Statin treatment is associated with insulin sensitivity decrease in type 1 diabetes mellitus: a prospective, observational 56-month follow-up study.

BACKGROUND: Statins are effective in the primary and secondary prevention of cardiovascular events in individuals with and without diabetes. Emerging evidence, however, suggests that statins might reduce insulin sensitivity and secretion in healthy population and in type 2 diabetes. ----- OBJECTIVE: We aimed to investigate the effect of statin therapy introduction on insulin sensitivity in patients with type 1 diabetes mellitus (T1DM). ----- METHODS: This prospective observational 56-month long study included 832 randomly selected T1DM patients aged 25 to 61 years. Uncontrolled dyslipidemia and clinician-perceived need for treatment, rather than randomization, were basis for individuals being started on either atorvastatin or simvastatin (10-40 mg); N = 345, 41.47%. Patients on statin treatment were compared with those unexposed to statin. Insulin sensitivity was assessed using equation derived from euglycemic-hyperinsulinemic clamp studies-estimated glucose disposal rate. ----- RESULTS: Patients who started statin therapy (N = 345, 59.42% atorvastatin and 40.58% simvastatin) experienced a greater decrease in insulin sensitivity (19.27% vs 12.82% P < .001) and metabolic control deterioration compared with statin-free group. The risk of decrease in insulin sensitivity attributable to statin use was 36.7% (hazard ratio 1.36; 95% confidence interval 1.31-1.43) after adjustment for age, gender, disease duration, smoking status, and the concomitant antihypertensive therapy. ----- CONCLUSION: Although there is still a lack of a clear molecular explanation on the adverse effects of statin therapy on insulin sensitivity, we showed that it deteriorates insulin sensitivity in T1DM. The cardiovascular benefits of statin treatment might outweigh the risk of developing insulin resistance, but, the possible metabolic control worsening merits to be considered

Redesain Interior Fasilitas Pelayanan Administrasi Umum Universitas Kristen Indonesia (UKI) Berkonsep Modern Natural dengan Penerapan Nilai-Nilai Kristiani

Universitas Kristen Indonesia (UKI) sebagai salah satu perguruan tinggi swasta Kristen dalam eksistensinya sebagai lembaga institusi pendidikan selalu menjaga kualitas dan pelayanan bagi mahasiswa, calon mahasiswa, para orangtua, hingga masyarakat umum. Salah satu alasan calon mahasiswa dalam memilih kampus yaitu faktor fisik bangunan serta fasilitas sarana dan prasarananya. Fenomena ini menjadi dasar bagi UKI untuk mendesain ulang interior pada sarana dan prasarana fasilitas pelayanan administasi umum, untuk menunjang aktifitas sivitas akademik. Desain interior pada pelayanan administrasi umum, meliputi tiga ruang terpilih, yaitu lobi utama, ruang seminar, serta information office. Konsep desain interior yang dapat menyelaraskan visi dan misi UKI, dengan menerapkan nilai-nilai kristiani dalam langgam modern natural. Konsep desain diperoleh berdasarkan metodologi desain yang meliputi tahapan pengumpulan data, observasi lapangan, wawancara, dan pembuatan desain. Nilai-nilai kristiani muncul dalam filosofi melayani dan menunjang kegiatan sivitas akademik UKI. Simbol-simbol kristiani yang digunakan adalah simbol salib dan burung merpati, juga menggunakan kutipan-kutipan rohani yang dapat memotivasi pembacanya. Nilai-nilai dan simbol-simbol kristiani diterapkan dalam desain yang dapat dinikmati oleh semua kalangan di sivitas akademik UKI, yang terdiri dari multikultural, agama dan suku. Konsep yang digunakan adalah transformasi bentuk. Transformasi bentuk diatas diterapkan pada elemen lantai, dinding, plafon, furnitur dan elemen estetis. Transformasi bentuk nilai dan simbol kristiani memberikan tampilan desain yang modern, dan dapat selaras dengan langgam natural. Sehingga tercapai suasana interior yang ramah, hangat, dan nyaman. Suasana tersebut diharapkan mampu memberikan rasa senang dan motivasi dalam belajar dan beraktifitas di lingkungan Kampus UKI

Waist-to-height ratio is independently associated with chronic kidney disease in overweight type 2 diabetic patients

OBJECTIVE: Chronic kidney disease (CKD) is one of the most serious complications in obesity-induced type 2 diabetes mellitus (T2DM). Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) are recognised as sensitive obesity measures. We aimed to investigate the association of BMI, WC, WHR and WHtR with CKD prevalence in overweight T2DM patients. ----- DESIGN, SUBJECTS AND METHODS: We obtained 125 overweight T2DM patients coming for their in-patient annual visit. Metabolic profiles and anthropometric indices were measured and calculated. Urine albumin excretion (UAE) was determined as the mean of 24-h urine from two consecutive days. Serum creatinine was measured from fasting blood sample in order to calculate the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration formula. Patients were divided into two groups according to CKD prevalence. ----- RESULTS: Thirty-six (28.8%) patients met diagnostic criteria for CKD. The WHtR and WC were higher in the group with CKD. WHtR correlated positively with UAE (r = 0.828, p < 0.001) and negatively with eGFR (r = -0.262, p = 0.015). No significant correlation was observed with WC in relation to UAE (p = 0.335) nor eGFR (p = 0.121). WHtR yielded the significant and great OR in association with nephropathy after adjustment for all confounding risk factors. ----- CONCLUSION: WHtR might be of a greater importance in association to CKD compared to other anthropometric parameters that indicate central obesity. Whether it is a best measure of central obesity and its exact role in CKD pathology is yet to be investigated

The role of endothelial dysfunction driven by adipocitokines in the development and progression of microvascular complications in patients with type 1 and type 2 diabetes

Micro and macrovascular complications are the leading cause of morbidity and mortality in diabetic patients. During the last decades attention has been focused on their early diagnosis and prevention. Diabetes related metabolic abnormalities: insulin resistance, hyperglycaemia and dyslipidaemia along with oxidative stress and low-grade inflammation contribute to the development of endothelial dysfunction and macrovascular complications. Recent investigations indicate a potential role of adipocitokines originating from visceral adipose tissue: adiponectin, leptin, resistin and dipepetidyl peptidase-4 (DPP-4) activity in the development of microvascular complications in diabetes. The association of these adipocitokines with the activity of endothelial synthetase (eNOS) involved into the metabolism of nitric oxide (NO) was documented in animal and cell culture studies. We hypothesize that lower adiponectin and higher leptin and resistin plasma concentration and DPP-4 activity are associated with the development and progression of diabetic microvascular complications by endothelial function impairment. A possible identification of new markers of the complex pathophysiology development and progression of microvascular complications in diabetes will contribute to improved diagnosis followed by an individualized patients approach

Circulating dipeptidyl peptidase-4 activity is associated with diabetic retinopathy in type 1 diabetic patients

PURPOSE: Diabetic retinopathy (DR) is the most frequent complication among patients with type 1 diabetes mellitus (T1DM). Dipeptidyl peptidase-4 (DPP4) is a protease with elevated activity in patients with T1DM. Several studies indicate that DPP4 inhibitors might have beneficial effect on nonproliferative retinopathy (NPR) development as well as on its progression to proliferative retinopathy (PR). We aimed to explore the relationship between serum DPP4 activity and DR in patients with T1DM. ----- METHODS: This cross-sectional study recruited 44 patients with T1DM. The DPP4 activity was measured by colorimetric assay in a microplate reader. Photodocumented retinopathy status was made according to the EURODIAB protocol. ----- RESULTS: A total of 28 (63.6%) patients were men, mean age 45.36 years, diabetes duration 23.71 years, glycated hemoglobin A1c (HbA1c) 7.4%. Patients were stratified into 2 groups according to retinopathy prevalence. Group 1 comprised 14 (31.85%) patients with DR absence while the second group consisted of 30 (68.15%) patients with both PR and NPR. Group 1 had lower fasting serum DPP4 activity (25.85 vs 33.84 U/L, p&lt;0.001) when compared to the second group. In the binary logistic regression model adjusted for age, sex, diabetes duration, and HbA1c level, DPP4 activity was associated with DR prevalence (odds ratio 1.887 [1.073-3.321]). ----- CONCLUSIONS: Serum DPP4 activity may be independently associated with both DR types in patients with T1DM. Further study is warranted to elucidate whether there is an association between DPP4 activity and DR severity and/or progression

Circulating dipeptidyl peptidase-4 activity is associated with insulin resistance in type 1 diabetic patients

AIM: The pathophysiology of insulin resistance (IR) comprises a complex adipokine mediated cross-talk between white adipose tissue and other organs. Dipeptidyl peptidase-4 (DPP4) is protease recently proposed as a novel adipokine linked to IR. We aimed to assess the relationship between fasting serum DPP4 activityand IR in type 1 diabetic (T1DM) patients. ----- METHODS: A cross-sectional study comprised 44 T1DM patients aged >18 and <65years. IR was esimated using the equation for insulin sensitivity derived from euglycemic-hyperinsulinemic clamp studies-estimated glucose disposal rate (eGDR). DPP4 serum activity was determined spectrophotometrically as a rate of cleavage of 7-Amino-4-Methyl Coumarin (AMC) from H-Gly-Pro-AMC. ----- RESULTS: Patients were divided according to DPP4 activity tertiles (<25.40; ≥36.54 U/L). Fasting serum DPP4 activity was related to disease duration (p=0.012), systolic (p=0.009) and diastolic (p=0.047) blood pressure, waist circumference (p=0.037), urine albumin excretion (p=0.022) and conversely related to eGDR (p=0.004). The linear regression has shown that eGDR decreases for 0.203 mgkg(-1)min(-1) by each increase of serum DPP4 activity of 1 U/L (p<0.001) after adjustment for adjusted for age, gender, disease duration, albuminuria and the use of antihypertensives and statins. ----- CONCLUSION: Serum DPP4 activity is associated with IR in T1DM patients and it might play an important role in its pathophysiology

Upotreba antropometrijskih obilježja debljine u procjeni mikrovaskularnih komplikacija u pretilih bolesnika s tipom 2 šećerne bolesti

Waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) are superior to body mass index (BMI) in predicting type 2 diabetes mellitus (T2DM) development. The aim of this study was to investigate the predictive power of BMI, WC, WHR and WHtR for microvascular (chronic kidney disease (CKD), retinopathy and peripheral neuropathy) prevalence in obese (BMI ≥35 kg/m2) T2DM patients. This cross-sectional study included 125 T2DM patients of both genders. The validity of each test was assessed by Receiver Operating Characteristic (ROC) curves; the area under the curve (AUC) was calculated for each anthropometric parameter and microvascular complication. AUCs for WHtR were significantly higher than AUCs for WC with respect to CKD. Optimal cut-off for WHtR was >0.593 and WC >112 cm regarding CKD. The AUC for peripheral neuropathy was significant only for WHR and optimal cut-off for WHR was >1.409 with low sensitivity and high specificity. Our study demonstrated that WHtR, WC and WHR might be used as simple and noninvasive methods for detection of CKD and peripheral neuropathy in obese T2DM population.Opseg struka (OS), omjer opsega struka i bokova (OSB) i omjer opsega struka i visine (OSV) su bolji predskazatelji razvoja šećerne bolesti tipa 2 (ŠB2) nego široko upotrebljavani indeks tjelesne mase (ITM). Svrha ovoga istraživanja je bila istražiti učinkovitost ITM, OS, OSB i OSV u procjeni učestalosti mikrovaskularnih komplikacija (kronična bubrežna bolest (KBB), retinopatija i periferna neuropatija) u pretilih (ITM ≥35 kg/m2) bolesnika sa ŠB2. Ova presječna studija je uključila 125 bolesnika oba spola sa ŠB2. Dijagnostička vrijednost testova je procijenjena krivuljama ROC (engl. Receiver Operator Characteristic); područje ispod krivulje (AUC) je izračunato za svaki antropometrijski parametar i rizični čimbenik (mikrovaskularnu komplikaciju). AUC za OSV je bio značajno viši nego AUC za OS za KBB. Optimalna granična vrijednost za OSV je bila >0,593, a za OS >112 cm za KBB. AUC za perifernu neuropatiju je bio značajan samo za OSB i optimalna granična vrijednost za OSB je bila >1,409, uz nisku osjetljivost i visoku specifičnost. Rezultati našega istraživanja ukazuju na to da OSV, OS i OSB mogu biti jednostavna i neinvazivna metoda procjene učestalosti KBB i periferne neuropatije u pretilih bolesnika sa ŠB2

Penerapan Karakter Islami pada Interior Ruang Kelas 1 Sekolah Dasar Islam Darush Sholihin

Masa pendidikan dasar merupakan masa keemasan pada pendidikan moral. Hal ini akan menjadi dasar penentuan bagaimana anak didik akan berkembang kedepannya. Kemerosotan moral masyarakat saat ini banyak disebabkan karena pendidikan nilai agama pada anak-anak usia sekolah dasar diabaikan. Oleh karena itu, pembentukan karakter dan kepribadian anak sesuai dengan nilai keagamaan menjadi sebuah kebutuhan dan keharusan. Penting sekali membentuk nilai-nilai karakter melalui metode pembiasaan. Namun berdasarkan pengamatan lapangan terdapat permasalahan terkait pembiasaan karakter yang ada di SD Darush Sholihin khususnya kelas 1. Maka dari itu, diperlukan konsep yang dapat membantu mengatasi masalah yang ada di SD darush Sholihin. Metode penelitian yang dipakai berupa kualitatif dengan cara studi literatur dan didapatkan dari beberapa sumber. Hasil yang dicapai berupa penerapan konsep Fun Learning. Dengan adanya re-desain interior dengan konsep Fun Learning, maka akan membantu dalam meningkatkan pembentukan karakter anak di sekolah. Re-desain Interior tersebut terdiri dari penerapan Karakter Islami yang akan diaplikasikan di Kelas 1. Penerapan Karakter Tersebut berupa pengaplikasian hadist mengenai alam sebagai pembentukan karakter Cinta Alam, pengaplikasian tempat sepatu sepagai pembentukan karakter Kemandirian dan sebagainya

Dipeptidyl peptidase-4 activity is associated with urine albumin excretion in type 1 diabetes

AIMS: The inability of kidneys to prevent urinary protein leakage represents the earliest sign of renal damage in diabetic kidney disease (DKD). Recent data suggest the possible nephroprotective role of the dipeptidyl peptidase-4 (DPP-4) inhibitors. We aimed to investigate whether serum DPP-4 activity is associated with urine albumin excretion (UAE) in patients with type 1 diabetes (type 1 DM). ----- METHODS: DPP-4 activity and UAE measurement were performed in 113 patients with type 1 DM and glomerular filtration rate (GFR) within normal range. They were divided into three groups according to UAE tertiles. ----- RESULTS: Worse lipid profile and higher waist circumference were observed in the group with highest DPP-4 activity. Patients within lowest UAE tertile group had lowest DPP-4 activity value (p<0.001) compared to group within second and third tertile of UAE. DPP-4 activity correlated with systolic blood pressure (ρ=0.142; p=0.001), HbA1c (ρ=0.133; p=0.013) and UAE (ρ=0.349; p<0.001). In the linear regression analysis when DPP-4 activity was adjusted for age, gender, disease duration, HbA1c, waist circumference, the use of ACEI and hypolipemic agents the association remained significant; UAE increased for 8.136mg/24h by each increase of DPP-4 activity of 1U/L (p<0.008). ----- CONCLUSION: Our results indicate that serum DPP-4 activity is associated with albuminuria in type 1 diabetes. This arises the question whether the use of DPP-4 inhibitors might serve as an additional therapeutic strategy to prevent proteinuria in patients with DKD