PROFILE OF TYPE 2 DIABETES MELLITUS IN ACUTE THROMBOTIC STROKE

Background: Stroke is a brain disorder in blood circulation that occur suddenly and last more than 24 hours, which is one leading cause of death in the world. One of the main risk factors of stroke is diabetes mellitus type 2. One complication is that when thrombosis occurs in the brain causing a stroke. Objective: This study aimed to determine the profile of type 2 diabetes mellitus in patients with acute thrombotic stroke who were treated in the Neurology Department at the Hospital Dr. Soetomo. Methods: Sampling was done with purposive sampling by observing the medical records of patients in the period of January 2014 to December 2015 based on inclusion and exclusion criterias that have been set. Results: Women with a history of type 2 diabetes are more exposed to acute thrombotic stroke; the age group which is most at risk for stroke is between age of 56-60 years; the average duration of DM until the occurence of stroke is 6,54 ± 4,85 years; more than two-thirds of patients come to the hospital when the acute thrombotic stroke occurs with a condition of hyperglycemia; the most common comorbid disease is hypertension; and insulin therapy is the most widely used therapy in acute thrombotic stroke patients with type 2 diabetes. Conclusion: Managing the risk factors of stroke should prolong or prevent the incident of acute thrombotic stroke since most of the patients with type 2 diabetes mellitus came to the hospital with a condition of hyperglycemia and hypertension

Association between Nutritional Status and Blood Glucose Level in Type 2 Diabetes Mellitus

Blood glucose levels in type 2 diabetes mellitus (T2DM) patients should be well controlled to prevent complications. In addition to diet and the use of drugs, nutritional status is known also play a role in maintaining blood glucose. This study aims to determine the association between nutritional status and blood glucose level of T2DM patients. This cross sectional study using T2DM outpatients at Endocrine Unit of RSUD dr Soetomo Surabaya on January-February 2017. The variables were nutritional status (body mass index/BMI) and fasting blood glucose (FBG). Primary data collected by measuring the weight and height and secondary data by looking at FBG result from patient’s medical record. The data was processed using SPSS program version 20. There were 65 subjects who met the criteria. The result showed 72.9% of patients had more nutritional status with an average BMI 26.06±4.625 kg/m2 and 61.52% had poor blood glucose levels with an average GDP of 142.17±44.012 mg/dL. Pearson test result showed an association between nutritional status and FBG with p value 0.04 and association coefficient value 0.256. &nbsp

Hubungan Status Gizi dan Kadar Glukosa Darah pada Pasien Diabetes Melitus Tipe 2

Abstrak Kadar glukosa darah pada pasien diabetes melitus tipe 2 (DMT2) harus dikontrol dengan baik untuk mencegah komplikasi. Selain diet dan penggunaan obat, status gizi juga berperan dalam menjaga glukosa darah. Tujuan penelitian ini adalah untuk mengetahui hubungan status gizi dan kadar glukosa darah pasien DMT2. Penelitian menggunakan desain cross sectional dengan subjek pasien DMT2 rawat jalan di Poli Endokrin RSUD dr Soetomo Surabaya pada bulan Januari-Februari 2017. Variabel yang diteliti adalah status gizi (nilai indeks massa tubuh/IMT) dan glukosa darah puasa (GDP). Metode pengumpulan data primer dengan mengukur berat dan tinggi badan serta data sekunder dengan melihat hasil GDP dari rekam medik pasien. Data diolah menggunakan program SPSS versi 20. Jumlah sampel yang memenuhi kriteria adalah 65 pasien. Sebanyak 72,9% pasien memiliki status gizi lebih dengan rerata IMT 26,06±4,625 kg/m2 dan 61,52% memiliki kadar glukosa darah buruk dengan rerata GDP 142,17±44,012 mg/dL. Hasil uji Pearson menunjukkan hubungan antara status gizi dan GDP pasien DMT2 dengan nilai p 0,04 dan nilai koefisien korelasi 0,256

Change in Bodyweight and Improving Adiponectin Level During Gliptin Therapy in T2DM-Mets

Background: Present study showed that despite the significant relationship of adiponectin with fasting triglyceride level and abdominal obesity in T2DM-MetS. In such patients, successful weight loss can improve glycemic control, as well as reduce concomitant cardiovascular risk factors,like hypertension and dyslipidemia. Large fat cells resist insulin-mediated lipolysis suppression, resulting in excess release of free fatty acid (FFA). Gliptin inhibits fat extraction from the gut, although it is in lesser degree compare with a lipase inhibitor agent such orlistat, this could be the one benefit of the Gliptin therapy. Adiponectin is synthesized at the adipocytes tissue and delivered into the bloodstream. High levels of adiponectin give benefits as anti-diabetic and anti-atherosclerotic effects. Weight loss during Gliptin therapy, probably caused by a reduction in visceral fat, and consequently there will be an increased in levels of adiponectin. This study aimed to see the correlation between the change of bodyweight and adiponectin improvement during gliptin therapy in T2DMMetS patients. Method: This is a retrospective study. We select 300 medical records from private out patient diabetes and endocrine clinic patients. And 60 patients were eligble to involve in our study. We select patient who received oral diabetic agent, subject with insulin, Thiazolidinediones and cacium channel blocker were elimanate from this trial. During the observation for 24 weeks, 10 subjects were eliminated because of dose adjusment on their oral anti diabetics agent, and addition of other anti diabetic agent. We collect the data such as bodyweight, age, HbA1c, and adiponectin level from the beginning and at the end of observation period. We calculate the change of body weight, HbA1c level, and Adiponectin. we analyzed the relationship between changes in body weight and levels of adiponectin using spearman test. Result: The subjects mean of age were: 58.98±10.03 years, average levels in A1C before therapy: 8.72±2.08 while after giving gliptin therapy is 7.51±1.911. While for the average levels of adiponectin before given gliptin therapy are 5.77±2.49 and after therapy was 5.87±2.46. For the mean of body weight before gliptin therapy: 82.22±14.54 kg, and after gliptin therapy was 81.22±14.15. And the mean of adiponectin level was 5.77±2.49, and after gliptin therapy: 5.87±2.46. there was significant in decrease of bodyweight (r = −0.997; p < 0.001); significant improvement in adiponectin level (r = −0.998; p < 0.001). Statistical analysis between two variables show no significant correlation between bodyweight change and adiponectin improvement (r = 0.697; p < 0.001). Conclusion: Decrease of bodyweight in this study doesn’t have significant correlation with Improvement of adiponectin levels. The adiponectin improvement probably through the other pathomechanism. Reactive Oksigen spesies and other pro-oksidan which are altering the adiponectin level, could be the explainable cause for these results

Gliptin Therapy Improve Adiponectin Levels in T2DM Mets

Background: Incretin released by cells in the small bowel in response to food intake, stimulate insulin release. The Incretin are significantly reduced in Type 2 Diabetes Mellitus (T2DM). This hormone have a variety of actions including the stimulation of insulin release from pancreatic beta cell. Some of the study models shows that incretin therapy are give a good improvement in increasing the adiponectin levels. This study is to identified the effect of incretin therapy to adiponectin levels. Method: This is a pre-post study. We recruited 63 subjects with T2DM-MeTS patients from out patient clinic. We excluded subjects who were on the insulin therapy and we also exclude subject with thiazolidinediones therapy. Most of the subject were refused to received insulin therapy and decided to continue oral anti Diabetik therapy. A ll of the sample were treated with gliptin as an add-on therapy. We collect the data of HbA1c level and Adiponectin on the first time they recruited as a trial sample. After they agree to involve in this trial, we add a gliptin as an add on therapy to their prior oral anti diabetec therapy. No spesific DPP-IV inhibitor use for this trial, we use sitagliptin, vildagliptin, saxagliptin and linagliptin on their therapeutic dose. We observed all of the subject in 24 weeks. No dose adjustment allowed during the observation, and not allowed to stop or added other Diabetic therapy during observation period. At the end of the observation period, we examine the level of HbA1c and adiponectin. We analyze the levels of adiponectin; A1C; body weight, and blood glucose levels during pre and post Gliptin therapy. We run this study for 6 months observation. We analyze the changes of adiponectin levels by using pair T-test. Result: The mean of age was 58.98±12.28 years, average levels in A1C1 before therapy: 8.56±2.1% while after giving gliptin therapy is 7.47±1.4%. While for the average levels of adiponectin before given gliptin therapy are 6.07±2.61 and after therapy was 6.17±2.58. For the mean of body weight before gliptin therapy: 80.66±13.55 kg, and 79.66±13.61 kg after treated with gliptin. By using pair T-Test, the results showed the A1c improvement were significant (r = 0.697; p < 0.001), while the correlation of adiponectin before and after gliptin therapy shows significant results (r = 0.998; p < 0.001) this result also showed significant in decrease of bodyweight (r = 0.997, p < 0.001). Conclusion: Decrease of body weight during gliptin therapy and reduce the visceral fat are the most possibel causes in the elevation of serum adiponectin level. Decrease of body weight should be a result of decrease in visceral fat which can influence in improving the adiponectin level. Study for gliptin as a combine therapy, showed a significant results in reducing total body weight, body mass index (BMI), fat mass, and tissue fat percentage and also the waist circumference (WC), and ended with the elevation of adiponectin level. It still need further clinical research on a larger scale and also long-term gliptin treatment to determine the exact mechanism and the beneficial effects of gliptin on serum adiponectin. In our clinical trial, there were significant improvement on the level of adiponectin after giving a gliptin as an add-on therapy for 6 months to prior diabetes management to the T2DM MetS subjects and also for the decrease of bodyweight