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"ABSTRAKLatar Belakang: Nefropati diabetik (ND) merupakan komplikasi mikrovaskular yang berkontribusi terhadap end stage renal disease (ESRD) pada penyandang DMT2. Polimorfisme gen apolipoprotein E (APOE) dihubungkan dengan dislipidemia merupakan faktor risiko untuk timbulnya ND.Tujuan: Mengetahui pengaruh polimorfisme gen APOE terhadap kejadian ND penyandang DMT2 di Palembang dan menganalisis pengaruh polimorfisme gen APOE terhadap perubahan profil lipid penyandang DMT2 dengan ND.Metode: Penelitian kasus kontrol pada penyandang DMT2 di Palembang. Kelompok kasus adalah penyandang DMT2 dengan ND dan kelompok kontrol adalah penyandang DMT2 tanpa ND yang memenuhi kriteria penyertaan.Hasil: Terdapat 37 penyandang DMT2 dengan ND (ACR > 300 mg/g kreatinin) dan 42 tanpa ND (ACR < 30 mg/g kreatinin). Tidak terdapat perbedaan bermakna pada usia, jenis kelamin, lama DM, tinggi badan, tekanan darah sistolik, glukosa darah puasa, HbA1c dan profil lipid. Terdapat perbedaan bermakna pada berat badan, IMT, TD diastolik, hemoglobin, ureum, kreatinin dan eGFR antara kasus dan kontrol. Distribusi genotip tidak berbeda bermakna. Pada kelompok kasus didapatkan peningkatan frekuensi alel gen APOE ε2 dibanding kontrol (62,2 % vs. 37,8 %). Dengan analisis bivariat didapatkan penyandang DMT2 yang mengandung alel gen APOE ε2 2,5 kali lipat dan bermakna (p = 0,023) dibandingkan gen APOE ε3 dalam menyebabkan ND sedangkan alel ε4 0,65 kali lipat dan tidak bermakna (p = 0,37). Profil lipid tidak berbeda bermakna baik pada penyandang DMT2 dengan ND maupun penyandang DMT2 tanpa nefropati.Simpulan: Frekuensi alel gen APOE ε2 lebih tinggi pada penyandang DMT2 dengan ND dibandingkan tanpa ND. Gen APOE ε2 merupakan faktor risiko kejadian ND pada penyandang DMT2. Tidak ada hubungan antara kejadian ND dengan perubahan profil lipid.

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ABSTRACT

Backgrounds. Diabetic nephropathy is microvascular complication, largely contributed to end stage renal disease in T2DM patients. Apolipoprotein E (APOE) genetic polymorphism in association with dyslipidemia have been proposed as one of the risk factors for the development of diabetic nephropathy (DN).

Aim: To examine the effect of apolipoprotein E (APOE) gene polymorphism to DN incidence in patients with T2DM and to analyze the effect of APOE gene polymorphism to lipid profile in DN.

Method. Case control study at Palembang. Case group were T2DM with nephropathy and control group were T2DM without nephropathy.

Results. There were 37 patients with DN (ACR > 300 mg/g creatinine) and 42 patients without nephropathy (ACR < 30 mg/g creatinine). No significant differences in terms of age, sex, duration of DM, height, systolic blood pressure, fasting glucose, HbA1c and lipid profiles between the two groups. There were significant differences in weight, BMI, diastolic blood pressure, hemoglobine, ureum, creatinine and eGFR with p value 0.028, 0.013, 0.017, < 0.001, < 0.001, < 0.003 and < 0.002 respectively. The distribution of APOE genotypes between the two groups are the same. However, there was a significant difference in the allele frequencies, ε2 frequency was significantly higher in case group compared to control group (62.2 % vs. 37.8 %). On bivariate analysis ε2 allele showed 2.50 times to DN risk with p 0.023 while ε4 allele 0.65 times to DN risk. No significant difference in lipid profiles between DN and without nephropathy.

Conclusions. APOE ε2 allele was significantly higher in macroalbuminuria group. These result suggest that ε2 allele may be associated with the development of DN and ε2 allele was risk factor in T2DM patients. There were no correlation between APOE gene polymorphism and lipid profiles."

"STEMI adalah IMA dengan risiko mortalitas tinggi. Risiko dikurangi dengan revaskularisasi berupa IKPP Gangguan kardiovaskular dikaitkan dengan penurunan konsentrasi vitamin D. Penurunan bisa disebabkan SNP gen CYP27B1 yang mengkode enzim 1α hidroksilase dan belum ada penelitian yang menghubungkan konsentrasi vitamin D pada pasien STEMI yang menjalani IKPP. Hasil IKPP berupa area sumbatan dan kemampuan darah mengalir ke pembuluh darah koroner, dikenal dengan TIMI grade 0-3. Penelitian bertujuan untuk menganalisis hubungan konsentrasi kalsidiol dan gen CYP27B1 (-rs10877012) perubahan G ke T pada pasien STEMI yang menjalani IKPP dengan aliran TIMI akhir. Seratus subjek STEMI dan kontrol diambil 3 mL darah. Plasmanya diukur konsentrasi kalsidiol dengan teknik ELISA. PBMC dianalisis gen CYP27B1 (- rs10877012) dengan qRT PCR teknik Taqman Probe. Data dianalisis statistik kemaknaan 0,05. Konsentrasi kalsidiol median kasus 35,94 ng/ml dan kontrol 20,89 ng/ml berbeda bermakna (p=0,0001). Variasi gen CYP27B1 pada kedua kelompok berbeda bermakna (p=0,0001), dengan polimorfisme TT kasus 28% dan kontrol 19%. Hubungan konsentrasi kalsidiol dengan polimorfisme gen CYP27B1 berbeda bermakna (p=0,0001), tidak terdapat hubungan konsentrasi kalsidiol dengan aliran TIMI dan polimorfisme gen CYP27B1 dengan p=0,232. Konsentrasi kalsidiol tinggi pada kasus dimungkinkan sebagai respon tubuh terhadap inflamasi yang mengalami serangan jantung. Polimorfisme TT kasus 28% tidak memiliki hubungan terhadap patofisiologi aliran TIMI akhir.

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STEMI is an AMI with a high risk of mortality. The risk is reduced by revascularization called by IKPP Cardiovascular disorders are associated with decreased vitamin D concentrations. The decrease could be due to the SNP gene CYP27B1 which encodes the enzyme 1α hydroxylase and no studies have linked vitamin D concentrations in STEMI patients undergoing IKPP. IKPP results in the form of block area and the ability of blood to flow to the coronary blood vessels, known as TIMI grade 0-3. The aim of this study was to analyze the relationship between calcidiol concentrations and the CYP27B1 gene (-rs10877012) G to T changes in STEMI undergoing IKPP with TIMI flow. One hundred STEMI and control subjects collected 3 mL of blood. Plasma concentration of calcidiol was measured using the ELISA technique. PBMCs were analyzed CYP27B1 gene (- rs10877012) by taqman probe qRT PCR. Data were analyzed by statistical significance of 0.05. Median calcidiol concentration of 35.94 ng / ml cases and 20.89 ng / ml controls was significantly different (p = 0.0001). CYP27B1 gene variation in the two groups was significantly different (p = 0.0001), with TT polymorphism of 28% and 19% of controls. The correlation between calcidiol concentration and CYP27B1 gene polymorphism was significantly different (p = 0.0001), there was no correlation between calcidiol concentration and TIMI flow and CYP27B1 gene polymorphism with p = 0.232. The high calcidiol concentration in this case may be the body's response to inflammation following a heart attack. The TT polymorphism of 28% cases had no relationship to the pathophysiology of late TIMI flow."

"ABSTRAKGen CYP2C8 mempunyai beberapa alel mutan yang menyandi enzim CYP2C8 dengan kapasitas metabolisme yang rendah. Enzim CYP2C8 berperanan penting dalam metabolisme antimalaria amodiakuin menjadi metabolit aktifnya desetilamodiakuin sehingga mutasi pada gen CYP2C8 diduga berpotensi menyebabkan kegagalan terapi maupun kejadian efek samping agranulositosis yang dipicu oleh metabolit nonenzimatiknya amodiakuinkuinonimin.Penelitian observasional ini bertujuan untuk mengetahui frekuensi distribusi alel mutan gen CYP2C8 yaitu CYP2C8*2, CYP2C8*3, dan CYP2C8*4 pada salah satu kelompok etnik yang tinggal di daerah endemik malaria, yaitu suku Nias. Analisis PCR-RFLP untuk identifikasi alel gen CYP2C8 yang dilakukan pada 214 sampel berupa tetes darah di kertas saring (dot blot) dan subjek suku Nias memperlihatkan bahwa semua sampel membawa alel normal (wild type). Dengan tidak ditemukannya alel mutan gen CYP2C8 pada suku Nias, kita dapat berharap bahwa kemungkinan kegagalan terapi amodiakuin dan efek samping obat akibat metabolit nonenzimatiknya pada suku Nias tidak berkaitan dengan polimorfisme gen CYP2C8.

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ABSTRACTThe CYP2C8 gene has been documented to have several alleles encoding enzyme with low metabolic capacity. Since CYP2C8 plays a major role in metabolizing antimalarial drug amodiaquine to its active metabolite desethylamodiaquine, it is assumed that mutation in CYP2C8 gene may potentially lead to treatment failure or to occurrence of adverse drug reactions such as agranulocytosis induced by its nonenzymatic metabolite amodiaquinequinoneimine.The aim of this study was to determine the frequency distribution of CYP2C8 mutant alleles particularly CYP2C8*2, CYP2C8*3 and CYP2C8*4 in one of the ethnic group that resides in malaria endemic area, Nias. PCR-RFLP analysis of 214 dot blot samples from Nias ethnic group subjects revealed that all of the samples carried the wild type allele of the CYP2C8 gene. In the absence of mutant alleles of CYP2C8 among Nias ethnic group, one can expect that treatment failure in amodiaquine therapy and adverse drug reactions associated with reactive metabolite of the drug are not related with CYP2C8 genetic polymorphisms."

"Pendahuluan: Neuropati diabetik merupakan komplikasi diabetes yang paling sering ditemukan dalam praktik sehari-hari. Gejala terutama dikeluhkan rasa nyeri atau baal pada kedua tungkai. Penyakit arteri perifer (PAP) juga merupakan komplikasi diabetes dengan manifestasi nyeri pada tungkai. Adanya neuropati dan PAP akan mempengaruhi gejala satu sama lain sehingga umumnya pasien akan datang dalam keadaan yang lebih berat. Penelitian ini bertujuan untuk mengetahui gambaran klinis dan hasil pemeriksaan elektrodiagnostik neuropati diabetik dengan atau tanpa PAP.Metode: Studi ini bersifat deskriptif dengan metode potong lintang pada pasien diabetes melitus tipe 2 dengan neuropati berdasarakan Toronto clinical neuropathy score (TCNS). Pasien kemudian dilakukan pemeriksaan elektrofisiologi (Kecepatan hantar saraf (KHS) dan sympathetic skin response (SSR)) untuk membuktikan adanya neuropati serta pemeriksaan ankle brachial index (ABI) dan toe brachial index (TBI) untuk mendiagnosis adanya PAP.Hasil: Sebanyak 46 subjek penelitian yang terdiri dari 22 laki-laki dan 24 perempuan. Rerata usia subjek penelitian adalah 63,09 (±9,98) tahun dengan rerata lama menderita diabetes 13,57 (±10,43) tahun. Kebanyakan pasien memiliki kontrol glikemik yang kurang baik dengan median HbA1C of 7,35 (min-max: 5,6-12,2). Didapatkan sebanyak 22 orang terdiagnosis PAP berdasarkan pemeriksaan TBI. Berdasarkan analisis bivariat didapatkan kemaknaan secara statistik antara adanya keluhan nyeri, rasa kram, lokasi nyeri, klaudikasio intermiten serta riwayat penyakit jantung koroner dengan adanya PAP (masing-masing p < 0,05).Kesimpulan: Adanya keluhan nyeri, rasa kram, lokasi nyeri, klaudikasio intermiten, serta riwayat penyakit jantung koroner dapat menunjukkan adanya kemungkinan PAP pada pasien neuropati diabetik.Kata kunci: neuropati diabetik, penyakit arteri perifer, kecepatan hantar saraf, respon kulit simpatetik

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Background: Diabetic neuropathy (DN) is a common complication of diabetes. Symptoms can be tingling, pain or numbness in the leg.(1) Peripheral arterial disease (PAD) is also a complication of diabetes which can cause pain in the leg. The presence of DN and PAD affect each other, resulting in worse patient condition. The aim of this study to evaluate clinical characteristics and electrodiagnostic findings in diabetic neuropathy with and without PAD.Method: a descriptive cross-sectional study in type 2 diabetes mellitus patient with neuropathy based on Toronto clinical neuropathy score (TCNS). Patients were evaluated with electrodiagnostic study (nerve conduction study (NCS) and sympathetic skin response (SSR)) to confirm neuropathy and also ankle brachial index (ABI) and toe brachial index (TBI) to evaluate PAD.Results: a total of 46 subjects consisted of 22 male and 24 females include in this study. The mean age of the study population was 63,09 years (±9,98). The mean duration of diabetes in the study population was 13,57 years (±10,43). Most of the patients had poorly controlled diabetes with a median HbA1C of 7,35 (min-max: 5,6-12,2). Ten patients have PAD based on TBI examination. From bivariate analysis, there is statistically significant association between pain, cramp, pain location, intermittent claudication, and history of coronary arterial disease with the presence of PAD (p < 0,05).Kesimpulan: The presence of pain, cramp, pain location, intermittent claudication, and history of coronary arterial disease can predict the presence of PAD in DN patients.Keywords: diabetic neuropathy, peripheral arterial disease, nerve conduction study, sympathetic skin response"

"Diabetes mellitus (DM) is a complex and chronic metabolic disorder leading to many complications. One of the most common complications of DM is diabetic neuropathy. There are many studies exploring corneal sensitivity as a potential marker of diabetic neuropathy. This review aims to explore association between corneal sensitivity and diabetic neuropathy. In diabetic neuropathy, corneal sensitivity is impaired due to low level of corneal nerve trophic factors, impaired sensory nerve fibers, and lost communication of dendtritic cell. In diabetic patients, this condition can be assessed by several techniques, such as Cochet Bonnet aesthesiometry, non-contact corneal aesthesiometry, and confocal microscopy. Few promising therapeutic targets for impaired corneal sensitivity include stem cell and growth factor therapy that can be used to prevent complication in patient with diabetic neurotrophic keratopathy. Impaired corneal sensitivity serve as a potential marker of diabetic neuropathy. Doctors, opthalmologists and internists, should anticipate the possibility of observing the following changes in diabetic patients with neuropathy by using corneal sensitivity assessment test."

"Alyxia reinwardtii dikenal sebagai Pulosari digunakan untuk pengobatan kencing manis dan beberapa penyakit lainnya, memiliki kandungan utama berupa Pulosariosida dan Skopolentin. Penelitian ini dilakukan untuk mengevaluasi efek antidiabetes dan antihiperlipidemia ekstrak etanol dari kulit batang pulosari pada tikus diabetes yang diinduksi kombinasi pakan tinggi lemak, streptozotocin, dan nikotinamid. Untuk mencapai tujuan tersebut, pada penelitian ini menggunakan 24 ekor tikus wistar jantan. Tikus dibagi menjadi enam kelompok (n=4). Kelompok normal dan negatif diberi CMC 0,5%, kelompok positif diberi Metformin dosis 90mg/200g/hari secara oral; dan tiga variasi dosis ekstrak kulit batang pulosari 150mg/kgBB tikus/hari; 300mg/kgBB tikus/hari; 600mg/kgBB tikus/hari secara oral. Tikus diinduksi pakan tinggi lemak (pakan standar : tallow : sukrosa : mentega, 50%:20%:20%:10%) selama 28 hari dan diinduksi nikotinamid (110mg/kgBB) dengan streptozotocin dosis rendah (40mg/kgBB) dua kali injeksi secara intraperitoneal. Kemudian diberikan baik dengan ekstrak kulit batang pulosari dan metformin selama 21 hari. Dosis 300mg/kg dan dosis 600mg/kg ekstrak pulosari melalui uji Anova memberikan perbedaan bermakna pada kadar glukosa darah setelah 21 hari (p<0,05). Ekstrak kulit batang pulosari memiliki potensi yang sama dengan metformin untuk menurunkan kadar glukosa, kolesterol, trigliserida, LDL dan meningkatkan kadar HDL. Berdasarkan hasil penelitian, ekstrak kulit batang pulosari dapat menurunkan dan memperbaiki profil lipid hewan model.

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Alyxia reinwardtii as known as Pulosari is used traditionally for the treatment of diabetes and some other diseases, the main constituent is Pulosarioside and Scopolentin. The aimed of this study to investigate the antidiabetic effects of extract etanol from bark Alyxia reinwardtii in diabetic rats induced by combination of high-fat diet, streptozotocin, and nicotinamide. To this end, we used 24 Wistar male rats. The rats were divided into six groups (n=4). The normal and negative groups were given 0,5% CMC, positive group was given Metformin dose 90mg/200g/day orally; and three variation dose groups of extract pulosari 150 mg/kg BW rats/day orally; 300 mg/kg BW rats/day orally; 600 mg/kg BW rats/day respectively.

All the treatment rats were induced by the combination of high-fat diet (standard feed: tallow: sucrose: butter, 50%:20%:20%:10%) for 28 days and received nicotinamide (110mg/kg BW) with Low dose STZ (40mg/kg BW) twice by intraperitoneal injection. Then treated with extract pulosari either metformin for 21 days. Doses 300mg/kg BW and 600 mg/kg of extract pulosari after 21 days significantly reduced glucose level (p<0,05). The power of extract pulosari similar to metformin to reduce glucose level, cholesterol level, triglyceride level, LDL level, and increase HDL level. Based on this result, pulosari extract have potency as antidiabetic and improve lipid profiles of animal model."

"Latar belakang: Diabetes Melitus hingga saat ini masih menjadi masalah global, termasuk di Indonesia. DM mampu menyebabkan komplikasi mikrovaskular dan makrovaskular, yang salah satunya adalah diabetik nefropati. Berbagai faktor dapat mempengaruhi perkembangan penyakit dari diabetes melitus menjadi diabetik nefropati, salah satunya adalah lingkungan tempat tinggal. Masyarakat yang tinggal di kampung kota memiliki keterbatasan untuk mengakses fasilitas kesehatan serta memiliki kesadaran yang rendah atas akibat dari penyakit kronis. Diduga, terdapat peningkatan risiko hiperglikemia yang berhubungan dengan diabetik nefropati. Oleh karena itu, kami melakukan studi yang bertujuan untuk mempelajari hubungan antara hiperglikemia dan penanda fungsi ginjal pada subjek dewasa yang tinggal di Kampung Kota Jakarta-Tangerang.Metode: Studi ini menggunakan data sekunder dengan desain cross-sectional pada subjek di atas umur 30 tahun di 4 wilayah Kampung Kota Jakarta-Tangerang tahun 2019-2020. Lalu, subjek disesuaikan dengan kriteria inklusi dan eksklusi untuk selanjutnya dinilai kadar gula darah menggunakan gula darah puasa (GDP) dan HbA1c, serta penanda fungsi ginjal dengan eGFR (estimated glomerular filtration rate).Hasil: Dari 220 subjek dewasa, 15 subjek (6,8%) berdasarkan gula darah puasa (GDP≥126 mg/dL) dan 26 subjek (11,8%) berdasarkan HbA1c (HbA1c ≥6,5%) digolongkan sebagai hiperglikemia. Sebanyak 12 subjek (5,5%) mengalami penurunan fungsi ginjal. Hasil uji statistik menjelaskan adanya hubungan bermakna antara GDP dan eGFR (p =0,005, OR= 8,955 , 95% CI=2,333 – 34,372). Namun, tidak terdapat hubungan bermakna antara HbA1c dan eGFR (p=0,156, OR=0, 156, 95% CI=0,677 – 10,621).Kesimpulan: Terdapat hubungan yang bermakna antara hiperglikemia yang ditentukan berdasarkan kadar glukosa darah puasa, tetapi tidak pada HbA1c, dengan penanda fungsi ginjal pada subjek dewasa yang tinggal di kawasan kampung kota.

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Introduction: Diabetes Mellitus is still a global problem, including in Indonesia. DM can cause microvascular and macrovascular complications, one of which is diabetic nephropathy. Various factors can affect the development of the disease from diabetes mellitus to diabetic nephropathy, one of which is the living environment. People living in urban kampung have limited access to health facilities and have low awareness of the consequences of chronic diseases. Presumably, there is an increased risk of hyperglycaemia associated with diabetic nephropathy. Therefore, we conducted a study aimed at studying the association between hyperglycaemia and markers of renal function in adult subjects living in Urban Kampung Jakarta-Tangerang.

Method: This study used secondary data with a cross-sectional design on subjects over the age of 30 years in the urban kampung area of Jakarta and Tangerang in 2019-2020. Then, subjects were selected using predetermined inclusion and exclusion criteria. Eligible subjects were further assessed for blood sugar levels using fasting blood sugar (FPG) and HbA1c, as well as kidney function markers eGFR (estimated glomerular filtration rate).

Result: : From 220 subjects whose data were obtained, 15 subjects (6.8%) based on fasting blood sugar (GDP≥126 mg/dL) and 26 subjects (11.8%) based on HbA1c (HbA1c ≥6.5%) were classified as hyperglycaemia. A total of 12 subjects (5.5%) had decreased kidney function. The results of the statistical test explained that there was a significant association between FPG and eGFR (p = 0.005, OR = 8.955, 95% CI = 2.333 – 34.372). However, there was no significant association between HbA1c and eGFR (p=0.156, OR=0.156, 95% CI=0.677 – 10.621)."

"Patogenesis nefropati diabetik (ND) merupakan hasil interaksi faktor hemodinamik, metabolik dan lingkungan serta faktor genetik. ND biasanya tidak terdeteksi secara klinis sampai terjadi kerusakan ginjal yang bermakna dapat berupa glomerulosklerosis, tubular atrofi dan fibrosis interstitial. KIM-1 dapat digunakan sebagai penanda adanya kerusakan tubulus ginjal. Hubungan polimorfisme gen ACE dengan nefropati diabetes masih tidak konsisten. Penelitian ini merupakan studi cross sectional komparasi antara dua kelompok penyandang DMT2 dengan atau tanpa nefropati yang bertujuan untuk mengetahui adanya kerusakan tubulus, polimorfisme gen ACE dan menganalisis hubungannya dengan kadar KIM-1 terhadap terjadinya kelainan tubulus. Didapatkan adanya peningkatan ekskresi KIM-1 urin pada 19 subjek pre-nefropati dengan median 1,3 (interquartile 1,5) ng/mL, 25 subjek nefropati insipien dengan median 1,6 (interquartile 2,3) ng/mL dan 12 subjek nefropati overt dengan rerata kadar KIM-1 3,1 ± 2,4 ng/mL. Terdapat polimorfisme gen ACE pada penyandang DMT2. Proporsi genotipe DD 9,3%, ID 33,3% dan II 57,4% pada kelompok NND, pada kelompok ND proporsi genotipe DD 4,7%, ID 34,1% dan genotipe II 61,2%. Dijumpai adanya hubungan bermakna antara alel D dengan peningkatan ekskresi KIM-1 urin pada kelompok pre-nefropati (p = 0,030). Peningkatan kadar KIM-1 urin pada kelompok pre-nefropati menunjukkan adanya kerusakan tubulus yang merupakan proses awal nefropati DM. Distribusi genotipe polimorfisme gen ACE pada penelitian ini menyerupai penelitian lain di negara-negara Asia, sedangkan di negara Eropa genotipe DD lebih banyak daripada genotipe II. Hubungan bermakna alel D dengan kadar KIM-1 hanya pada kelompok prenefropati mungkin disebabkan adanya faktor lain seperti kadar glukosa, kontrol glikemik, ureum, kreatinin dan kadar trigliserida yang memengaruhi. Simpulan: Terdapat peningkatan ekskresi KIM-1 urin pada penyandang DMT2 kelompok pre-nefropati yang meningkat secara bermakna pada penyandang DMT2 dengan nefropati overt. Peningkatan ekskresi KIM-1 urin dapat dipakai sebagai penanda kerusakan tubulus. Terdapat polimofisme gen ACE pada penyandang DMT2. Genotipe II lebih banyak dibanding genotipe ID dan DD. Dijumpai adanya hubungan alel D dengan peningkatan kadar KIM-1 urin pada penyandang DMT2 pre-nefropati.

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The pathogenesis of nephropathy diabetic (ND) is the result of the interaction of haemodynamic, metabolic, environment, and genetic factors. In general, ND was clinically undetectable until kidney has been damaged significantly, in the form of glomerulosclerosis, tubular atrophy, or interstitial fibrosis. KIM-1 can be used as the initial indicator of kidney tubules damage. The relationship between ACE gene polymorphism and diabetic nephropathy was still inconsistent.

This research was a comparative cross-sectional study on two groups of DMT2 patients with and without nephropathy diabetic. The objectives of this study were to identify the tubules damage, ACE gene polymorphism, and to analyze the relationship between the degree of KIM-1 and the tubules damage. The increase of KIM-1 urine excretion was found in 19 pre-nephropathy subject (median = 1.3 with interquartile 1.5 ng/mL), in 25 incipient nephropathy subject (median = 1.6 (2.3) ng/mL), in 12 overt nephropathy subject (Mean = 3.1 ± 2,4 ng/mL). ACE polymorphism gene was found in DMT2 patients. In the NDD group, the genotype proportion of DD = 9.3%, ID = 33.3% and II = 57.4%. Whereas, in the ND group, the figures were 4.7%, 34.1% and 61.2%, respectively.

Significant relationship was found between allele D and the increase of KIM-1 urine on pre-nephropathy group (p = 0.030). The increase of KIM-1 urine on prenephropathy group shows the tubules damage which is the initial process of nephropathy diabetic. The genotype distribution of ACE gene polymorphism in this study was similar with the studies in Asian countries; however, in European countries the genotype DD is found higher than genotype II. The significant relationship between allele D and KIM-1 level in pre-nephropathy group might be the influence of other factors, such as glucose level, glycaemic control, urea, creatinine, and triglyceride level.

Conclusion: There was KIM-1 excretion increased on DMT2 pre-nephropathy group, which increase significantly in DMT2 overt nephropathy group. The increase of KIM-1 urine excretion can be used as the indicator of tubules damage. ACE gene polymorphism was found in DMT2 group, with genotype II was higher than genotype ID and DD. A significant relationship between allele D and the increase of KIM-1 urine excretion was found in pre-nephropathy group."

"ABSTRAK Neuropati diabetika ND adalah penyakit sistem saraf yang menyebabkan kematian rasa, rasa tebal, nyeri, dan ketidakmampuan untuk merasakan panas dan dingin. Komplikasi diabetes ini merupakan kelainan progresif dan berkaitan pula dengan menurunnya kualitas hidup penderita. Berbagai pilihan pengobatan seperti medikamentosa dan non medikamentosa digunakan untuk menangani keluhan ini. Namun pengobatan yang ditujukan untuk mengganggu proses-proses patologis telah dibatasi oleh efek samping dan kurangnya efektifitas. Penelitian ini bertujuan untuk mengetahui efek terapi kombinasi laserpunktur dan medikamentosa dibandingkan laserpunktur sham dan medikamentosa pada penderita neuropati diabetika di ekstremitas inferior. Uji acak tersamar ganda dengan kontrol dilakukan pada 32 pasien ND yang dialokasikan kedalam kelompok kasus n=16 dan kelompok kontrol n=16 . Tindakan laserpunktur dilakukan pada titik telinga MA-IC3 endokrin, ST36 Zusanli, ST40 Fenglong, dan SP6 Sanyinjiao bilateral dua kali seminggu selama dua belas kali. Skor VAS, kadar IL6, dan QOL digunakan untuk mengukur keluaran penelitian. Terdapat perbedaan bermakna secara statistik pada perbedaan rerata selisih skor VAS sebelum dan sesudah antara kelompok kasus -4,12 1,204 dan kelompok kontrol -1,37 0,718 dengan nilai p"

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""ABSTRACT" Diabetic neuropathy is a nervous system disease that causes numbness, thick flavor, tenderness, and inability to feel heat and cold. Complications of diabetes is a progressive disorder and also related to the declining quality of life of the patient. Various treatment options like medical treatment and non pharmacological are used to treat this problem, but a treatment that is intended to disrupt the pathological processes have been limited by side effects and lack of effectiveness. This study aims to determine the effect of combination therapy laserpuncture and medical compared with sham laserpuncture and medical in patients with diabetic neuropathy in the lower extremities. A randomized double blind controlled trials with controls carried out on 32 patients with DN, they were allocated into case group n 16 and control group n 16 . Laserpuncture action performed at bilateral the ear point MA IC3 endokrin, ST36 Zusanli, ST40 Fenglong, and SP6 Sanyinjiao twice a week for twelve times. VAS score, IL6 levels, and QOL are used to measure the output of the study. There are statistically significant in the mean difference of VAS score before and after treatment between case group 4.12 1.204 and control group 1.37 .718 with a p value "