Pengaruh suplementasi serat Psyllium husk dan diet rendah kalori seimbang terhadap berat badan, kadar kolesterol high-density lipoprotein, dan trigliserida serum pada obes I

Background: The increased prevalence of obesity will bring a great impact in the health sector, due to the effect of the influence of organ in the body such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Reduced energy diet and exercise are effective for management weight loss. During the restriction diet, an obese person should increase the amount of dietary fiber up to 20−35 g/day, specifically of soluble fiber, to more effective fat loss and improve serum high-density lipoprotein (HDL) and triglyceride (TG) cholesterol concentration. Psyllium husk (PH) is a source of natural soluble fiber obtained from Plantago ovate Forssk seed.Objective: The aim of the study have investigated the change of body weight, serum HDL cholesterol, and TG concentration in obese I after supplemented PH 8.4 g/day and balanced deficit calories diet (BDCD) for 4 weeks.Method: The survey used double-blind randomized clinical trial with parallel design. Subjects were randomly divided into two groups; treatment (T) group and placebo (P) group. The T subjects received psyllium husk (PH) 8.4 g/day and BDCD 1200 kcal/day and the P subjects received placebo and BDCD 1200 kcal/day. The analyzed used independent t-test and Mann-Whitney.Results: A total 28 subjects (14 subjects in each group) had completed the intervention. There were no serious adverse effects reported during the intervention. Intake of dietary fiber in T group was 17.2 ± 2.8 g/day had significantly higher than P group 8.6 (5.2−15.2) g/day, although supplemented with PH didn’t meet the recommendation of fiber intake (20-35 g/day). Decrease of body weight was -1,8 ± 0,8 kg and triglyceride level was -1,5 (-416−77) in T group that statistically insignificant difference (p=0,39 and p=0,84) with P group -1,6 ± 0,9 kg and -10,0 ± 31,3. Soluble supplementation (P group) increased serum HDL cholesterol concentration was 0,0 ± 4,3 mg/dL that statistically insignificant difference (p=0,86) with T group -0,4 ± 5,9.Conclusion: PH supplementation 8.4 g/day and BDCD 1200 kcal/day in obese I can not reduce body weight, serum high-density lipoprotein cholesterol, and triglyceride concentration level in 4 weeks

Thyroid Dysfunction in Type 2 Diabetes Mellitus Patients

Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients.Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA.Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively.Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients

Faktor risiko disfungsi endotel pada prediabetes

Prevalensi kasus prediabetes di Indonesia pada saat ini cukup tinggi, dan oleh karena itu proporsi wanita berisiko penyakit kardiovaskular meningkat. Penelitian ini bertujuan untuk mengetahui faktor risiko disfungsi endotel pada wanita prediabetes melalui pemeriksaan kadar asymmetric dimethylarginine (ADMA) serum. Penelitian ini dilakukan dengan desain case control pada populasi wanita prediabetes berusia 30-55 tahun. Kriteria prediabetes ditentukan dari pemeriksaan toleransi glukosa oral (TTGO) dengan pemberian 75 gram glukosa. Selanjutnya dilakukan pemeriksaan kadar kolesterol total, LDL, HDL, trigliserida dan HbA1c sebagai variabel independen, serta ADMA sebagai variabel dependen. Terdapat 41 subjek wanita prediabetes yang memenuhi kriteria inklusi dan dimasukkan dalam kelompok kasus, dan 39 subjek yang dimasukkan dalam kelompok kontrol. Terdapat hubungan yang bermakna dan korelasi yang kuat antara peningkatan kadar ADMA dengan glukosa darah puasa, glukosa darah pasca pemberian glukosa 75 gram dan HbA1c. Namun hasil analisis multivariat membuktikan bahwa faktor yang menentukan kadar ADMA adalah HbA1c.Probabilitas subjek prediabetes dengan HbA1c lebih dari 6% untuk mendapatkan kadar ADMA yang tidak normal adalah 96,03%. Faktor risiko terjadinya disfungsi endotel pada wanita prediabetes adalah peningkatan HbA1c lebih dari 6%

DISTRIBUTION PATTERNS AND RISK FACTORS OF DYSLIPIDEMIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL STUDY IN BOGOR, INDONESIA

Objective: Type 2 diabetes mellitus (T2DM) patients tend to have abnormal lipid profiles, explaining the association between elevated cholesterol andtriglyceride levels in diabetic patients and coronary heart disease. This study aims to evaluate how the common risk factors for dyslipidemia affectthe lipid profile of diabetic patients and to determine which factors can be used as predictors for the occurrence of dyslipidemia in T2DM patients.Methods: A total of 238 diabetic patients (63 male and 175 female; age: 31–70 years) were enrolled in this cross-sectional study. All of them hadundergone regular examinations in cohort studies on risk factors for non-communicable diseases conducted by the Ministry of Health in Bogorbetween December 2017 and January 2018.Results: The result found that age differences did not affect lipid profile levels, and the females had higher mean values of body mass index (p<0.001),total cholesterol (TC) (p<0.05), and high-density lipoprotein (HDL) (p<0.001) than the males. The most common occurrences of dyslipidemia werehigh TC level (57.1%), followed by high low-density lipoprotein (LDL) level (47.1%), high triglyceride level (37.4%), and low HDL level (16.4%). Beingoverweight was found to be the best predictor of dyslipidemia.Conclusion: The results of this study suggest that in T2DM patients, sex affects TC and HDL levels, whereas age does not exert a significant effect onthe lipid profiles. In addition, poor glycemic control, hypertension, and obesity may serve as predictors of dyslipidemia in T2DM patients

Practical Guidelines Management of Graves Ophthalmopathy

Graves’ ophthalmopathy is the most common extra-thyroid manifestation in patients with Graves’ disease, based on inflammatory and autoimmune conditions in orbital tissue. This practical guideline was formed by a multidiciplinary team, and is intended to provide guidance for diagnosis and management of Graves’ ophthalmopathy in daily clinical practice to improve quality of care and treatment outcome

Diagnostic Approach for Thyroid Nodules

Thyroid nodule is a health problem which commonly found in daily practice, therefore clinical guidance is needed. This guideline was compiled by a multidisciplinary team and expected to be a guideline in diagnosing thyroid nodules on daily clinical practice

Analysis of MCP-1 Levels and TNF-alfa /Il-10 Ratio in First Degree Relatives (FDR) Type 2 Diabetes Mellitus Subjects with High Fat Diet Treatment

Type 2 diabetes mellitus is a chronic metabolic disease, which involves a variety of pathogenic processes. Overall these processes result in loss of mass and/or function of pancreatic-cells which is manifested as hyperglycemia. The influence of familial factors appears to be involved in the initiation and development of T2DM through both genetic and non-genetic factors. In the same family environment as patients with diabetes, first-degree relatives of patients with diabetes show a 30-70% increased risk of developing diabetes. Insulin resistance and cell dysfunction have been identified in individuals with a family history of diabetes, even before the onset of T2DM symptoms. Monocyte chemoattractant protein-1 (MCP-1) is a CC-chemokine with an attractant effect on monocytes, memory T cells and basophils. Expression of adipose tissue MCP-1 and circulating levels were  positively correlated with adiposity. Larger adipocytes are associated with insulin resistance. This study aims to determine the changes in MCP-1 expression on monocytes before and after treatment with a high-fat diet for five days. The results showed that there was a change in inflammatory activity which was indicated by a high ratio of TNF-alfa/IL – 10 in the FDR group so that it could increase MCP-1 activity. However, there was no relationship between serum MCP-1 levels and the percentage of CD14+CD16+ monocytes in both groups

Thyroid Dysfunction in Type 2 Diabetes Mellitus Patients

Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients