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A CASE REPORT OF FAMILY MEDICINE:

MANAGEMENT OF DIABETES MELLITUS AND HYPERTENSION

AUTHORS:

Anis Nabilah binti Muhammad Razi C014182224

Aslan Tripanji C014181046
Ayu Sofeya binti Hishamudin C014182223

SUPERVISOR:

Dr. dr. Andi Alfian Zainuddin, MKM

drg. St. Maisarah M.Kes

DEPARTMENT OF FAMILY AND PREVENTIVE MEDICINE

FACULTY OF MEDICINE, HASANUDDIN UNIVERSITY
JULY, 2019
A CASE REPORT OF FAMILY MEDICINE: MANAGEMENT OF DIABETES
MELLITUS AND HYPERTENSION
Anis Nabilah binti Muhammad Razi1*, Aslan Tripanji1*, Ayu Sofeya binti Hishamuddin1*,
Andi Alfian Zainuddin2*, St. Maisarah2*
3) Department of Family and Preventive Medicine
*Faculty of Medicine Hasanuddin University, Makassar, Indonesia
4) Cendrawasih Health Center, Makassar, South Sulawesi

ABSTRACT

Diabetes is a major health problem that has reached alarming levels. Nearly half a
billion people live with diabetes worldwide. The average prevalence of DM in Indonesia
for ages above 15 years is 10.9%. Currently an estimated 10.7 million people are
diagnosed with DM. With these figures, Indonesia ranks 7th in the world. Hypertension
is a global health problem resulting in increased morbidity and mortality and the burden
of health costs, including in Indonesia. The prevalence of hypertension in Indonesia with
a population of around 260 million is 34.1%. This descriptive study was obtained
through history taking and physical examination, home visits, family data equipment,
psychosocial and environmental analysis, and assessment based on a holistic
diagnosis. This case describes a 66-year-old female patient with diabetes mellitus and
hypertension. Based on the author's observations, obtained several factors that
influence the patient's disease. Internal risk factors are obtained, namely the influence
of a bad personal lifestyle, which is the diet of patients who often consume foods high in
sugar and cholesterol, and lack of early awareness about the disease. External risk
factors are genetics and environmental factors. The study is carried out deeper into the
perspective of family medicine and looking holistically. It is also hoped that the results of
this report will not only solve the patient's clinical problems, but also seek and provide
solutions to matters that affect the health of the patient and family.

Keywords : Diabetes Mellitus, Hypertension, Family Medicine, Holistic Diagnosis, Cendrawasih

Health Centre
Introduction

Diabetes is a major health issue that has reached alarming levels: today, nearly
half a billion people are living with diabetes worldwide.Diabetes is a group of disorders
caused by a complex interaction between genetic susceptibility, environmental factors,
and personal lifestyle choices that share the phenotype of hyperglycemia. Type 2
diabetes mellitus (DM) is a heterogeneous group of chronic disorders caused by a
progressive insulin secretory defect and increased glucose production in the setting of
insulin resistance. Prevalence in the United States, 25.8 million adults and children
(8.3% of the population), including 18.8 million who have been diagnosed, have
diabetes. This includes about 1 in 400 children and adolescents and 26.9% of people
age 65 years and older. Type 2 DM is the most common form, accounting for more than
90% of cases.(Richard et al., 2013) The World Health Organization (WHO) predicts an
increase in the number of people with DM who become one of the global health threats.
WHO predicts an increase in the number of people with DM in Indonesia from 8.4
million in 2000 to around 21.3 million in 2030. The report on the results of the Basic
Health Research (Riskesdas) in 2018 by the Ministry of Health, showed that the
average prevalence of DM in Indonesia for ages above 15 years was 10.9%. When
compared with data from Riskesdas in 2013, the prevalence of DM in Indonesia was
6.9%. The lowest prevalence was in TTN Province at 0.9%, and the largest in DKI
Province was 3.4%. The prevalence of DM in South Sulawesi is 1.6%.(Riskesdas,
2018) The data above shows that the number of people with DM in Indonesia is very
large. With the possibility of an increase in the number of people with DM in the future it
will be a very heavy burden to be handled alone by specialist doctors / subspecialists or
even by all available health workers. Based on 2019 IDF data, currently an estimated
10.7 million people are diagnosed as people with DM and 7.9 million people are not
diagnosed as people with DM. With this number, Indonesia ranks 7th in the world.(IDF,
2019) Problems faced by Indonesia include not all people with DM have access to
adequate health care centers. Likewise, the availability of oral and injection
hypoglycemic drugs in primary services (Puskesmas) and limited facilities /
infrastructure in several health service centers. Likewise, the ability of health workers is
not optimal in handling DM cases, both in the aspects of preventive, promotive, curative,
and rehabilitative.(Soelistijo, Novida and Rudijanto, 2015) One study showed that age,
gender, area status, employment status, obesity, hypertension, and dyslipidemia are the
contributing factors in the development of diabetes mellitus. Therefore, individuals need
to constantly control their blood glucose, blood pressure, and cholesterol levels, as well
as exercise regularly. The government needs to design a preventive program to control
the prevalence of diabetes mellitus through early prevention by considering the risk
factors that may lead to the development of the disease.(Idris, Hasyim and Utama,
2017)

Hypertension (HTN) is a global health problem resulting in increased morbidity

and mortality and the burden of health costs, including in Indonesia. HTN is a major risk
factor for both myocardial infarction and stroke. Primary HTN constitutes 90% of HTN
cases. Initial treatment includes lifestyle modifications and medications. Most patients
require at least 2 medications to achieve control. Patients who are not controlled on 3
medications should undergo a work-up for secondary causes. Primary HTN (>90% of
patients). The specific cause is unknown, but environmental factors (i.e., salt intake,
excess alcohol intake, obesity) and genetics both play a role. In the United States, HTN
contributes to 1 of every 7 deaths and to half of the cardiovascular disease-related
deaths.. (Richard et al., 2013) Basic Health Research (Riskesdas) in 2018 showed an
increase in the prevalence of hypertension in Indonesia with a population of around 260
million is 34.1% compared to 27.8% at Riskesdas in 2013. Most cases of hypertension
begin with hypertension and eventually hypertension occurs. Early awareness should
be educated to all people so as not to be underestimated with change the lifestyle that
is fast in the right diet and adequate physical. Activities are mandatory for young adults,
before other risk factors happen. Most modifiable risk factors that can be modified
mainly are lifestyle changes. By preventing the condition of prehypertension to develop
further into hypertension, this can help reduce the burden on the health care system in
terms of pharmacotherapy treatment costs and complications.(Widjaja et al., 2013) In
an effort to reduce the prevalence and incidence of cardiovascular disease due to
hypertension, it requires strong determination and a continuous joint commitment of all
related parties such as health workers, policy makers and also community participation.
(Is, 2009)

Case description

Discussion

Conclusion (100 WORDS MAXIMAL)

Reference

IDF (2019) IDF Diabetes Atlas Ninth edition 2019, International Diabetes Federation.
Available at: http://www.idf.org/about-diabetes/facts-figures.

Idris, H., Hasyim, H. and Utama, F. (2017) ‘Analysis of Diabetes Mellitus Determinants
in Indonesia: A Study from the Indonesian Basic Health Research 2013’, Acta medica
Indonesiana, 49(4), pp. 291–298.

Is, P. R. A. K. T. (2009) ‘Penatalaksanaan Hipertensi’, 36(6), pp. 451–452.

Richard et al. (2013) The Color Atlas of Family Medicine.

Riskesdas (2018) ‘Hasil Utama Riset Kesehatan Dasar’, Kementrian Kesehatan

Republik Indonesia, pp. 1–100. doi: 1 Desember 2013.

Soelistijo, S. A., Novida, H. and Rudijanto, A. (2015) Perkumpulan Endokrinologi

Indonesia, Pb Perkeni. doi: 10.1017/CBO9781107415324.004.

Widjaja, F. F. et al. (2013) ‘Prehypertension and hypertension among young Indonesian

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