Hypertension and Type 2 Diabetic Mellitus in the Middle-ages

Persons

Ade Heryana

, Intam Silviana Mustikawati

, Prima Darma Bekti

and Iin Desmiany Duri

Faculty of Health Sciences,Esa Unggul University

Public Health Department, Respati Indonesia University

Faculty of Public Health, Diponegoro University

Keywords: Type-2 Diabetic Mellitus, Risk Factors, Hypertension, Chronic Disease, Middle-ages

Abstract: Type-2 Diabetic Mellitus (NIDDM) is a chronic disease that glucose blood level elevated significantly

without dependency to insulin level. Diabetes gave medical and non-medical impacts for patients if

adequacy prevention was not arranged. Sedentary lifestyle made a significant positive trend to the

prevalence of diabetes. This study is a quantitative analytic investigated association between type-2 DM

with age and hypertension. Total of 680 health records from primary health service involved with

systematic random sampling. This study provided significance association between age and type-2 DM (OR

= 5.859), hypertension and type-2 diabetes (OR = 4.173) and age and hypertension (OR = 3.081).

Conclusion: people above or at 45 years old should be aware of the risk of hypertension that a gateway to

type-2 diabetes. They should routinely control blood pressure and modify healthy lifestyle to prevent

hypertension and type-2 diabetic mellitus.

1 INTRODUCTION

Diabetes Mellitus (DM or diabetes) is a group of

disease primarily characterized by chronic

hyperglycemia due to a lack of sufficient insulin

action (American Diabetes Association, 2014;

Nowotny et al., 2015; Areosa et al., 2017). One type

of DM is type 2 Diabetes or Noninsulin-Dependent

Diabetes (NIDM) is called adult-onset diabetes,

although there is tend to suffer among overweight

children (Sone, 2018).

The condition of diabetes will cause chronic

complications in various organs of the body if there

is no adequate treatment. The chronic compilations

are 1) stroke, in the cerebral blood vessels; 2)

blindness, in the blood vessels of the eye; 3)

coronary heart disease, in the heart blood vessels; 4)

chronic kidney disease, in the kidney blood vessels;

and 5) wounds difficult to heal, in the leg veins

(Waspadji, 2011; Huang et al., 2014; Sjöström et al.,

2014; Mostafa et al., 2018). This complication

definitely will reduce employee work productivity

for the productive age group.

There is an elevated level of prevalence of

diabetes in 2013 (diagnosed by doctors or

symptoms) compared to 2007 in the age group ≥ 15

years. In 2007 the prevalence of diabetes was 1.1%

while in 2013 it was 2.1% throughout Indonesia.

Prevalence of diabetes in Indonesia diagnosed by

doctors was 1.5% in 2013(Balitbangkes Kemenkes

RI, 2013). Diabetes Care Report projected the

prevalence of diabetes in Indonesia in 2030 is about

21.3 million peoples (Puskom Publik Kemenkes RI,

2009).

Hypertension or high blood pressure is a

condition where a person's blood pressure against

the arterial wall is consistently high, when the heart

contracted (systolic) greater than 140 mmHg and

when the heart weakened (diastolic) greater than or

equal to 90 mmHg (Boslaugh, 2008).This is a

chronic condition that could lead to heart disease,

stroke, and other diseases that can result in

premature death (Kung and Xu, 2015). Most of the

disease burden caused by high blood pressure is

borne by low-income and middle-income countries,

by people in middle age, and by people with

prehypertension. Prevention and treatment strategies

restricted to individuals with hypertension will miss

a much blood-pressure-related disease (Lawes et al.,

2008). RISKESDAS 2013 reported that the

prevalence of hypertension is 26.5% among peoples

≥ 18 years old. It is declined compared to the

Heryana, A., Silviana Mustikawati, I., Darma Bekti, P. and Desmiany Duri, I.

Hypertension and Type 2 Diabetic Mellitus in the Middle-ages Persons.

DOI: 10.5220/0009951430013007

In Proceedings of the 1st International Conference on Recent Innovations (ICRI 2018), pages 3001-3007

ISBN: 978-989-758-458-9

3001

prevalence in 2007,i.e. 31.7% (Balitbangkes

Kemenkes RI, 2013).

Arterial hypertension reported came upon a two-

third person with type 2 diabetes. Hypertension

increases the incidence of both micros- and

macrovascular complications. A person with

hypertension and type 2 diabetes leads to four-

foldincreased risk for cardiovascular disease (CVD)

compare to type 2 diabetes with normal tension

(Pavlou et al., 2018). The inaccuracy of salt and

water storage and the elevated of pressure from the

body in the peripheral blood circulation caused of

blood pressure closely related to insulin resistance as

the originator of the incidence of diabetes (Fatimah,

2015).

Hypertension strongly associated with the risk of

developing type 2 diabetes mellitus, as well as a

significant predictor of the incidence of

nephropathy, retinopathy, and cardiovascular disease

that accompanies DM. A study conducted in Osaka

(Osaka Health Survey), the relative risk of the

development of type 2 diabetes mellitus was 1.76 in

hypertensive men compared to 1.39 in normal

tension men. The incidence of hypertension is

increased in patients with 1.5 to 3 times diabetes

compared to normal patients. A study shows 40% of

people with diabetes experienced hypertension at 45

years old, and more than 60% at the 60 years old

(Cordario, 2005).

Diabetes risk factors due to hypertension in the

18 and above years old population reached 25.8%

(Ministry of Health, 2014). In general, the

proportion of people with diabetes who suffer from

hypertension is almost the same (Soewondo and

Pramono, 2011). The association of diabetes and

hypertension study in Indonesia showed that A

significant relationship between blood pressure and

the incidence of diabetes with odd ratio 6.85 times

compared to people with normal blood pressure

(Trisnawati and Setyorogo, 2013). There was a

significant relationship between hypertension and

the incidence of diabetes, with the risk of diabetes in

the group who had a higher history of hypertension

than the group with the normal tension of 3.41 times.

Hypertension and diabetes are interconnected risk

factors (Nainggolan et al., 2013).

The term “age” according to WHO is the amount

of time a person has gone through to date by

calculating the day/date of birth as zero. Humans

generally experienced a faster physiological decline

at 40 years old, and diabetes is more common at

above 40 years old (Yuliasih and Wirawanni, 2009).

In (Cho et al., 2018) state the prevalence of diabetes

8% (peaked) in the low-income countries among the

55-64 age group.

Some study in Indonesia showed the relationship

between age and diabetes. Indonesian mostly

suffered diabetes at the 38-47 years old with a

proportion of 25.3%. The risk of DM increases

gradually according to the development of age

(Soewondo and Pramono, 2011), the older had

tendency to suffer from diabetes and the group of

55-64 years old had a 14 times risk of diabetes

compared to the 25-34 years old group (Nainggolan

et al., 2013),84% of diabetes cases could be

prevented by taking into account age risk factors,

and the probability of diabetes occurring at below 45

years old and at 45 years is around 1 in 6 (Zahtamal

et al., 2007),diabetes risk in the <45 years old group

is 72% lower than the group ≥ 45 years old

(Trisnawati and Setyorogo 2013).

The Hypertension report by the World Health

Organization states that aging is one of the main

factors that contribute to the development of high

blood pressure and its complications (World Health

Organization, 2013).

The risk of hypertension higher with the

increasing of person’s life stages (Rahajeng and

Tuminah, 2009). Several studies in Indonesia is

proventhe association between age and

hypertension. Study at Public Health Careshowed

that there is an association between age and

hypertension with risk 13,34 times to peoples > 30

years old (Mutmainah and Heryana, 2017).Study at

rural community showed that peoples ≥ 31 years old

3,76 times likely to hypertension than others

(Yogaswara and Heryana, 2018).

2 RESEARCH METHOD

This study held in Cempaka Putih public health

service district that we called “Puskesmas Cempaka

Putih.” Type 2 diabetes is a 3

rank disease at

Puskesmas Cempaka Putih with the incidence

increased from 2014 to 2015. In 2014 the cases of

type 2 DM patients reached 2,022 while in 2015

increased to 2,446. Thus according to the whole

population in 2012, the prevalence of type 2 DM in

2015 is about 2.67%.

The objective of this study is to proof (1) the

association between age with type 2 DM and

hypertension; and (2) the association between age

and hypertension. From several studies we state the

model age-DM-hypertension as follow:

ICRI 2018 - International Conference Recent Innovation

3002

Figure 1: Age-Diabetes-Hypertension Model

We propose three hypothetical testing: positive

association between age and hypertension, positive

association between age and type-2 diabetes; and

positive association between hypertension and type-

2 diabetes (see Figure 1).We defined: (1) Type 2

diabetes is a condition of hyperglycemia in patients

that is stated with a doctor's diagnosis or ICD-X

code on a health record; (2) Hypertension is blood

pressure at the time of the study based on medical

record. Measurement classified by (1) Hypertension

if hystolic blood pressure ≥ 140 mmHg and or

systolic blood pressure ≥ 90 mmHg; and (2) Normal

tension if hystolic blood pressure <140 mmHg and

or systolic blood pressure <90 mmHg; and (3) Age

is the period of the respondent at the time of the

study which is known from the health records data.

The measurement classified into (1) Risk, if age ≥

45 years old; and (2) Not at risk, if the age is <45

years old.

Case-Control design held for the association

between type-2 diabetes and age/hypertension, and

Cross-sectional design for the association between

age and hypertension. Cases group was people with

diabetes mellitus ≥ 15 years old during 2016-2017

who were obtained from the healthrecord, while

Control group was patients ≥ 15 years old who

visitedgeneral medical service thatwere not type 2

diabetes diagnosed by a medical doctor. The

population were all of the patients visited general

medical service in 1 year period,it isabout 2.540

peoples in 2016. Total of 680 sample size counted

with Hypothesis Test for the Odds Ratio methods,

obtained 340Case and 340 Control group.Systematic

randomsampling was carried out to this study.

Inclusion criteria are above 15 years old, no barrier

in communication, and willing to be a respondent.

Exclusion if pregnant women and in illness

condition.

3 RESULTS

Table 1 showed that the mean of systolic blood

pressure is 120.4 mmHg (CI 95% : 119.1 – 121.6

mmHg), with a range from 80 to 200 mmHg.

Diastolic blood pressure’s mean is 78.7 mmHg (CI

95% = 78.1 – 79.4 mmHg), with range from 30 to

110 mmHg. The range of age from 16-74 years with

the mean 45.5 (CI 95% = 44.7 – 46.3 years).

Table 2 showed that 313 participants (55.6%)

diabetesin hypertension condition, and 90

participants (76.9%) non type-2 diabetes in normal

tension, there is a significant association with risk

4.173 times likely suffering type-2 DM for

hypertension participants.

Table 1: Age and Blood pressure Profiles (N=680)

No Characteristics Mean CI95% SD SE Min Max

1 Systolic blood pressure 120.4 119.1 – 121.6 16.9 0.647 80 200

2 Diastolic blood pressure 78.7 78.1 – 79.4 9.0 0.346 30 110

3 Age 45.5 44.7 – 46.3 10.8 0.413 16 74

Table 2: Association between Type-2 DM with Hypertension and Age (N=680)

No Independent variables

Type-2 Diabetic Mellitus

p-value Odds Ratio (CI 95%) Case (+) Control (-) Total

Freq. % Freq. % Freq. %

1 Blood pressure

Hypertension 313 55.6 250 44.4 563 100.0 0.000 4.173 (2.589 – 6.880)

Normal tension 27 23.1 90 76.9 117 100.0

2 Age

≥ 45 years old 199 75.1 66 24.9 265 100.0

0.000 5.859 (4.096 – 8.406)

< 45 years old 141 34.0 274 66.0 415 100.0

Age

Hypertension

Type 2 DM

Hypertension and Type 2 Diabetic Mellitus in the Middle-ages Persons

3003

Table 3: Association between Age with Hypertension (N=680)

No Age

Blood Pressure

p-value Odds Ratio (CI 95%)

Hypertension Normal Total

Freq. % Freq. % Freq. %

1 ≥ 45 years old 94 22.7 321 77.3 415 100.0 0.000 3.081 (1.868 – 5.245)

2 < 45 years old 23 8.7 241 91.3 265 100.0

Table 2 also showed that 199 participants

(75.1%) with type-2 DM were above and at 45 years

old. Otherwise, 241 participants (91.3%) non type-2

DM were below 45 years old. Thisresults proof that

age and type-2 DM had a significant association,

with risk 5.859 times likely suffering type-2 DM for

participants above and at 45 years old compared to

below 45 years old.

In another analysis, Table 3 showed that 94

participants (22.7%) above and at 45 years old had

hypertension. Otherwise,241 participants (76.9%)

below 45 years oldhad normal tension. Thisresults

proof that age and hypertension had a significant

association, with risk 3.081 times likely suffering

hypertension for participants above and at 45 years

oldcompared to below 45 years old participants.

4 DISCUSSION

4.1 High Blood Pressure and Diabetic

Mellitus

This study provided that The mean of systolic blood

pressure is 120.4 mmHg (95 CI = 119.1 – 121.6

mmHg) and diastolic is 78.7 (78.1 – 79.4),

hypertension has a significant association with type

2 diabetes mellitus. This result linear with other

hypertension studies.

According to Joint National Committee Report,

participants in this study on average have a normal

tension both systolic and diastolic, but if we look the

maximum value, there are some participants in stage

2 hypertension. JNC VII stated that normal tension if

systolic < 120 mmHg and diastolic and< 80 mmHg

(National Institute of Health, 2004). It isimportant

for the authority of the health system to take action

in controlling blood pressure especially to peoples

above 45 and at years old.

Early detection of blood pressure is an effective

intervention and treatment to prevent hypertension

and more impact of cumulative cardiovascular risk

(Volpe et al., 2018). Furthermore this healthy action

effective in the association with diabetes risk factors.

Unfortunately, this healthy behavior is rarely seen in

our community. This condition includes the

prevention of hypertension with decreasing risk

factors and routine blood pressure control.

Blood pressure controlling in Indonesia showed

that only 18% of hypertension participants were

under control (Herwati and Sartika, 2013). Maharani

and Syafrandi (2017) reported that 60% of

hypertension persons had unhealthy behavior in

controlling blood pressure. This study proofed that

people’s awareness of the importance of routinely

blood pressure control already in low level,

especially among people with high-risk factors.

For persons who are suffering diabetes should

manage and control hypertensionshould be ˂ 130/85

mmHg (Niakan and Cushman, 2018). In (Grenier et

al., 2018) only about one-third of patients with

diabetes achieved the target blood pressure below

130/80 mmHg. Patients with blood pressure ≥

130/80 mmHg were also less likely to achieve

optimal guideline-recommended glycated

hemoglobin and low-density lipoprotein-cholesterol

targets. Improved comprehensive management of all

risk factors in patients with diabetes is warranted.

The empowerment of older health integrated unit

and chronic disease control program at public health

care in Indonesia is a useful intervention to promote

controlling blood pressure. It is the cross-section

tasks that public healthcare has to collaborate with

all stakeholders.

4.2 Association between Age and

Diabetes and Hypertension

This study provided that age has a significant

association with type 2 diabetes and hypertension.

This result linear with other studies. Middle-ages is

human life stages that decline some organ function

(Knopman et al., 2001). It isimportant for the

authority of health system to promote

healthylifestyle among ≥ 45 age group, especially

for the older group. IDF predicted by 2050 the

proportion of older people in the population will

increase from 15% to 25%. Itis led to the prevalence

of type 2 diabetes in older people,andunfortunately,

the management of diabetes for this group is not

easy(Colagiuri et al., 2014).

ICRI 2018 - International Conference Recent Innovation

3004

One of national levelhealth program that aids

action to prevent hypertension and diabetes at

middle-ages is “Prolanis”.Since 2014 Prolanis is

health programdirected by primary health care and

supervised by national health insurance to maintain

the healthy condition of NHI member that suffering

chronic disease. “Prolanis” aims to reach optimal

quality of life with effective and efficient in service

cost(BPJS Kesehatan, 2014).

Prolanistargeted for peoples who registered as

NHI members (BPJS Kesehatan, 2014). Study

conducted at one of primary health care in Indonesia

showed that the members of Prolanis largely women,

above 45 years old, had lower education,

unemployment, and had obesity condition. Most of

members are disobedient to routinely implement the

education of this program and physical activity and

had unstable glucose level in blood.The obedient to

implement Prolanis associated with stability of

glucose level in blood(Primahuda and Sujianto,

2016).It is suggested that Prolanis program should be

empower by all stakeholders in diabetes prevention

Prolanis is an appropriate way to increase health

statue for people who above or at 45 years old.

Prevalence of hypertension in elderly higher than

adult, wich is most of primary hypertension and

isolated systolic hypertension. Hypetension

management in elderly basically similar with adult, it

is included life-style modification and

pharmacotherapy intervention. Several life-style

should be improved are decreasing body weight if

obesity or overweight, restricted to alcohol, pyshical

activity, low salt intake, adequate potasiumand

magnesium intake, stop smoking, and decreasing

intake of saturated fat and cholesterol (Kuswardhani,

2006).

Some of foods and beverages should avoid to

prevent hypertension include: high level of

saturated-fat, process with natrium salt, Cans

food/drink, preserved meal, full cream milk,

margarine, mayonnaise, eggs, seasonings with high

natrium, alcohol, and alcohol contained food like

durian (Kemenkes RI, 2014).

Theaction of hypertension intervention above

should undertake with others activity to prevent

diabetes. In (Chatterjee et al., 2017) prevention of

type 2 diabetes should attempted with widespread

national prevention programmes. Prolanis is the

right intervention for controlling prevalence of

hypertension and diabetes focus on middle-aged.

5 CONCLUSIONS

This study provided significance association

between age and type-2 DM (OR = 5.859),

hypertension and type-2 DM (OR = 4.173) and age

and hypertension (OR = 3.081). People above or at

45 years old should be aware with the risk of

hypertension that a gateway to type-2 diabetes. They

should routinely control blood pressure and modify

healthy life-style to prevent hypertension and type-2

diabetic mellitus. Primary health care should

intensively arrange “Prolanis” program that

supervised by National Health Insurance.

ACKNOWLEDGEMENTS

We thanks to staff of Puskesmas Cempaka Putih that

accompanied this study and Professor Bacharudin

Lapau to supervised progress of research.

REFERENCES

Areosa, A. S., Vernooij, R. W., González-Colaço, M. H.,

and Martínez, G. (2017). Effect of the treatment of

Type 2 diabetes mellitus on the development of

cognitive impairment and dementia. Cochrane Library.

John Wiley & Sons, Ltd. Available at:

https://www.journalslibrary.nihr.ac.uk/downloads/othe

r-nihr-research/cochrane-programme-

grants/Effect%20of%20the%20treatment%20of%20T

ype%202%20diabetesmellitus%20on%20the.pdf

American Diabetes Association. (2014). Diagnosis and

Classification of Diabetes Mellitus. Diabetes Care,

37(1): S81-S90.

Balitbangkes Kemenkes RI. (2013). Riset Kesehatan

Dasar: RISKESDAS 2013. Laporan Nasional 2013.

Jakarta: Kementerian Kesehatan RI. https://doi.org/1

Desember 2013

Boslaugh, S. (2008). Hypertension. In Encyclopedia of

Epidemiology 1&2 (p. 513). SAGE Publications.

BPJS Kesehatan. (2014). Panduan praktis PROLANIS

(Program pengelolaan penyakit kronis). BPJS

Kesehatan. Jakarta: BPJS Kesehatan.

Chatterjee, S., Khunti, K., and Davies, M. J. (2017). Type

2 diabetes. The Lancet. https://doi.org/10.1016/S0140-

6736(17)30058-2

Cho, N. H., Shaw, J. E., Karuranga, S., Huang, Y., da

Rocha Fernandes, J. D., Ohlrogge, A. W., and

Malanda, B. (2018). IDF Diabetes Atlas: Global

estimates of diabetes prevalence for 2017 and

projections for 2045. Diabetes Research and Clinical

Practice, I(38): 271–281.

Colagiuri, S., Cho, N. H., Distiller, L., Dong, B., Duning,

T., Gadsby, R., … Sinay, I. (2014). The IDF global

Hypertension and Type 2 Diabetic Mellitus in the Middle-ages Persons

3005

guideline for managing older people with type 2

diabetes. Journal of Diabetes Nursing.

https://doi.org/10.1016/j.diabres.2014.03.005

Cordario, R. A. (2005). Type-2 Diabetes, Prediabetes, and

the Metabolic Syndrome: The Primary Care Guide to

Diagnosis and Management. New Jersey: Humana

Press.

Fatimah, R. N. (2015). Diabetes Melitus Tipe 2. Majority,

4(5): 93–101. https://doi.org/10.2337/dc12-0698

Grenier, J., Goodman, S. G., Leiter, L. A., Langer, A.,

Teoh, H., Bhatt, D. L., … Yan, A. T. (2018). Blood

Pressure Management in Adults With Type 2

Diabetes: Insights From the Diabetes Mellitus Status

in Canada (DM-SCAN) Survey. Canadian Journal of

Diabetes, 42(2): 130–137.

https://doi.org/10.1016/j.jcjd.2017.01.005

Herwati, H., and Sartika, W. (2013). Terkontrolnya

Tekanan Darah Penderita Hipertensi Berdasarkan Pola

Diet Dan Kebiasaan Olahraga Di Padang Tahun 2011.

Andalas Jorunal of Public Health, 8(1): 8–14.

Huang, E. S., Laiteerapong, N., Liu, J. Y., John, P. M.,

Moffet, H. H., and Karter, A. J. (2014). Rates of

complications and mortality in older patients with

diabetes mellitus: the diabetes and aging study. JAMA

internal medicine, 174(2): 251-258.

Kemenkes RI, P. (2014). Hipertensi. Infodatin. Jakarta.

https://doi.org/10.1177/109019817400200403

Knopman, D., Boland, L. L., Mosley, T., Howard, G.,

Liao, D., Szklo, M., … Folsom, A. R. (2001).

Cardiovascular risk factors and cognitive decline in

middle-aged adults. Neurology, 1(2): 42–48.

https://doi.org/10.1212/WNL.56.1.42

Kung, H. C., and Xu, J. (2015). Hypertension-related

Mortality in the United States, 2000-2013. NCHS data

brief, (193): 1-8.

Kuswardhani, T. (2006). Penatalaksanaan Hipertensi Pada

Lanjut Usia. Jurnal Penyakit Dalam, 7(2): 135–140.

Lawes, C. M., Hoorn, S. Vander, and Rodgers, A. (2008).

Global burden of blood-pressure-related disease, 2001.

The Lancet, 371(9623): 1513–1518.

https://doi.org/10.1016/S0140-6736(08)60655-8

Maharani, R., and Syafrandi, D. P. (2017). Faktor yang

Berhubungan dengan Perilaku Pengendalian Tekanan

Darah pada Penderita Hipertensi di Puskesmas

Harapan Raya Kota Pekanbaru Tahun 2016.

Kesehatan Komunitas, 3(5): 165–171.

Mostafa, S. A., Coleman, R. L., Agbaje, O. F., Gray, A.

M., Holman, R. R., and Bethel, M. A. (2018).

Modelling incremental benefits on complications rates

when targeting lower HbA1c levels in people with

Type 2 diabetes and cardiovascular disease. Diabetic

Medicine, 35(1): 72-77.

Mutmainah, N., and Heryana, A. (2017). Faktor-faktor

Risiko yang Berhubungan dengan Kejadian Hipertensi

pada Pasien di Puskesmas Kecamatan Kembangan

Tahun 2017. Universitas Esa Unggul.

Nainggolan, O., Kristanto, A. Y., and Edison, H. (2013).

Determinan Diabetes Melitus Analisis Baseline Data

Studi Kohort Penyakit Tidak Menular Bogor 2011.

Buletin Penelitian Kesehatan, 16(3 Juli 2013): 331–

339.

National Institute of Health. (2004). The Seventh Report of

the Joint National Comittee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure.

Niakan, A., and Cushman, W. C. (2018). Hypertension

and Diabetes. In Encyclopedia of Endocrine Disease

(pp. 1–6). Elsevier.

Nowotny, K., Jung, T., Höhn, A., Weber, D., and Grune,

T. (2015). Advanced glycation end products and

oxidative stress in type 2 diabetes mellitus.

Biomolecules, 5(1): 194-222.

Pavlou, D. I., Paschou, S. A., Anagnostis, P., Spartalis,

M., Spartalis, E., Vryonidou, A., … Siasos, G. (2018).

Hypertension in Patients with Type 2 Diabetes

Mellitus: Targets and Management. Maturitas, 112:

71–77.

Primahuda, A., and Sujianto, U. (2016). Hubungan Antara

Kepatuhan Mengikuti Program Pengelolaan Penyakit

Kronis (PROLANIS) BPJS Dengan Stabilitas Gula

Darah Pada Penderita Diabetes Melitus Di Puskesmas

Babat Kabupaten Lamongan. Jurnal Jurusan

Keperawatan, 1–8. Retrieved from

http://eprints.undip.ac.id/49908/

Puskom Publik Kemenkes RI. (2009). Tahun 2030

Prevalensi Diabetes Melitus Di Indonesia Mencapai

21,3 Juta Orang. Retrieved August 26, 2018, from

http://www.depkes.go.id/article/view/414/tahun-2030-

prevalensi-diabetes-melitus-di-indonesia-mencapai-

213-juta-orang.html

Rahajeng, E., and Tuminah, S. (2009). Prevalensi

Hipertensi dan Determinannya di Indonesia. Majalah

Kedokteran Indonesia, 59(12): 580–587.

Sjöström, L., Peltonen, M., Jacobson, P., Ahlin, S.,

Andersson-Assarsson, J., Anveden, Å., ... and

Näslund, I. (2014). Association of bariatric surgery

with long-term remission of type 2 diabetes and with

microvascular and macrovascular complications.

Jama, 311(22): 2297-2304.

Soewondo, P., and Pramono, L. a. (2011). Prevalence,

characteristics, and predictors of pre-diabetes in

Indonesia. Medical Journal of Indonesia, 20(4): 283–

294. https://doi.org/10.13181/mji.v20i4.465

Sone, H. (2018). Diabetes Mellitus. In Encyclopedia of

Cardiovascular Research and Medicine (pp. 9–16).

Elsevier.

Trisnawati, S. K., and Setyorogo, S. (2013). Faktor Risiko

Kejadian Diabetes Melitus Tipe II Di Puskesmas

Kecamatan Cengkareng Jakarta Barat Tahun 2012.

Jurnal Ilmiah Kesehatan, 5(1): 6–11.

Volpe, M., Gallo, G., and Tocci, G. (2018). Is Early and

Fast Blood Pressure Control Important in

Hypertension Management? International Journal of

Cardiology, 254: 328–332.

Waspadji, S. (2011). Diabetes Melitus: Penyulit Kronik

dan Pencegahannya. In S. Soegondo, P. Soewondo;, &

I. Subekti (Eds.), Penatalaksanaan Diabetes Melitus

Terpadu (FK Univers). Jakarta.

ICRI 2018 - International Conference Recent Innovation

3006

World Health Organization. (2013). A Global Brief on

Hypertension: Silent Killer, Global Public Health

Crisis. Geneva, Switzerland.

Yogaswara, Y. M., and Heryana, A. (2018). Faktor-faktor

yang Berhubungan dengan Kejadian Hipertensi di

RT11 Desa Pantai Hurip Kabupaten Bekasi 2018. Esa

Unggul.

Yuliasih, W., and Wirawanni, Y. (2009). Obesitas

Abdominal sebagai Faktor Risiko Peningkatan Kadar

Glukosa Darah. Universitas Diponegoro.

Zahtamal, Z., Chandra, F., Suyanto, S., and Restuastuti, T.

(2007). Faktor-faktor Risiko Pasien Diabetes Melitus.

Berita Kedokteran Masyarakat, 23(3): 142–147.

Hypertension and Type 2 Diabetic Mellitus in the Middle-ages Persons

3007