A Systematic Review: Evaluation of Treatment for Diabetes Mellitus

with Comorbidities Who Have Been Vaccinated Against COVID-19

Maria Sheila Setya Ningtyas and Diana Laila Ramatillah

Faculty of Pharmacy, University of 17 Agustus 1945 Jakarta, Jakarta, Indonesia

Keywords: Comorbidities, Diabetes Mellitus, Evaluation, Treatment, Vaccinated COVID-19.

Abstract: Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycemia. Diabetes

mellitus is a major public health problem with a wide impact because it can cause other comorbidities such

as hypertension, heart and blood vessel disease, stroke, kidney failure, blindness, leg amputation, and death.

This study aims to determine the treatment evaluation of patients with diabetes mellitus with comorbidities

who have been vaccinated with COVID-19. Literature review using research reports from several journal

databases, namely Google Scholar, PubMed, Science Direct, and Vaccine. The article search used the PICOS

method and the analysis was carried out qualitatively. The results of the stTTudy obtained 23 research reports.

The results of the systematic review that have been reviewed are the most widely used drugs as a treatment

for diabetes mellitus, namely metformin both single and combined, then the sulfonylurea group. The most

widely used treatment for comorbid hypertension is candesartan. The conclusion from the literature review is

that the evaluation of diabetes mellitus treatment with comorbidities is by the management guidelines and

overall is appropriate, namely the right indication, the right drug, the right dose, the right method of

administration, the right time interval and the right duration of administration.

INTRODUCTION

Diabetes mellitus is a medical condition in which

blood glucose levels rise above normal levels. Sugar

levels remain high in the blood, which can be caused

by insulin not being produced, insulin that is

insufficient for the body's needs, or ineffective.

Diabetes mellitus is currently one of the global health

threats (Endocrinology Society Indonesian).

WHO predicts that globally there will be a

considerable increase in the number of patients with

type 2 diabetes mellitus in the coming years.

Meanwhile, the prevalence in Indonesia is predicted

to be around 21.3 million in 2030. The International

Diabetes Federation (IDF) predicts that in 2045

people with diabetes mellitus in Indonesia will reach

16.6 million (IDF, 2019). Based on data from Basic

Health Research (Riskesdas, 2018), the prevalence of

diabetes mellitus in Indonesia has increased to 8.5%

(Ministry of Health of the Republic of Indonesia,

2018).

In general, the goal of diabetes mellitus

management is to improve the quality of life of

diabetic patients and the ultimate goal of management

is to reduce the morbidity and mortality of diabetes

mellitus (Endocrinology Society of Indonesia, 2021).

Diabetes mellitus is one of the non-communicable

diseases and is also called the "silent killer" and

"Mother of disease" which is the carrier or parent of

other diseases or other comorbidities such as

hypertension, heart and blood vessel disease, stroke,

kidney failure, blindness, leg amputation until death.

(Meryta and Fachdiana, 2023).

Diabetes mellitus is one of the main risk factors

for Covid-19 exposure. People with diabetes mellitus

are susceptible to infection due to hyperglycemia,

impaired immune function, vascular complications,

and other comorbidities such as hypertension,

dyslipidemia, and cardiovascular disease. The

severity and mortality of COVID-19 are significantly

higher in patients with diabetes mellitus than non-

diabetes mellitus. Due to a decrease in the function of

the body's immune system, people with diabetes

mellitus are one of the factors that trigger the young

Covid-19 during the pandemic. (Jeong et al., 2020).

According to data from the Indonesian Ministry of

Health, 70% of the 8,320 patients who died from

covid-19 had not received the full vaccine. The

COVID-19 vaccine can significantly reduce the

severity of the disease course and death. In addition,

Ningtyas, M. and Ramatillah, D.

A Systematic Review: Evaluation of Treatment for Diabetes Mellitus with Comorbidities Who Have Been Vaccinated Against COVID-19.

DOI: 10.5220/0012585100003821

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 4th International Seminar and Call for Paper (ISCP UTA ’45 JAKARTA 2023), pages 165-170

ISBN: 978-989-758-691-0; ISSN: 2828-853X

165

a low immune system can produce strong antibodies

after vaccination, so the COVID-19 vaccine is very

important for susceptible patients. (Asriati et al.,

2023).

Combined efforts between pharmacological and

non-pharmacological therapies can be part of the

management of diabetes mellitus and its

comorbidities. Patterns and conformity with

standards, especially oral antidiabetics as the first line

of pharmacological therapy for type 2 diabetes

mellitus, are very important for proper therapy.

(Endocrinology Society Indonesian.

Based on the research of Inayah et.al (2016), the

treatment of diabetes mellitus with comorbid

hypertension mostly uses metformin and candesartan

drugs. Where this is by PERKENI 2021.

Administration of hypertension drugs in the calcium

channel blocker group can improve cardiovascular

performance (Inayah et al., 2016).

Research Jonathan et.al (2019) patients with type

2 diabetes mellitus are mostly given single drug

therapy (65.2%), namely metformin. If single therapy

has not reached the target (HbA1C), a combination

therapy of 2 drugs with different mechanisms is

given, if the combination therapy of 2 drugs has not

reached the target, it is increased to a combination

therapy of 3 drugs with different mechanisms. This is

by the management of diabetes mellitus regulated by

Perkeni 2021. (Jonathan et al., 2019).

Based on Pratama and Ratnasari's research

(2021), the most widely given diabetes mellitus

treatment is a combination of two oral antidiabetics,

namely metformin and glimepiride. Aims to better

control the patient's blood glucose with different

mechanisms of action of the drugs. Then additional

vitamin drugs such as mecobalamin are given to treat

comorbid diabetic neuropathy patients. (Pratama and

Ratnasari, 2021).

According to research by Nuraisyah et al. (2022)

the use of drugs for patients with diabetes mellitus

with stroke complications both combination and

single is dominated by the use of parenteral

antidiabetic drugs such as novorapid injection, while

the most widely used oral antidiabetic drugs such as

glimepiride, calcium channel blocker

antihypertensive drugs, antiplatelet drugs. (Octariani

et al., 2022)..

Based on the background that has been described,

the authors consider it is necessary to conduct a

systematic review study to discuss and examine

various scientific information regarding the

evaluation of treatment of patients with diabetes

mellitus with comorbidities who have been

vaccinated with COVID-19.

METHODS

This study is a systematic review, using the PRISMA

(Preferred Reporting Items for Systematic Reviews

and Meta-analyses) method which is carried out

systematically by following the correct stages or

research protocols. The procedure of this systematic

review consists of several steps, namely 1) compiling

Background and Purpose, 2) Research Question, 3)

Searching for the literature 4) Selection Criteria 5)

Practical Screen 6) Quality Checklist and Procedures

6) Data Extraction Strategy, 7) Data Synthesis

Strategy.

This study was conducted in June-August 2023 in

Jakarta. The search for research articles relevant to

the topic of this study was carried out using

keywords: diabetes mellitus, asthma, covid-19

vaccination, metabolic syndrome, comorbid, covid-

19 obtained from Google Scholar, PubMed,

ScienceDirect, Vaccine published between (2011-

2023). The inclusion criteria in this study were

patients with diabetes mellitus, comorbidities, and

covid-19 vaccination. The exclusion criteria for this

study were literature that was not available in full text,

case reports. A total of 102 articles were identified,

then filtered into 50 articles. Then after adjusting the

inclusion criteria, 23 articles were obtained.

RESULTS AND DISCUSSION

The results of the systematic review obtained 23

research reports that can be used to answer the

formulation of this research problem. Diabetes

mellitus is one of the chronic diseases that is

catastrophic because it has a high morbidity and

mortality rate throughout the world, both in

developed countries and in developing countries. This

disease has become more important to pay attention

to because of the COVID-19 pandemic, a viral

infectious disease that mainly affects the respiratory

tract.

Determining the amount of diabetes mellitus

therapy requires HbA1C examination as a standard

according to PERKENI 2021, namely, if HbA1C is

below 7.5% and within 3 months HbA1C is above

7%, monotherapy is given. If within 3 months

monotherapy does not reach the target below 7.5%, it

is upgraded to a combination of 2 drugs with different

modes of action. If within 3 months it has not reached

the target, it is given a combination therapy of 3 drugs

with different mechanisms of action or with

additional insulin. If HbA1C is above 9% needs to be

ISCP UTA ’45 JAKARTA 2023 - THE INTERNATIONAL SEMINAR AND CALL FOR PAPER (ISCP) UTA ’45 JAKARTA

166

given insulin (Endocrinology Society Indonesian.

Research by Fortuna et al (2023) with a total of

120 patients found that in the evaluation of diabetes

mellitus treatment at Baptist Batu Hospital, there

were problems with antidiabetic drugs such as

ineffective drugs, patients should have received

combination therapy, instead of receiving single

therapy, then dose selection, inappropriate indication,

dose. So that in the future more evaluation must be

carried out regarding the selection of drugs, and doses

and must be according to the right indications

(Fortuna Surat Bala et al., 2023).

Research by Kuna et.al (2022) at the Gogagoman

Health Center using descriptive methods

retrospectively with the sampling method, namely

total sampling of 81 people, found that the treatment

of type 2 diabetes mellitus used metformin (61%),

glimepiride (11%), glibenclamide (2%), metformin &

glimepiride (11%), and a combination of metformin

& glibenclamide (2%). The rationality of treatment

for type 2 diabetes mellitus at the Gogagoman Health

Center in 2022 was 34%. Based on the evaluation of

antidiabetic treatment, 68% of patients had the right

indication, 68% had the right drug, 69% had the right

patient 75%, and 77% had the right dose. (Kuna et al.,

2022).

Based on research by Meryta et al (2023)

descriptive method with the number of prescriptions,

namely 499 prescription sheets. Based on the class of

drugs and active substances most widely used are the

biguanid group (Metformin) as many as 13,356

tablets (68.62%), 3rd Generation Sulfonylurea Group

(Glimepiride) as many as 3,232 tablets (16.61%), 2nd

Generation Sulfonylurea Group (Glibenclamide) as

many as 2,716 tablets (13.95%), Alpha Glucosidase

Inhibitors (Acarbose) as many as 160 tablets (0.82%).

(Meryta et.al, 2023).

This is in line with research with a retrospective

method with a total of 97 patients. It was found that

there were 97 subjects of Type 2 DM patients who

received single and combination metformin therapy

in 2019. Based on the data, the female gender with

age 56-65 years is more and patients also have a

diagnosis of DM with complications. The accuracy of

prescribing based on research obtained the right

indication based on the patient's BMI of 76.3%, and

based on the doctor's diagnosis of 100%. Appropriate

medication based on the dose of administration was

100%. The right patient condition was 97.94%.

Overall evaluation of metformin prescribing has

reached 75.26%. (Indah Cahyaningsih et al., 2021)

According to research by Bintang et.al (2021) in a

cross-retrospective manner with a sample size of 64

patients, it was found that the most prescribed drug

was a combination of oral antidiabetics, namely

Gliklazid and Metformin (29.70%), in terms of the

correct dose and the right way of administering the

drug, it was by the guidelines in the Ministry of

Health and FRS (100%), in data on patients who

experienced a decrease in GDA, it was seen that the

administration of sulfonylurea and biguanide

combination therapy compared to single therapy was

92.5%. (Bintang et.al, 2021).

This is supported by a research article by Jonathan

et al. (2019) with a total sample of 115 samples, the

single oral antidiabetic therapy most widely used for

the treatment of patients with type 2 diabetes mellitus

at the Bandung City Hospital is metformin (43.5%).

This is by the management of diabetes mellitus

regulated by Perkeni 2021. Most cases of type 2 DM

use metformin as first-line therapy (Jonathan et al.,

2019). Metformin has the main effect of reducing

liver glucose production (gluconeogenesis) and

improving glucose uptake in peripheral tissues by 10-

40% and can reduce HbA1C by 1-1.3%. In addition,

metformin is safe, effective, and inexpensive, does

not cause hypoglycemia compared to the sulfonylurea

group, and can also reduce the incidence of CVD.

However, metformin cannot be used in patients who

have GFR < 30 mL/min. (Endocrinology Society

Indonesian.

Treatment of patients with diabetes mellitus and

stroke comorbidities at Aji Muhammad Parikesit

Tenggarong Hospital with a total sample of 20

people, it was found that the most widely used

antidiabetics were metformin monotherapy and

combination therapy between metformin and

glimepirid, In In In which In In In amounted to 15%.

The combination of oral antidiabetic drugs is the right

combination because it has a synergistic way of

working that can reduce blood glucose more than

every single treatment. In addition to the combination

of oral drugs, oral-insulin combination therapy was

also obtained, namely metformin with novorapid

insulin. The use of insulin is given if the patient's

condition has dropped or has high blood glucose

levels. The widespread use of novorapid injection is

because it is rapid-acting and can provide a faster

postprandial glucose level reduction effect than

regular insulin. (Octariani et al., 2022)..

As for the comorbid stroke itself, the therapy

given is ARB hypertension drugs, namely

candesartan by 20%. This is by Perkeni 2021. The use

of aspirin antiplatelets (40%) is also important to

reduce vascular risk, especially in the 24-48 hours of

the attack. Aspirin is the most commonly used

antiplatelet agent because it reduces recurrent

vascular events from 22% to 13% and the risk of

A Systematic Review: Evaluation of Treatment for Diabetes Mellitus with Comorbidities Who Have Been Vaccinated Against COVID-19

167

recurrent stroke 15% compared to placebo (Octariani

et al., 2018). (Octariani et al., 2022)..

Research by Inayah et.al (2016) in one of the

hospitals in Pekanbaru with a total of 296 patients

with diabetes mellitus with comorbid hypertension,

found that the most widely used diabetes mellitus

treatment was metformin by 90.3% and the smallest

was acarbose by 1.69%. As for the treatment of

comorbid hypertension, not all patients with type 2

DM with comorbid hypertension received OAH

therapy, almost half of the subjects without

antihypertensive drugs, namely 44.91%. This can

occur because the subjects included in the study were

those who had complete data at the first visit, so

maybe the doctor had just diagnosed comorbid

hypertension for the first time. So that this can be a

consideration for doctors not to immediately provide

OAH therapy because the management of type 2 DM

patients with comorbid hypertension also begins with

lifestyle modification. As for patients who received

antihypertensive treatment therapy, the most widely

used was candesartan at 66.24%. Candesartan

administration has almost the same effect as ACE-I

but has the advantage of not causing side effects of

dry cough and angioedema. (Inayah et al., 2016).

Based on the research by Irene et.al (2020) with a

cross-sectional, retrospective research design using a

total of 115 samples. It was found that patients who

used oral antidiabetics generally had used them <5

years (76.3%) and used monotherapy (63.5%).

Neuropathy (42.6%) and hypertension (85.9%) were

the most common complications and comorbidities of

diabetes in this study. Tight glycemic control is an

important management for people with diabetes

mellitus. (Irene et al., 2020)

Pratama and Ratnasari's research at Denpasar Bali

Private Hospital used a cross-sectional research

design with a descriptive observational approach of

120 patients. It was found that the most widely used

antidiabetics were the biguanid group (37.9%) with

the type of drug metformin (37.9%). As many as

43.32% of patients received a combination of two

antidiabetic therapies, namely biguanid and

sulfonylurea groups with metformin and glimepiride.

The most widely used pattern of use of other drugs is

the vitamin group (41.48%) with the type of drug

mecobalamin (40.37%). (Pratama and Ratnasari,

2021).

Based on research by Kardela et al. (2022) using a

cross-sectional design, the number of subjects was 23

patients. The results of the evaluation of drug-related

problems in 23 patients showed that there were two

categories of drug-related problems identified, namely

the problem of potential drug interactions of as many

as 35 events (59%) and the problem of too high doses

or frequencies as many as 24 events (41%). Based on

the results of the assessment and identification of

drug-related problems, it is necessary to prevent and

manage drug-related problems in patients with type 2

diabetes mellitus with chronic renal failure. (Kardela

et al., 2022).

Millah's research (2018) used a retrospective

method with a sample size of 54 patients. It was found

that the pattern of use of treatment for diabetic ulcers

was the most given single antibiotic combination

therapy and the combination of ceftriaxone +

metronidazole. And obtained the results of the

evaluation of the correct use of antibiotics for

indications, the right drug, the right dose, the right

way of administration, the right time interval, and the

right duration of administration. (Millah, 2018).

Research by Ohsugi et.al (2021) with a total of

10,151 patients found that 6.6% of patients with

diabetes mellitus had comorbidities, including

Dyslipidemia (84.7%) and hypertension (75.1%)

were the most common diseases, followed by chronic

kidney disease (35.4%), retinopathy (23.1%), and

cardiovascular disease (22.1%). Overall, 36.0% of

patients were overweight/obese (body mass index 25

kg/m2) and 18.6% had a history of neoplasm. The

prevalence of comorbid conditions/complications

tends to increase with age and duration of type 2

diabetes mellitus (Ohsugi et al., 2021).

Meanwhile, according to research by Kuo et al

(2015) with a total of 33,709 patients. Comorbidities

found in DM patients include hypertension,

hyperlipidemia, stroke, coronary artery disease,

and/or kidney disease. The HR of dementia in

diabetics increased from 1.41 in those with no

comorbidities to 2.49 in those with ≥4 comorbidities.

In the DM group, HRs were 1.22 for non-insulin users

1.41 for insulin users, and 1.49 for type 1 DM, and

1.23 for type 2 DM. Diabetic patients have an

increased risk of dementia, and comorbidities

increase this risk (Kuo et al., 2015).

DM patients who experience Acute Myocardial

Infarction have worse in-hospital clinical outcomes

than non-diabetic patients. There are important

differences in DM type with patients with type 1

diabetes mellitus having worse outcomes overall and

receiving less revascularization overall. (Sethupathi

et al., 2023)..

Covid-19 patients with diabetes mellitus have a

higher severity of infection such as experiencing

cytokine storms to the risk of death. The use of

antidiabetic drugs has a target activity on DPP4 which

increases insulin secretion with DPP4 as an

aminopeptidase on the cell membrane which plays a

ISCP UTA ’45 JAKARTA 2023 - THE INTERNATIONAL SEMINAR AND CALL FOR PAPER (ISCP) UTA ’45 JAKARTA

168

role in various physiological processes including the

immune response. Chronic hyperglycemia causes

abnormal immune responses and not. This

mechanism further increases the risk of death in

COVID-19 patients with diabetes mellitus (Rahayu et

al., 2021). The research of Nanda et al. (2021) from a

total of 404 samples, shows the effect of diabetes

mellitus on covid-19 and has a risk of being infected

with Covid-19 of 0.307 times compared to patients

without diabetes mellitus. High blood sugar will

accelerate the replication of the coronavirus (Nanda

et al., 2021). (Nanda et al., 2021).

Priscilla and Heri's research (2023) is an

observational analytic study with a cross-sectional

research design, which was conducted on 418

COVID-19 patients who were treated at Husada

Hospital from January to December 2020. The results

showed that the majority of COVID-19 patients with

comorbid diabetes mellitus experienced

severe/critical severity (61.4%) and the presence of

comorbid diabetes mellitus increased the incidence of

death in COVID-19 patients by 5.9 times (p-value

<0.05). This study also found that age, use, insulin

therapy, and the presence of other comorbidities also

played a role in the worsening of the COVID-19

condition. (Erwani and Nofriandi, 2017)..

Based on research by Esfandiari et al. (2022) this

study used descriptive-comparative research methods

with a cross-sectional approach. Based on the results

of this study, 71 respondents were obtained, the most

respondents consisted of age> 45 years with a total of

50 patients (70.4%) the most respondents were

women as many as 37 patients (52.1%). Patients

without comorbidities were 44 people (62%). Covid-

19 patients who recovered were more than Covid-19

patients who died, namely 59 patients (83.1%). In the

results of statistical test analysis with Mann Whitney,

the p-value = 0.000 (p <0.05) was obtained, which

means that there is a significant difference in the

recovery rate between COVID-19 patients who have

comorbid diabetes mellitus and COVID-19 patients

without comorbidities at Natar Medika Natar

Hospital in 2021. (Esfandiari et al., 2022).

This is in line with the research of Mauricio et.al

(2023) with a retrospective cohort design method

using subjects totaling 1,238,710 subjects. It was

found that diabetes mellitus was an independent risk

factor for mortality in people with Covid-19. The

number of fatal events decreased during the second

and third waves in our region, both in people with

diabetes and obesity (Mauricio et al., 2023).

In the research of Gouda et.al (2022) with a

Cohort study research design. The total sample of 135

obtained the results of the study that SARS-CoV-2

vaccination in children and adolescents with type 1

diabetes is safe and not associated with glucose

imbalance directly. (Gouda et al., 2022). Then there

was a retrospective study with a total of 39 samples,

it was found that no significant differences in

glycemic control and glycemic index were observed

at different times throughout the vaccination cycle

and did not depend on the type of vaccine. (Piccini et

al., 2022)

CONCLUSIONS

Based on systematic reviews that have been reviewed

and reviewed, it is found that the treatment of diabetes

mellitus mostly uses biguanide drugs (metformin)

both as single and combination therapy. The most

widely used treatment for comorbidities such as

hypertension is candesartan, while for other

comorbidities it is adjusted to the management

guidelines. Evaluation of diabetes mellitus treatment

with comorbidities is by the Perkeni 2021

management guidelines so there are no problems.

Overall, it is appropriate, namely the right indication,

the right drug, the right dose, the right method of

administration, the right time interval, and the right

duration of administration.

REFERENCES

Aries Meryta*, Fachdiana Fidia, A. S. (2023). Penggunaan

Antidiabetik Oral Pada Pasien Diabetes Melitus Tipe Ii

Di Instalasi Farmasi Rumah Sakit Pinna Bekasi.

Farmasi Ikifa, 2.

https://repositorio.ufsc.br/xmlui/bitstream/handle/1234

56789/167638/341506.pdf?sequence=1&isAllowed=y

%0Ahttps://repositorio.ufsm.br/bitstream/handle/1/831

4/LOEBLEIN%2C LUCINEIA

CARLA.pdf?sequence=1&isAllowed=y%0Ahttps://an

tigo.mdr.gov.br/saneamento/proees

Asriati, Pamangin, L. O. M., & Juniasti, H. T. (2023).

Faktor yang Memengaruhi Kelengkapan Vaksin Covid-

19 pada Penderita Penyakit Tidak Menular di

Puskesmas Twano Kota Jayapura. Jambura Journal of

Health Science and Research, 5(1), 378–390.

Bintang, S. (2021). Evaluasi Oral Antidiabetik Pada Pasien

Diabetes Melitus Tipe 2 Di Rsud “X” Lamongan.

Journal of Herbal, Clinical and Pharmaceutical

Science (HERCLIPS), 2(1), 1.

https://doi.org/10.30587/herclips.v2i1.2188

erwani, erwani, & nofriandi, nofriandi. (2017). Faktor –

Faktor Yang Berhubungan Dengan Insomnia Pada

Lansia Di Puskesmas Belimbing Padang. Jik- Jurnal

Ilmu Kesehatan, 1(1), 123–132.

https://doi.org/10.33757/jik.v1i1.38

A Systematic Review: Evaluation of Treatment for Diabetes Mellitus with Comorbidities Who Have Been Vaccinated Against COVID-19

169

Esfandiari, F., Nurdiana, D. R., Triwahyuni, T., & Prasetia,

T. (2022). Perbandingan Angka Kesembuhan Antara

Pasien Covid-19 Yang Memiliki Komorbid Diabetes

Melitus dengan Pasien Covid-19 Tanpa Komorbid

Diabetes Melitus Di Rumah Sakit Natar Medika Tahun

2021. Journal Medula, 12(2), 342–346.

Fortuna Surat Bala, D., Aditya, M., & Yulinda Cesa, F.

(2023). Evaluasi Penggunaan Obat Antidiabetes Pada

Pasien Diabetes Mellitus Tipe 2 Di Rumah Sakit Baptis

Batu. Sainsbertek Jurnal Ilmiah Sains & Teknologi,

3(2), 9–18. https://doi.org/10.33479/sb.v3i2.215

Gouda, N., Dimitriadou, M., Sotiriou, G., & Christoforidis,

A. (2022). The impact of COVID-19 vaccination on

glycaemic control in children and adolescents with type

1 diabetes mellitus on continuous glucose monitoring.

Acta Diabetologica, 59(12), 1609–1614.

https://doi.org/10.1007/s00592-022-01968-y

Inayah, I., Hamidy, M. Y., & Sari, M. (2016). Gambaran

Terapi Diabetes Melitus Tipe 2 dengan Komorbid

Hipertensi di Rumah Sakit X Pekanbaru. Jurnal Ilmu

Kedokteran, 10(2), 84.

https://doi.org/10.26891/jik.v10i2.2016.84-91

Indah Cahyaningsih, O., Rahmania Eka Dini, I., & Hardian,

dr. (2021). Gambaran Peresepan Metformin Pada

Pasien Diabetes Melitus Tipe 2 Di Rumah Sakit

Nasional Diponegoro Semarang Description of

Metformin Prescription in Diabetes Mellitus Type 2

Patients in Diponegoro National Hospital, Semarang.

Generics : Journal of Research in Pharmacy, 1(2), 14–

2021.

Indonesia, P. E. (2021). Pedoman Pengelolaan dan

Pencegahan Diabetes Melitus Tipe 2 Dewasa di

Indonesia 2021. PB Perkeni, 46. www.ginasthma.org.

Irene, G. Y., Kuswinarti, K., & Kusumawati, M. (2020).

Understanding Patients with Type 2 Diabetes Mellitus

Using Oral Antidiabetic Drugs. Journal of Medicine

and Health, 2(5), 61–75.

https://doi.org/10.28932/jmh.v2i5.1110

Jeong, I., Ho, K., & Kyu, M. (2020). Since January 2020

Elsevier has created a COVID-19 resource centre with

free information in English and Mandarin on the novel

coronavirus COVID- 19 . The COVID-19 resource

centre is hosted on Elsevier Connect , the company ’ s

public news and information . January.

Jonathan, K., Natalia, N., & Soetedjo, M. (2019). Pola

Penggunaan Antidiabetes Oral Pasien Diabetes

Melitus Tipe 2 di Bagian Penyakit Dalam RSUD Kota

Bandung Tahun 2017. 46(6), 407–413.

Kardela, W., Bellatasie, R., Nurayni, N., & Rustam, E.

(2022). Evaluasi Masalah Terkait Obat pada Pasien

Diabetes Melitus Tipe II dengan Gagal Ginjal Kronik

di Rawatan Inap RSUP DR. M. Djamil Padang.

Jurnal

Farmasi Higea, 14(1), 72.

https://doi.org/10.52689/higea.v14i1.451

Kuna, Mega, Manika, P. (2022). Analisis Penggunaan Obat

Pada Pasien Diabetes Melitus Di Puskesmas Goagoman

Tahun 2022. Jurnal Cakrawala Ilmiah, 2(4), 1–23.

Kuo, S. C., Lai, S. W., Hung, H. C., Muo, C. H., Hung, S.

C., Liu, L. L., Chang, C. W., Hwu, Y. J., Chen, S. L., &

Sung, F. C. (2015). Association between comorbidities

and dementia in diabetes mellitus patients: Population-

based retrospective cohort study. Journal of Diabetes

and Its Complications, 29(8), 1071–1076.

https://doi.org/10.1016/j.jdiacomp.2015.06.010

Mauricio, D., Vlacho, B., Ortega, E., & Cos-claramunt, X.

(2023). Primary Care Diabetes Outcome of COVID-19

infection in people with diabetes mellitus or obesity in

the primary care setting in Catalonia , Spain : A

retrospective cohort study of the initial three waves.

Primary Care Diabetes, 17(1), 12–18.

https://doi.org/10.1016/j.pcd.2022.12.002

Millah, M. (2018). Evaluasi Penggunaan Antibiotik pada

Pasien Diabetes Melitus Dengan Ulkus Diabetikum di

RSI Siti Hajar Sidoarjo Periode 2016. 54–56.

Nanda, C. C. S., Indaryati, S., & Koerniawan, D. (2021).

Pengaruh Komorbid Hipertensi dan Diabetes Mellitus

terhadap Kejadian COVID-19. Jurnal Keperawatan

Florence Nightingale, 4(2), 68–72.

https://doi.org/10.52774/jkfn.v4i2.72

Octariani, S., Mayasari, D., & Ramadhan, A. M. (2022).

Evaluasi Penggunaan Obat pada Pasien Diabetes

Melitus dengan Komplikasi Stroke di RSUD Aji

Muhammad Parikesit Tenggarong Tahun 2020.

Proceeding of Mulawarman Pharmaceuticals

Conferences, Mei 2022, 142–148.

http://prosiding.farmasi.unmul.ac.id/index.php/mpc/art

icle/view/416/399

Ohsugi, M., Eiki, J. ichi, Iglay, K., Tetsuka, J., Tokita, S.,

& Ueki, K. (2021). Comorbidities and complications in

Japanese patients with type 2 diabetes mellitus:

Retrospective analyses of J-DREAMS, an advanced

electronic medical records database. Diabetes Research

and Clinical Practice, 178, 108845.

https://doi.org/10.1016/j.diabres.2021.108845

Piccini, B., Pessina, B., Pezzoli, F., Casalini, E., & Toni, S.

(2022). COVID-19 vaccination in adolescents and

young adults with type 1 diabetes: Glycemic control

and side effects. Pediatric Diabetes, 23(4), 469–472.

https://doi.org/10.1111/pedi.13326

Pratama, I. P. Y., & Ratnasari, P. M. D. (2021). Pola

Penggunaan Obat Pada Pasien Diabetes Melitus Tipe Ii

Dengan Komplikasi Neuropati Pada Salah Satu Rumah

Sakit Swasta Denpasar Bali. Acta Holistica

Pharmaciana, 3(2), 30–37.

Rahayu, L. A. D., Admiyanti, J. C., Khalda, Y. I., Ahda, F.

R., Agistany, N. F. F., Setiawati, S., Shofiyanti, N. I., &

Warnaini, C. (2021). Hipertensi, Diabetes Mellitus,

Dan Obesitas Sebagai Faktor Komorbiditas Utama

Terhadap Mortalitas Pasien Covid-19: Sebuah Studi

Literatur. JIMKI: Jurnal Ilmiah Mahasiswa

Kedokteran Indonesia, 9(1), 90–97.

https://doi.org/10.53366/jimki.v9i1.342

Sethupathi, P., Matetić, A., Bang, V., Myint, P. K., Rendon,

I., Bagur, R., Diaz-Arocutipa, C., Ricalde, A.,

Bharadwaj, A., & Mamas, M. A. (2023). Association of

diabetes mellitus and its types with in-hospital

management and outcomes of patients with acute

myocardial infarction. Cardiovascular

Revascularization Medicine, 52, 16–22.

https://doi.org/10.1016/j.carrev.2023.02.008

ISCP UTA ’45 JAKARTA 2023 - THE INTERNATIONAL SEMINAR AND CALL FOR PAPER (ISCP) UTA ’45 JAKARTA

170