Revisiting metabolic syndrome: The importance of weight management

Metabolic syndrome is an increasing major health problem worldwide, including Indonesia. More than one third of adult Indonesian population suffered from metabolic syndrome. Metabolic syndrome itself is actually a clustering of risk factors which increase the risk for diabetes mellitus and cardiovascular diseases in the future. Therefore, prompt management of metabolic syndrome is required to prevent the development of diabetes mellitus dan cardiovascular diseases

The Selection of Oral Antidiabetic Drugs in Type 2 Diabetes Mellitus Patients with High Risk for Cardiovascular Events

Type 2 diabetes mellitus (DMT2) patients are associated with an increased risk of cardiovascular events. Prior to the era of cardio-vascular trial outcome (CVOT) evidence on the efficacy of old oral diabetes (OAD) drugs such as metformin, sulfonylurea, thiazolidindion, glinid, and alpha glucosidase inhibitors in reducing the risk of cardiovascular events was very limited. Since 2008, all OADs must have CVOT data. DPP-4 inhibitors are neutral against the risk of cardiovascular events while SGLT-2 inhibitors are reported to significantly reduce the risk of cardiovascular events. This finding even helped to change the DMT2 management guidelines issued by American Diabetes Association (ADA-EASD) in late 2018. However, SGLT-2 inhibitor applications in Indonesia are likely to be constrained in terms of costs. When compared with an intensive multifactorial approach that seeks to reduce blood glucose, lipids, blood pressure, weight, and aspirin; it turns out that this multifactorial approach is associated with a lower risk of higher cardiovascular events and lower costs. In the JKN era, where quality control and cost control are needed, it seems that the multifactorial approach will still be the main choice in reducing cardiovascular events in people with T2DM in Indonesia

Herpes Zooster Induced Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes which is common in daily practice. DKA is the result of severe insulin deficiency and often presents as the first symptom of an undiagnosed diabetes even though it may also appear in individuals with diabetes.Some conditions that can trigger DKA include infections, myocardial infarction, stroke, pancreatitis, trauma, or poor treatment compliance. Skin tissue infections such as herpes zoster are rare inciting factor in DKA. This article will discuss a case of DKA that is triggered by herpes zoster

RELATIONSHIP OF METHYL MERCAPTAN AND HYDROGEN SULFIDE LEVELS WITH TANNERELLA FORSYTHIA QUANTITY IN PERIODONTITIS PATIENTS WITH HALITOSIS AND DIABETES MELLITUS

Objective: Halitosis may be caused by several factors, including various types of food, periodontal diseases, layer of tongue bacteria, and systemicdisorders such as diabetes mellitus (DM), which is a chronic disease that affects the health of periodontal tissue. The present study aimed to assessthe association between the quantity of Tannerella forsythia bacteria and the levels of methyl mercaptan and hydrogen sulfide in periodontitis patientswith type 2 DM (T2DM).Methods: Gingival crevicular fluids (GCF) were collected from 20 patients who were divided into those with periodontitis and who were normoglycemic(n=8); those with periodontitis and T2DM (n=8); and healthy controls (n=4). The patients underwent intraoral periodontal tissue examination,including pocket depth, attachment loss, plaque index, calculus index, and papilla bleeding index. The quantity of T. forsythia bacteria was evaluatedusing quantitative real-time reverse transcription–polymerase chain reaction. The relationship between the number of T. forsythia bacteria and thelevels of methyl mercaptan and hydrogen sulfide in the patients was analyzed by Spearman’s correlative tests.Results: There is a weak and non-significant correlation (p>0.05) between the levels of methyl mercaptan and hydrogen sulfide and the quantity ofT. forsythia in the GCF and tongue coating of periodontitis patients with halitosis regardless of the presence of T2DM.Conclusion: This study suggests no significant relationship between the levels of methyl mercaptan and hydrogen sulfide and the quantity ofT. forsythia in periodontitis patients with halitosis and DM

Efficacy and Safety of Oral Antidiabetic Drugs in Type 2 Diabetes Mellitus with Chronic Kidney Disease

Selection of oral antidiabetic drugs (OAD) in patients with type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) is very important because most OAD is secreted through the kidneys so dose adjustment is required. In Indonesia, short acting sulfonylureas (SU) are commonly used for the management of T2DM with CKD. This review article aimed to compare the effectiveness and safety of certain SU types with other OAD in T2DM with CKD. Sulfonylureas, tiazolidindion (TZD), DPP-IV-inhibitor, and SGLT-2-inhibitor were evaluated. Short acting sulfonylureas (glycazides and glipizids) and SGLT-2-inhibitor (empaglifozin and canaglifozin) may inhibit the progression of CKD in T2DM. On the contrary, pioglitazone and sitagliptin are associated with higher progression of CKD, while linagliptin has a neutral effect on deterioration of CKD. However, sitagliptin and linagliptin have lower risk of causing hypoglycemia than short acting SU. In conclusion, short acting SU can still be the primary choice for the blood glucose management in T2DM with CKD in Indonesia

Herpes Zooster Induced Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes which is common in daily practice. DKA is the result of severe insulin deficiency and often presents as the first symptom of an undiagnosed diabetes even though it may also appear in individuals with diabetes. Some conditions that can trigger DKA include infections, myocardial infarction, stroke, pancreatitis, trauma, or poor treatment compliance. Skin tissue infections such as herpes zoster are rare inciting factor in DKA. This article will discuss a case of DKA that is triggered by herpes zoster

The Association of Lipoprotein Changes and the Development of Plasma Leakage in Dengue Infection

There’s interrelationship between infection and lipoprotein. This is a cohort prospective study which conducted November 2010 – February 2011. This study aimed to assess the changes of HDL-C, LDL-C, total cholesterol (TC), triglyceride (TG), in acute and critical phase of dengue infection and its association with plasma leakage. Subjects who had fever 48 hours or less and Dengue NS1 antigen test positive were admitted to Cipto Mangunkusumo Hospital Jakarta. We examined clinical and CBC daily; level of albumin, HDL-C, LDL-C, TC, TG; ultrasound to find ascites and pleural effusion. Among 51 subjects, 21 subjects (41%) had plasma leakage. There were significant lower of HDL-C, LDL-C, and higher TG in critical phase than acute phase. In critical phase, subjects with plasma leakage had a significant lower HDL-C level [26.3 (8.2) vs 33.1 (12.1) mg/dL, p=0.029] but not for LDL-C, TC, and TG. They also had a significantly higher reduction in HDL-C [19.6 (9.1) vs 11.5 (5.8) mg/dL, p<0.0001] and TC [25.1 (20.0) vs 15.2 (14.5) mg/dL, 0.045] over the course of acute to critical phase. Lipoprotein changes during dengue infection were more pronounced among subjects who developed plasma leakage. The higher reduction in HDL-C is associated with the development of plasma leakage. &nbsp

Association between Statin Use and Poor Outcomes in COVID-19 Patients with Diabetes Mellitus: A Systematic Review

Background and Aims: Diabetes mellitus, cardiovascular diseases, obesity, and dyslipidaemia are considered risk factors for more severe forms of COVID-19 infection. Statins have been widely used in such patients to prevent the occurrence of cardiovascular events and the associated mortality. However, statin use has been suggested to promote a more severe form of infection. This review aims to investigate the association between statin use and poor outcomes in COVID-19 patients with diabetes. Methods: Literature search was performed in PubMed, CENTRAL, Scopus, and pre-print databases (MedRxiv and BioRxiv), and studies published up to March 6th, 2021 have been reviewed. Selected studies were then assessed for risk of bias with the Newcastle Ottawa Scale. Result: Four studies were included in the final analysis; all were retrospective studies. Two studies reported a decreased risk of mortality with statin use, while one study reported opposite findings. The other one did not find a significant association between statin use and poor COVID-19 outcomes. Conclusion: Available data suggest that statins may be safely administered to diabetic COVID-19 patients as the majority of evidence signifies statins to confer benefits and improve clinical outcomes in COVID-19 patients. </jats:sec