Chancellor of the Universitas Indonesia, Prof. Ari Kuncoro, S.E., M.A., Ph.D., authorized Prof. Dr. dr. Em Yunir, SpPD-KEMD as a professor in Endocrine, Metabolic and Diabetes Sciences, Internal Medicine, Faculty of Medicine UI. Prof. Em Yunir delivered a speech on “Challenges of Diabetic Foot Management in Indonesia”.
According to Prof. Yunir, the prevalence of diabetes throughout the world continues to increase. Basic Health Research Data from the Ministry of Health showed an increase in the prevalence of diabetes in the population over 15 years, from 6.9% in 2013 to 10.9% in 2018. In 2021, Indonesia ranked 5th with the highest number of people with diabetes. This figure is expected to increase to 28.6 million in 2045. Uncontrolled diabetes due to damage to pancreatic beta cells, insulin resistance, and an increase in free fatty acids will cause chronic inflammation and endothelial dysfunction, which can cause various micro and macrovascular complications. The Multicenter Study on Diabetes Care Asia 2012 showed several diabetes complications found in Indonesia, including peripheral neuropathy, eye, cardiovascular, kidney complications, and diabetic foot complications.
Prof. Yunir found that 35% of people with diabetes are at risk of developing diabetic foot ulcers (LKD). Of this number, 20% of them undergo amputation, which causes disability, decreased quality of life, increased health costs, and mortality—data from Dr. National Central General Hospital. Cipto Mangunkusumo Hospital (RSCM) showed that 40% of LKD patients passed within one year after hospitalization.
Complications of LKD will cause various biomechanical abnormalities. These acute wounds can become chronic wounds, risk of amputation, or heal with defects, each of which requires multiple disciplines, facilities, and infrastructure for treatment. Diabetic foot neuropathy experiences decreased pain sensation, skin moisture, and repeated trauma. These cause the feet to get injured easily.
“Wound healing goes through 4 stages: hemostasis, inflammation, proliferation, and remodeling. In people with diabetes, foot wounds become difficult to heal due to impaired blood circulation, tissue hypoxia, impaired growth factors, impaired angiogenesis, increased inflammation, and decreased immunity. During the last COVID-19 pandemic, LKD patients experienced worse conditions, more severe infections, and osteomyelitis.
“The waiting time for surgery is twice as long, and the amputation rate is two times higher,” he said. He emphasized that medical rehabilitation is an important part of managing LKD, before the injury occurs and after the amputation is carried out. The role of medical rehabilitation is vital to reduce the risk of amputation and reamputation by up to 80%. Unfortunately, the National Health Insurance (JKN) has not fully covered rehabilitation measures. There are several other methods that can help treat LKD, namely surgery with high-speed water flow, negative pressure wound therapy, blood platelet concentration, growth factors, low-level laser therapy, and stem cells.
A holistic multidisciplinary approach is needed for preventive and curative efforts. An internist or endocrinologist can be in charge of the patient in a hospital. According to Prof. Yunir, cross-professional collaboration in hospitals can reduce the incidence of LKD by up to 85%. In addition, the Ministry of Health has developed a Health Transformation Program in a Diabetes Priority Service Enablement Program by developing and strengthening hospital networks to improve access and quality of hospital services throughout Indonesia.
Before conducting a study on diabetic foot management, Prof. Yunir has done much research. Some of them are Factors of Affecting Mortality of Critical Limb Ischemia 1 Year after Endovascular Revascularization in Patients with Type 2 Diabetes Mellitus (2022); Characteristics of Diabetic Foot Ulcer Patients Pre- and During COVID-19 Pandemic: Lessons Learned From a National Referral Hospital in Indonesia (2022); and Three Years Survival and Factor Predicting Amputation or Mortality in Patients with High Risk for Diabetic Foot Ulcer in Fatmawati Hospital, Jakarta (2022).
Prof. Dr. dr. Em Yunir, SpPD-KEMD, completed his medical education at the Faculty of Medicine in 1988, in the Internal Medicine Specialist Education Program in 2000, in Endocrinology, Metabolism and Diabetes Consultant Subspecialty Medical Education Program in 2008, and received a Doctor of Medicine degree from UI in 2016. He serves as Teaching Staff for the Endocrine Metabolic and Diabetes Division, IPD Department, UI-RSCM, Jakarta and Education and Student Affairs Manager for the Specialist and Subspecialist Doctor Program. In 2023, Prof. Emir received the Award for Excellence in All Study Programs at the Medicine Faculty UI.
