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Latar Belakang: Penyakit kardiovaskular merupakan salah satu penyebab kematian tertinggi pada pasien-pasien dengan diabetes dan pasien-pasien dengan diabetes melitus memiliki risiko dua kali lebih tinggi mengalami gagal jantung. Dalam beberapa tahun terakhir, red cell distribution width (RDW) telah diteliti sebagai alternatif hemoglobin terglikasi (HbA1c) untuk mengukur kontrol glikemik pada diabetes melitus dan sebagai prediktor keparahan penyakit kardiovaskular. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui korelasi RDW dengan HbA1c pada pasien diabetes melitus dengan gagal jantung. Metode: Penelitian ini merupakan studi potong lintang menggunakan data rekam medis pasien dengan DM dan gagal jantung yang dirawat di RSUP Prof. Dr. I.G.N.G. Ngoerah, Denpasar, Bali antara Agustus 2020 hingga Agustus 2021. Data yang dikumpulkan meliputi umur, indeks massa tubuh (BMI), durasi penyakit, HbA1c, dan RDW. Uji korelasi Spearman digunakan untuk menentukan hubungan bivariat dan uji korelasi parsial digunakan untuk mengontrol variabel pengganggu (usia, IMT, dan lama sakit). Hasil: Sebanyak 68 subjek didapatkan, terdiri dari 57,6% laki-laki dan 42,4% perempuan. Dalam analisis bivariat RDW didapatkan memiliki korelasi negatif yang signifikan dengan HbA1c (r=-0,301, p=0,013) tetapi menjadi tidak signifikan setelah uji korelasi parsial untuk variabel pengganggu korelasi (r=-0,223, p=0,074). Simpulan: RDW memiliki korelasi negatif dengan HbA1c pada pasien diabetes melitus dengan gagal jantung. Kami menduga korelasi negatif terjadi karena penurunan efek umur eritrosit pada HbA1c dari gagal jantung dan kondisi terkait usia. Studi lebih lanjut diperlukan untuk lebih menjelaskan temuan ini.

Background: Obesity is an inflammatory condition that results in an increase in high sensitive C-Reactive Protein (hs-CRP), a risk for insulin resistance (IR). Vaspin has the effect of increasing insulin receptor sensitivity and on the other hand is a compensatory response to insulin resistance, one of which is measured by homeostasis models assessment-insulin resistance (HOMA-IR). This study was an analytical cross-sectional observational design, to determine the association between insulin, glucagon, CRP, and HOMA-IR levels with serum vaspin in obesity. Method: This study is an analytical study with a cross-sectional design. Criteria of inclusion were subjects in the range 18-60 years Denpasar citizen with BMI above 25 kg/m2 and willing to be involved in this study, while exclusion criteria were with either chronic conditions or acute inflammation such as infection, cancer, tumor, or chronic disease which is altered and threatening life. Correlation tests using spearman analysis. Results: From 131 obese subjects in this study, there were 72 (55%) men and 59 (45%) women. Median age: 33 (22-57) years, fasting insulin: 8.90 (2.20-74.50) ìIU/mL, glucagon: 48.10 (7.58-293.90) pq/mL, hs-CRP: 1.90 (0.20-9.50) mg/L, HOMA-IR: 2 (0.50-23.15), and vaspin levels: 0.16 (0.04-1.46) ng/mL. There was a significant positive correlation between HOMA-IR, insulin and glucagon with vaspin (r = 0.20, p = 0.020; r = 0.20, p = 0.022; and r = 0.28, p = 0.001), and a significant negative correlation between hs-CRP and vaspin (r = -0.24, p = 0.005) in obesity. In the path analysis, there was a direct and total negative effect of hs-CRP on vaspin (coefficient = -0.19; p = 0.027 and coefficient = -0.02; p = 0.038). Conclusion: This study shows a positive association between insulin, glucagon, and HOMA-IR with serum vaspin, while CRP is negatively associated with serum vaspin in obesity.

Background: Coronavirus disease (COVID-19) infection has become a worldwide pandemic. Diabetes Mellitus is a comorbid disease that can increase in severity. The most common clinical finding in severe COVID-19 infection is a high Neutrophil Lymphocyte Ratio (NLR). In patients with Diabetes Mellitus (DM) type 2, it is also known that high NLR values ​​have a poor prognosis. This study analyzes the risk factors associated with high NLR values ​​in type 2 DM patients infected with COVID-19 at Sanglah General Hospital. Methods: A cross-sectional analytical study was conducted on the medical records of 70 patients with COVID-19 infection with type 2 DM who were treated at Sanglah General Hospital, Denpasar, for the period April 2020-October 2020. The samples were divided into two groups, namely high and normal NLR. The analysis was conducted to see which risk factors were significantly associated with high NLR values ​​in COVID-19 patients with type 2 diabetes. The analysis was carried out using an independent T-test for numerical variables and chi-square for nominal variables. Results: Most of the study samples had high levels of NLR (65.71%). Risk factors that had a significant relationship with high NLR values ​​were random blood sugar levels (p=0.00), fasting blood sugar levels (p=0.00), HbA1c (p=0.002), CRP levels (p=0.00), leukocyte level (p=0.00), BUN level (p=0.004), history of type 2 DM before COVID-19 infection (p=0.009) and control HbA1c (0.001). Conclusion: The risk factors associated with high NLR values ​​in COVID-19 patients with type 2 DM at Sanglah Hospital Denpasar are random blood sugar levels, fasting blood sugar levels, HbA1c, CRP levels, leukocyte levels, BUN levels, history of type 2 diabetes before COVID-19 infection and HbA1c control. Latar Belakang: Infeksi Coronavirus disease (COVID-19) telah menjadi pandemik di seluruh dunia. Diabetes Mellitus merupakan penyakit komorbid yang dapat meningkatkan keparahan. Temuan klinis yang banyak ditemukan pada infeksi COVID-19 berat adalah nilai neutrophil lymphocyte ratio (NLR) yang tinggi. Pada pasien Diebetes Mellitus (DM) tipe 2 juga diketahui nilai NLR yang tinggi memiliki prognosis buruk. Penelitian ini bertujuan untuk menganalisis faktor risiko yang berhubungan dengan nilai NLR tinggi pada pasien DM tipe 2 yang terinfeksi COVID-19 di RSUP Sanglah. Metode: Studi analitik potong lintang dilakukan pada rekam medik 70 pasien dengan infeksi COVID-19 dengan DM tipe 2 yang dirawat di RSUP Sanglah Denpasar periode April 2020-Oktober 2020. Sampel dibagi menjadi dua kelompok yakni NLR tinggi dan normal. Analisis dilakukan untuk melihat faktor risiko yang signifikan berhubungan dengan nilai NLR tinggi pada pasien COVID-19 dengan DM tipe 2. Analisis dilakukan menggunakan uji independent T-test untuk variabel numerik dan chi-square untuk variabel nominal. Hasil: Mayoritas sampel penelitian memiliki kadar NLR tinggi (65,71%). Faktor risiko yang memiliki hubungan signifikan dengan nilai NLR tinggi adalah kadar gula darah acak (p=0,00), kadar gula darah puasa (p=0,00), HbA1c (p=0,002), kadar CRP (p=0,00), kadar leukosit (p=0,00), kadar BUN (p=0,004), riwayat DM tipe 2 sebelum infeksi COVID-19 (p=0,009) dan kontrol HbA1c (0,001). Kesimpulan: Faktor risiko yang berhubungan dengan nilai NLR tinggi pada pasien COVID-19 dengan DM tipe 2 di RSUP Sanglah Denpasar adalah kadar gula darah acak, kadar gula darah puasa, HbA1c, kadar CRP, kadar leukosit, kadar BUN, riwayat DM tipe 2 sebelum infeksi COVID-19 dan kontrol HbA1c.

Background: The pathogenesis of COVID-19 infection is the occurrence of excessive inflammatory reactions in which one of the markers of inflammation that is easy to work with is the value of the Neutrophil Lymphocyte Ratio (NLR). The NLR value increases in uncontrolled type 2 DM patients and is a prognostic factor for the occurrence of severe symptomatic COVID-19 infection. This study aims to examine the correlation between NLR values ​​and various laboratory parameters of type 2 DM patients with COVID-19 infection at Sanglah Hospital. Methods: This study used a cross-sectional analytical design and involved 70 research samples from the medical records of type 2 DM patients with COVID-19 who were treated at Sanglah Hospital from April 2020 to October 2020. Analysis with Pearson and Spearman tests to see the correlation between NLR values ​​and 12 laboratory parameters such as GDS, GDP, HbA1c, Leukocytes, Hemoglobin, BUN, D-Dimer, CRP, serum creatinine, SGOT, SGPT and Ferritin using SPSS software version 21 for Windows. Results: From the results of the correlation test, laboratory parameters that were found to be significantly positively correlated with NLR values ​​were GDS levels (r=0.451; p=0.000), GDP (r=0.037; p=0.001), leukocytes (r=0.479; p=0.000), BUN (r=0.368; p=0002), D-dimer (r=0.348; p=0.011), CRP (r=0.557; p=0.000), serum creatinine (r=0.313; p=0.009) and ferritin (r=0.337; p=0.011). Conclusion: The NLR value in type 2 DM patients with COVID-19 is positively correlated with glycemic markers, namely GDS and GDP. In addition, it is also positively correlated with leukocytes, BUN, D-dimer, CRP, serum creatinine and ferritin. Latar belakang: Patogenesis infeksi COVID-19 adalah terjadinya reaksi inflamasi berlebihan dimana salah satu penanda inflamasi yang mudah dikerjakan adalah nilai Neutrophil Lymphocyte Ratio (NLR). Nilai NLR meningkat pada pasien DM tipe 2 yang tidak terkontrol dan menjadi faktor prognostik untuk terjadinya infeksi COVID-19 gejala berat. Penelitian ini bertujuan untuk meneliti korelasi antara nilai NLR dengan berbagai parameter laboratorium pasien DM tipe 2 dengan infeksi COVID-19 di RSUP Sanglah. Metode: Studi ini menggunakan desain analitik potong lintang dan melibatkan 70 sampel penelitian dari rekam medik pasien DM tipe 2 dengan COVID-19 yang dirawat di RSUP Sanglah bulan April 2020 hingga Oktober 2020. Analisis dengan Uji Pearson dan Spearman untuk melihat korelasi antara nilai NLR dengan 12 parameter laboratorium berupa GDS, GDP, HbA1c, Leukosit, Hemoglobin, BUN, D-Dimer, CRP, serum kreatinin, SGOT, SGPT dan Ferritin menggunakan piranti lunak SPSS versi 21 untuk Windows. Hasil: Dari hasil uji korelasi, parameter laboratorium yang ditemukan signifikan berkorelasi positif dengan nilai NLR adalah kadar GDS (r=0,451; p=0,000), GDP (r=0,037; p=0,001), leukosit (r=0,479; p=0,000), BUN (r=0,368; p=0002), D-dimer (r=0,348; p=0,011), CRP (r=0,557; p=0,000), serum kreatinin (r=0,313; p=0,009) dan ferritin (r=0,337; p=0,011). Kesimpulan: Nilai NLR pada pasien DM tipe 2 dengan COVID-19 berkorelasi positif dengan penanda glikemik yaitu GDS dan GDP. Selain itu berkorelasi positif juga dengan leukosit, BUN, D-dimer, CRP, serum kreatinin dan ferritin.

Background: The aging process is characterized by a gradual decline in physical aspect. Changes in body composition are an important sign of the aging process. Lung disease and respiratory disorders are one of the main health problems in the elderly. Various studies have examined the relationship between decreased muscle mass, obesity, and lung function. However, the results of these studies are still unclear. Aims of this study to determine the relationship between sarcopenia, obesity, and lung function in the elderly group in Tabanan City, Bali. Methods: This study is an analytical study with cross-sectional design conducted at Tabanan City, Bali, in February 2017. The data was taken using the consecutive sampling technique method; 187 samples were collected from the primary data according to inclusion and exclusion criteria—the analysis using univariate, bivariate and multivariate analysis. Results: Prevalence of Sarcopenia and obesity in the elderly in Tabanan Regency, Bali was 18.2% and 46%, respectively. Meanwhile, those who experienced sarcopenic obesity were 3.2%. Peak expiratory rates were significantly lower in the elderly group with sarcopenia than those without sarcopenia (p=0.026). Peak expiratory rate was significantly higher in the obese elderly group than in the non-obese group p=0.001). Conclusion: Peak expiratory rates were significantly different in the elderly group with Sarcopenia and obese than those without Sarcopenia or obese.

Background: The prevalence of heart failure (HF) is 4 times higher in patients with diabetes mellitus (DM) than general population. Coronary heart disease (CHD), hypertension, DM, obesity, smoking and atrial fibrillation are risk factors for HF. However, many observational studies have shown that DM is an independent risk factor for HF through the mechanism of diabetic cardiomyopathy. Objective: This study aimed to determine the characteristic heart failure in patients with DM. Methods: This study used a cross sectional descriptive design and the secondary data originating from medical records of patient in the intermediate ward and intensive care coronary care unit, Sanglah Hospital on March 2020 - March 2021. The inclusion criteria were DM patients with acute or chronic HF, while the exclusions criteria were DM patients with anemia, pregnancy and incomplete medical record data. Result: A total of 65 subjects were male (43%), aged > 60 years (52.3%), had a history of smoking (50.8%), experienced obesity grade I (35.4), with duration of DM > 5 years (67.7%) and had poor glycemic control (55.4%). The majority of DM complications were CHD (86.2%). Based on echocardiography results, the subjects had heart failure with reduced ejection fraction (43.1%), left atrial dilatation (58.5%), left ventricular hypertrophy (80%), heart valve abnormalities (66.2%) and left ventricular diastolic dysfunction (73.8%). Conclusion: There were no subjects who only suffered from DM type 2 without other comorbid diseases such as CHD, hypertension or heart valve disease.

Background: Glucagon like peptide 1 (GLP1) is incretin hormone which possess biological effect on the kidneys. In conditions where the estimated glomerular filtration rate (eGFR) decreases or in the condition of chronic kidney disease (CKD), there is an increase in the inactive GLP1 or metabolites levels. Objective: To prove the relationship between eGFR with fasting and response of GLP1 after oral glucose loading in type 2 diabetes mellitus (T2DM) patients. Methods: An analytic cross sectional study on fasting and response of GLP1 after glucose loading in 60 subject with T2DM, age 35-65 years, was conducted. Each subject was obtained for fasting GLP1 and 30 minutes after 75 gram oral glucose loading. Subject were grouped based on eLFG into

Abstract: Diabetes mellitus, defined as long-standing hyperglycemic conditions caused by a defect in insulin production and activity, has become a major healthcare burden as the number of catastrophic and life-threatening complications rises. Microvascular complications [neuropathy, retinopathy, and nephropathy] While it is impossible to pinpoint the specific crucial timing when the complications become fully entrenched, looking for novel sensitive biomarkers to identify physiological changes in the initial stages would be needed. An increasing amount of data shows that miRNAs, particularly miRNA146a, are stable in a range of body fluids and can be used to identify pathogenic changes at the cellular or tissue level. In this brief review, we highlight the important functioning of miRNA146a and its putative target of action in diabetic microvascular and cardiovascular complications. A decrease in miRNA146a levels may play a critical role in the onset and development of diabetes complications, whereas its anti-inflammatory properties were revealed to be associated with the pathogenesis of numerous diabetic complications, including diabetic nephropathy, retinopathy, neuropathy, and diabetes-related cardiovascular disorders, even tending to be a potential biomarker of the disease's inflammatory status.

Gilang Bhaskara,1 Anak Agung Gde Budhiarta,2 Wira Gotera,2 Made Ratna Saraswati,2 I Made Pande Dwipayana,2 I Made Siswadi Semadi,2 Ida Bagus Aditya Nugraha,2 Ida Ayu Kusuma Wardani,3 Ketut Suastika2 1Internal Medicine Education Program, Faculty of Medicine, Udayana University, Bali, Indonesia; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia; 3Department of Psychiatry, Sanglah General Hospital, Denpasar, Bali, IndonesiaCorrespondence: Ketut Suastika, Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia, Tel +62 81 138 0916, Email ksuas@unud.ac.idBackground: Diabetes-related distress is a unique emotional problem that is directly related to the burden and anxieties felt by type 2 diabetes mellitus (T2DM) patients. Diabetes-related distress may lead to pessimism and lower self-efficacy which resulted in a deficiency of self-treatment compliance and can cause further bad glycemic control. Knowing the associated factors of diabetic-related distress and solving them may help T2DM patients improve their glycemic control.Methods: This study is an analytical study with cross-sectional design conducted at Sanglah General Hospital from January to April 2021. The data were taken using the consecutive sampling method; 124 samples were collected according to inclusion and exclusion criteria. The participants filled Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). The data analysis was done using univariate (descriptive), bivariate (chi-square) and multivariate (logistic regression) analysis.Results: Seventy-five subjects out of 124 (60.5%) had diabetes-related distress. The associated factors of diabetes-related distress one among others are the insulin usage as diabetic therapy (OR= 8.30, 95% CI 2.24– 30.72; p = 0.002), had a hypoglycaemia in last 3 months (OR=44.59, 95% CI 4.36– 455.51; p = 0.001), had diabetes-related retinopathy (OR=10.28, CI 95% 1.54– 68.70; p=0.016), and lack of family support (OR=44.791, 95% CI 10.02– 200.22; p < 0.001).Conclusion: Our present study revealed that diabetes distress prevalence is predominantly and associated among in type 2 diabetes mellitus. We suggest diabetes-related distress screening and regular health promotion which focus on relationship between diabetes and psychological may be a great potential action to improve public health and patient outcomes.Keywords: type 2 diabetes mellitus, diabetes-related distress, factors associated

Background. The extract of Andrographis paniculata (Burm. F.) Wall. Ex. Nees. (sambiloto) (穿心蓮 chuān xīn lián) has been reported to have an antidiabetic effect on mice models and has been used traditionally in the community. The exact mechanism of sambiloto extract in decreasing plasma glucose is unclear, so we investigated the role of sambiloto extract in the incretin pathway in healthy and prediabetic subjects. Methods. This study was a randomized, placebo-controlled, crossover, double-blind trial. It included 38 people who were healthy and 35 people who had prediabetes. All subjects were randomly assigned to receive either the intervention sambiloto extract or a placebo. All subjects were randomly assigned to receive the first intervention for 14 days. There was a washout period between subsequent interventions. The primary outcome was glucagon-like peptide 1 (GLP-1) concentration, and secondary outcomes were fasting insulin, 2-hour postprandial insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose, 2-hour postprandial blood glucose, dipeptidyl peptidase-4 (DPP-4), and glycated albumin before and after the intervention. Result. After the intervention, GLP-1 concentration significantly increased in prediabetes by 19.6% compared to the placebo ( p = 0.043 ). There were no significant differences in the changes of fasting insulin, 2-hour postprandial insulin, HOMA-IR, fasting blood glucose, 2-hour postprandial blood glucose, DPP-4, and glycated albumin levels after the intervention. Sambiloto extract did not inhibit the DPP-4 enzyme in healthy and prediabetic subjects. Conclusion. Sambiloto extract increased GLP-1 concentration without inhibiting the DPP-4 enzyme in prediabetic subjects. This trial is registered with ClinicalTrials.gov (ID: NCT03455049), registered on 6 March 2018—retrospectively registered (https://clinicaltrials.gov/ct2/show/NCT03455049).

Background Dyslipidemia is one of the major risks for the development of cardiovascular diseases which has been the leading cause of death in developing countries. Previously, common polymorphisms of the transcription factor 7-like 2 (TCF7L2) gene have been associated with altered lipid profiles. In this study, we investigated the associations of TCF7L2 SNPs, rs290487 and rs290481, with dyslipidemia and altered lipid profile in the Balinese. Methods A total of 565 subjects from four locations in the Bali Province, Indonesia, were recruited. Serum lipid concentrations (triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC)) were measured using standard protocol. SNP genotyping was done using the amplification refractory system mutation polymerase chain reaction (ARMS-PCR) method. Results We found the shifted major/minor allele frequencies of both SNPs (0.56 for rs290487 T allele, 0.53 for rs290481 T allele) in the Balinese, as compared to dbSNP. The rs290487 and rs290481 C alleles were significantly associated with dyslipidemia, particularly high TC and high LDL-C. These associations were independent of age, sex, population, obesity, diabetes mellitus, and high TyG index as a proxy for insulin resistance. The haplotype CC also showed similar association with these traits. Our findings indicate that TCF7L2 polymorphisms are associated with dyslipidemia and altered lipid profile in the Balinese.

Primary adrenal insufficiency, also known as Addison’s disease, is a rare but potentially fatal condition resulting from the failure of the adrenal cortex to produce glucocorticoid and/or mineralocorticoid hormones. Unfortunately, the clinical manifestation of primary adrenal insufficiency is not specific and often progresses insidiously, resulting in late diagnosis, or in severe cases, life-threatening circulatory collapse. Adrenal insufficiency should be considered in patients with unexplained vascular collapse. We report the case of a woman who presented to the emergency ward with unexplainable shock that was later diagnosed as adrenal crisis due to Addison’s disease. The presence of hyperpigmentation in patients with rapid progression of adrenal insufficiency suggests the diagnosis of Addison’s disease presenting with adrenal crisis.

Background: Diabetic Nephropathy (DN) is Diabetes Mellitus’s microvascular complication with albuminuria and decrease glomerular filtration rate. DN pathogenesis is related with inflammatory process induced by chronic hyperglycaemia. Mean platelet volume (MPV) and platelet-lymphocyte ratio (PLR) are potential for reviewing systemic inflammation. The combination of MPV and PLR index into MPVLR shows significant results in prognostic patients with diabetes mellitus and acute myocardial infarction and predicted DN. This study aims to determine the MPVLR index of DN risk in type II diabetes mellitus patients at Sanglah Hospital, Denpasar.Method: Cross-sectional study of 50 DM-2 patients at Sanglah Hospital in 2016. The data is secondary data from the medical records of DM-2 patients according the inclusion and exclusion criteria with purposive sampling technique. Diabetic nephropathy is diagnose based on diagnostic criteria. Complete blood count (CBC) using the CELL-DYN Ruby System. MPVLR is an absolute comparison of the calculation of MPV and total lymphocytes. T-test and Mann-Whitney Test to assess differences mean of data. The MPVLR index for diabetic nephropathy was assessed by Receiver Operating Curve (ROC) and Area Under the Curve (AUC). p 0.05). The MPVLR ratio was statistically significantly higher in the nephropathy group (5.11 ± 2.20; P = 0.004). The MPVLR index cut point value was 3.835 with a sensitivity value of 73.7% and specificity of 71%.Conclusion: MPVLR can use as independent predictor of diabetic nephropathy in diabetic patients. Latar Belakang: Diabetik Nefropati (DN) merupakan komplikasi mikrovaskular Diabetes Melitus dengan albuminuria dan penurunan estimasi laju filtrasi glomerulus. Patogenesis DN berkaitan dengan proses inflamasi terinduksi hiperglikemia kronis. Indeks rerata volume trombosit (MPV) dan rasio trombosit-limfosit (PLR) potensial untuk meninjau inflamasi sistemik. Gabungan indeks MPV dan PLR menjadi MPVLR menunjukan hasil yang signifikan dalam diagnostik prognostik pada pasien diabetes melitus dan infarksi miokardial akut serta menjadi prediktor DN. Penelitian ini bertujuan untuk mengetahui indeks MPVLR terhadap risiko DN pada pasien diabetes melitus tipe II di RSUP Sanglah, Denpasar.Metode: Studi potong lintang (cross-sectional) terhadap 50 pasien DM-2 di RSUP Sanglah tahun 2016. Data penelitian adalah data sekunder dari rekam medis pasien DM-2 yang memenuhi kriteria Inklusi dan Eksklusi dengan teknik purposive sampling. Diabetik nefropati ditegakkan berdasarkan kriteria diagnosis. Pemeriksaan darah lengkap (DL) menggunakan CELL-DYN Ruby System. Rasio MPV terhadap limfosit (MPVLR) adalah perbandingan absolut dari perhitungan MPV dan limfosit total. Uji-t dan Uji Mann-Whitney untuk menilai perbedaan antara rata-rata data dua kelompok. Indeks MPVLR terhadap diabetic nefropati dinilai dengan Receiver Operating Curve (ROC) dan Area Under the Curve (AUC). Nilai p0,05). Rasio MPVLR secara statistik bermakna lebih tinggi pada kelompok dengan nefropati (5,11±2,20; P=0,004). Nilai titik potong indeks MPVLR sebesar 3,835 dengan nilai sensitifitas sebesar 73,7% dan spesifisitas 71%.Simpulan: MPVLR dapat sebagai prediktor kuat dan independen diabetik nefropati pada pasien diabetes.

Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are limited to curing the symptoms and have not been able to restore insulin sensitivity in insulin-sensitive tissues that have become resistant. In the past decade, some studies have shown the significant role of a chaperone family, heat shock protein 70 (HSP70), in insulin resistance pathogenesis that leads to T2DM. HSP70 is a cytoprotective molecular chaperone that functions in protein folding and degradation. In general, studies have shown that decreased concentration of HSP70 is able to induce inflammation process through JNK activation, inhibit fatty acid oxidation by mitochondria through mitophagy decrease and mitochondrial biogenesis, as well as activate SREBP-1c, one of the lipogenic gene transcription factors in ER stress. The overall molecular pathways are potentially leading to insulin resistance and T2DM. Increased expression of HSP70 in brain tissues is able to improve insulin sensitivity and glycemic control specifically. HSP70 modulation-targeting strategies (including long-term physical exercise, hot tub therapy (HTT), and administration of alfalfa-derived HSP70 (aHSP70)) in subjects with insulin resistance are proven to have therapeutic and preventive potency that are promising in T2DM management.

Background. Altered lipid profiles have consistently been linked to cerebrovascular events. Ischemic stroke (IS) was a common comorbid condition established in type 2 diabetes mellitus (T2DM). The apolipoprotein E (ApoE) gene which has a notably critical function in lipoprotein metabolism is believed as one of the potential candidate genes susceptible to IS complications in T2DM. This research aimed to determine the association of apolipoprotein E gene polymorphism with lipid profile and IS risk in T2DM patients. Methods. This case-control study involved a total of 60 diabetic participants divided into two groups with and without IS. ApoE was genotyped using PCR and sequencing analysis. Results. The most predominant genotype observed in 27 participants (45%) was E3/E3. Lower levels of high-density lipoprotein cholesterol (HDL-C) were found in ε2 carriers ( p = 0.003 ; 95% CI −23.35–−4.89) and ε4 carriers ( p = 0.019 ; 95% CI 1.38–14.55) compared to ε3 homozygotes. Total cholesterol (TC), triglyceride, and low-density lipoprotein cholesterol (LDL-C) levels had no association with ApoE gene polymorphism in this study. ApoE gene polymorphism was not related to IS in T2DM ( p = 0.06 ; adjusted OR: 4.71; 95% CI 0.93–23.79). Conclusions. ApoE ε2 and ε4 carriers were associated with lower levels of HDL-C. No association was identified between ApoE gene polymorphism and IS in T2DM patients.

We have reported a case of 21 year old patient with congenital adrenal hyperplasia that manifestated with ambiguous genitalia and other signs of androgen excess. Chromosome analysis revealed 46 XX. Laboratory examination and imaging showed high level of 17-hydroxyprogesterone, undeveloped uterus, two ovaries with follicles, no testicles, no prostate, and mass at upper side of both kidney with irregular border confirmed the diagnosis. It was planned to give glucocorticoid therapy to the patient to suppress androgen level, genital reconstruction surgery and psychosexual therapy to reared as a woman, but she refused all suggestions because she wanted to be considered a man.

Transcription factor 7-like 2 (TCF7L2) protein plays an important role in glucose and lipid metabolisms. Single nucleotide polymorphisms (SNPs) in the TCF7L2 gene contribute to increased fasting plasma glucose (FPG) and body mass index (BMI), and altered lipid concentrations in various population. We investigated whether the TCF7L2 SNPs were associated with obesity, high FPG and altered lipid profile in the Balinese. A total of 608 Balinese from rural and urban Bali, Indonesia, were recruited. Triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and FPG were measured, and BMI was calculated. Ratios of TG/HDL-C, LDL-C/HDL-C, and TC/HDL-C were determined. Genotyping of SNPs rs7903146, rs10885406, and rs12255372 were done in all samples. Genetic association analyses under a dominant model showed that the rs7903146 (OR 5.50, 95% CI 2.34–12.91, p = 8.5 × 10−5), rs12255372 (OR 4.15, 95% CI 1.66–10.33, p = 0.003) and rs10885406 (OR 2.43, 95% CI 1.39–4.25, p = 0.003) were significantly associated with high TC/HDL-C ratio. The rs10885406 also presented a significant association with high TG (OR 2.21, 95% CI 1.29–3.81, p = 0.004) and low HDL-C (OR 3.02, 95% CI 1.58–5.80, p = 0.001) concentrations, as well as high TG/HDL-C ratio (OR 1.95, 95% CI 1.16–3.27, p = 0.013). None of the SNPs exhibited significant association with obesity or high FPG. SNPs in the TCF7L2 gene are associated with altered lipid profile in the Balinese.

Background: Polymorphisms in the transcription factor 7 like-2 (TCF7L2) gene have been consistently reported to be associated with increased risk of type 2 diabetes mellitus in various populations, in particular, the rs7903146, rs12255372, and rs10885406 polymorphism. Objective: The aim of this study was to investigate whether these polymorphisms in the Balinese population of Legian village. Methods: A cross-sectional study enrolling 286 participants (178 male, 108 female), mean age was 46.0±10.0 (range 20–83) years. PCR-RFLP conducted genotyping for rs7903146, rs12255372, and rs10885406 polymorphism, fasting and two hours after meal blood glucose were measured. Student’s t-test and analysis of variance (ANOVA) and chi-square test were employed. Results: The frequencies of the CC and CT genotypes of the rs7903146 polymorphism were 93.4% and 6.6%. The GG and GT genotypes of the rs12255372 polymorphism were 94.8% and 5.2%, while in the rs10885406 they were 87.1%, 12.2%, and 0.7% for the AA, AG, and GG genotypes. The TT genotypes of the rs7903146 and rs12255372 not found. The prevalence of type 2 diabetes in this population were 9.0%. The frequency of the CT genotype of the rs7903146 was higher in diabetes compare to the non-diabetes group (7.6% vs. 6.5%, p=0.822), while GT genotype in rs12255372 was lower (3.8% vs. 5.3%, p=0.737). The AG genotype of the rs10885406 also lower in diabetes group (7.6% vs. 12.6%, p=0.679). In the CT genotype of rs7903146, the two hours after meal blood glucose were significantly higher (141.15 ± 125.06 vs. 107.50 ± 46.94, p=0.012). Interestingly, although not statistically significant, individuals with the GG genotype showed the lowest blood glucose. Conclusion: Rs7903146, rs12255372, and rs10885406 polymorphisms in the TCF7L2 genes did not show association with type 2 diabetes in the Balinese population of Legian Village. However, two hours after meal blood glucose level was found to be significantly higher in the CT genotype of the rs7903146.

The increasing cases of type 2 diabetes mellitus (T2DM) have made it a very concerning metabolic disease worldwide. The increasing understanding of the role of gut microbiota in metabolism process has lead to a promising intervention of T2DM that can relieve not only the symptoms but also help improve the disrupted metabolic mechanisms. Probiotics are now widely studied for its potential in the management of T2DM. From 50 journals reviewed, 43 were found suitable as references for this paper. The keywords used are “probiotics,” “gut microbiota,” “obesity” and “type 2 diabetes mellitus” on selected search engines. In general, it has shown that probiotics do have systemic therapeutic effects as it can increase the secretion of gut hormones, maintain gut barrier function and improve inflammatory response, thereby providing a hopeful future for a comprehensive management of metabolic disorders, especially T2DM.

Latar Belakang: Glycated albumin (GA) merupakan indeks kontrol glikemik yang relatif baru. GA mencerminkan statusglukosa darah yang lebih pendek dibandingkan HbA1C, yakni 2-4 minggu sebelumnya. Tujuan: untuk mengetahuiapakah GA dapat digunakan sebagai penanda kontrol glikemik pada penderita DM tipe 2 (DMT2) dengan mencarisensitivitas, spesifisitas, nilai duga positif (NDP), dan nilai duga negatif (NDN) dari GA. Metode: Penelitian inimerupakan uji diagnostik, studi potong lintang, dilaksanakan di RSUP Sanglah dari Desember 2015 hingga Februari2016 menggunakan sampel 59 pasien DMT2. Kontrol glikemik ditentukan dengan HbA1C, glukosa puasa dan glukosa2JPP (baku emas). Hasil: Didapatkan area under ROC curve GA adalah 0,9135 (91,35%). Didapatkan 5 cut off point GAdimana 2 cut off point menunjukkan kemampuan skrining GA yakni ≥18,7% dan ≥19%, 2 cut off point menunjukkankemampuan diagnostik GA yakni ≥21,4% dan 22,4%, dan 1 cut off point optimal yakni 20,4%. Hasil uji diagnostikdengan menggunakan tabel silang 2x2 pada masing-masing cut off point yaitu GA ≥18,7% sensitivitas 94,7%;spesifisitas 76,2%; NDP 87,8%; NDN 88,9%. GA ≥19% sensitivitas 89,5%; spesifisitas 81%; NDP 89,5%; NDN 81%. GA ≥20,4% sensitivitas 81,6%; spesifisitas 85,7%; NDP 91,2%; NDN 72%. GA ≥21,4% sensitivitas 76,3%; spesifisitas 90,5%;NDP 93,5%; NDN 67,9%. GA ≥22,4% sensitivitas 63,2%; spesifisitas 95,2%; NDP 96%; NDN 58,8%. Berdasarkan ujikorelasi, terdapat hubungan positif kuat antara GA dengan HbA1C, GA dengan glukosa puasa dan GA dengan glukosa2JPP. Kesimpulan: Pemeriksaan GA darah dapat digunakan sebagai modalitas diagnostik dalam menilai kontrolglikemik pada penderita DMT2.

Tujuan: Studi ini bertujuan melakukan pencarian prevalensi obesitas orangtua, anak, serta hubungan obesitas orangtua terhadap obesitas anak remaja sekolah menengah atas (SMA) di Denpasar tahun 2015. Metode: Penelitian observasional ini memiliki rancangan studi potong lintang dengan melakukan pengambilan data anak sekolah menengah atas dibeberapa sekolah di Denpasar. Secara acak dipilih sampel yang dapat mewakili Denpasar. Kuesioner dibagikan dan diminta untuk diisi oleh siswa-siswi. Dilanjutkan dengan pengukuran berat badan, tinggi badan, lingkar pinggang, maupun lingkar lengan atas. Pengukuran dilakukan pada siswa-siswi maupun kedua orangtuanya. Hasil: Dari 298, 188 (63,09%) yang dapat diambil menjadi data. Prevalensi obesitas orangtua 40,96% dan obesitas anak sekolah menengah atas 15,4%, di Denpasar tahun 2015. Analisis data menunjukkan bahwa terdapat hubungan antara status nutrisi atau gizi ibu ditinjau dari indeks massa tubuh dengan lingkar pinggang atau lingkar lengan atas terhadap status gizi anak sekolah menengah atas di Denpasar. Hubungan dari status gizi pada jumlah orangtua obesitas berdasarkan indeks massa tubuh dengan status gizi pada anak sekolah menengah atas di Denpasar pada 2015 juga ditemukan, nilai p < 0,05. Simpulan: Terdapat hubungan obesitas orangtua ditinjau dari indeks massa tubuh terhadap obesitas anak sekolah menengah atas di Denpasar pada tahun 2015. Adanya kelemahan di dalam penelitian membuat perlu dilakukannya penelitian lebih lanjut dengan topik ini, dengan sampel lebih besar dan memperhatikan faktor-faktor perancu penelitian.

The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in this region. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance (IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment are urgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestyle modification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importance of lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting, experts from the Asian region convened to develop consensus recommendations to guide clinicians in the management of Asian patients with pre-diabetes. These consensus recommendations provide a clear and concise approach to the management of individuals with IGT based on the available evidence and current best clinical practice.

Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are limited to curing the symptoms and have not been able to restore insulin sensitivity in insulin-sensitive tissues that have become resistant. In the past decade, some studies have shown the significant role of a chaperone family, heat shock protein 70 (HSP70), in insulin resistance pathogenesis that leads to T2DM. HSP70 is a cytoprotective molecular chaperone that functions in protein folding and degradation. In general, studies have shown that decreased concentration of HSP70 is able to induce inflammation process through JNK activation, inhibit fatty acid oxidation by mitochondria through mitophagy decrease and mitochondrial biogenesis, as well as activate SREBP-1c, one of the lipogenic gene transcription factors in ER stress. The overall molecular pathways are potentially leading to insulin resistance and T2DM. Increased expression of HSP70 in brain tissues is able to improve insulin sensitivity and glycemic control specifically. HSP70 modulation-targeting strategies (including long-term physical exercise, hot tub therapy (HTT), and administration of alfalfa-derived HSP70 (aHSP70)) in subjects with insulin resistance are proven to have therapeutic and preventive potency that are promising in T2DM management., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/5ihbHqWNRuE

Purpose To establish the lipid pattern in subjects with diabetes mellitus (DM) and factors that are correlated with insulin resistance and lipid disorders in a population of Bali. Methods A cross-sectional population-based study which enrolled 1840 subjects (age 13–100 years) from 7 villages was carried out. Several clinical parameters were measured including age, gender, body mass index, waist circumference (WC), fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A (apoA), apoB, non-HDL-C, T/HDL-C ratio, LDL-C/apoB ratio, apoB/A ratio, plasma insulin, and homeostasis of model assessment-insulin resistance (HOMA-IR). Results TC, TG, and non-HDL-C levels were higher in DM subjects than in normal glucose tolerance (NGT) subjects in both genders; total/HDL-C ratio was higher in subjects with DM than in NGT subjects only in men; LDL-C levels, apoB levels, and apoB/A ratios were higher and LDL/apoB was lower in subjects with DM than in NGT in women. In subjects with DM, the target for LDL-C (79%), non-HDL-C (85.2%), apoB (80%), HDL-C (34.9%), TG (46.7%), and small-dense low density lipoprotein (42.2%) was not achieved. Conclusion FBG was correlated with TC, TG, LDL-C, apoB, non-HDL-C levels, LDL/apoB, and apoB/apoA ratios. Subjects with DM had higher levels of TC, TG, and non-HDL-C levels in both genders; T/HDL-C ratio only in men; LDL-C, apoB/apoA ratio and lower LDL/apoB ratio only in women. Obesity was correlated with lipid levels. WC was correlated with LDL/apoB ratio, insulin level, HOMA-IR, and TG; highest absolute strength of correlation was with LDL/apoB ratio. Insulin resistance was correlated with lipid levels or ratios, especially in women. In women, HOMA-IR had a positive correlation with total/HDL-C ratio, non-HDL-C, apoB, and a negative correlation with HDL-C levels.

BACKGROUND: Prevalence of obesity increased sharply recently; it was associated with an increased prevalence of several cardiometabolic diseases. Reduced glucagon-like peptide 1 (GLP-1) secretion is observed among obese subjects in many studies, and it may mediate the failure of insulin secretion response to food intake. AIM: To evaluate the pattern of fasting and post 75 g glucose loading of GLP-1 levels in obese and non-obese subjects. METHODS: An experimental study on the pattern of GLP-1 levels in fasting state and response in post 75 g glucose loading in obese and non-obese subjects, was conducted. Sixteen obese and 16 non-obese subjects were enrolled in the study, with age- and sex-matching in both groups. GLP-1 levels were measured at fasting state (0), 15, 30, 60, and 120 minutes post-glucose loading. RESULTS: The GLP-1 response to glucose loading were similar in obese and non-obese subjects, which increased from fasting state to post glucose loading and reaching the peak levels in 15 minutes, then declined until the end of observation. There was tendency that GLP-1 levels in fasting state and post glucose loading were lower in obese subjects compared to in non-obese subjects (in fasting state, 5.67 vs. 6.16 ng/mL, P = 0.338; in 15 minutes, 6.20 vs. 6.94 ng/mL, P = 0.239; in 30 minutes 6.20 vs. 6.90 ng/mL, P = 0.264; in 60 minutes, 5.77 vs. 6.12 ng/mL, P = 0.242), but the difference were not statistically significant, except in 120 minutes (5.24 vs. 6.67 ng/mL, P = 0.049; in obese and non-obese subjects, respectively). Similar finding was also seen in the pattern of response (delta) of GLP-1 from time-to-time observation among obese and non-obese subjects (0-15 minutes [0.52 vs. 0.8 ng/mL, P = 0.350], 0-30 minutes [0.53 vs. 0.74, P = 0.550], 0-60 minutes [0.11 vs. 0.31 ng/mL, P = 0.546], in 0-120 minute [-0.42 vs. 0.31, P = 0.006]). CONCLUSIONS: The patterns of GLP-1 levels post glucose loading were similar in obese and non-obese subjects which increased from fasting state to post glucose loading, reaching the peak levels in 15 minutes and then declined until the end of observation, except in non-obese subjects where the GLP-1 levels were increased at 120 minutes. There was a tendency of GLP-1 levels in fasting state and post-glucose loading to be lower in obese subjects compared within non-obese subjects.

BACKGROUND: Vaspin concentration was thought to be associated with obesity, impaired insulin sensitivity, and fitness level. The correlation of vaspin and leptin supports the theory of vaspin associated with body fat mass. AIM: To determine the correlation between visceral fat distributions and serum vaspin level in type II DM patients. METHODS: We conduct an observational, analytical cross-sectional study. Sixty subjects with type II diabetes mellitus who came to Diabetes Center of Sanglah General Hospital were included consecutively. Each subject has to sign an informed consent before physical and laboratory examination took place. Spearman correlation test was used to analyse the correlation between waist circumference and visceral fat percentage with serum vaspin level since the data were not distributed normally. RESULTS: Mean laboratory results in all subjects of vaspin levels was 2.389 ± 3.586 ng/ml, mean waist circumference was 94.95 ± 11.78 cm and mean visceral fat percentage was 18.05 ± 23.63%. We found we found no significant correlation between between vaspin with waist circumference (r = -0.044; p = 0.738) and visceral fat percentage (r = -0.103; p = 0.435). CONCLUSIONS: The vaspin level did not significantly correlate with waist circumference and visceral fat percentage in type II diabetes patients.