Articles

Management of a Patient with Type 2 Diabetes Mellitus and Uncontrolled Hypertensive Urgency Using a Family Doctor Approach in a First-Level Health Facility in Indonesia: A Case Report

Noncommunicable diseases (NCDs) result from genetic, environmental, and behavioral factors. These diseases include cardiovascular conditions and diabetes. According to the Lampung Provincial Health Office in 2021, the prevalence of type 2 diabetes mellitus increased from 1.37% to 3.76% (equivalent to 88,518 cases), and the prevalence of hypertension rose from 15.10% to 17.35%. NCDs are chronic and affect quality of life and productivity, necessitating comprehensive management.  The goal of a family medicine approach in treating patients with type 2 diabetes mellitus and hypertension is to identify clinical, psychological, and psychosocial factors. Primary data is collected through anamnesis, physical examination, and home visits to evaluate the physical environment.  Patient Mrs. A, a 55-year-old farmer, reported complaints of headaches and frequent nighttime urination. She has a history of hypertension since 2022 and type 2 diabetes mellitus since 2023. Management was carried out holistically using a patient-centered, family-oriented, and community-based approach grounded in Evidence-Based Medicine. Interventions included both pharmacological and non-pharmacological via family conferences.  Evaluation of the interventions showed improved knowledge among the patient and her family, a reduction in the patient’s blood pressure and blood glucose levels, and behavioral changes in the patient to consume meals aligned with recommended dietary allowances.

Holistic Management of Diabetic Ulcer in Construction Worker with Low-Risk Neuropathy Symptoms Score and Proximal Phalanx Diggiti III-IV Pedis Dextra Amputation History

Diabetic ulcers are the most common complication of uncontrolled Diabetes Mellitus (DM), characterized by high blood glucose levels that lead to complications such as neuropathy (motor, sensory, autonomic) and vascular abnormalities, making infections more likely. According to research in Indonesia, the incidence of diabetic ulcers ranges from 15-25% of the total number of diabetes mellitus patients, with an annual prevalence of 2% to 5-7.5% in patients with neuropathy. Application of evidence-based medicine-based family doctor services to patients by identifying risk factors, clinical problems, and patient management based on a patient-centered and family problem-solving framework. This case report taken by primary data through auto-anamnesis, physical examination and home visits. Secondary data was obtained from the patient’s medical record. The assessment is based on a holistic diagnosis from entire of the study qualitatively and quantitatively. Patient Mr. E, 61 years old has internal factor risks such as elderly age, curative treatment patterns, inappropriate eating habits, lack of knowledge about the disease which, and external risk factors in the form of curative family treatment patterns and lack of family support related to patient’s disease. Patient’s management is holistic and comprehensive, patient-centered, family approach, and community-based in the literature based on EBM. Patient was intervened with media posters about DM, diet, proper diabetic ulcer care and educating families to support patients. Results of the intervention evaluation are increase in patient and family’s knowledge, controlled blood sugar, and eating behavior according to Adequacy of Nutrition Level.