

Wound type assessment

Severe tissue damage

Thermography

Cleansing

Vibration
EMS

Debridement

Dressing: trad./modern

Assessment wound healing NPWT

DFU heal

Infection
Prevention of amputation

Detection of Skin Layers by

Ultrasound Device

10MHz

Suspected DTI

Discontinuous
layer

Edema

Evidence Based Approach

in Clinical Practice

Best available
research evidence
Population
characteristics,
needs, values and
preferences

Decision
Making
Resources,
including
practitioner
expertise

Environment
and
organizational
context

THANK YOU