A report of two cases of type 2 diabetes mellitus (T2DM): happy and longevity

Chronic hyperglycemia in patients with type 2 diabetes mellitus (T2DM) isassociated with the development of complications and the increase of risk ofmortality. Patients with T2DM have a shorter life expectancy than non-diabeticpopulation. It is attributed to cardiovascular disease, stroke, renal disease,and infection. Depression secondary to T2DM worsens the quality of life. Onthe contrary, positive emotions correlated strongly with long life expectancy.A number of mechanisms might explain this correlation. We reported twogeriatric patients over 80 y.o. with T2DM comorbidity for more than 20 years.Discussion point of these cases is the subject’s longer life span compared to theaverage diabetic patient’s life expectancy and great quality of life despite thedisease burden of chronic hyperglycemia in T2DM and cardiovascular risk

The Difference Plasma Levels of Endotelin-1 in Type 2 Diabetes Mellitus Women with and without Hypertension

Background. Diabetes and hypertension are related to each other and have a strong pre-disposition on the incidence of atherosclerosis. The incidence of hypertension 2 times greater in patients with DM than non DM. Endothelial dysfunction underlies these events. Endothelial markers, endothelin-1 is known to affect blood pressure.Aim. The aim of this study is to determine the difference plasma levels of endothelin-1 in type 2 diabetes mellitus in women with and without hypertension.Methods. The cross sectional design was conducted on women with type 2 diabetes mellitus with and without hypertension at metabolic and endocrinology clinic, Dr. Sardjito General Hospital Yogyakarta from July 2010 until the sample met the criterias. Subjects were divided into two groups, type 2 DM woman with hypertension groups and without hypertension. ELISA sandwich’s method was used to measure plasma levels of endothelin-1. Characteristics of the study are presented in the form of mean Kurniaatmaja et al.Results. In this research, the plasma levels of endothelin-1 in in type 2 diabetes mellitus in women with hypertension (n=32) and without hypertension (n=32) respectively 19.17±7.53 ng/ml and 13.75±6.19 ng/dl, and this difference was stastistically signifi cant with p= 0.003 CI 95% -8.87 to -1.97.Conclusion. Plasma levels of endothelin-1 in type 2 diabetes woman with hypertension higher than without hypertension.

Effects of valsartan compared with telmisartan in reducing insulin resistance on type 2 diabetes mellitus (T2DM) patients with hypertension

Insulin resistance is a major risk factor for patients with type 2 diabetesmellitus (T2DM). Telmisartan and valsartan are angiotensin II type I receptorblockers (ARBs) that are often used in patients with metabolic syndrome andT2DM. This study aimed to compare the effect of valsartan and telmisartan inreducing insulin resistance on T2DM with hypertension. Patients of T2DM wereopen-label screened at the Endocrinology Policlinic, Department of InternalMedicine, Dr. Sardjito General Hospital, Yogyakarta, and then randomized intotwo groups. The first group received valsartan 80 mg per day up to 160 mg perday, the second group received telmisartan 40 mg per day up to 80 mg per dayin addition with life-style modifying and diabetes therapy. Homeostasis modelassessment of insulin resistance (HOMA-IR), triglyceride and HDL cholesterollevels of patients were measured before and after receiving telmisartan andvalsartan for 12 weeks. A total of forty-nine outpatients were involved in thisstudy comprised of 25 female patients (51%) and 24 male patients (49%) with27 patients (55.1%) received telmisartan and 22 patients (44.9%) receivedvalsartan as the hypertension therapy. No significantl difference were observedbetween telmisartan group compared with valsartan group in HOMA-IR (14.01± 16.39 vs. 5.31 ± 3.51; p=0.053), triglyceride levels (165.71 ± 94.70 vs 144.41 ±48.33 mg/dL; p=0.620), HDL-C level (48.57 ± 9.78 vs 49.24 vs 49.24 ± 12.56 mg/dL;p=0.999). In conclusion, telmisartan demonstrated no difference compared tovalsartan in reducing insulin resistance on T2DM patients with hypertension

Th e eff ect of Providing Food Made from Resistant Starch Fiber (Dioscorea Esculenta, Maranta Arundinaceae L, Cucurbita Moschata, Manihot Utilissma) on the Improvement of Glycated Albumin in Type 2 Diabetes Mellitus Patients at Dr. Sardjito General Hospital

Background. One of the characteristics of the Diabetes diet is giving food with a high complex carbohydrates, particularly fiber.  The benefit of resistant starch fiber includes maintaining blood glucose and increasing insulin sensitivity.Aims. This study aimed to find the effect of providing food made from resistant starch fiber (Dioscorea esculenta, Maranta arundinaceae L, Cucurbita moschata, Manihot utilissma) on the improvement of blood glucose control in diabetes patients based on glycated albumin test.Methods. The Quasi-experimental study was used in diabetes type-2 patients who visited endocrinology polyclinic at Dr Sardjito Hospital, during 1 November 2015-31 January 2016. Food made from the resistant starch fiber was served as a daily snack for one month. Blood glycated albumin was examined before and after food providence. SPSS was used for statistical analyses.Results.  We recruited 17 subjects in the control group and 17 subjects in the treatment group. In the control group, the index of albumin was significantly deteriorated from 15.1% to 18.13%. In the treatment group, the index of albumin was reduced from 29.71% to 18.73% showing an improvement of 10.97% (p= 0.01).Conclusion. There was a significant improvement of blood glycated albumin (10.97%) after consuming food that was made from resistant to starch fiber (p=0.01)

Low level of plasma VEGF-A and C allele of -2578*C/A polymorphism in the VEGF-A gene are risk factors of diabetic foot ulcer in Javanese ethnic

Diabetes mellitus (DM) is caused by abnormal insulin secretion, impairedinsulin action, or both. Approximately 12-25% of type 2 diabetes mellitus(T2DM) patients will develop diabetic foot ulcers (DFU). Vascular endothelialgrowth factor (VEGF) is a group of platelet-derived growth factors (PDGF)which have a potential role in angiogenesis. Low levels of VEGF-A can causeinsufficient angiogenesis leading to wound healing inhibition. The 2578*C/Apolymorphism of VEGF-A gene has been reported as a candidate markerfor the DFU development. However, the variant role in the development ofDFU in Javanese ethnic needs to be clarified. This study was conducted tocompare VEGF-A levels and the -2578*C/A polymorphism of the VEGF geneamong diabetic patients with and without DFU in Javanese ethnic. In thiscase-control study, the T2DM individuals with DFU as case group (n=19) andwithout DFU as control group (n=41) were recruited. The VEGF-A levelsweredetermined by ELISA. The ARMS-PCR technique was applied to investigate thepresence of -2578*C/A polymorphism of the VEGF gene. Data were analyzedwith independent t, Mann-Whitney, Chi-square, and Kruskal-Wallis tests withsignificance level of p<0.05. The median of plasma VEGF-A level was significantlydifferent between case and control groups (p=0.001). The genotype frequencyof -2578*C/A polymorphism of VEGF gene was no difference between case andcontrol groups. However, individuals with C allele have a higher risk factor todevelop DFU than A allele (CC+CA vs AA;p=0.042; OR=2.5). The plasma VEGF-Alevels were lower in T2DM subjects with DFU than those without DFU. Inconclusion,individuals with C allele of -2578*C/A polymorphism of VEGF geneare more susceptible to have DFU than individuals with A allele in Javaneseethnic with T2DM

Predictive factors for recurrence in patients with Graves’ Disease following treatment with methimazole

Graves’ disease (GD) contributes for 60–80% of all hyperthyroidism. Methimazoleis the first line drug and most commonly used as antithyroid drug (ATD). However,the relapse rate following ATD therapy is 40–50%. The aimed of this studywas to evaluate long-term ATD treatments and to identify prognostic factorsthat contribute to GD recurrence. A total of 46 GD patients who referred to theEndocrinology Clinic, Dr. Sardjito General Hospital, Yogyakarta between January2016 and December 2018 with thyrotropin receptor antibody (TRAb) tested andtreated with methimazole were included in this study. Size of goiter was measuredbased on WHO grading system and eye syndrome based on NOSPEC score system.Patients were classified into recurrence and remission groups based on TRAbevaluation at 12 month following treatment. Result of thyroid hormone level (FT4)and subject characteristic as predictive factors observed at 3-, 6- and 12-month post-treatment were compared and analyzed.Among 46 patient involved in this study, 23patients demonstrated remission of hyperthyroidism based on TRAb evaluation at12-month. The size of thyroid at onset of disease in 30 (65%) patients was grade 2 orabove (p<0.05). Free FT4 levels at the end of observation (12 month) was 1.9±0.6 ng/dL in recurrent and 1.4±0.5 ng/dL in remission group (p<0.05). TRAb levels at earlyof study was higher in the recurrent group (p<0.05). Logistic regression analysisdemonstrated that thyroid size, FT4 level, and TRAb at diagnosis were associatedwith recurrencies. In conclusion, GD patients with large thyroids size, high TRAblevels, and high FT4 level at the onset of disease tended to fail to respond to ATD andwere associated with recurrence incidence

Dukungan keluarga dan jadwal makan sebelum edukasi berhubungan dengan kepatuhan jadwal makan pasien diabetes melitus (DM) tipe 2 rawat jalan yang mendapat konseling gizi di RSUD Kota Yogyakarta

Background: Diabetes mellitus (DM) is a clinical syndrome with symptoms of hyperglycemia, urinary glucose excretion and disorder of insulin mechanism. Approximately 90-95% of diabeteic patients suffer from type 2 DM. Various studies show that compliance to treatment of chronic disease in general is low. Compliance to eating or food frequency amongst DM patients in hospital in particular is very low. The success of self management of blood glucose (SMBG) needs participation of the patient, families, and educator team. Objective: To study the factors affecting eating compliance particularly eating schedule among type 2 diabetic out-patient who had nutrition counseling in RSUD Kota Yogyakarta. Method: It was an observasional study with cross sectional design and purposive sampling. Data collection was done in October 2008 with 98 subjects. The sampel were type 2 diabetic out-patients according to inclusion criteria at out-patient clinic in RSUD Kota Yogyakarta. Statistical test with 95% confidence interval was applied to investigate factors influenced eating compliance. Results: There were no correlations between eating compliance and disease duration (RP= 1,253 and p =0,403), and also with type of occupation (RP= 1,047 dan p= 1,000). However, it was found that family support affected eating compliance (RP= 1,723 dan p= 0,025) as well as eating schedule before nutrition counseling (RP = 2,151 and p= 0,02). Conclusion: Duration of disease and type of occupation did not affect eating compliance. Nevertheless, family support and eating schedule before nutrition education affected eating compliance among type 2 DM out-patients in RSUD Kota Yogyakart

Dukungan keluarga dan jadwal makan dan sebelum edukasi berhubungan dengan kepatuhan jadwal makan pasien diabetes melitus (DM) tipe 2 rawat jalan yang mendapat konseling gizi di RSUD Kota Yogyakarta

Background: Diabetes mellitus (DM) is a clinical syndrome with symptoms of hyperglycemia, urinary glucose excretion and disorder of insulin mechanism. Approximately 90-95% of diabetic patients suffer from type 2 DM. Various studies show that compliance to treatment of chronic disease in general is low. Compliance to eating or food frequency amongst DM patients in hospital in particular is very low. The success of self management of blood glucose (SMBG) needs participation of the patient, families, and educator team.Objective: To study the factors affecting eating compliance particularly eating schedule among type 2 diabetic out-patient who had nutrition counseling in RSUD Kota Yogyakarta.Method: It was an observasional study with cross sectional design and purposive sampling. Data collection was done in October 2008 with 98 subjects. The sampel were type 2 diabetic out-patients according to inclusion criteria at out- patient clinic in RSUD Kota Yogyakarta. Statistical test with 95% confidence interval was applied to investigate factors infuenced eating compliance.Results: There were no correlations between eating compliance and disease duration (RP=  1,253 and p =0,403), and also with type of occupation (RP= 1,047 dan p= 1,000). However, it was found that family support affected eating compliance (RP= 1,723 dan p= 0,025) as well as eating schedule before nutrition counseling (RP = 2,151 and p= 0,02).Conclusion: Duration of disease and type of occupation did not affect eating compliance. Nevertheless, family support and eating schedule before nutrition education affected eating compliance among type 2 DM out-patients in RSUD Kota Yogyakarta

Health measurement profile of older adults in Sleman District, Yogyakarta: its correlation with low-grade chronic inflammation in hypertension

The older adult often experiences a low-grade chronic inflammation that commonly manifests in various conditions without infection, including hypertension. The serum neutrophil-to-lymphocyte ratio (NLR) and hyperuricemia are important markers for various diseases including hypertension. Older adult accounts for 17.33% of the total population of Yogyakarta Special Province, which is the highest compared to other provinces. The study aimed to evaluate the relationship between NLR and hyperuricemia with hypertension among adult patients in Sleman District, Yogyakarta, Indonesia. It was a community-based cross-sectional nested study involving 90 older adults aged ≥70 y.o. living around of the Sleman Health and Demographic Surveillance System (HDSS). Data of demographic and health characteristics of the subjects were collected. Independent t test, and Mann Whitney test were used to analyze mean differences between normotensive and hypertensive groups.  Multivariate analysis with logistic regression was used to analyze correlation between all variables. The results showed 59 respondents (65%) suffered from hypertension and 31 (35%) respondents had normal and pre-hypertension. No significantly different in almost of the subject characteristics between the normotensive and the hypertensive groups was observed (p>0.05). However, significantly different between the normotensive group and the hypertensive group was observed in the history of hypertension, blood pressure/BP, mean arterial pressure/MAP, abdominal circumstance/AC, fasting blood glucose/FBG, triglyceride, and hemoglobin (p0.05). However, the uric acid level of the hypertensive group [5.6 (2.9-9.4 mg/dL)] was significantly higher than that the normotensive group [4.7 (2.9-8.0 mg/dL)] (p=0.042), although it was no significantly relationship with hypertension (p>0.05). In conclusion, there is no relationship between NLR, HsCRP and uric acid with hypertension among middle old and oldest old in Sleman District

Vitamin D levels of obesity and non-obesity health workers: a cross-sectional study in Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta

Obesity is one of the causes of chronic diseases, such as diabetes, hypertension, stroke, cancer, dyslipidemia, and heart disease. It is considered a financial burden on national health insurance since it drains the largest health fund. The study aimed to determine the difference in vitamin D levels in obese and non-obese health workers and analyze the factors that influence it. This was a cross-sectional study of the obese and non-obese health workers at Dr. Sardjito General Hospital, Yogyakarta. A total of 50 subjects, including 25 obese and 25 non-obese subjects were involved. Serum vitamin D levels was determined by ELISA. There was no significant difference between the obese and non-obese groups on vitamin D status (p30 min (OR 7.061; 95% CI: 1.064-46.872; p=0.043). In conclusion, there is no significant difference in vitamin D levels between the obese and non-obese groups. Vitamin D deficiency/insufficiency is more common in non-obese subjects than in obese subjects. Outdoor activity <30 min is a risk factor for vitamin D insufficiency/deficiency despite living in a tropical country with abundant sunlight throughout the year.