39
Lampiran 1: Persetujuan Komisi Etik Penelitian
Lampiran 2
LEMBAR PENJELASAN KEPADA CALON SUBJEK PENELITIAN
Selamat pagi/siang Bapak/Ibu, pada hari ini saya, dr. M. Fahmi Hidayat,peserta
Pendidikan Pasca Sarjana Ilmu Penyakit Dalam / Magister Klinik FK USU Medan akan
melakukan penelitian yang berjudul ”Korelasi Antara Asam Urat dan HbA1C Pada
Pasien Diabetes Mellitus Tipe 2”.
Kepada Bapak/Ibu yang bersedia mengikuti penelitian ini nantinya akan diminta
mengisi surat persetujuan ikut dalam penelitian, mengikuti wawancara untuk mencari
adanya hal-hal yang dapat mengganggu penelitian, dilakukan pengukuran tekanan darah
(TD), berat badan (BB), tinggi badan (TB), parameter kegemukan (IMT), pemeriksaan
laboratorium berupa pemeriksaan darah sebanyak 15 cc (1 sendok makan)yang akan
diambil dari lengan oleh ahlinya untuk menilai parameter darah rutin, kadar gula darah
puasa dan 2 jam setelah makan, HbA1C, profil lipid, asam urat, ureum kreatinin.
Manfaat penelitian ini adalah dapat memantau dan memberi informasi tentang
progresifitas DM, melihat apakah gula darah sudah terkontrol dan apakah ada
peningkatan asam urat pada DM, meringankan biaya pemeriksaan laboratorium untuk
pemantauan penyakit DMdan pemeriksaan menjadi lebih sederhana, murah dan tidak
membutuhkan waktu yang lama.
Pada penelitian ini tidak menimbulkan efek samping apapun, hanya risiko yang
dapat terjadi dari penelitian ini adalah terjadinya lebam setelah pengambilan darah.
Setelah hasil akhir diperoleh, nantinya akan terlihat apakah terdapat hubungan
antara nilai asam urat dan HbA1C yang didapat dari pemeriksaan darah rutin. Bila
masih terdapat pertanyaan atau keluhan sewaktu penelitian ini berjalan, maka Bapak/Ibu
dapat menghubungi saya pada:
Nama
: dr. M. Fahmi Hidayat
Alamat
: Jl. Suka Makmur No.7
Telepon
: 061-7869168 dan 085371489789
Peneliti,
41
Lampiran 3
.
SURAT PERSETUJUAN SETELAH PENJELASAN
(INFORMED CONCERN )
Saya yang bertanda tangan dibawah ini :
Nama
:...
Alamat
:...
Umur
:... Tahun
Jenis Kelamin : Laki-laki/ Perempuan.
No Telp/HP :
Setelah mendapat penjelasan dari peneliti tentang kebaikan dan keburukan prosedur
penelitian ini, menyatakan bersedia
ikut serta dalam penelitian tentang ”Korelasi Antara
Asam Urat dan HbA1C Pada Pasien Diabetes Mellitus Tipe 2”.Apabila sewaktu-waktu
saya mengundurkan diri dari penelitian ini, kepada saya tidak dituntut apapun.
Demikianlah surat persetujuan bersedia ikut dalam penelitian ini saya buat, untuk dapat
digunakan seperlunya.
Medan, ...2014
Yang Memberi Pernyataan
(...)
Lampiran 4
KERTAS KERJA PROFIL PESERTA PENELITIAN
I.IDENTITAS PRIBADI
Nama
: Kode : X / Y
Tempat/Tanggal Lahir:
Jenis Kelamin
: Laki-laki/Perempuan.
Pendidikan Terakhir :
Pekerjaan
:
Status
: Kawin/Belum Kawin. No Telp/Hp:...
Riwayat Penyakit
: DM / Hipertensi / Sakit jantung / Stroke
Durasi/lama menderita DM :
Durasi/lama menderita HT
:
Riwayat DM dalam keluarga :
Merokok
: Ya / Tidak
Jika Ya: ...Batang/hari
II.PEMERIKSAAN FISIK
Tekanan Darah : ... mmHg
.
Pemeriksaan Parameter Antrometri.
Parameter Antropometri
Nilai
Berat Badan (kg)
Tinggi Badan (m
2)
Indeks Massa Tubuh (kg/m
2)
III.PEMERIKSAAN LABORATORIUM
Parameter
Nilai
Hb (gr/dl)
Asam Urat
Ureum Kreatinin
KGD puasa
KGD 2 jam PP
HbA1C
43
Lampiran 5 Master Tabel Hasil Penelitian
No Nama
Jenis
18 LLT
0
73
26.4
5.6
0
13.7
1
293
406
209
176
43
125
19 SG
1
68
25.1
3.7
2
9.9
1
297
327
307
365
42
186
20 R
1
51
26.8
2.2
2
10.5
1
290
377
228
150
53
133
21 M
0
58
31.9
7
0
7.2
1
116
274
269
129
33
183
22 MP
1
58
34.7
5.3
2
9.4
1
163
237
241
183
57
139
23 LH
1
49
24.9
3.7
2
9.4
1
207
287
214
129
45
136
24 S
1
65
29.7
4.7
2
8.3
1
221
374
305
470
37
161
25 YHL
1
51
30.9
7.2
3
8.6
1
152
229
269
143
53
174
26 SL
0
67
21.4
7.5
1
6.5
0
155
196
184
158
50
97
27 MZ
0
53
28.1
4.5
0
7.5
1
185
275
181
133
46
102
28 MS
1
51
25
4.7
2
9.9
1
197
254
236
91
43
157
29 IS
1
66
28
5.9
2
6.3
0
94
247
206
134
51
113
30 A
0
66
24.3
5.4
0
6.1
0
84
121
219
104
44
133
31 HS
0
74
33.8
6.4
0
6.7
0
123
260
134
60
44
65
32 J
1
38
26.2
3.8
2
7.8
1
187
337
244
232
31
146
33 KEL
0
36
28.1
5.8
0
6.7
0
99
187
196
140
32
119
34 Ny.H
1
67
24
7.1
3
7.2
1
122
172
274
103
44
184
35 SI
1
54
28.5
6.6
3
10
1
195
329
194
321
40
96
36 JSG
1
65
19.8
5.6
2
12
1
361
467
207
136
61
109
37 PN
0
62
21.5
4.7
0
8.3
1
109
269
262
126
51
166
38 LG
0
63
27.6
5.6
0
9.3
1
125
259
211
242
32
124
39 SAM
1
53
29.1
7.8
3
7.7
1
193
188
147
113
38
83
40 AT
1
62
28.9
7.4
3
10.7
1
246
430
308
191
44
198
41 ES
1
57
25.7
6.4
3
12.3
1
246
446
176
99
34
107
45
43 B
1
54
27.2
7.2
3
5.5
0
157
255
150
88
37
75
44 RS
0
52
31.4
10
1
6.2
0
146
309
266
136
52
161
45 Tn.A
0
52
24.7
7.9
1
8.3
1
148
258
236
221
22
149
46 TPA
0
56
29.3
5.2
0
8.2
1
74
164
296
527
36
131
47 IS
0
45
27.6
4.6
0
9.8
1
293
377
221
126
53
128
48 SA
1
68
29.6
6.6
3
10.5
1
173
418
226
134
37
140
49 BS
1
79
25.5
5.2
2
5.7
0
107
301
152
84
59
66
50 LM
1
73
26.5
4.3
2
9.6
1
135
338
317
217
63
192
51 SA
1
44
32.8
4.8
2
7.6
1
164
307
237
106
59
145
52 TB
1
60
27.7
9.2
3
8.3
1
44
238
292
194
59
178
53 DPG
0
63
32.2
9.8
1
7.9
1
145
243
196
119
34
102
54 LWS
1
46
24.1
6.8
3
12.1
1
125
214
206
79
53
119
55 RGBA
1
77
26.2
9.1
3
7.1
1
135
188
270
135
67
152
56 H
0
51
24.2
8.5
1
7.6
1
190
216
196
132
31
122
57 RS
1
71
29.1
7.3
3
7
1
102
234
268
154
41
174
58 JS
0
75
25
3.5
0
8.7
1
183
381
178
115
21
112
59 MS
0
61
25.6
8
1
5.9
0
98
234
209
87
68
113
60 SS
1
73
26.2
5.6
2
7.8
1
67
215
228
134
71
119
61 NS
1
76
18.1
7
3
6.9
0
153
169
226
76
64
135
62 SI
0
53
25.1
6.2
0
9.6
1
166
367
217
108
48
131
63 Ny.S
1
51
27
4.9
2
10.7
1
158
469
252
194
35
174
64 DA
1
68
26.7
5.1
2
8.2
1
221
315
303
658
30
121
65 NM
1
55
23.9
5.7
2
12.8
1
437
523
243
263
48
132
66 ON
1
59
21.6
5.1
2
8.6
1
195
261
199
122
52
112
67 RL
1
61
24.9
8.2
3
7.3
1
106
282
233
109
51
146
68 SHS
0
58
28.2
9.5
1
8.9
1
311
496
232
110
54
140
Jenis Kelamin
Kategori DM
(0) Laki-laki
(0) DM terkontrol
(1) Perempuan
(1) DM tidak terkontrol
Kategori Asam Urat
(0) Normal Pria
Riwayat Asam Urat
(0) Tidak
(1) Hiperuricemia Pria
(1) Ya
(2) Normal Wanita
(3) Hiperuricemia Wanita
47
Lampiran 6 Analisa statistik
Jenis Kelamin
Frequency Percent Valid Percent
Cumulative
Percent
Valid Laki-laki 40 48.8 48.8 48.8
Perempuan 42 51.2 51.2 100.0
Total 82 100.0 100.0
Riwayat Asam Urat
Frequency Percent Valid Percent
Cumulative
Percent
Valid Tidak 82 100.0 100.0 100.0
Kategori Asam Urat
Frequency Percent Valid Percent
Cumulative
Frequency Percent Valid Percent
Cumulative
Percent
Valid DM terkontrol 23 28.0 28.0 28.0
DM tidak terkontrol 59 72.0 72.0 100.0
Total 82 100.0 100.0
Descriptives
Statistic Std. Error
Usia Mean 59.12 1.022
95% Confidence Interval for
Mean
Lower Bound 57.09
Upper Bound 61.16
5% Trimmed Mean 59.26
Median 59.00
Variance 85.615
Std. Deviation 9.253
Minimum 36
Maximum 79
Range 43
Interquartile Range 13
Skewness -.064 .266
Kurtosis -.198 .526
TDS Mean 127.89 .780
95% Confidence Interval for
Mean
Lower Bound 126.34
Upper Bound 129.44
5% Trimmed Mean 128.12
Median 130.00
Variance 49.951
Std. Deviation 7.068
Minimum 105
Maximum 143
Range 38
Interquartile Range 5
Skewness -.458 .266
Kurtosis 1.181 .526
TDD Mean 78.00 .607
95% Confidence Interval for
Mean
Lower Bound 76.79
Upper Bound 79.21
49
Median 80.00
Variance 30.247
Std. Deviation 5.500
Minimum 70
Maximum 90
Range 20
Interquartile Range 10
Skewness -.180 .266
Kurtosis -.457 .526
IMT Mean 27.326 .4080
95% Confidence Interval for
Mean
Lower Bound 26.514
Upper Bound 28.137
5% Trimmed Mean 27.300
Median 26.950
Variance 13.648
Std. Deviation 3.6943
Minimum 18.1
Maximum 37.0
Range 18.9
Interquartile Range 4.3
Skewness .266 .266
Kurtosis .508 .526
Hb Mean 13.518 .1695
95% Confidence Interval for
Mean
Lower Bound 13.181
Upper Bound 13.856
5% Trimmed Mean 13.497
Median 13.500
Variance 2.356
Std. Deviation 1.5349
Minimum 10.4
Maximum 17.7
Range 7.3
Interquartile Range 2.3
Skewness .189 .266
Kurtosis -.286 .526
Kreatinin Mean .9155 .03019
95% Confidence Interval for
Mean
Std. Deviation .27339
Minimum .39
Maximum 1.45
Range 1.06
Interquartile Range .41
Skewness .382 .266
Kurtosis -.731 .526
Asamurat Mean 6.693 .2341
95% Confidence Interval for
Mean
Lower Bound 6.227
Upper Bound 7.158
5% Trimmed Mean 6.636
Median 6.550
Variance 4.493
Std. Deviation 2.1196
Minimum 2.2
Maximum 12.7
Range 10.5
Interquartile Range 2.8
Skewness .497 .266
Kurtosis -.103 .526
HbA1C Mean 8.240 .2022
95% Confidence Interval for
Mean
Lower Bound 7.838
Upper Bound 8.643
5% Trimmed Mean 8.146
51
Variance 3.352
Std. Deviation 1.8309
Minimum 4.9
Maximum 13.7
Range 8.8
Interquartile Range 2.6
Skewness .758 .266
Kurtosis .331 .526
KGD puasa Mean 168.60 8.205
95% Confidence Interval for
Mean
Lower Bound 152.27
Upper Bound 184.92
5% Trimmed Mean 163.68
Median 152.50
Variance 5520.120
Std. Deviation 74.298
Minimum 44
Maximum 437
Range 393
Interquartile Range 84
Skewness 1.137 .266
Kurtosis 1.411 .526
KGD 2 JamPP Mean 290.91 11.472
95% Confidence Interval for
Mean
Lower Bound 268.09
Upper Bound 313.74
5% Trimmed Mean 285.30
Median 274.50
Variance 10792.622
Std. Deviation 103.888
Minimum 110
Maximum 735
Range 625
Interquartile Range 137
Skewness 1.222 .266
Kurtosis 2.994 .526
Total kolesterol Mean 221.12 4.829
95% Confidence Interval for
Mean
Lower Bound 211.51
Upper Bound 230.73
5% Trimmed Mean 220.49
Median 220.00
Variance 1912.503
Std. Deviation 43.732
Minimum 134
Maximum 317
Range 183
Interquartile Range 56
Skewness .235 .266
Kurtosis -.386 .526
Trigliserida Mean 166.15 12.504
95% Confidence Interval for
Mean
Lower Bound 141.27
Upper Bound 191.02
5% Trimmed Mean 148.81
Median 134.00
Variance 12820.176
Std. Deviation 113.226
Minimum 56
Maximum 684
Range 628
Interquartile Range 83
Skewness 2.930 .266
Kurtosis 9.804 .526
HDL Mean 43.91 1.228
95% Confidence Interval for
Mean
Lower Bound 41.47
Upper Bound 46.36
5% Trimmed Mean 43.80
Median 43.00
53
Std. Deviation 11.124
Minimum 21
Maximum 71
Range 50
Interquartile Range 16
Skewness .289 .266
Kurtosis -.355 .526
LDL Mean 131.12 3.495
95% Confidence Interval for
Mean
Lower Bound 124.17
Upper Bound 138.08
5% Trimmed Mean 131.19
Median 131.50
Variance 1001.787
Std. Deviation 31.651
Minimum 65
Maximum 198
Range 133
Interquartile Range 49
Skewness -.086 .266
Kurtosis -.677 .526
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
KGD 2 JamPP .118 82 .006 .930 82 .000
Total kolesterol .046 82 .200* .982 82 .304
Trigliserida .226 82 .000 .668 82 .000
HDL .094 82 .067 .978 82 .184
LDL .062 82 .200* .984 82 .406
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Descriptives
Kat DM Statistic Std. Error
Asam urat DM terkontrol Mean 7.757 .3954
95% Confidence Interval for
Mean
Lower Bound 6.937
Upper Bound 8.576
5% Trimmed Mean 7.641
Median 7.500
Variance 3.595
Std. Deviation 1.8961
Minimum 5.2
Maximum 12.7
Range 7.5
Interquartile Range 2.5
Skewness .811 .481
Kurtosis .533 .935
DM tidak terkontrol Mean 6.278 .2695
95% Confidence Interval for
Mean
Lower Bound 5.738
Upper Bound 6.818
5% Trimmed Mean 6.216
Median 5.600
Variance 4.287
Std. Deviation 2.0704
Minimum 2.2
55
Range 9.8
Interquartile Range 3.1
Skewness .596 .311
Kurtosis -.141 .613
Tests of Normality
Kat DM
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Asam urat DM terkontrol .145 23 .200* .938 23 .160
DM tidak terkontrol .137 59 .008 .961 59 .054
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Correlations
HbA1C asam_urat
Spearman's rho HbA1C Correlation Coefficient 1.000 -.407**
Sig. (2-tailed) . .000
N 82 82
Asam urat Correlation Coefficient -.407** 1.000
Sig. (2-tailed) .000 .
N 82 82
**. Correlation is significant at the 0.01 level (2-tailed).
Descriptives
Statistic Std. Error
Asam urat Mean 6.693 .2341
95% Confidence Interval for
Mean
Lower Bound 6.227
Upper Bound 7.158
5% Trimmed Mean 6.636
Median 6.550
Variance 4.493
Std. Deviation 2.1196
Minimum 2.2
Maximum 12.7
Range 10.5
Interquartile Range 2.8
Skewness .497 .266
Kurtosis -.103 .526
KGD puasa Mean 168.60 8.205
95% Confidence Interval for
Mean
Lower Bound 152.27
Upper Bound 184.92
5% Trimmed Mean 163.68
Median 152.50
Variance 5520.120
Std. Deviation 74.298
Minimum 44
Maximum 437
Range 393
Interquartile Range 84
Skewness 1.137 .266
Kurtosis 1.411 .526
KGD 2jamPP Mean 290.91 11.472
95% Confidence Interval for
Mean
Lower Bound 268.09
Upper Bound 313.74
5% Trimmed Mean 285.30
Median 274.50
Variance 10792.622
Std. Deviation 103.888
Minimum 110
Maximum 735
Range 625
Interquartile Range 137
Skewness 1.222 .266
57
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Asam urat .099 82 .044 .974 82 .088
KGD puasa .118 82 .007 .921 82 .000
KGD 2JamPP .118 82 .006 .930 82 .000
a. Lilliefors Significance Correction
Correlations
Asam urat KGD puasa
Spearman's rho Asam urat Correlation Coefficient 1.000 -.338**
Sig. (2-tailed) . .002
N 82 82
KGD puasa Correlation Coefficient -.338** 1.000
Sig. (2-tailed) .002 .
N 82 82
**. Correlation is significant at the 0.01 level (2-tailed).
Correlations
Asam urat KGD 2 JamPP
Spearman's rho Asam urat Correlation Coefficient 1.000 -.318**
Sig. (2-tailed) . .004
N 82 82
KGD 2 JamPP Correlation Coefficient -.318** 1.000
Sig. (2-tailed) .004 .
N 82 82
**. Correlation is significant at the 0.01 level (2-tailed).
Descriptives
Statistic Std. Error
Total kolesterol Mean 221.12 4.829
95% Confidence Interval for
Mean
Lower Bound 211.51
Upper Bound 230.73
5% Trimmed Mean 220.49
Median 220.00
Variance 1912.503
Std. Deviation 43.732
Minimum 134
Maximum 317
Range 183
Interquartile Range 56
Skewness .235 .266
Kurtosis -.386 .526
Trigliserida Mean 166.15 12.504
95% Confidence Interval for
Mean
Lower Bound 141.27
Upper Bound 191.02
5% Trimmed Mean 148.81
Median 134.00
Variance 12820.176
Std. Deviation 113.226
Minimum 56
Maximum 684
Range 628
Interquartile Range 83
Skewness 2.930 .266
Kurtosis 9.804 .526
HDL Mean 43.91 1.228
95% Confidence Interval for
Mean
Lower Bound 41.47
Upper Bound 46.36
5% Trimmed Mean 43.80
Median 43.00
Variance 123.733
Std. Deviation 11.124
Minimum 21
Maximum 71
Range 50
Interquartile Range 16
Skewness .289 .266
Kurtosis -.355 .526
LDL Mean 131.12 3.495
59
Mean Upper Bound 138.08
5% Trimmed Mean 131.19
Median 131.50
Variance 1001.787
Std. Deviation 31.651
Minimum 65
Maximum 198
Range 133
Interquartile Range 49
Skewness -.086 .266
Kurtosis -.677 .526
Asam urat Mean 6.693 .2341
95% Confidence Interval for
Mean
Lower Bound 6.227
Upper Bound 7.158
5% Trimmed Mean 6.636
Median 6.550
Variance 4.493
Std. Deviation 2.1196
Minimum 2.2
Maximum 12.7
Range 10.5
Interquartile Range 2.8
Skewness .497 .266
Kurtosis -.103 .526
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Total kolesterol .046 82 .200* .982 82 .304
Trigliserida .226 82 .000 .668 82 .000
HDL .094 82 .067 .978 82 .184
LDL .062 82 .200* .984 82 .406
Asam urat .099 82 .044 .974 82 .088
a. Lilliefors Significance Correction
*. This is a lower bound of the true significance.
Correlations
Asam urat Total kolesterol
Asam urat Pearson Correlation 1 -.058
Sig. (2-tailed) .603
N 82 82
Total kolesterol Pearson Correlation -.058 1
Sig. (2-tailed) .603
N 82 82
Correlations
Asam urat Trigliserida
Spearman's rho Asam urat Correlation Coefficient 1.000 -.051
Sig. (2-tailed) . .647
N 82 82
Trigliserida Correlation Coefficient -.051 1.000
Sig. (2-tailed) .647 .
61
Correlations
Asam urat HDL
Asam urat Pearson Correlation 1 -.057
Sig. (2-tailed) .614
N 82 82
HDL Pearson Correlation -.057 1
Sig. (2-tailed) .614
N 82 82
Correlations
Asam urat LDL
Asam urat Pearson Correlation 1 .014
Sig. (2-tailed) .900
N 82 82
LDL Pearson Correlation .014 1
Sig. (2-tailed) .900
N 82 82