Association of Serum Magnesium Levels with Glycemic Control in Patients with Type 2 Diabetes Mellitus

Background: Hypomagnesemia is one of the conditions that can accelerate diabetes complications in patients with type 2 diabetes mellitus (T2DM) by altered insulin function and secretion. Hypomagnesemia has been linked to poor glycemic control due to increased insulin resistance and impaired of insulin secretion. Objective: The aim of this study is to analyze the association between serum magnesium levels and glycemic control in patients with T2DM who treated with metformin or pioglitazone. Methods: Serum magnesium levels and HbA1c were examined from a total of 41 patients with T2DM treated with metformin ≥ 750 mg/day for at least 3 weeks or pioglitazone ≥ 15 mg/day for at least 4 weeks with a body mass index (BMI) of < 30 kg/m2. An examination of HbA1c was analyzed using Variant and D10 with National Glychohaemoglobin Standardization Program (NGSP) certification. The serum magnesium level was analyzed using Roche/Hitachi Cobas C 311/501 System. Results: The mean value of serum magnesium levels was 2.04±0.19 mg/dl and the mean of HbA1c was 7.44±1, 57%. There was significant negative correlation between serum magnesium levels with HbA1c (r-0.449, p-value 0.003). Low serum magnesium levels was correlated with poor glycemic control. Conclusion: Serum magnesium levels in patients with T2DM treated with metformin or pioglitazone was inversely correlated to glycemic control. Serum magnesium levels monitoring is important to reduce the risk of diabetes-related complications

Association of Serum Magnesium Levels with Homeostatic Models Assesment of Insulin Resistance in Patients with Type 2 Diabetes Mellitus on Metformin or Pioglitazone

Background: Magnesium is known to be associated with insulin resistance in type 2 diabetes mellitus (DM) resulting in the accelerated progression of the disease causing the risk of complications in type 2 DM. In a hypomagnesemic state, there is a decrease in the phosphorylation of insulin receptor which leads to an increase in insulin resistance. Methods: The inclusion criteria were the patients of type 2 DM who had already used metformin or pioglitazone with a body mass index of <30 kg/m2. An examination of magnesium nutrient intake on the patients was carried out with a validated food frequency questionnaire of nutrient intake for the past 3 days by a nutritionist. Fasting plasma glucose was analyzed using Roche/Hitachi Cobas C System. Fasting insulin was analyzed using the Elecsys and Cobas E Immunoassay Analyzers. Serum magnesium level was analyzed using Roche/Hitachi Cobas C 311/501 System. Results: The study involved 41 subjects of patients with type 2 DM. The mean of magnesium nutrient intake was still low with an average of 207.2 ± 52.9 mg/day. The mean value of serum magnesium levels was 2.04 ± 0.19 mg/dl. The mean of homeostatic model assessment of insulin resistance (HOMA-IR) was 4.82 ± 5.66. The lower level of the serum magnesium had a significant correlation with HOMA IR. Conclusion: The nutrient intake containing magnesium is lower than recommendation. There is a significant negative correlation between the magnesium level and HOMA-IR on type 2 DM on metformin or pioglitazone

GAMBARAN KLINIS SINDROM KORONER AKUT BERDASARKAN STATUS GULA DARAH DI RSUD Dr. SOETOMO SURABAYA

Sindrom Koroner Akut (SKA) merupakan penyebab utama morbiditas dan mortalitas di dunia, termasuk Indonesia. SKA merupakan kumpulan gejala akibat iskemia miokardium karena terdapat penyumbatan pada arteri koronaria. Penyumbatan tersebut sebagian besar disebabkan oleh terbentuknya plak aterosklerosis. Salah satu faktor risiko terbentuknya plak aterosklerosis adalah gangguan metabolisme glukosa. Di sisi lain, gangguan metabolisme glukosa dapat terjadi pada penyakit akut dan kritis, sindroma koroner akut adalah salah satu dari antaranya. Tujuan penelitian ini adalah untuk mengetahui karakteristik penderita SKA berdasarkan kadar gula darah acak ketika masuk rumah sakit RSUD Dr. Soetomo Surabaya. Penelitian ini menggunakan data rekam medis penderita SKA yang masuk rumah sakit pada periode Januari - Desember 2013 di Intensive Cardiac Care Unit (ICCU) RSUD Dr. Soetomo Surabaya. Metode sampling yang digunakan adalah total sampling, dimana jumlah sampel yang diperoleh yaitu 62 sampel. Data yang diperoleh kemudian dianalisis dengan metode statistik deskriptif. Dari penelitian dapat disimpulkan bahwa 72,6% penderita SKA mengalami hiperglikemia. Hiperglikemia terjadi pada penderita berjenis kelamin laki-laki dan berusia lebih dari 55 tahun. Gejala nyeri dada spesifik lebih banyak dikeluhkan pada penderita hiperglikemik (66,7%) daripada normoglikemia (47,1%). Diagnosa akhir ST-Elevation Myocardium Infarction (STEMI) lebih banyak daripada Non ST-Elevation Myocardium Infarction (NSTEMI) baik pada hiperglikemia (97,8% banding 2,2%) maupun normoglikemia (82,4% banding 17,6%). Riwayat penyakit diabetes mellitus tipe 2 lebih banyak didapatkan pada penderita SKA dengan hiperglikemik (53,3%) daripada normoglikemia (11,8%). Komplikasi ketika perawatan lebih banyak terjadi pada penderita SKA dengan hiperglikemia (1,2 komplikasi/penderita) daripada normoglikemia (1,17 komplikasi/penderita), dengan komplikasi organ jantung yang paling banyak terjadi, yaitu 64,4% pada hiperglikemia dan 58,8% pada normoglikemia. Lama rawat penderita SKA dengan hiperglikemia lebih lama daripada normoglikemia (7,81 ± 2,71 hari banding 6,67 ± 1,03 hari). Penderita SKA dengan hiperglikemia lebih banyak yang meninggal daripada penderita SKA normoglikemia

Pre-Clinical trial autologus MSc bone marrow stem cell dan allogenic pancreatic stem cell untuk repair sel beta pankreas pada diabetes mellitus

Background: Diabetes Mellitus (DM) is a group of metabolic diseases due to abnormal insulin secretion, insulin action or both. This pancreatic produced insulin has an important function in the body in glucose regulation and utilization in almost all body tissues, especially muscle, fat and liver. When there are disorders of insulin secretion and utilization that results in diabetes mellitus, alternative therapies in DM management is the use of stem cells. Stem cell therapy alternative used here used the cells taken from adult stem cell, the bone marrov. stem cell, and from transplanted pancreatic cells from donor. Methods: This was a trial used animal models of DM induced Wistar with 50 mglkg Aloxan. DM Wistars were divided into 4 treatment groups, group 1 was transplanted with autologous MSCs bone marrow stem cell, group 2 was given allogenic pancreatic stem cells injected with open laparotomy and intra peritoneal, group 3 was given with insulin subcutaneously, and group 4 served as control. MSC was characterized by DAB immunostaining using CD44 and CD 105 markers,· whereas pancreatic cell characterization was done by immunofluoresence with nestin marker as well as Elisa c peptide and insulin. The dosage was 200,000 cells/rats. The results were evaluated for BSN blood sugar, 2 hours PP, C peptide, and insulin. The results were analyzed with T test. Results: Post therapy results in group 1 revealed significant decrease of blood sugar levels, both BSN and 2-hour PP (p = 0015), an increase in insulin levels (p = 0015) and increased insulin levels (p = 0.002). In group 2, there was decreased levels of BSN and 2-hour PP (0.002), an increase in insulin levels (p = 0.000), and increased level of C peptide (p = 0.003). Those receiving insulin also showed decreased levels of blood sugar, although the decrease was not as good as that in those receiving MSC and pancreatic (p = 0.002), increased insulin levels (p = 0.001) and increased levels of C peptide (p = 0088). Control group did not show decreased levels of sugar. Reduction in BSN level, 2 hours PP, increased c peptide and insulin in pancreatic stem cell administration was significant as compared to the MSC and insulin

Pre-Clinical trial autologus MSc bone marrow stem cell dan allogenic pancreatic stem cell untuk repair sel beta pankreas pada diabetes mellitus

Background: Diabetes Mellitus (DM) is a group of metabolic diseases due to abnormal insulin secretion, insulin action or both. This pancreatic produced insulin has an important function in the body in glucose regulation and utilization in almost all body tissues, especially muscle, fat and liver. When there are disorders of insulin secretion and utilization that results in diabetes mellitus, alternative therapies in DM management is the use of stem cells. Stem cell therapy alternative used here used the cells taken from adult stem cell, the bone marrov. stem cell, and from transplanted pancreatic cells from donor. Methods: This was a trial used animal models of DM induced Wistar with 50 mglkg Aloxan. DM Wistars were divided into 4 treatment groups, group 1 was transplanted with autologous MSCs bone marrow stem cell, group 2 was given allogenic pancreatic stem cells injected with open laparotomy and intra peritoneal, group 3 was given with insulin subcutaneously, and group 4 served as control. MSC was characterized by DAB immunostaining using CD44 and CD 105 markers,· whereas pancreatic cell characterization was done by immunofluoresence with nestin marker as well as Elisa c peptide and insulin. The dosage was 200,000 cells/rats. The results were evaluated for BSN blood sugar, 2 hours PP, C peptide, and insulin. The results were analyzed with T test. Results: Post therapy results in group 1 revealed significant decrease of blood sugar levels, both BSN and 2-hour PP (p = 0015), an increase in insulin levels (p = 0015) and increased insulin levels (p = 0.002). In group 2, there was decreased levels of BSN and 2-hour PP (0.002), an increase in insulin levels (p = 0.000), and increased level of C peptide (p = 0.003). Those receiving insulin also showed decreased levels of blood sugar, although the decrease was not as good as that in those receiving MSC and pancreatic (p = 0.002), increased insulin levels (p = 0.001) and increased levels of C peptide (p = 0088). Control group did not show decreased levels of sugar. Reduction in BSN level, 2 hours PP, increased c peptide and insulin in pancreatic stem cell administration was significant as compared to the MSC and insulin

Effect Of Atorvastatin Treatment On Vascular Aterogenic Factors (Lipid Profiles And VCAM-1) In Patient Diabetes With Dyslipidemia

To analyze effectiveness of atorvastatin 20mg on lipid profiles and adhesion molecule VCAM-1 in patient with diabetes dyslipidemia. An observational prospective cohort study was conducted from November 2016 to March 2017. Patients who fulfilled the inclusion criteria were taken twice for their lipid profiles and VCAM-1 measurements (before initiation of study and after 6 weeks treatment of atorvastatin 20mg). There were 13 patients who met the inclusion criteria. The results of 13 patients showed that after 6 weeks of atorvastatin therapy, there was a 28% decrease in total cholesterol (t0=223.77±49.69, t1=160.92±24.69), 39% LDL decrease (t0=152.59±44.25, t1 =93±21.44), a decrease in TG 38.6% (t0=200.85±101.53, t1=123.30±62.77) and a statistically significant decrease in VCAM-1 7.47% (t0=729.59±208.06, t1=675.06±182.88). The results of the correlation test between total cholesterol and VCAM-1 (p=0.185, r=0.268), LDL and VCAM-1 (p=0.127, r=0.307), TG and VCAM-1 (p=0.198, r=0.261) showed no correlation. Based on the results of the study, it can be concluded that atorvastatin therapy can provide improvements in atherogenic factors such as decreased lipid profile and VCAM-1, and there was no correlation between lipid profile and VCAM-1 in type 2 DM patients with dyslipidemia

CORRELATION OF RADIOGRAPHIC DAMAGE AND METABOLIC SYNDROME IN SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY

Background: Cardiovascular complication remains the long-term complications in spondyloarthritis (SpA). Previous studies revealed that metabolicsyndrome is the risk factor of cardiovascular in SpA patients. Previous studies also revealed that the prevalence of the metabolic syndrome is 34.9–45.7% in SpA patients. However, previous studies also revealed the controversy of the correlation of SpA’ disease activity with metabolic syndrome.Aim: The aim of the study was to investigate the correlation of SpA’ radiographical damage measured with a modified Stoke Ankylosing SpondylitisSpinal Score (mSASSS) score with metabolic syndrome in SpA patients, which routinely visited Rheumatology Outpatient Department in Dr. SoetomoGeneral Hospital.Methods: An observational study with cross-sectional design with consecutive sampling technique was conducted in July–October 2018. All SpApatients who fulfilled the inclusion criteria were included in this study. Data analysis was performed with SPSS v21.0.Results: There were 33 SpA patients (10 males and 23 females) included in this study. The average age was 48.18±12.27 years-old. The averagemSASSS score was 24,36 (K:0.93, p:0.00). Metabolic syndrome was diagnosed in 54.5% patients with 100% patients had central obesity, 66.7% hadincreased blood pressure, 61.5% had impaired fasting glucose, 55.6% had increased triglycerides, and 77.8% had decreased high-density lipoproteincholesterol. Positive correlation between mSASSS score and metabolic syndrome was observed (r:0.510, p:0.002).Conclusion: A correlation between SpA disease activity measured with mSASSS score and metabolic syndrome was observed. Therefore, routinemetabolic syndrome screening is strongly suggested for SpA patients

Brain Derived Neurotropic Factors in Speed vs. Inclined Treadmill in Young Adult Healthy Male With Occult Balance Disorder

Background: There is an increase in fall risk among elders and young adults consecutively due to various causes. Occult balance disorder may be among the abnormal causes of falling in young adults as well as elders. The One Leg Stance (OLS) test is used to diagnose this balance performance; it’s a proven test to measure static balance function which would lead to dynamic balance function. It has been proven that aside from cardiopulmonary exercises, treadmill workout can be used as a dynamic balance exercise. The Brain Derived Neurotropic Factor (BDNF) increases balance function through the treadmill exercise (the inclination and speed). This hormone is one of the tropical hormones generated in neurons, muscles, hematopoietic tissue and it is characterized by neurons morphology regulation and neuroplasticity. Materials and Methods: We divided 20 healthy young adult men to work out on inclination and speed groups treadmill exercise. The workout lasted for 2 weeks. We immediately observed the effect of exercise on serum BDNF as two tests were taken on before and 30 min after the workout. Result: There were significant increases of pre-exercise serum BDNF level in speed group between the first and the last exercise (p = 0.001), post-exercise between the first day and the last exercise (p = 0.001). No significant increase of serum BDNF in speed group pre- and post-exercise on the first exercise (p = 0.159), pre- and post-exercise on the last exercise (p = 0.892). There was no significant increase in serum BDNF in inclination group on all parameters (p > 0.05). The serum BDNF is actually a neurotropic factor that affects not just the neuronal system, but also molecular energy and metabolism regulation. This serum is dependent on the aerobic capacity, lactate production, muscle calcium uptake, and muscle fiber type used in exercises. Furthermore, the serum BDNF is increased by treadmill exercises in escalated speed. Conclusion: Treadmill exercises with average speed escalation increase the serum BDNF

Correlation of radiographic damage and central obesity in ankylosing spondylitis: A cross sectional study

Background Cardiovascular complications remain the leading of many long-term complications in Ankylosing Spondylitis (AS), accounting for 40% of all-cause mortalities. Previous studies reported the high prevalence of metabolic syndrome in AS with its prevalence ranging from 27% to 54.5%. Among its components, central obesity was the most prevalent component seen in AS with its prevalence ranging from 45.8 to 90.9%. However, lack of study, differences of disease activity index used, and inability to exclude confounding risk factors, might have contributed with previous studies report's conflicting results. Thus, the correlation between severity of AS and central obesity remains controversy. Aim To investigate the correlation of AS's severity measured with radiographic damage and central obesity measured with Indonesian's Waist circumference and Body Mass Index (BMI) criteria with Indonesian's cut-off. Methods This is a cross-sectional study with consecutive sampling involving 28 AS patients aged 18–60 years old receiving csDMARDs. Exclusion criteria of this study were recent infections, recent anti-TNFα, history of end state renal disease, history of metabolic syndrome before Ankylosing Spondylitis diagnosis, current smokers, and current alcohol consumption. Radiographic damage was scored using modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) score. Statistical analysis was computed with SPSS v21.0 for mac OSX. Results There were 7 males and 21 females with average age 45.07 ± 10.46 years old. Average anthropometric measures of the subjects were: waist circumference 87.37 ± 11.91 cm, height 157.05 ± 8.57 cm, weight 62,28 ± 11,50 kg, and BMI 25.42 ± 5.23 kg/m2. The average mSASSS score was 22.39 ± 5.85 (κ:0.92, p = 0.00). Analysis with Pearson's correlation revealed positive correlation between mSASSS score and waist circumference (ρ:0.49, p = 0.02) and particulary female subjects (ρ:0.52, p = 0.01). Furthermore, revealed positive correlation between mSASSS score and BMI (ρ:0.389, p = 0.04). Conclusion Positive correlation between severity of AS measured with mSASSS score with central obesity measured with waist circumference and BMI was observed in Indonesian AS patients receiving csDMARDS. Further studies are needed to investigate the nature of the relationships regarding chronic inflammation's pathway of AS and central obesity

The Effects of Moderate Intensity Treadmill Exercise with Gradual Increase of Speed and Inclination on VO2max in Men with Type 2 Diabetes Mellitus

Background: The American College of Sport Medicine (ACSM) recommends cardiorespiratory fitness training in people with diabetes mellitus (DM) for 3-7 days a week, total duration 150 minutes a week with moderate intensity using large muscle groups. Treadmill training is the best cardiorespiratory fitness training because it involves large muscle group compared to static cycle and arm crank. Aim: To determine the effect of moderate intensity treadmill exercise with gradual increase of speed and inclination on VO2max in men with T2DM. Material and Methods: Randomized group design in 22 men with T2DM, suitable with inclusion criteria was divided into 2 groups, the experimental and control group. The experimental group received moderate intensity treadmill exercise, 3 times a week with gradual increase of speed and inclination for 4 weeks. The control group underwent standard therapy. Measurement of VO2max was performed before and after program in both groups. Results: A significant increase of VO2max in the experimental group (p = 0.003). Compared to the control group, alteration of VO2max also significant among the experimental group (p = 0.000). Conclusion: Moderate intensity treadmill exercise with gradual increase on speed and inclination for 4 weeks increase VO2max in men with T2DM