Advance on Study: Its Long Term Benefits of Kidney Protection

Diabetes mellitus (DM) is increasing, and Indonesia is one of the top 10 countries with the most prevalent in DM. It is associated with an approximately three-fold risk of all cardiovascular diseases, and a substantial reduction in life expectancy, Micro and macrovascular complications are the major cause of morbidity and mortality, however, much of the morbidity associated with long-term vascular complications can be substantially reduced by interventions that achieve glucose levels close to the nondiabetic range. Chronic kidney disease (CKD) is recognized as one of the strongest risk factors for cardiovascular disease, particularly in the presence of diabetes, conferring a substantial increase in the risk ol death and hospitalization (3). Despite the implementation of "best practice" standards of care for lifestyle modification, blood pressure lowering, and reninangiotensin-aldosterone system blockade, there remains a high level of progression to end stage renal disease (ESRD) for those with diabetic kidney disease. The UKPDS, DCCT, DECODE study have provide strong evidence that vigorous treatment of diabetes to achieve tight blood glucose control of FPG, HbA1c, and 2hPPG as well, can decrease morbidity and mortality of the disease by decreasing its micro- and macro-vascular complications. ADVANCE study provides a lesson that a strategy of intensive glucose control, involving modified release gliclazide and other drugs as required, that lowered the glycated hemoglobin value to 6.5% yielded a 10% relative reduction in the combined outcome of major macrovascular and microvascular events, primarily as a consequence of a 21% relative reduction in nephropathy. lntensified multifactorial intervention including glucose control, hypertension, dyslipidemia and other emerging risk factors, has been shown to reduce the risk of cardiovascular complications in may studies, and becomes new strategy in current day management, to provide optimal health-care status for people with diabetes. ADVANCEON was a post-trial follow-up study of surviving ADVANCE trial patients. After following the ADVANCE trial cohort for total of 9.9 years, it was shown that a prior period of intensive glucose control continues to protect against the development of end stage kidney disease (ESKD) in patients with type 2 diabetes. The patients who appear to benefit the most are those with preserved kidney function, with intermediate effects in the group with CKD stage 1 or 2 and lesser effects in participants with CKD stage 3 or greater at baseline

Type 2 Diabetes Mellitus and Cardiovascular Disease: the Unmet Needs

Tingginya prevalensi diabetes melitus masih merupakan masalah di Indonesia. Dengan jumlah penderita sekitar 10 juta Indonesia menempati urutan ke 7 negara di dunia dengan jumlah penderita diabetes mellitus (DM) terbanyak. Penurunan beban komplikasi atherosclerotic cardiovascular disease (ASCVD) merupakan tujuan utama pengelolaan DM, yang diutamakan pada penurunan kematian dini, perbaikan kualitas hidup, dan meminimalkan beban ekonomi yang diakibatkan oleh penurunan produktivitas penderita dan tingginya biaya perawatan. Atherosclerotic cardiovascular disease masih merupakan penyebab utama kematian dan disabilitas. Dua pertiga kematian penderita DM adalah akibat penyakit kardiovaskuler dengan akibat penyakit jantung iskemik, 15% penyakit jantung lainnya terutama gagal jantung kongestif, dan sekitar 10% akibat stroke. Kematian yang tinggi akibat dari ASCVD ini lebih banyak pada penderita yang lebih muda, dengan glukosa yang tidak terkontrol, lebih banyak komplikasi ginjal. Walaupun ada kecenderungan penurunan insidens komplikasi DM dalam 2 dekade terakhir ini, namun penderita DM masih menanggung beban risiko komplikasi vaskuler yang terus meningkat dibandingkan dengan individu yang bukan diabetes. Manifestasi utama dari ASCVD adalah penyakit jantung coroner, stroke iskemik, penyakit arteri perifer dan gagal jantung

Metformin, Effects Beyond Glycemic Control

Metformin is an appropriate first-line medication, not only for glycemic control, but also in other situations. Most recently, the spectrum of metformin’s target site has expanded to include the endothelium and ovaries. Even if many of these actions are individually modest, they seem to be collectively sufficient to confer therapeutic benefits, not only in cardiometabolism, but also in reproductive aspects related to insulin resistance and proinflammatory states, with promising antitumor and cancer protection properties. The aim of this study was to explain Metformin, Effects Beyond Glycemic Control. In 50 years of its clinical use, there have been no major risks reported with metformin, and serious adverse events attributed to metformin appear to be very low due to some contraindications. The limited use in chronic kidney disease needs to be redefined since many data suggest that metformin may protect against the deleterious consequences of hyperglycemia in the kidneys

Comparison of Serum Magnesium Level in Diabetes Mellitus (DM) Patients with or without Acute Coronary Syndrome (ACS)

Introduction: Until now, cardiovascular complications are still the highest cause of death and disability in DM patients. Hypomagnesemia in DM accelerate atherosclerosis and can cause instability and plaque rupture which can lead to acute coronary syndrome. Methods: Design of this study was observational analytic using a "case control" study involved 76 samples of DM patients, consisting of 38 samples with SKA (+) and 38 samples with SKA (-). Subjects of this study were all DM patients in the period July-December 2018 in the Emergency Room (ER) and Outpatient Installation of Endocrine at the RSUD Dr. Soetomo Surabaya, which fulfills the criteria for inclusion and exclusion. Demographic data and clinical characteristics are presented descriptively. If data is normally distributed then an unpaired t test is carried out and if the data is not normally, distributed with Mann Whitney test is performed. The statistical test was stated to be significant if p <0.05. The association between hypomagnesemia and the incidence of ACS a multivariate logistic regression test was performed, the risk number was in the form of odds ratios (OR). Results: This study involved 76 subjects with diabetes mellitus with SKA and non SKA 38 subjects. The mean serum magnesium level in the ACS group was lower than non ACS (1.9 mg / dL vs. 2.1 mg / dL), hypomagnesemia cut-off of <2.08 mg / dL. In this study hypomagnesemia as a risk factor for the incidence of ACS in DM patients with OR 2.8 (CI 1.1-7.6; p = 0.039). Conclusion: Magnesium levels in the ACS group were lower than the non ACS group. Hypomagnesemia Increase The Incidence of Acute Coronary Syndrome in Diabetes Mellitus Patients

A Prediction Model of Mortality in Patients Hospitalized with Diabetic Ketoacidosis in a Tertiary Referral Hospital in Surabaya, Indonesia

Abstract Background: The mortality rate of diabetic ketoacidosis (DKA) remains high in Indonesia. Different patterns were contributing to DKA mortality from previous studies. We aim to identify clinical and laboratory findings as mortality predictors of DKA. Methods: This retrospective study was conducted in a tertiary referral hospital in Surabaya. Medical records of DKA patients from January 2016 to December 2018 were analyzed. Clinical and laboratory data were obtained from medical records for three years period. Clinical outcome was defined as either discharged home or death. Results: Fifty-six among 116 DKA patients did not survive during hospitalized. Age of 60 or older, the depressed mental state with GCS below 13, potassium serum less than 3.5 mmol/L, and bicarbonate serum less than 15 mmol/L are found to be significant as independent factors of mortality in DKA patients. Conclusion: The mortality rate of DKA patients in this study is still high. It independently associated with the age of 60 years or older, depressed mental state, hypokalemia, and low bicarbonate level. Early stratification of these predictors would help to treat patients accordingly

Effects of Prebiotics, Probiotics, and Synbiotics on the Bodyweight, Blood Glucose, Triglyceride and TNF-α of Diet-induced Obesity Rats

Abstract  High-fat diet leads to obesity-associated chronic low-grade inflammation. Prebiotics, probiotics, and synbiotics produced short-chain fatty acids (SCFA), bonded to G protein-coupled receptors (GPR)-41 and GPR-43 decreased triglyceride deposits in adipocytes and liver, decreased fatty acid oxidation, increased glucose regulation and insulin sensitivity thus reduced the risk of obesity and metabolic syndrome. This study conducted in order to evaluate the effects of prebiotics, probiotics, and synbiotics on the body weight, blood glucose, triglyceride, and TNF-α used rats model, which were fed by a high-fat diet. Thirty-eight 6-8 weeks old male rats were fed by high-fat diet for three weeks, then rats were randomly divided into four groups, high-fat diet (HFD), a high fat diet with prebiotics supplementation (HFD+ PRE), a high fat diet with probiotics supplementation (HFD+PRO), and high-fat diet with synbiotics supplementation (HFD+SYN) for three weeks. Blood samples and body weight were measured at the third and sixth week. There was no effect of prebiotics, probiotics, and synbiotics on body weight, triglyceride levels, blood glucose, and TNF-α in rats fed a high-fat diet compared to control. These results suggested that supplementations gave inconsistent results with other studies and needed further researches.Keywords             : high fat diet, prebiotics, probiotics, synbiotics, meta-inflammationCorrespondence   : [email protected]

The Combination Effect of Simvastatin and Virgin Coconut Oil on Total Cholesterol Levels in Dislipidemic Male Albino Rats (Rattus norvegicus)

Introduction: Simvastatin is a primary pharmacological therapy for dyslipidemia (hypercholesterolemia). Virgin coconut oil (VCO) is a companion intake of statin drugs considered capable of lowering blood cholesterol levels. This study aimed to determine the combination effect of statin drug groups with VCO on total cholesterol. Methods: The stages of this study started with the adaptation process of animals, giving a high-fat diet (HFD), and treatment with simvastatin and VCO. The adaptation process was conducted where the experimental animals were fed pellets and drank clean water in a container. A HFD was given by mixing pork brains with distilled water with a ratio of 1:3 as much as 2 ml per day for 21 days. In simvastatin and VCO treatment for 7 days, the experimental animals were divided into 4 groups; group I was given aquades, group II was given VCO, group III was given simvastatin, and group IV was given simvastatin and VCO. The total cholesterol levels in the blood of albino rats were examined by employing a BS-300 Chemistry Analyzer through a spectrophotometric method. The total cholesterol levels data obtained were then examined for normality (Shapiro-Wilk test) and analyzed parametrically by utilizing One-way ANOVA. Results: The average total cholesterol level in the negative control group (being given a standard diet) was 45.57 mg/dL. The averages of blood total cholesterol levels were 47.28 mg/dL, 45.00 mg/dL, 46.85 mg/dL, 41.42 mg/dL, and 44.28 mg/dL in the positive control group (given an HFD), in the treatment group I, in the treatment group II, in the treatment group III, and in the treatment group IV, respectively. There were no significant distinctions in the statistical test on decreasing blood total cholesterol among the negative control group, positive controls I, II, III, and IV. Conclusion: Combination of simvastatin and VCO tends to reduce the total cholesterol level in albino rats. This is better than just giving VCO simvastatin alone

Association of Metabolic Syndrome with Albuminaria in Diabetes Mellitus Type-2

Background : Metabolic syndrome is a risk factor for cardiovascular disease as well as the occurrence of chronic kidney disease. According to the IDF, the metabolic syndrome is diagnosed when central obesity obtained with 2 or more metabolic abnormalities that include impaired glucose metabolism, increased blood pressure, hypertriglyceridemia, and low HDL-C. Several previous studies reported an significant association found between the metabolic syndrome with albuminuria. In Indonesia, the association of metabolic syndrome with albuminuria in type 2 diabetes have not been.reported. Objectives : To investigate the association of metabolic syndrome with albuminuria in type 2 diabetes patients. Methods : This is an analytic observational study, cross-sectional design in type 2 diabetes mellitus patients and we studied 131 subjects. Criteria metabolic syndrome according to IDF consensus and albuminuria assessed using the ACR method and the classification of albuminuria was based on consensus of Perkeni 2006. As for Statistical analysis using spearman correlation and Mann-whitney test. Significance level used was 0.05. Results : Of the 131 type 2 diabetes patients with metabolic syndrome were found normoalbuminuria proportion 65.4%, microalbuminuria 27.1% and macroalbuminuria 7.5%. Obtained a significant association between systolic blood pressure with albuminuria, p = 0.000, r = 0.325. Fasting blood sugar with albuminuria, p = 0.01, r = 0.223. But not found significant association between diastolic blood pressure with albuminuria, p = 0.153, r = 0.125, waist circumference with albuminuria, p = 0.311, r = 0.089, low HDL with albuminuria p = 0.771, r = -0.025. Hypertriglyceridemia with albuminuria, p = 0.727 and r=0,031. Conclusion : The results of this study indicate a strong association between the components of metabolic syndrome, systolic blood pressure with albuminuria, and fasting blood sugar with albuminuria. Whereas diastolic blood pressure, waist circumference, low HDL, and hypertriglyceridemia were not found significant associations

A Prediction Model of Mortality in Patients Hospitalized with Diabetic Ketoacidosis in a Tertiary Referral Hospital in Surabaya, Indonesia

Background: The mortality rate of diabetic ketoacidosis (DKA) remains high in Indonesia. Different patterns were contributing to DKA mortality from previous studies. We aim to identify clinical and laboratory findings as mortality predictors of DKA. Methods: This retrospective study was conducted in a tertiary referral hospital in Surabaya. Medical records of DKA patients from January 2016 to December 2018 were analyzed. Clinical and laboratory data were obtained from medical records for three years period. Clinical outcome was defined as either discharged home or death. Results: Fifty-six among 116 DKA patients did not survive during hospitalized. Age of 60 or older, the depressed mental state with GCS below 13, potassium serum less than 3.5 mmol/L, and bicarbonate serum less than 15 mmol/L are found to be significant as independent factors of mortality in DKA patients. Conclusion: The mortality rate of DKA patients in this study is still high. It independently associated with the age of 60 years or older, depressed mental state, hypokalemia, and low bicarbonate level. Early stratification of these predictors would help to treat patients accordingly