Case Report DM

44 Shofi Hesfianto │ Case Report: Type 2 Diabetes Mellitus
CASE REPORT: TYPE 2 DIABETES MELLITUS

Shofi Hesfianto1
1
Puskesmas Playen II (Community and Primary Health Care Center) – Gunungkidul, Yogyakarta
(Training Participant of Primary Care Doctors Preceptors – Ministry of Health Republic of Indonesia 2016)
Corresponding Author:
Shofi Hesfianto: UPT Puskesmas Playen II, Beberan, Playen, Gn. Kidul Kec. Playen, Bleberan, Wonosari, Kabupaten Gunung Kidul, Daerah
Istimewa Yogyakarta 55861
E-mail: shf.hesfianto@gmail.com
To cite this article:

Hesfianto S. Case report: Diabetes mellitus in Puskesmas Playen II. Rev Prim Care Prac and Educ. 2018; 1(1): 44-45.
CASE REPORT her illness.

A female patient aged 44 years came to check the level
of blood glucose because of non-healing wounds since an PROBLEM
accident 2 weeks ago. The results showed that her blood A patient who was first diagnosed with a chronic disease
glucose during the examination was 567 mg/dl. Since 2013, often does not fully understand the meaning or significance
the patient was already diagnosed with Type 2 Diabetes of the chronic disease with which his/ her body suffers,
Mellitus (T2DM). At that time the patient experienced against the risk of future complications if the disease is not
vomiting and had to be hospitalized, and apparently her well-controlled. On the other hand, in this reported case,
blood glucose level was 538 mg/dl when she had the same the patient’s expectation was that her chronic disease, the
checkup. The patient received treatment according to the T2DM, can be cured. Therefore, a shared understanding
national protocol on T2DM. Approximately 2 months after between health care providers and patient is likely the
the treatment, the patient discontinued checking the blood key to commencing the course of managing any chronic
glucose and was no longer taking the medicine because disease in a patient effectively.
she was influenced by information from her relative to
DISCUSSION
not to take continuous medication. The patient was asked
According to the current evidences, the diagnosis of T2DM
by her relative to do only exercise and to discontinue any
is often found at a younger age than before the many
medicine.
advances in modern medicine. This fact is likely due to a
Patient is the second child of 4 siblings. The patient has been
combination of the development of diagnostic criteria, and
married for 22 years and has two children, a 21-year-old
increases in physician knowledge of diabetes as a disease,
female and a 19-year-old male. The patient currently lives
and increased public awareness. The diagnosis at younger
at home with her husband and two children. Patient works
ages may also reflect the genuine initial population trend
as an entrepreneur, joining regular in social gatherings at
in T2DM1. So it is likely that this patient has suffered
her neighborhood, and has regular spiritual activities at the
from T2DM at a younger age. But perhaps because of
mosque near her house.
inadequate levels of education or access to inadequate
Biological Diagnosis and Psychological Diagnosis health information, the patient did not feel the importance
of the symptoms. And even knowing that she was suffering
Biological Diagnosis for T2DM disease is established by from a chronic disease, in this case T2DM, she did not
examining Fasting Blood Glucose and Blood Glucose 2 know the importance of controlling the symptoms and
hours after meal. In this case, the confirming diagnosis seeking treatment routinely so that her blood glucose was
was made after the second examination, which justified the controlled and any organ complications could be avoided
initial diagnosis that was first established in 2013. and minimized.
Health literacy is defined as the level of a person’s ability
Psychosocial diagnosis is established by exploring to obtain, process and understand basic health information
the patient’s reasons for visiting the doctor which was and services needed to make the right health decisions.
apparently she was concerned that her blood glucose is Limited health knowledge, which refers to marginal health
likely high, although she has been trying to do exercise literacy, inadequate health knowledge, or both, depending
regularly. Patient’s understanding of her illness had not been on the definition of the study, have been independently
fully established, and the patient received information from associated with some undesirable outcomes regarding the
others who advised her on non-medication management of outcome of health problems2.
Shofi Hesfianto │ Case Report: Type 2 Diabtetes Mellitus 45
Compared to individuals with sufficient levels of health depression associated with T2DM, continuous evaluation
knowledge, those with limited health knowledge have a is needed such as assessment of mental health status.
poorer understanding of their chronic disease, doctor’s Such a thorough assessment can only be undertaken if the
guidance and health-related websites; less effective disease continuity of care occurs.
management skills; higher disease indicator level; and
worse health outcome reported. Limited health knowledge Preventive Medicine has the potential to improve health
is also associated with poor using of certain prevention in chronic conditions such as T2DM, but many patients
services, increasing hospitalization, and increasing health in Indonesia are not getting optimal quality health care,
care costs. However, all these associations have not been so the results are rarely satisfying as happened in this
found with perfect consistency2. case. Achieving treatment goals for T2DM requires close
collaboration between patients, doctors, and other T2DM
To increase the level of understanding of a patient care team members during a long period of T2DM5.
concerning chronic illnesses, a good primary care feature
recommends a continuity of care approach. Continuity of REFERENCES
1. Koopman RJ, Mainous 3rd AG, Diaz VA, Geesey ME.
care is defined as consulting the same health care provider Changes in age at diagnosis of type 2 diabetes mellitus in
for a certain period of time. It is expected that high provider the United States, 1988 to 2000. Ann Fam Med [Internet].
continuity can have a positive impact on the quality of care 2005;3(1):60–3.
because of the growing personal knowledge and personal 2. Jeppesen KM, Coyle JD, Miser WF. Screening question
relationships between patient and service providers. The to predict limited health literacy: a cross-sectional study of
patients with diabetes mellitus. Ann Fam Med [Internet].
continuity of primary care is linked to better prevention 2009;7(1):24–31. Available from: www.annfammed.org
efforts (including immunization for children and adults), 3. Gill JM, Mainous 3rd. AG, Diamond JJ, Lenhard MJ. Impact
improving patient compliance in the treatment process of provider continuity on quality of care for persons with
because of sufficient understanding, improving doctor’s diabetes mellitus. Ann Fam Med [Internet]. 2003;1(3):162–
ability to identify and address bio-psychosocial problems, 70.
4. Bogner HR, Morales KH, de Vries HF, Cappola AR. Integrated
and decreasing referral to hospitals and visiting to management of type 2 diabetes mellitus and depression
emergency care. Patients who have access to continuity treatment to improve medication adherence: a randomized
of care with Family Doctors / Primary Care Doctors, controlled trial. Ann Fam Med. 2012;10:15–22.
feel more satisfied with their health services, tend to seek 5. Gulliford MC, Naithani S, Morgan M. Measuring continuity
follow-up treatment and counselling and communicate of care in diabetes mellitus: An experience-based measure.
Ann Fam Med. 2006;4(6):548–55.
better with health personnels3.
Another benefit of continuity of care is that it can improve

the quality of care for people with chronic conditions, such
as T2DM. T2DM as a chronic disease (which cannot be
cured but can be managed properly) requires considerable
medical management. This medical management tends to
be easier when the patient is treated by the same health
care provider continuously, because the health care
provider will be more likely to know when tests are needed
and encourage treatment changes when indicated. A more
recent study suggests that higher provider continuity could
lead to better glucose control3.
Patient management in this case is not yet compatible with

the primary care feature of the continuity of care, where
a reciprocal relationship between primary care providers
and patients is required. If the relationship is achieved
optimally then the severity of the disease suffered by the
patient does not become worse. Conversely, as occurred in
the patient in this case, after experiencing complications
from the disease, then the patient continued her medical
treatment.
Two-way associations were found between depression and

T2DM. Depression is a risk factor for T2DM and T2DM
increases the risk of depression. It is not only depression
that patients with T2DM commonly feel, it also contributes
to adherence to treatment and diet regimens, physical
inactivity, poor glycemic control, reduced quality of life,
disability, and increasing health expenditure4.
To determine the likelihood of patients suffering from

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44 Shofi Hesfianto │ Case Report: Type 2 Diabetes Mellitus

CASE REPORT: TYPE 2 DIABETES MELLITUS

To cite this article:

CASE REPORT her illness.

Another benefit of continuity of care is that it can improve

Patient management in this case is not yet compatible with

Two-way associations were found between depression and

To determine the likelihood of patients suffering from

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