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Lampiran 1. Lembar Pengumpulan Data

No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
1. 01225329 54 L 140/90 - - Inj. Novomix 16-0-16 2x1 - - Amlodipin - TO TD
2. 00539479 50 L 120/80 280 475 Metformin 500 3x1 250-3000 1-3 Propanolol - TO TD
3. 01027757 74 L 180/110 - - Inj. Novomix 14-0-14 2x1 - - Tanapres - TO TD
4. 00866801 74 P 120/80 - - Glucodex 40 2x1 80-320 1-2 HCT - TO TD
Glucotika 500 1x1 250-3000 1-3 Amlodipin TO TD
5. 00509177 76 L 130/60 131 130 Lodem 30 3x1 30-120 2-3 Tenapril - TO TD
6. 00456756 56 P 180/80 351 462 Levemir 0-0-0-16 1x1 12-16 - - Aspilet TTO TD
Novorapid 10-10-8 3x1 12-16 - TTO TD
7. 00689898 77 L 140/70 153 233 Inj. Novomix 22-0-22 2x1 Intervask - TO TD
8. 00611145 58 L 140/80 - - Metformin 500 3x1 250-3000 1-3 - Aspilet TO TD
9. 00812890 61 P 150/80 136 234 Lodem 30 3x1 30-120 2-3 - Aspilet TO TD
. Solosa 2 1x1 1-6 1 TO TD
10. 00840218 67 L 110/80 109 256 Inj.Novorapid 18-18-16 3x1 - - Intervask - TTO TD
Inj.Levemir 0-0-0-2 1x1 TTO TD
11. 01221859 52 L 110/80 119 - Inj.Novorapid 10-10-8 3x1 - - Furosemid - TO TD
12. 01125027 65 L 160/90 118 184 Metformin 500 3x1 250-3000 1-3 Amlodipin - TO TD
Glikuidon 30 3x1 30-120 2-3 TO TD
13. 00665024 67 P 130/70 160 221 Eclid 50 3x1 100-300 3 Amdixal - TO TD
Glucodek 80 3x1 80-320 1-2 TO TTD
14 00368763 65 L 170/70 - 140 Inj. Novomix 38-0-40 2x1 - - - Aspilet TTO -
Eclid 50 2x1 100-300 3 TO TTD
15. 00919748 55 P 140/90 117 143 Metformin 500 3x1 250-3000 1-3 - Aspilet TO TD
16. 01128225 64 P 120/70 127 178 Solosa 2 1x1 1-6 1 Canderin - TO TD
Eclid 50 3x1 100-300 3 TO TD
17 01234101 69 P 140/80 - - Inj. Novomix 16-0-16 2x1 - - Canderin Aspilet TO TD
18. 01005860 57 P 150/60 - - Acarbose 50 3x1 50-100 3 Amlodipin - TO TD
Furosemid

19. 00911735 57 P 150/80 174 310 Inj. Levemir 0-0-10 1x1 10-14 - - Vaclo TO TD
Eclid 50 3x1 100-300 3 TO TD
20. 00670497 55 P 140/90 140 167 Gludepatic 850 2x1 250-3000 1-3 - CPG TO TD
Glimepirid 2 1x1 1-6 1 TO TD

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No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
21. 00766292 65 L 150/70 367 489 Metformin 850 3x1 250-3000 1-3 Captopril - TO TD
Glibenclamide 5 2x1 2.5-15 1-2 HCT TO TD
22. 00298336 65 L 130/70 - - Inj. Novomix 26-0-26 2x1 - 1-3 Intervask - TTO -
Gludepatic 500 3x1 250-3000 TO TD
23. 00905223 60 L 150/80 - - Diaversa 2 1x1 1-6 1 Tenapril - TO TD
24. 00834416 54 L 130/90 297 287 Inj. Novomix 34-0-34 2x1 - - Tenapril - TO TD
25. 00689859 58 P 150/90 - - Levemir 0-0-26 1x1 - - Tenapril - TTO -
Glidiab 30 3x1 30-120 2-3 TO TD
26. 00956748 54 L 120/80 96 84 Diaversa 2 1x1 1-6 1 Canderin - TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD
27. 00378802 65 L 140/90 - - Inj. Novorapid 8-8-8 3x1 - - Canderin - TTO -
Lantus 0-0-2 1x1 - - TTO -
Gludepatic 500 3x1 250-3000 1-3 TO TD

28. 00864530 52 L 180/100 - - Gludepatic 500 3x1 250-3000 1-3 Candersartan - TO TD

Glucobay 50 3x1 50-100 3 TO TD
29. 00587499 55 P 150/110 193 284 Selosa 2 1x1 1-6 1 Intervask - TO TD
Gludepatic 500 2x1 250-3000 1-3 TO TD
30. 00890114 61 L 150/100 - - Lantus Flexpen 0-0-0-20 1x1 - - Candesartan - TO TD
Amlodipin
31. 00981701 56 P 140/90 91 146 Metformin 500 2x1 250-3000 1-3 Amlodipin - TO TD
32. 01172719 61 P 140/80 176 178 Humulin R 8-8-6 3x1 10-14 - Captopril - - TTD
Metformin 500 3x1 250-3000 1-3 Diltiazem TO TD
33 00980692 61 P 160/80 - - Metformin 500 3x1 250-3000 1-3 Canderin - TO TD
34. 00803792 52 P 190/100 196 284 Humulin N 10-0-10 3x1 12-16 - Captopril - TTO TTD
Merformin 500 3x1 250-3000 1-3 Diltiazem TO TD
35. 00509177 76 L 110/70 131 130 Lodem 30 3x1 30-120 2-3 Tenapril - TO TD
36. 00588221 56 L 130/80 163 209 Solosa 2 1x1 1-6 1 Tenapril Aspilet TO TD
37. 00662667 74 L 140/80 177 225 Eclid 100 3x1 100-300 3 - Vaclo TO TD
Glidiab 30 3x1 30-120 2-3 TO TD

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No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
38. 00717805 51 L 110/80 - - Eclid 100 3x1 100-300 3 Noperten - TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD
39. 00852606 54 L 130/96 - - Eclid 50 3x1 100-300 3 Canderin - TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD
40. 00862046 60 L 140/70 117 128 Eclid 50 3x1 100-300 3 Intervask - TO TD
Glidiab 30 3x1 30-120 2-3 TO TD
41. 00873414 59 L 150/90 180 371 Novorapid 18-18-18 3x1 10-14 - - vaclo TTO TTD
Levemir 0-0-0-22 1x1 10-14 - TTO TTD
42. 00897343 66 P 170/100 156 274 Gludepatic 500 3x1 250-3000 1-3 Canderin - TO TD
Eclid 50 3x1 100-300 3 TO TD
Glidiab 30 3x1 30-120 2-3 TO TD

43. 01065678 61 L 140/70 130 100 Gludepatic 500 3x1 250-3000 1-3 Alpentin TO TD
Eclid 50 3x1 100-300 3 TO TD
Glidiab 30 3x1 30-120 2-3 TO TD

44. 01110304 66 L 120/80 95 232 Metformin 500 2x1 250-3000 1-3 Canderin - TO TD
Eclid 50 3x1 100-300 3 TO TD
Diamicron 40 2x1 80 1-2 TO TD
45. 01199746 50 P 140/90 112 120 Metformin 500 3x1 250-3000 1-3 Captopril - TO TD
46. 01234428 46 P 160/100 168 - Metformin 500 3x1 250-3000 1-3 Captopril - TO TD
47. 00264553 72 L 130/70 - - Gludepatic 500 3x1 250-3000 1-3 Valsartan - TO TTD
Glucodex 80 3x1 80-320 1-2 TO TD
48. 00055922 55 L 140/90 230 337 Novomix flexpen 52-0-52 2x1 12-16 - Candesartan - TTO TTD
Metformin 500 3x1 250-3000 1-3 TO TD
49. 00157584 65 P 160/70 181 335 Lodem 30 3x1 30-120 2-3 Canderin - TO TD
Eclid 50 3x1 100-300 3 HCT TO TD
.50 00342504 62 L 120/90 386 317 Diamicron 20 2x1 80-320 1-2 Adalat - TO TTD
Eclid 100 3x1 100-300 3 TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD

51. 00267047 58 P 170/90 179 252 Inj. levemir 0-0-0-44 1x1 10-14 - Intervask - TTO TTD
Gludepatic 500 3x1 250-3000 1-3 TO TD

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No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
52. 00414025 70 L 140/80 140 224 Inj. levemir 0-0-0-22 1x1 8-12 - Intervask - TTO TTD
Metformin 500 3x1 250-3000 1-3 Irbesartan TO TD
53. 00425749 60 L 180/110 - - Lodem 30 3x1 30-120 2-3 Intervask - TO TD
Gludepatic 500 3x1 250-3000 1-3 Noperten TO TD
54. 00307997 61 P 150/100 343 434 Lodem 30 3x1 30-120 2-3 Canderin - TO TD
Eclid 100 3x1 100-300 3 TO TD
55. 00160973 67 L 140/90 - - Inj. novomix 4-0-4 2x1 - - Noperten - TTO -
Eclid 100 2x1 100-300 3 TO TTD
56. 01239857 67 L 140/90 - - Metformin 500 3x1 250-3000 1-3 Captopril TO TD
57. 01234143 64 P 150/90 214 303 Novopid 6-6-6 3x1 12-16 - Captopril - TTO TTD
Metformin 500 3x1 250-3000 1-3 HCT TO TD
58. 01175132 48 P 160/90 - - Gludepatic 500 3x1 250-3000 1-3 Tenapril - TO TD
Eclid 100 3x1 100-300 3 Propanolol TO TD
59. 01124776 61 L 120/80 109 275 Eclid 50 3x1 100-300 3 Tenapril - TO TD
Glucodex 80 3x1 80-320 1-2 TO TTD
60. 01063262 53 P 110/80 152 238 Glidiab 30 3x1 30-120 2-3 Canderin - TO TD
Eclid 50 3x1 100-300 3 TO TD
61. 01049357 61 P 150/90 - - Gludepatic 500 3x1 250-3000 1-3 Tenapril - TO TD
Eclid 50 3x1 100-300 3 TO TD
62. 01057874 52 L 130/80 194 261 Solosa 2 3x1 1-6 1 Canderin - TO TTD
Eclid 50 3x1 100-300 3 TO TD
63. 00804644 50 P 150/90 126 126 Gludepatic 500 2x1 250-3000 1-3 Intervask - TO TD
64. 00749660 69 P 120/80 131 197 Metformin 500 3x1 250-3000 1-3 Captopril - TO TD
65 00644911 65 L 160/80 164 172 Gludepatic 500 3x1 250-3000 1-3 Intervask - TO TD
Eclid 50 3x1 100-300 3 Canderin TO TD
66. 00319555 59 L 130/80 - - Deculin 15 1x1 15-30 1 - Aspilet TO TD
Diaversa 3 1x1 1-6 1 TO TD
Eclid 100 2x1 100-300 3 TO TD

67. 00957011 55 L 130/80 - - Novomix flexpen 20-0-20 2x1 - - Furosemid Aspilet TTO -

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No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
68. 00455997 48 P 150/100 118 182 Glidiab 30 3x1 30-120 2-3 Actapin - TO TD
Eclid 100 2x1 100-300 3 Canderin TO TTD
69. 00912564 57 L 130/80 153 176 Novorapid 6-6-4 3x1 10-14 - - Aspilet TTO TTD
Levemir 0-0-0-4 1x1 10-14 - TTO TTD
70. 01240269 56 L 130/100 - - Inj. novomix 10-0-10 2x1 - - - Vaclo TTO -
Metformin 500 3x1 250-3000 1-3 TO TD
71. 01239624 57 L 140/90 196 - Glibenklamid 5 1x1 2.5-15 1-2 - Aspilet TO TD
72. 00711551 55 L 140/100 194 315 Humalog mix 24-0-24 2x1 - - Canderin Aspilet TTO TTD
Eclid 50 3x1 100-300 3 TO TD
73. 00141185 77 L 150/90 161 261 Lodem 30 3x1 30-120 2-3 Tenapril - TO TD
Eclid 50 3x1 100-300 3 TO TD
74. 00304948 64 P 120/70 118 150 Eclid 50 3x1 100-300 3 Intervask - TO TD
Glukotica 500 3x1 250-3000 1-3 Canderin TO TD
75. 00514779 58 P 120/80 112 126 Lodem 30 3x1 30-120 2-3 Intervask - TO TD
Eclid 50 3x1 100-300 3 TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD

76. 00714531 64 P 130/80 200 126 Novomix 16-0-16 2x1 12-16 - Tenapril - TTO TD
Eclid 50 3x1 100-300 3 Intervask TO TD
77. 01167386 62 L 160/80 218 337 Diaversa 2 1 1-6 1 CPG - TO TD
Glukotica 850 2x1 250-3000 1-3 TO TD
Eclid 50 3x1 100-300 3 TO TD

78. 00489611 71 L 90/60 164 185 Eclid 100 3x1 100-300 3 Intervask - TO TD
Diamicron MR 30 1x1 30-60 1 TO TD
79. 00860360 52 L 120/70 155 213 Lodem 30 3x1 30-120 2-3 - Ganin TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD
Eclid 50 3x1 100-300 3 TO TD
80. 00246671 73 L 130/80 176 197 Solosa 2 1x1 1-6 1 Intervask - TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD
81. 01190678 46 P 150/100 - - Inj. Levemir 0-0-0-10 1x1 - Furosemid - TTO -
Inj. Novorapid 16-16-16 3x1

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No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
82. 00197003 73 L 170/100 122 235 Gludepatic 500 3x1 250-3000 1-3 Amlodipin - TO TD
Lodem 30 3x1 30-120 2-3 TO TD
Eclid 50 3x1 100-300 3 TO TD

83. 00457502 55 P 140/90 145 183 Novomix pen 58-0-0-58 2x1 10-14 - Adalat oros - TTO TTD
Gludepatic 500 3x1 250-3000 1-3 Clonidin TO TD
84. 01030879 52 P 130/90 98 136 Metformin 500 1x1 250-3000 1-3 Captopril - TO TD
85. 01125027 65 L 120/70 - - Metformin 500 3x1 250-3000 1-3 Candesartan - TO TD
86. 01228119 65 P 150/80 224 356 Inj. Levemir 0-0-0-14 1x1 - - Amlodipin - TTO TD
Metformin 500 3x1 250-3000 1-3 TO TD
87. 00482835 50 P 130/70 - - Metformin 500 3x1 250-3000 1-3 Amlodipin - TO TD
Solosa 2 1x1 1-6 1 TO TD
88. 01241561 61 L 140/100 - - Inj. novomix 14-0-12 2x1 Amlodipin - TTO -
89. 01030050 54 P 150/80 243 313 Gludepatic 500 3x1 250-3000 1-3 - Ganin TO TD
Eclid 50 3x1 100-300 3 TO TD
Lodem 30 3x1 30-120 2-3 TO TD

90. 00684977 57 P 130/80 - - Metformin 500 2x1 250-3000 1-3 Amlodipin - TO TD

91. 00644525 66 L 140/90 121 265 Glidiab 30 3x1 30-120 2-3 Noperten - TO TD
Gludepatic 500 3x1 250-3000 1-3 TO TD
Eclid 50 3x1 100-300 3 TO TD

92. 00749660 69 P 140/70 152 258 Metformin 850 3x1 250-3000 1-3 Captopril - TO TD
93. 00751661 59 P 120/80 - 390 Novomix 18-0-18 2x1 - - Intervask - TTO -
Eclid 50 3x1 100-300 3 TO TD
94. 00792162 60 P 120/90 485 412 Novorapid 18-18-16 3x1 12-16 - Furosemid - TTO TTD
Captopril
95. 01231614 50 P 140/90 - - Inj. Humulin R 12-12-10 3x1 - - Captopril -
96. 00803421 66 L 120/80 118 135 Glmepiride 2 1x1 1-6 1 Tenapril - TO TD
97. 00931219 56 P 120/80 - - Novomix 46-0-46 2x1 - - Candesartan - TTO -
Eclid 50 3x1 100-300 3 TO TD
98 01246902 55 P 150/90 - - Novorapid 12-12-12 3x1 - - Captopril - TTO -
Metformin 500 2x1 250-3000 1-3 TO TD

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No. No.Reg Umur Jk TD Obat Dosis Frek Standar Obat Obat lain Keterangan
( th) (mmHg) GDP GD2JPP Antidiabetik (mg) (kali/hari) antihipertensi (obat antidiabetik)
Dosis (mg) Frek Tepat obat Tepat dosis
99. 01248427 51 P 150/90 288 362 Glikuidon 30 2x1 30-120 2-3 Amlodipin - TO TD
Metformin 500 3x1 250-3000 1-3 Furosemid TO TD
100. 01093088 62 L 150/90 470 - Novorapid 10-10-10 3x1 12-16 - HCT - TTO TTD
Metformin 500 3x1 250-3000 1-3 Captopril - TO TD

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