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)

Adyarini, Dwita Dyah

Ikhsan, Muhammad Robikhul

Sinorita, Hemi

English

Acta Interna: The Journal of Internal Medicine

Acta Interna The Journal of  Internal Medicine ,Volume 9, Number 1, June 2019: 1-71 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 HospitalDwita Dyah Adyarini1, Hemi Sinorita2, Mohammad Robikhul Ikhsan21Specialty Training Program in Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital2Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General HospitalAbstractBackground. One of characteristics in Diabetes diet is giving food with high complex carbohydrate, particularly fi ber.  Th e benefi t of resistant starch fi ber include maintaning blood glucose and increasing the insulin sensitifi ty. Aims. Th is study aimed to fi nd the eff ect of providing food made from resistant starch fi ber (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. Th e 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 resistant starch fi ber 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 signifi cantly 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. Th ere was a signifi cantly improvement of blood glycated albumin (10.97%) after consuming food that was made from resistant of starch fi ber (p=0.01). Keywords:  Diabetes type 2, food made resistant starch fi ber, Glycated albuminAbstrakLatar Belakang. Salah satu ciri khas dari diet Diabetes Melitus (DM) tipe 2 adalah pemberian  makanan tinggi karbohidrat kompleks terutama serat. Diet pati resisten berfungsi untuk mengatur agar glukosa darah tidak meningkat secara signifi kan dan meningkatkan sensitivitas insulin pada DM. Tujuan Penelitian. Mengetahui pengaruh pemberian makanan berbahan dasar serat pati resisten (Dioscorea esculenta, Maranta arundinaceae L, Cucurbita moschata, Manihot utilissma) terhadap perbaikan kendali glukosa darah pasien Diabetes Mellitus tipe 2 berdasarkan pemeriksaan albumin terglikasi.Metode. Uji Kuasi Experimental pada pasien DM tipe 2 Obes yang kontrol di poli endokrin RSUP Dr. Sardjito, selama tanggal 1 November 2015-31 Januari 2016. Subyek diberikan konsumsi makanan dalam bentuk makanan ringan berbahan dasar serat pati resisten selama 1 bulan, dan di hitung albumin terglikasi sebelum dan setelah perlakuan dan dibandingkan dengan kelompok kontrol. Hasil diuji dengan SPSS untuk mencari perbedaan rerata.Adyarini et al.2 Introduction Diabetes Mellitus (DM) is a chronic disease. World Health Organization (WHO) predicts the increase of frequency of diabetes patients in Indonesia from 8.4 million in 2000 to 21.3 million in 2030.1Management in DM consists  of education, lifestyle modification, physical exercise, diet modifi cation and pharmacology treatment.1 One particular diet in DM type 2 is carbohydrate complex, high fi ber and low simple carbohydrate. Resistant Starch fi ber can control the blood glucose because it is slowly digested, slower transit time and improve the insulin sensitivity.2Resistant Starch Fiber has high viscosity and can block glucose absorbtion, thus it will decrease blood glucose.3,4 Resistant starch fi ber is fermented in colon because of microfl ora and produces short chain fatty acid such as acetate, propionate and butyrate which improve insulin sensitivity.3,5,6 Some of roots have a fi ber resistant starch fi ber compotition such as gembili (Dioscorea esculenta), garut (Maranta arundinacea), kimpul and gadung.7 Th e result of study in diabetes experimental Wistar mouse shows a signifi cant blood glucose decrease in a group provided with gembili as a diet.8 One of an accurate long biomarker of glycemic control is glycated albumin. Th is test can show glycemic control within 2-4 weeks before.9Th is study aimed to give evidence about the good eff ect of providing food containing resistant starch fiber to improve glycemic control in diabetes type 2 patients based on glycated albumin test. MethodsThis study was Quasi Experimentally designed. Th is study was one of a part in the study by dr. Sunarti, M.Kes titled “Th erapy of food based on Gembili as antidyslipidemia and antihyperglicemia in Diabetes Mellitus type 2 subject” with ethical clearance number KE/FK/1073/EC (28 August 2015). Th e study was done in Endocrinology clinic, Department of Internal Medicine, Dr. Sardjito General Hospital Yogyakarta during 1 November 2015 until 31 January 2016. Study subject were hospital employees with diabetes and obesity. Th ey were patients with type 2 diabetes, obesity with body mass index > 23.5 kg/m2, regularly used willing to participate in the study. Exclusion criteria for this study included alcohol consumption, pregnancy, have severe infection, with renal inufi ciency (creatinine >1.5 mg/dl), hypoalbuminemia, proteinuria Hasil Penelitian. Sebanyak 17 subyek dalam kelompok kontrol dan 17 subyek dalam kelompok perlakuan dianalisis. Pada kelompok kontrol, indeks albumin terglikasi mengalami perburukan dari 15,1 % menjadi 18,13 %. Sebaliknya pada kelompok perlakuan, indeks albumin terglikasi menurun dari 29,71 % menjadi 18,73 % atau terdapat perbaikan sebesar 10,97% (p=0,01).  Kesimpulan. Terdapat perbaikan kadar albumin terglikasi secara klinis dan statistik sebesar 10,97% pada kelompok yang mendapatkan makanan berbahan dasar serat pati resisten bila dibandingkan dengan kelompok yang tidak mendapatkan diet serat pati resisten (p=0,01).Kata Kunci: Diabetes type 2, makanan serat pati resisten, Albumin terglikasiActa Interna The Journal of  Internal Medicine ,Volume 9, Number 1, June 2019: 1-73 >3.5 gr/day, hipertiroidism, malnutrition, hypotiroidism, chonic heart failure, icteric, liver cirrhosis, drink anorectic, steroid drugs, and the use sulfonylurea, acarbose, DPP IV Inhibitor, and GLP1 agonist.Th e subjects was given food in a form of 32 gram snack for a month, consisting of fi ber resistant starch fi ber from gembili (Dioscorea esculenta), garut  (Maranta arundinaceae L), labu kuning (Cucurbita moschata), and singkong  (Manihot utilissma)  with total calories 144.55 and resistant starch of 14.91%. Subject was educated about diet in diabetes. Calory counting was done every day by telephone interview and home visit by diabetic nutritionist. Glycated albumin were checked before and after one month.Univariat analysis was done for each variable, distribution and characteristic of subject. Data was analyzed using SPSS and presented as means ± standar deviation. Normality data test continue used Saphiro-Wilk. Mann Whitney test was used to analyze and compare the means of glycated albumin in both groups. Unpaired t-test was used if the data was normally distibuted and Mann Whitney if the data not normally distibuted. Signifi cant level of this study was p < 0.05. Th is study has been approved by ethical comitte of biomedical Faculty of Medicine Gadjah Mada University and permitted by the Director of Dr. Sardjito General Hospital Yogyakarta. Each subject provided a concent to participate.ResultTh is study included 17-control subject and 17 subjects who received food based on resistant starch fi ber. Baseline characteristic is showed in table 1.  Mean of age in the control group was 53.82 years and in experimental group 54.12 years. Male ini control group was 47.1% compared to 41.2% in experimental group. Body mass index control group was 28.64 kg/m2 and experiment group was 28.5 kg/m2.Table 2 showed a rise of body mass index from 28.64 kg/m2 to 28.69 kg/m2 in control group and 28.5 kg/m2 to 28.54 kg/m2 in experimental group, but the diff erences were not statistically signifi cant. In control group, glycated albumin increased from 15.1% to 18.13 %. In the experimental group, glycated albumin improved from 29.71 % (fail control) to 18.73 % (good control). From table 2 we got the delta albumin in the group that did not get additional food-based resistant starch fi ber was increased about 3.02 ± 7.13% glycated albumin, and in the group which got additional food-based fi ber resistant starch fiber have improvement of glycated albumin equal to 10.97 ± 14.6% (p = 0.01).In control group, failed subjects (17.6%) increased from 3 to 5 subjects (29.4%) and good test decreased from 13 subjects (76.5%) to 12 subjects (70.6%). In experimental group very good response improved from 8 subjects (47.1%) to 11 subjects *64.7%) and in fail group down from 7 subjects (41.2%) to 4 subjects (23.5%) (see table 3).Adyarini et al.4 DiscussionIn baseline characteristic of the study, there were no signifi cant diff erences in age, sex, education, comorbid, medication and body mass index. Th us, all basic factors did not infl uence the study results.One study showed that the albumin was not diff erent by sex, unlike HbA1c, which was signifi cantly higher in men than in women. One study mentioned that the published albumin refl ects postprandial hyperglycemia and indicates glycemic fl uctuations. Invalid albumin levels are associated with HbA1c levels. Glycated albumin will be affected in conditions that interfere with albumin metabolism. Glycated albumin will be lower in patients with nephrotic syndrome, severe obesity, hyperthyroidism and glucocorticoid use. Glycated albumin is higher in patients with T able 1 Characteristic Data subjectCharacteristic Frequency Therapy groupFrequency Control Group  PAge (years)Mean     54.12 ± 2.6    53.82 ± 2.8            0.756**Sex:- Male (%)- Female (%)     7 (41.2%)   10 (58.8%)    8 (47.1%)   9 (52.9%)        0.734*Education:- High School (%)-  Diploma (%)- Bachelor (%)    5 (29.4%)    7 (41.2%)    5 (29.4%)   6 (35.3%)   6 (35.3%)   5 (29.4%)        0.826*Comorbid:- Hypertension (%)- Cardiac (%)- Post Stroke (%)- No Comorbid (%)     4 (23.5%)     2 (11.8%)     2 (11.8%)     9 (52.9%)   3 (17.6%)   3 (17.6%)    2 (11.8%)  9 (52.9%)       0.910*Diabetes Medication:- Metformin (%)- Insulin (%)- Insulin and metformin (%)- No therapy (%)      8 (47.1%)      3 (17.6%)      3 (17.6%)      3 (17.6%)   8 (47.1 %)   3 (17.6%)   3 (17.6%)   3 (17.6%)      0.99*Another medication :- Anti hypertension (%)- Anti coagulant (%)- Anti dyslipidemia (%)- Anti hypertension and anti coagulant (%)- Combination anti hypertension, anti coagulant, anti dyslipidemia (%)- No medication (%)   3 (17.6%)   2 (11.8%)   3 (17.6%)   0 (0%)   1 (5.9%)  8 (47.1%)2 (11.8%)2 (11.8%)3 (17.6%)1 (5.9%)1 (5.9%)8 (47.1%)       0.812*Physical exercise :- Walking (%)- Treadmill (%) - Cycling (%)- No excersise (%)  5(29.4%)  1 (5.9%)  6 (29.4%)  6 (35.3%)  5 (29.4%)  1 (5.9%)  5 (29.4%)  6 (35.3%)       0.99*BMI (kg/m2)   28.5± 3.46 28.64 ± 3.3       0.886*Smoking                              4 (23.5%)    5 (29.4%)       0.006*Creatinin (mg/dl)   0.90 ± 0.20 0.93 ± 0.21        0.7**Albumin (g/dl)    5.67 ±1.03 5.67 ± 1.02        0.9** p < 0.05 was  statistically signifi cant diff erence *t-test  **Mann Whitney testActa Interna The Journal of  Internal Medicine ,Volume 9, Number 1, June 2019: 1-75 High starch fi ber versus low fi ber foods has been proven to be suitable for patients with type 2 DM. Lifestyle changes with an increase in fi ber mean in the included study is about 18 g / day; to apply this in one's diet will include eating a bowl of high fi ber cereal and adding more servings of vegetables a day. Th e American Diabetes Association recommends consumption of 30-50 grams of fi ber per day in patients with type 2 diabetes. Epidemiological studies show that increased fi ber intake will lower the risk of coronary heart disease.Research Hallstrom et al.12 showed that administration of 7.7 grams of resistant starch fi ber, high wheat amylose would lower blood glucose and increase insulin. In the study of Al Tamimi et al.13 the administration of 20 grams of resistant starch would lower blood glucose levels.Polysaccharide content in gembili has the ability to lower blood glucose by decreasing the cirrhosis of the liver and hypothyroidism. In the obese group, glycated albumin also showed lower levels due to chronic micro-infl ammation of cytokines secreted by obese adipose subjects, which would increase albumin catabolism and shorten the albumin cycle. Glycated albumin is also lower than blood glucose in patients with smokers, hyperuricemia, hypertriglyceridemia, and non-alcoholic fatty liver disease.10,11 In this study, the increased levels of glycated albumin were increased in the control group; this is still possible due to glucose fl uctuations or postprandial glucose rise, which was not assessed in this study.Metformin is an oral drug that shows a decrease in HbA1c ranging from 0.2% -2%. In this study with the change of dietary resistant starch was detected 10.97% decreased of glycated albumin. Th is opens a possibility of resistant starch fi ber to be added for DM management strategy in controlling blood glucose.6Table 2 Comparison of body mass index and glycated albumin (%) in control group and experimental group VariableExperimental Control  P valueMeans (SD) Means (SD)IMT (kg/m2) PreIMT (kg/m2) Post28.50 ± 3.4628.54 ± 3.02  28.64 ±3.33  28.69 ±2.89*0.88*0.81Glycated albumin (%) PreGlycated albumin (%) Post29.71 ± 22.9318.73 ± 15.97  15.1 ± 12.03  18.13 ± 16.43**0.667**0.66Δ Glycated albumin  -10.97 ± 14.6   3.02 ±7.13 **0.01p < 0.05 was statistically signifi cant diff erence * t-test; ** Mann Whitney test; Δ pre-post test of glycated albuminTable 3 Subanalysis comparison of group glycated albumin (%) in control group and experimental group Variable Pretest p Post test pControl Experimental Control ExperimentalVery good 13 (76.5%) 12 (70.6 %) 0.132 8 (47.1%) 11 (64.7 %) 0.5Good 1 (5.9 %) 0 2 (11.8%) 2 (11.8 %)Fair 0 0 0 0Fail 3 (17.6%) 5 (29.4 %) 7 (41.2 %) 4 (23.5 %)Adyarini et al.6 absorption of blood glucose in the intestines. Non-starch fi bers, which also contain cellulose, lignin, and insoluble inulin, will shorten transit time in the intestines. In the colon, carbohydrate compounds that are not digesting by digestive enzymes fermented by bacteria and produce major short chain fatty acids such as acetic acid, propionic acid and butyric acid. Th e type of short-chain fatty acids produced depends on the source of food consumed. Short chain fatty acids are able to control the body's metabolism, which among others was to regulate insulin sensitivity, regulate the secretion of hormones in the digestive tract and regulate other metabolic processes. Th e magnitude of acetate, propionate, butyric formation is infl uenced by environmental conditions of colon, microbiota type and free fatty acid receptor 2 and free fatty acid receptor 3.14Conclussion In this study it was shown that there was a signifi cant improvement of glycated albumin in the group receiving dietary supplementation based on resistant starch fiber. advanced research with randomized and assessed uric acid and triglycerides that may interfere with albumin glycation and glucose examination can improve the accuracy of this research. References1. Perkeni. 2015. Konsensus Pengelolaan dan Pencegahan diabetes Melitus tipe 2 di Indonesia. Jakarta pusat: July 2015. 2. Tjokroprawiro A, Sri Murtiwi, 2014. Diagnosis dan Klasifi kasi Diabetes Melitus dalam S Setiati, I Alwi, A W Sudoyo, M Simadabrata, B Setiyohadi, A F Syam (Eds) Buku Ajar Ilmu Penyakit Dalam. PAPDI Jakarta, 3010 : 2336-23463. Tensiska. 2009. Serat akanan. Jurusan teknologi industri pangan Fakultas Teknologi Industri Pertanian Universitas Padjajaran.4. Robertson MD, Bisckerstone AS, Dennis AL, Vidal H, Frangklun KN. 2005. Insulin sensitizing eff ect of dietary resisten starch and eff ect on skeletal muscle and adipose tissue metabolism. Am J clin Nutrs 82 (3): 559-5675. Cumming JH, Edmond LM dan Magee EA. 2004. Dietary Karbohidrat and Health: do we still need the fi ber concept. Clin Nutr Suppl 1(2) : 5-176. Robert E Post, Arch. G Maoinus, Dana E. King, Kit N Simpson. 2012. Diatery Fiber for the Treatment of Type 2 Diabetes Mellitus: A meta analysis. J Am Board Fam Med January- February 2012, vol 25 (1) : 16-237. Saputro P, Teti G. 2015. Pengganti polisakarida larut air dan seni pangan umbi-umbian dan kadar glukosa darah. Jurnal pangan dan agro industry vol 3 no 2 p 750-756 April 20158. Marsono Y. 1998. Perubahan kadar resisten starch dan komposisi kripik beberapa bahan pangan kaya karbohidrat dalam pengelohan. Agrikultur (19 (3) : 124-1279. Arasteh A, Sara Farahi, Mehran Habibi-Rezaei Ali Akbar Moosavi-Movahedi. 2014. Glycated albumin: an overview of the In Vitromodels of an In Vivo potential disease marker. Journal of Diabetes & Metabolic Disorders 2014, 13:4910. Tahara Y. Kettou Wo Miru Kangaeru, Shima K. Glycoalbumin (GA). Takyo: Nankodo; 2000. p62-69. (in Japan)Acta Interna The Journal of  Internal Medicine ,Volume 9, Number 1, June 2019: 1-77 11. Illie-Robert Dinu dan Eudgen M. 2014. Glycated Albumin more than the missing link in the evaluation of Diabetes Control. Rom J Diabetes Nutr Metab Dis, 21 (2):137-150.12. Hallstro¨m E, Sestili F, Lafiandra D, Bjork I, Ostman E. 2011. A novel wheat variety with elevated content of amylose increases resistant starch formation and may benefi cially infl uence glycaemia in healthy subjects. Food Nutr Res 2011; 55.13. Al-Tamimi EK, Seib PA, Snyder BS, Haub MD. 2010. Consumption of cross-linked resistant starch (RS4(XL)) on glucose and insulin responses in humans. J Nutr Metab 201014. Olivia Yofananda dan Teti Estiasih. Potensi Senyawa Bioaktif Umbi-umbian Lokal Sebagai Penurun Kadar Glukosa Darah: Kajian pustaka. Jurnal Pangan dan Agroindustri Vol. 4 No 1 p.410-416, January 2016

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

https://jurnal.ugm.ac.id/jain/article/download/51364/26082

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

Abstract

Similar works

Full text

Available Versions

Acta Interna: The Journal of Internal Medicine