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"Latar Belakang: Peningkatan kadar high sensitivity C-reactive protein ( hsCRP ) dan kekakuan arteri berhubungan dengan peningkatan insiden kejadian kardiovaskular dan peningkatan mortalitas akibat penyakit jantung koroner pada pasien diabetes melitus tipe 2.Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara kadar hsCRP dan kekakuan arteri pada pasien diabetes melitus tipe 2.Metode : Melalui studi cross-sectional, dilakukan pemeriksaan kadar hsCRP dan derajat kekakuan arteri karotis pada 40 pasien dengan diabetes melitus tipe 2. Kekakuan arteri karotis kommunis diperiksa dengan doppler echotracking system untuk menentukan pulse wave velocity (PWV) atau kekakuan arteri karotis lokal (carotid-PWV).Hasil : Nilai median hsCRP pada penelitian ini adalah 4,5 (0,2 - 18,9) mg/L dan nilai rata-rata kekakuan arteri karotis adalah 8,8 ±1,7 m/detik. hsCRP berkorelasi kuat dengan karotid-PWV (r = 0,503, P = 0,001). Korelasi hsCRP dengan karotid-PWV ini tetap terlihat setelah dilakukan koreksi terhadap umur, indeks masa tubuh dan mean arterial pressure (r = 0,450, P = 0,005).Kesimpulan : Setelah dilakukan koreksi terhadap umur, indeks masa tubuh dan mean arterial pressure, hsCRP berkorelasi positif cukup kuat dengan kekakuan arteri pada pasien diabetes melitus tipe 2.

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Background: The elevated level of high-sensitivity C-reactive protein (hsCRP) and arterial stiffness are associated with higher incidences of cardiovascular events and with increased mortality from coronary heart disease in type 2 diabetic patients.

Aim: The aim of this study was to investigate the relationship between hsCRP and arterial stiffness in type 2 diabetic patients.

Methods: A cross-sectional study was conducted to assess the plasma levels of high sensitive C-reactive protein and carotid arterial stiffness among 40 patients with type 2 diabetes mellitus. The common carotid artery was studied by a doppler echotracking system to determine the local carotid pulse wave velocity (carotid-PWV).

Results: The median value of hsCRP in this study was 4.5 (0.2 to 18.9) mg/L and the average value of local carotid stiffness was 8.8 ± 1.7 m/sec. hsCRP showed a strong correlation with carotid-PWV (r = 0.503, P = 0.001). Levels of hsCRP were independently associated with carotid-PWV after adjusting for age, body mass index, and mean arterial pressure (r = 0,450, P = 0,005).

Conclusion: After adjusting for age, body mass index, and mean arterial pressure, hsCRP was strongly positively correlated with arterial stiffness in patients with type 2 diabets mellitus."

"Pendahuluan. Stress pembedahan merupakan faktor yang dapat mempengaruhi keluaran pasca pembedahan ortopedi, khususnya pada populasi diabetes mellitus tipe dua dimana regulasi glukosa sangat penting baik sebelum maupun pasca bedah. Kadar glukosa dan C-reactive protein merupakan biomarker yang akan meningkat bila terjadi stress pembedahan. Penelitian ini bertujuan untuk membandingkan kadar rerata glukosa dan C-reactive protein pada subjek penelitian dengan diberikan lidokain intravena dan kontrol pada operasi ortopedi.Metode. Penelitian ini merupakan uji klinis acak tersamar yang mengikutsertakan 42 pasien yang menjalani pembedahan ortopedi. Sampel dilakukan pengelompokan dengan metode randomisasi menjadi dua kelompok. Kelompok pertama adalah pasien yang diberikan lidokain intravena selama pembedahan dalam anestesia umum. Kelompok kedua adalah pasien dalam anestesia umum tanpa lidokain. Pada kedua kelompok dilakukan dua kali pemeriksaan sampel glukosa dan C-reactive protein pada sebelum operasi dan sesudah operasi. Kedua kelompok dilakukan uji hipotesis untuk melihat perbedaan rerata glukosa dan C-reactive protein dengan analisa statistik menggunakan software SPSS.Hasil. Tidak terdapat perbedaan bermakna antara rerata kadar glukosa dan C-reactive protein antara kelompok pasien dengan lidokain intravena dan kontrol. Rerata kadar glukosa pasca pembedahan lebih rendah pada kelompok lidokain dibandingkan kelompok kontrol, namun tidak berbeda bermakna (p>0.05). Tidak terdapat perbedaan rerata C-reactive protein pada kelompok lidokain dan kelompok kontrol (p>0.05).Kesimpulan. Tidak terdapat perbedaan kadar glukosa dan C-reactive protein yang bermakna antara kelompok lidokain dan kelompok kontrol pada operasi ortopedi dalam anestesia umum pada populasi dengan diabetes mellitus tipe dua.

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Introduction. Surgical stress is a factor that can influence orthopaedic postoperative outcomes, particularly in the type two diabetes mellitus population where blood sugar regulation is critical both before and after surgery. Blood sugar levels and C-reactive protein are biomarkers that will increase in the event of surgical stress. This study aimed to compare the average levels of blood sugar and C-reactive protein in study subjects with intravenous lidocaine and control in orthopaedic surgery.

Methods. The study was a randomized clinical trial that included 42 patients undergoing orthopaedic surgery. Samples were grouped by randomization method into two groups. The first group were patients who were given lidocaine intravenously during surgery under general anaesthesia. The second group is patients under general anaesthesia without lidocaine. In both groups, two blood sugar and c-reactive protein samples were examined before surgery and after surgery. Both groups tested the hypothesis to see the difference in average blood sugar and C-reactive protein with statistical analysis using SPSS software.

Results. There were no significant differences between mean blood sugar levels and C-reactive protein between the intravenous and control lidocaine groups. Average postoperative blood sugar levels were lower in the lidocaine group than in the control group, but not significantly different (p>0.05). There was no difference in mean C-reactive protein in the lidocaine group and the control group (p>0.05).

Conclusions. There were no significant differences in blood sugar and C-reactive protein levels between the lidocaine group and the control group in orthopaedic surgery under general anaesthesia in the population with type two diabetes mellitus."

"Diabetes Melitus tipe 2 merupakan penyebab kematian ke-2 pada kelompok usia 45-54 tahun di daerah perkotaan, sedangkan di pedesaan menduduki peringkat ke-6. Angka kejadiannya berhubungan dengan adanya resistensi insulin akibat berbagai macam faktor. Pola paling umum dijumpai adalah dislipidemia terutama hipertrigliseridemia dan pengurangan kadar HDL. Penelitian ini dirancang untuk melihat gambaran kadar trigliserida pada pasien DM tipe 2 yang berobat ke Poli IPD RSCM pada tahun 2010. Didapatkan bahwa dari 108 subyek, 55 orang berusia ≥55 tahun, 68 orang berjenis kelamin perempuan, 71 orang tidak merokok, dan 84 orang dengan kadar trigliserida normal. Dari hasil analisis didapat hubungan tidak bermakna antara kadar trigliserida dengan usia (Mann-Whitney, p = 0.104), jenis kelamin (Chi-square, p = 0.062), perilaku merokok (Chi-square, p = 0,973), kadar gula darah puasa (Mann-Whitney, p = 0.973), dan kadar gula darah dua jam post prandial. (Mann-Whitney, p = 0.539). Rerata TG berdasarkan analisis data adalah 140,5 (49-1144) mg/dL. Nilai rerata kadar glukosa darah puasa (GDP) 186,5 (114-559) mg/dL. Analisis data menunjukkan sebaran tidak normal dengan rerata kadar gula darah dua jam post prandial (GD2PP) sebesar 291 (178-582) mg/dL.

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Type 2 diabetic melitus is the second death cause on urban residencies age ranged 45-54 year old, while it is the 6th leading death cause on rural area, based on RISKEDA 2007. High rate of prevalencies is because insulin resistancies as results of multifactorial. Most common patern is dislipidemia especially hypertriglyceride and low level of HDL. This researh is designed to picture triglyceride level on type 2 diabetic melitus patients in RSCM on year 2010. Known that from 108 subjects, 55 are aged ≥55 year old, 68 are women, 71 don’t smoke and 84 with normal level of triglyceride. From analitic processes, known that triglyceride level is not associated with age (Mann-hitney, p = 0.104), sex (Chi-square, p = 0.062), smoking habbit (Chi-square, p = 0,973), fasting blood glucose (Mann-Whitney, p = 0.973), and 2 hours post-prandial blood glucose (Mann-Whitney, p = 0.539). Mean rate of triglyceride level is 140,5 (49-1144) mg/dL. Mean rate fasting blood glucose is 186,5 (114-559) mg/dL. Data analysis doesn’t show normal distribution on mean rate of level 2 hours post prandial blood glucose 291 (178-582) mg/dL."

"Type 2 diabetes mellitus (DM) altered the quantity and quality of saliva by disturbing the salivary glands. The objective of this study was to examine the relation between the concentration of salivary total protein and viscosity in patient with poorly controlled type 2 DM. Whole unstimulated saliva samples were collected from 12 poorly controlled diabetic patients (diabetic group) and 16 non diabetics (control group). Diabetic group had fasting blood sugar ³ 126 mg/dL and HbA1c > 8%. Control group were matched on age and sex to diabetic group, and had fasting blood sugar < 100 mg/dL. Saliva was analyzed for concentration of total protein, flow rate and viscosity. The total protein concentration was measured by Bradford method. Statistical analyzed was done by using paired sample t-test to compare concentration of salivary total protein, flow rate and viscosity between diabetic and control group. Statistical analyzed was done by using Pearson test to correlate salivary flow rate and viscosity, and concentration of salivary total protein with viscosity. Neither concentration of salivary total protein nor viscosity differed significantly between the two groups. Significantly greater salivary flow rate was seen in diabetic group. However, no correlation was found between the salivary flow rate and viscosity or concentration of salivary total protein and viscosity in diabetic group. In conclusion, there was no significant correlation between concentration of salivary total protein and viscosity in poorly controlled diabetic."

"Diabetes melitus tipe 2 biasanya mengakibatkan perubahan sekresi saliva akibat berbagai gangguan pada kelenjar saliva yang akan mempengaruhi kuantitas, komposisi, dan kualitas saliva. Tujuan penelitian ini adalah untuk mengetahui hubungan antara konsentrasi protein total saliva dengan pH saliva tanpa stimulasi pada penyandang diabetes melitus tipe 2 terkontrol buruk. Subyek penelitian terdiri dari kelompok diabetes melitus sebanyak 13 pasien dari Poliklinik Metabolik-Endokrin Ilmu Penyakit Dalam Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta dan 16 orang kontrol sebagai kelompok kontrol. Gula darah puasa (≥ 126 mg/dl) dan HbA1c (> 8%) diukur untuk menentukan kriteria diabetes melitus tipe 2 terkontrol buruk. Gula darah puasa (< 100 mg/dl) diukur untuk menentukan kriteria kelompok kontrol. Setelah pengumpulan saliva tanpa stimulasi, pH dan konsentrasi protein total saliva diukur. pH saliva diukur dengan pH meter Mettler Toledo. Konsentrasi protein total saliva diukur dengan metode Bradford. Analisis statistik digunakan uji t-berpasangan untuk membandingkan konsentrasi protein total saliva dan pH saliva tanpa stimulasi pada kelompok diabetes melitus dan kontrol. Uji korelasi Pearson digunakan untuk melihat korelasi antara konsentrasi total protein saliva dan pH saliva. Konsentrasi protein total saliva dan pH saliva antara kelompok diabetes melitus dan kontrol tidak berbeda bermakna berdasarkan uji t-berpasangan. Konsentrasi protein total saliva dan pH saliva tanpa stimulasi tidak mengalami korelasi bermakna pada kelompok diabetes melitus berdasarkan uji Pearson. Konsentrasi protein total saliva dan pH saliva dapat berubah pada kelompok diabetes melitus tapi tidak ada korelasi di antara konsentrasi total protein saliva dengan pH saliva.

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Type 2 diabetes mellitus usually altered salivary secretion. The objective of this study was to examine if there is a correlation between total salivary protein concentration and whole unstimulated salivary pH in poorly controlled type 2 diabetes mellitus. A diabetic group comprised 13 patients from Metabollic-Endocrin Clinic of Department of Internal Medicine of Cipto Mangunkusumo National Hospital, with 16 healthy subjects as a control group. Fasting blood sugar (≥ 126 mg/dl) and HbA1c (> 8%) were measured to determine poorly controlled diabetics. Fasting blood sugar (< 100 mg/dl) was measured to determine healthy subjects. After collecting whole unstimulated saliva, pH and concentration of total protein were measured. Salivary pH was measured by pH meter Mettler Toledo. Total salivary protein concentration was analyzed by Bradford method. The data was statistically analized by using paired sample T-test to compare salivary pH and concentration of total protein between diabetic and control group. Pearson?s correlation coefficient was used to examine the relation between total salivary protein concentration and salivary pH. There were no statistical significant difference between diabetic and control group in salivary pH and concentration of salivary total protein. There were no statistical significant correlation of concentration of salivary total protein between whole unstimulated salivary pH in diabetic group. Total salivary protein concentration and salivary pH could be changed in diabetic group but no correlation between total salivary protein concentration and salivary pH."

"ABSTRAK Latar Belakang. Prevalensi disfungsi tiroid lebih tinggi pada pasien diabetes dibandingkan populasiumum. Hipotiroidisme memperburuk komplikasi, morbiditas, mortalitas, dan kualitas hidup pasiendiabetes melitus tipe 2 (DM tipe 2). Faktor risiko hipotiroidisme pada pasien DM tipe 2 selama ini masihkontradiktif dan belum dikaji secara lengkap. Keberadaan sistem skor hipotiroidisme pada pasien DMtipe 2 diperlukan untuk membantu diagnosis dan menapis pasien DM tipe 2 yang memerlukanpemeriksaan laboratorium fungsi tiroid sebagai baku emas diagnosis hipotiroidisme.Tujuan. Mengetahui prevalensi dan determinan hipotiroidisme pada pasien DM tipe 2.Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Divisi Metabolik Endokrin(Poliklinik Diabetes) RSCM pada Juli sampai September 2015 dengan metode sampling konsekutif.Subjek menjalani anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium (TSH dan fT4). Analisisdata dilakukan dengan program statistik SPSS Statistics 17.0 untuk analisis univariat, bivariat,multivariat, dan Receiving Characteristics Operator (ROC) dan SPSS Statistics 20.0 untuk analisisbootstrapping pada Kalibrasi Hosmer-Lemeshow.Hasil. Sebanyak 303 subjek dianalisis untuk mendapatkan proporsi disfungsi tiroid dan 299 subjekdianalisis untuk mendapatkan determinan hipotiroidisme. Sebanyak 23 subjek (7,59%) terdiagnosishipotiroidisme, terdiri dari 43,5% subjek hipotiroid klinis dan 56,5% subjek hipotiroid subklinisberdasarkan Indeks Zulewski dan/atau Indeks Billewicz, dengan 16,7% hipotiroid klinis dan 83,3%hipotiroid subklinis berdasarkan hasil pemeriksaan fT4. Determinan hipotiroidisme pada pasien DMtipe 2 adalah riwayat penyakit tiroid di keluarga dengan OR sebesar 4,719 (95% IntervalKepercayaan/IK 1,07-20,8, p = 0,04), keberadaan goiter dengan OR sebesar 20,679 (95% IK 3,49122,66, p = 0,001),kontrol glikemik yang buruk dengan OR sebesar 3,460 (95%IK 1,075-11,14, p = 0,037), dan adanya sindrom metabolikOR sebesar 25,718 (95% IK 2,21-299,99, p = 0,01). Simpulan. Proporsi hipotiroidisme pada pasien DM tipe 2 adalah 7,59%. Determinan diagnosis dan komponen sistem skor hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga, keberadaan goiter, kontrol glikemik yang buruk, dan adanya sindrom metabolik. Sistem skor yang diberi nama Skor Hipotiroid RSCM ini diharapkan menjadi alat bantu diagnosis hipotiroidisme pada pasienDM tipe 2. ABSTRACT Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results.303subjectsincludedforproportionstudyofthyroiddysfunctionand299subjectsincludedforanalysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01).Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to generalpopulation. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are stillcontradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism inT2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergothyroid function test as a gold standard diagnostic for hypothyroidism.Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients.Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient ClinicCipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. Allsubjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysiswas done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (ReceivingOperator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshowCalibration. Results.303subjectsincludedforproportionstudyofthyroiddysfunctionand299subjectsincludedforanalysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as havinghypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidismbased on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinicalhypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination.Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719(95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95%CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01).Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and componentsof scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease,having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which iscalled RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism inT2DM patients."

"Hingga saat ini, belum ada penanda biologis yang menggambarkan kondisi penyakit ginjal kronik (PGK) akibat diabetes melitus (DM) sejak dini. Studi ini bertujuan untuk mengetahui hubungan antara rasio albumin kreatinin urin (Urine Albumin Creatinine Ratio, UACR) dengan laju filtrasi glomerulus yang diestimasi (estimated Glomerular Filtration Rate, eGFR) sebagai penanda gangguan fungsi ginjal pada pasien DM tipe 2 RSUPN Dr. Cipto Mangunkusumo. Sampel urin dan serum diambil dari 18 subjek sehat dan 10 pasien DM tipe 2. Metode spektrofotometri digunakan untuk mengukur kadar albumin urin, kreatinin urin dan kreatinin serum. Data lain diperoleh dari kuesioner. Hasilnya, nilai eGFR pasien DM (68,85 ± 15,36 (Cockroft); 73,94 ± 16,30 (CKD-EPI)) lebih rendah dibandingkan dengan subjek sehat (90,51 ± 15,69, p < 0,01 (Cockcroft); 91,13 ± 21,21, p < 0,05 (CKD-EPI)), sedangkan nilai UACR pasien DM (314,99 ± 494,92) lebih tinggi dibandingkan dengan subjek sehat (0,48 ± 0,75, p < 0,01). Namun, tidak ditemukan hubungan yang bermakna antara UACR dengan eGFR pasien DM.

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Until now, no biological marker that describes the condition of chronic kidney disease (CKD) due to diabetes mellitus (DM) from the outset. This study aimed to determine the relationship between urine albumin creatinine ratio (UACR) with estimated Glomerular Filtration Rate (eGFR) as a marker of renal dysfunction at type 2 diabetes mellitus patients at RSUPN Dr. Cipto Mangunkusumo. Urine and serum samples taken from 18 healthy subjects and 10 type 2 diabetic patients. Spectrophotometric methods used to measure levels of urinary albumin, urinary creatinine and serum creatinine. Other data obtained from questionnaires.

Results, eGFR values were lower in DM patients (68.85 ± 15.36 (Cockroft); 73.94 ± 16.30 (CKD-EPI)) compared with healthy subjects (90.51 ± 15.69, p < 0.01 (Cockcroft); 91,13 ± 21,21, p < 0,05 (CKD-EPI)), while the value of UACR in DM patients (314.99 ± 494.92) was higher than healthy subjects (0.48 ± 0.75, p < 0.01). However, there was no significant correlation between UACR with eGFR of DM patients."

"Latar Belakang: Insidensi dan prevalensi diabetes melitus tipe 2 (DMT2) terus meningkat. Penurunan imunitas yang terjadi pada DMT2 dapat meningkatkan risiko infeksi. Kontrol gula darah yang baik bermanfaat dalam pengendalian infeksi dan pencegahan komplikasi makro dan mikrovaskuler tetapi penelitian yang melibatkan pasien DMT2 usia lanjut masih belum konklusif. Serial kasus ini dilakukan untuk melihat efektivitas kontrol gula darah terhadap kesintasan pasien DMT2 yang dirawat di rumah sakit, dan untuk implementasi tatalaksana nutrisi sesuai kebutuhan dan kondisi klinis pasien. Metode: Pasien pada serial kasus ini berusia antara 47 ? 65 tahun. Penyulit infeksi pada keempat pasien ini yaitu gangren diabetikum, selulitis, dan sepsis dengan infeksi paru dan infeksi saluran kemih. Tatalaksana nutrisi pasien dilakukan sesuai dengan rekomendasi American Diabetes Association dan Therapeutic Lifestyle Changes disesuaikan dengan kondisi klinis dan toleransi pasien. Perhitungan kebutuhan nutrisi menggunakan rekomendasi untuk perawatan pasien sakit kritis bagi pasien yang dirawat di intensive care unit (ICU), dan menggunakan perhitungan dengan formula Harris-Benedict bagi yang dirawat di ruangan dengan faktor stres sesuai derajat hipermetabolisme pasien. Pasien dipantau selama 7 ? 11 hari. Edukasi diberikan kepada pasien dan keluarga selama perawatan dan saat akan pulang. Hasil: Dalam pemantauan, tiga pasien menunjukkan perbaikan klinis, toleransi asupan, dan laboratorium, dan dapat dipulangkan, sedangkan satu pasien meninggal dunia. Kesimpulan: Kontrol gula darah, asupan nutrisi yang adekuat, dan edukasi yang sesuai, dapat meningkatkan kesintasan pasien DMT2 dengan penyulit infeksi yang dirawat di rumah sakit.

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Background: The incidence and prevalence of type 2 diabetes mellitus (T2DM) is increasing. Immune disfunction in T2DM patient may increase the risk of infection. The appropriate blood glucose control has a benefit in infection control and macro and microvascular complication prevention. The Studies of glycaemic control included older patients did not find convincing evidence. The aim of this case series is to assess the association between glycaemic control and clinical outcome of hospitalized T2DM patient with comorbid infection, and to provide appropriate nutrition therapy based on individual nutrition needs.

Method: Patients in this case series were between 47 - 65 years old. There of those patients were diagnosed T2DM with comorbid gangrenous diabeticum, cellulitis, and sepsis with lung infection and urinary tract infection. Two patients need intensive care in ICU, and another patients in the ward. Two patients received nutrition therapy as critically ill condition, and the rest as American Diabetic Association recommendation, with basal calorie requirement were calculated using Harris-Benedict formula and stress factor suitable for metabolic changes. Monitoring was done for 7 - 11 days. Education was done for the patient and family during hospitalization and discharge planning.

Results: Three patients showed the improvement of clinical conditions, intake tolerance, and laboratory results, whatever one patient was pass away.

Conclusion: Glycaemic control, adequate nutrition intake, and intensive education, may improve survival rate in hospitalized T2DM patient with infection as comorbid."

"Latar Belakang: Sindroma dispepsia sering dialami oleh penderita DM. Asam lambung salah satu faktor agresif terjadinya sindroma dispepsia dan tukak lambung. Penelitian ini bertujuan untuk mencari perbedaan pH lambung pada pasien dispepsia DM dengan yang bukan DM dan untuk mengetahui apakah ada korelasi antara pH lambung dengan proteinuria dan HbA1c. Metode: Pasien terdiri dari 30 kelompok DM dan 30 kelompok bukan DM. Masing-masing kelompok dihitung pH lambung basal. pH lambung basal diukur dgn memasukkan elektroda kateter kedalam lambung selama 30 menit kemudian di rekam dgn alat PH Metri merek Digitrapper pH-Z. Beratnya komplikasi DM diukur dengan mikroalbuminuria, sedangkan kendali gula darah diukur dgn HbA1c. Dilakukan uji chi square utk mencari perbedaan pH lambung kelompok DM dgn yg bukan DM, dengan terlebih dahulu menentukan titik potong dgn analisa ROC (Receiver Operating Caracteristic). Dilakukan uji korelasi antara pH lambung basal dengan mikroalbuminuria dan HbA1c pada kelompok pasien DM. Hasil: pH lambung basal pada dispepsia DM vs non DM (2.30±0.83 vs 2.19±0.52). Dgn uji chi square terdapat perbedaan bermakna antara kelompok DM dengan yang bukan DM. Pada uji korelasi antara pH lambung dengan mikroalbuminuria dijumpai r = 0.47 dan p < 0.05, sedangkan HbA1c dijumpai r=0,59 dan p > 0.05. Simpulan: Ada perbedaan bermakna pH lambung basal antara pasien dispepsia DM dengan pasien dispepsia bukan DM. Ada korelasi antara pH lambung basal dengan mikroalbuminuria, sedangkan dengan HbA1c tidak ada korelasi. pH lambung basal pada pasien DM adalah 2.03±0.83 sedangkan pada yang bukan DM adalah 2.19±0.52.

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Aims: Dyspepsia syndrome often experienced in diabetic patients. Gastric acid was one aggressive factors in dyspepsia syndrome. This aim of this study was to determine differences gastric pH between dyspepsia diabetic and dispepsia without diabetic patients. Also to determine whether there were a correlation between basal gastric pH and microalbuminuria and also HbA1c.

Methods: There were 30 patients diabetic and 30 patients without diabetic. Basal gastric pH was measured with an electrode catheter that inserted into the stomach for 30 minutes. Gastric pH will be recorded with PH Metri Digitrapper pH-Z. Diabetic complications measured by microalbuminuria, while the measured blood sugar control with HbA1c. Chi-square test to determine differences gastric pH between diabetic and without diabetic patients. Correlation test was performed between basal gastric pH and microalbuminuria and also HbA1c.

Results: We found basal gastric pH diabetic and non diabetic patients were (2.30±0.83 vs 2.19±0.52). There was significant differences between diabetic and non diabetic patients. From 30 diabeic patients we found a corelation between basal gastric pH and microalbuminuria (p < 0.05 and r = 0.47) and a no corelation with HbA1c (p > 0.05 and r=0,59).

Conclusions: There was significant differences basal gastric pH between diabetic and non diabetic patients. There was correlation between basal gastric pH and microalbuminuria, and no correlation with HbA1c. Basal gastric pH diabetic patients was 2,30 ± 0.83 and non diabetic patients was 2,19 ± 0,52."

"Komplikasi ulkus diabetikum pedis (UDP) terjadi pada 15% pasien DM tipe 2. Seluruh kasus UDP dalam serial kasus ini diawali oleh trauma pedis sehingga menyebabkan luka yang tidak menyembuh disertai demam, kelemahan tubuh, mual, anoreksia, dengan atau tanpa disertai gejala klasik DM. Suatu uji klnis mendapatkan sebanyak 69% penderita DM dengan komplikasi UDP menderita malnutrisi. Tata laksana nutrisi pada serial kasus ini adalah pemberian nutrisi optimal, meliputi makronutrien, mikronutrien, dan nutrien spesifik sesuai kebutuhan untuk memperbaiki dan mencegah malnutrisi, komplikasi lainnya, dan kekambuhan serta mendukung penyembuhan ulkus.Rentang usia pasien pada serial kasus ini adalah 52–70 tahun. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict. Kebutuhan energi total didapat dari perkalian kebutuhan energi basal dengan faktor stres. Pemberian nutrisi dilakukan bertahap sesuai toleransi sampai mencapai kebutuhan total.Makronutrien diberikan dengan komposisi sesuai dengan keadaan pasien.Pemberian protein sesuai dengan fungsi ginjal, pembatasan asam lemak jenuh dan kolesterol, karbohidrat terutama jenis kompleks, dan cukup serat.Garam diberikan sesuai tekanan darah.Diusulkan pemberian mikronutrien berupa vitamin dan mineral sesuai Angka Kecukupan Gizi (AKG) serta nutrien spesifik asam lemak omega-3.Pemantauan dilakukan terhadap perkembangan klinis, toleransi asupan makanan, kapasitas fungsional, status ulkus, laboratorium, dan antropometri.Seluruh pasien membutuhkan insulin dengan dosis yang terus meningkat untuk menjaga kadar glukosa darah dan mengalami penurunan berat badan, namun kebutuhan energi total dapat tercapai, luka membaik dan kapasitas fungsional meningkat. Tata laksana nutrisi yang diberikan harus bersifat individual disesuaikan dengan keadaan umum dan klinis pasien.Edukasi nutrisi selama dan pasca rawat penting diberikan dalam meningkatkan motivasi pasien menjalankan diet yang benar untuk menjaga status gizi. Status gizi dan kontrol glikemik yang baik penting dalam penyembuhan luka, mencegah kekambuhan dan timbulnya komplikasi diabetes melitus yang lain.

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Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals. All patients had pedal trauma as an initiation of their non-healing wounds which were then developed to form ulcers. The ulcers presented with febrile, lethargy, nausea, anorexia, with or without diabetes mellitus classical symptoms. A clinical trial found 69% patients of this disease were malnourished. The goal of medical nutrition therapy on type 2 diabetes mellitus with diabetic foot ulcer is to provide the patients with appropriate nutrition containing macronutrient, micronutrient, and specific nutrient according to the requirement, to reverese and prevent malnutrition, other complications and recurrence, and support the wound healing.

Patient’s age range in this case series was 52–70 years old. Basal energy requirements calculated using Harris-Benedict equation and multiplyit by stress factor for the total energy requirements. Diets were gradually given according patient’s tolerance until total energy requirements were achieved.Macronutrients composition were given according to patient’s condition, with protein adjusted to renal function, limiting saturated fat and cholesterol, complex carbohydrate, sufficient fiber and sodium given according to blood pressure. Micronutrient recommendation was vitamin and mineral sejumlah as much as Recommended Dietary Allowance (RDA) and omega-3 fatty acid. Monitoring was done at clinical status, nutrition intake and tolerance, functional capacity, wound/ulcer status, laboratory and anthropometric assessment.

All patients needed increasing dose of insulin in maintainingglucose control and experienced mild weight loss, total energy requirements were achieved by all patients. Patient’s functional capacities were increased, and had improvement wound status. Nutrition therapy for patients should be given individuallyaccording to general and clinical condition. Nutrition education and motivation during and after hospitalization are important part of this disease’s management to keep the patient’s compliance on nutrition intake as recommended to maintain good nutritional status and glycemic control, prevent other complications and re-ulceration."