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Background: The utilization of technology in diabetes management, especially self-monitoring blood glucose (SMBG), is growing rapidly. However, the effectiveness of SMBG applications on the smartphone is not yet known. This study aims to assess the effectiveness of using a smartphone-based SMBG application in type 2 diabetes mellitus (T2DM) patients in the Indonesian population.Methods: This is a quasi-experimental (before and after) study conducted at three tertiary hospitals in Jakarta and Malang, Indonesia. Inclusion criteria were T2DM patients aged 18 years and above who have been familiar with performing SMBGÂ and manually record the results. All subjects were asked to use a smartphone-based SMBG application named Teman Diabetes application for six months, and patients' SMBG performance was assessed at the end of the study Bivariate analysis using T-test or with the Mann Whitney U test performed. Chi-square test is used to analyze the categorical with Risk Ratio (RR) and 95% Confidence Interval (CI). The p-value

Introduction: This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM) Methods: This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020 We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12 2%) or pre-existing T2DM (16, 17 8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital Results: Critical conditions occurred in 50% of T2DM and 54 55% of the in-hospital hyperglycemia group Mortality was documented in 68 75% of T2DM and 81 82% of in-hospital hyperglycemia group Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12 5%, 25%, 18 75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group However, respiratory failure (45 45% vs 6 25%) and septic shock (27 27% vs 6 25%) were more frequent than in the T2DM group Conclusion: In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia In T2DM subjects, diabetes related complications contributed to a higher mortality rate, while in hospital hyperglycemia group, respiratory failure and septic shock were more frequent © 2020, Sanglah General Hospital All rights reserved

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia that can cause various complications, economic burdens, and psychosocial issues that eventually lead to depression. This study aimed to describe the prevalence of depression among type 2 diabetes mellitus patients in the Internal Medicine Outpatient Clinic of a South Jakarta tertiary hospital during the COVID-19 pandemic. This cross-sectional study was conducted from May to July 2021. The data were collected consecutively from 100 patients aged 18 years or older who came for regular consultation. The instrument used for determining depression is Beck Depression Inventory-II. The prevalence of depression, a correlation between depression and participants' characteristics, and multivariate analysis for risk factors were determined. The results showed that the prevalence of mild to severe depression based on the BDI-II classification was 17%. Screening showed mild to severe depression predominantly in females above 60 years old, with higher levels of education, obesity grade I, individuals with one or more comorbidities, and those who had diabetes for more than ten years. In this study, having one or more comorbidities was associated with an increased risk of depression in people with diabetes.

Background and aims Hyperglycemia is a condition often found in hospitalized patients due to stress injury, parenteral nutrition or medications administered during hospitalization. According to previous studies, hyperglycemia could be an independent predictor of mortality. The objective of the study is to assess the risk of mortality in non-diabetic patients with hyperglycemia during hospitalization. Methods In this systematic review, we conducted literature reviews on several databases. Twelve studies were retrieved and critically reviewed using NOS. Results A majority of the studies reported that hospital related hyperglycemia increased the mortality rate. Conclusions Hospital related hyperglycemia is an independent predictor factor for both in-hospital and long-term mortality.

BackgroundAs the country with the 7th largest number of People with Diabetes (PWD) in the world, the COVID-19 pandemic, and the Large Social Scale Restriction (LSSR) policy taken by the Indonesian government to reduce the number of COVID-19 transmissions is estimated to interfere diabetes management and will increase the incidence of diabetes complications. This study aims to determine the difficulties of diabetes management and its impact on diabetes morbidity during the COVID-19 pandemic in Indonesia.MethodologyThis study is a cross-sectional study using a national scale web survey. This research was conducted in Indonesia enrolling 1,124 PWD aged 18 years or older. Diabetes complications are defined as any incidence of hypoglycaemia, or Diabetic Foot Ulcer (DFU), or hospital admission experienced by PWD in Indonesia during the COVID-19 pandemic. The correlation between diabetes management difficulties and diabetes-related complications was measured using a modified cox regression test.ResultsDiabetes management difficulties were experienced by 69.8% of PWD in Indonesia. The difficulties include attending diabetes consultation 30.1%, access to diabetes medication 12.4%, checking blood sugar levels 9.5%, controlling diet 23.8%, and performing regular exercise 36.5%. Diabetes-related complications occurred in 24.6% of subjects. Those who had diabetes management difficulties during the COVID-19 pandemic are prone to have diabetes complications by 1.4 times greater (PR: 1.41, 95% CI: 1.09-1.83) than those who did not.ConclusionThe COVID-19 pandemic and LSSR have a substantial impact on diabetes management and indirectly increased diabetes morbidity in Indonesia.

Background: Adrenal crisis is an emergency condition in endocrinology that commonly found in primary adrenal insufficiency but also occur in chronic adrenal insufficiency triggered by various conditions such as sepsis, infection, trauma, burns, surgery, and myocardial infarction. In chronic adrenal insufficiency, adrenal crisis can be induced by excessive reductions or inadequate discontinuation of steroid treatment. Case Illustration: A 40-year old-man admitted with chief complaint abdominal pain since seven days before admission. He felt pain in the umbilical area and slowly radiated to all the part of abdomen. Other than that, he also felt nausea, had vomitus, fever, and constipation for five days. He was immobilized for four months, with muscles weakness and atrophy. He was diagnosed with Focal Segmented Glomerulosclerosis and had a high dose of methylprednisolone (48 mg) for 6 months, 40 mg for the next 2 months and methylprednisolone 12 mg for the last 2 months. The last two month, he began to have severe general weakness and hypotension. On physical examination we found hypotension, fever (38.1o C), pale conjunctiva, moon face, buffalo hump, slightly distended and tenderness of abdomen, normal bowel sound, and purple striae all over the abdomen and extremities. On laboratory examination, Hb was 8.2 (n 11.7 – 15.5 g/dl), leukocytes 10,400 (5.00 – 10.00 x 103/μL), Na 123 (n 135 – 147 mmol/L), random blood glucose 74 (n 70 – 140 mg/dL). On abdominal X ray, there was prominent faecal material and no signs of ileus. No sign of infection found in urinalysis. He had sodium correction, packed red cell transfusion, symptomatic therapy including laxative, methylprednisolone 12 mg, but no improvement of signs and symptoms beside be able to defecate. The abdominal ultrasound gave a normal result. The morning cortisol level was then examined, with the result 14.4 (n 3.7–19.4). The patient was then diagnosed with adrenal crisis based on the clinical manifestations and had hydrocortisone therapy 100 mg a day for 2 consecutive days. After hydrocortisone administration, the symptoms improved, no fever and abdominal pain, he had normotension, increased sodium level 132 (n 135 – 147 mmol/L) and blood glucose level 118 (n 70 – 140 mg/dL). On the third day the patient discharged with oral hydrocortisone 15 mg in the morning and 10 mg in the afternoon. Conclusion: Adrenal crisis was generally found in primary adrenal insufficiency but could also occur in secondary adrenal insufficiency due to inappropriate tapering off process of long term glucocorticoid use.

Recurrent Abortion in Multigravid Type 1 Diabetes Mellitus Woman With Subclinical Hypothyroidism Hashimoto’s Thyroiditis and Antiphospholipid Syndrome as a Manifestation of Type III Autoimmune Polyglandular Syndrome: A Case Report Background: Type 1 Diabetes Mellitus, Antiphospholipid Syndrome, and autoimmune thyroid disease such as Hashimoto’s Thyroiditis had been reported for increasing risk of miscarriages. Meanwhile, the type III Autoimmune Polyglandular Syndrome comprises of autoimmune hypothyroidism and immune mediated diabetes mellitus. Here we report a manifestation of the syndrome presented as a recurrent pregnancy loss in newly diagnosed subclinical hypothyroidism phase of Hashimoto’s Thyroiditis and Antiphospholipid Syndrome, in multigravid woman with long standing Type 1 Diabetes Mellitus. Clinical Case: A 31 years old woman, 20 weeks pregnant, with previously known Type 1 Diabetes Mellitus since the age of 11 years old, came to the Emergency Room with diabetic ketoacidosis. She complained of having nausea, vomiting, and diarrhea two days before hospital admission. She also had history of six spontaneous abortions which all occurred at below 20 weeks of gestation, but no further examination was done to find the cause. The patient was examined with fetal ultrasound and showed good fetal condition, fetal heart rate 143 bpm, estimated fetal weight 562 grams, polyhidramnion, and single umbilical artery. The patient denied any symptoms regarding hair loss, cold intolerence, slow movement, slow speech, or constipation. From physical examination, we found normal vital signs, no abnormalities in thyroid physical examination, but dry hyperpigmented skin in both legs. The patient was examined for thyroid function and found elevated TSH (5.625 IU/mL, n = 0,48 - 4,17 mIU/L) and normal free T4 (1,3 ng/dL, n = 0,89 - 1,76 ng/dL). The TPO antibody was 549,59 IU/mL (n Conclusion: Type III Autoimmune Polyglandular Syndrome could be manifested as recurrent pregnancy loss in patient with Type 1 Diabetes Mellitus, therefore the examination of thyroid function and other autoimmune disease such as Antiphospholipid Syndrome should be conducted.

Background: Serum β-Human Chorionic Gonadotropin (HCG) levels can be increased not only in pregnancy but also in various malignancies such as germ cell malignancy, lung cancer, ovarian cancer, and breast cancer. The alpha subunit of HCG and TSH are homologous, so β-HCG can cross-react with the TSH receptors and induce hyperthyroidism. High level of β-HCG serum can lead to hyperthyroidism, which can aggravate the patient’s malignant manifestations. Case Presentation: A 33-year old woman admitted to our hospital with chief complaint general weakness one week before admission. The patient was 8 week-pregnant and the transabdominal ultrasound showed a gestational sac and she had also a positive urine β-HCG test. The patient had slight vaginal bleeding 1 month ago. The physical examination revealed tachycardia, pale conjunctiva, and multiple nodules in both breasts. On laboratory examination, we found low level of Hb 6.7 (n 11.7 - 15.5 g/dl), serum iron 18 (n 65 - 175 mg/dL), TIBC 164 (n 253 - 435 mg/dL), and ferritin 1971(n 4.63-204 mg/dL), positive urine β-HCG, potassium 2.5 (n 3.1 - 5.1 mmol/L). On transvaginal and transabdominal ultrasound examination, there was no gestational sac in the uterine cavity and there are no abnormalities in other gynecology organs. The chest X-ray showed a nodule in the upper right lung suggestive of metastasis with thickening of the soft tissue of the left mammary region suggestive of a left breast mass. We also found a consistent positive result of urine β-HCG, though it had passed four weeks after the occurrence of vaginal bleeding. Finally, the serum β-HCG examination was carried out and showed an increased result, 290,398 (n Conclusion: Trophoblastic and non-trophoblastic tumors that secrete high level of β-HCG can induce hyperthyroid manifestations, particularly if the level was more than 20,000 mIU/mL