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"Aim: The purpose of the study was to investigate the prevalence of diastolic dysfunction in patients with type II diabetes mellitus without overt cardiovascular disease, and to investigate whether its presence is associated with age, sex, onset of diabetes, glycemic control and obesity.Patient and methods: We studied 30 patients with type 2 diabetes; II were men and 19 were women; their ages ranged from 40 - 65 years; all patients had no evidence of hypertension, coronary artery disease, congestive heart failure, anatomical disease of heart, arrhythmia; and myocardiac ischemia at maximal treadmill exercise test. Diastolic dysfunction was evaluated using Doppler echocardiography.Results: Diastolic dysfunction was found in 22 subjects (73.3%) of whom 21 (70%) had abnormal relaxation and one (3.3%) had a pseudonormal pattern of ventricular filling. Systolic function was normal in all subjects, and there was no correlation between diastolic dysfunction and age, sex, onset of diabetes, glycemic control and obesity.Conclusion: Diastolic dysfunction is much more common than previously reported. The high prevalence of this phenomenon population suggests the importance of screening for diastolic dysfunction among such high-risk patients."

"Pada 28 kasus diabetes melitus ( DM ) tipe 2 tanpa kelainan kardiovaskular yang diperiksa di Bagian Metabolik Endokrin, Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Jakarta, mulai Oktober 2001 sampai Desember 2001, dilakukan pemeriksaan ekokardiografi untuk melihat fungsi diastolik ventrikel kiri dan dilakukan pemeriksaan urin mikroalbuminuria. Disfungsi diastolik ditemukan pada 73,7 % pasien DM tipe 2 tanpa mikroalbuminuria dan 66,7% pada DM tipe 2 dengan mikroalbuminuria. Tidak terdapat hubungan bermakna kejadian disfungsi diastolik pada kelompok DM tipe 2 dengan mikroalbuminuria maupun DM tipe 2 tanpa mikroalbuminuria. (Med J Indones 2005; 14: 169-72)

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Twenty-eight cases of type 2 diabetes mellitus (DM) without any cardiovascular disease were recruited from the Department of Metabolic-Endocrine, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta. Recruitment of the study began in October 2001 and was completed by December 2001. Participants were examined for echocardiography and microalbuminuria urinary examination. Diastolic dysfunction was found in 73.7% of type 2 diabetic patients without microalbuminuria and 66.7% in type 2 diabetic patients with microalbuminuria. Neither type 2 diabetic groups with nor without microalbuminuria indicated any significant association to the occurrence of diastolic dysfunction. (Med J Indones 2005; 14: 169-72)"

"Disfungsi otonom kardiovaskular (DOK) merupakan komplikasi diabetes melitus tipe 1 (DMT1) yang menjadi penyebab kematian tersering pada dewasa. Gejala subklinis dapat berawal sejak remaja tetapi deteksi dini melalui pemeriksaan fungsi otonom kardiovaskular belum rutin dilakukan. Studi terdahulu menunjukkan bahwa kontrol glikemik dan lama sakit berpengaruh terhadap progresivitas DOK. Data di Indonesia mengenai masalah ini belum ada. Penelitian ini bertujuan untuk mengetahui prevalens DOK pada pasien DMT1 anak dan menilai hubungan DOK dengan rerata lama sakit dan kadar HbA1C. Tiga puluh delapan anak berusia 10-18 tahun dengan DMT1 yang terdiagnosis lebih dari 5 tahun menjalani 3 pemeriksaan uji refleks kardiovaskular (URK) di Poliklinik Endokrinologi Anak RSCM Kiara. Disfungsi otonom kardiovaskular dengan 1 nilai abnormal URK ditemukan pada 36,8% anak. Tidak ditemukan korelasi bermakna antara DOK dengan rerata lama sakit dan kadar HbA1C. Berdasarkan penelitian ini, prevalens DOK pada remaja cukup tinggi sehingga deteksi dini sebaiknya dilakukan secara rutin. Penelitian lanjutan dengan rentang sakit yang lebih panjang dan data HbA1C serial perlu dilakukan untuk mengevaluasi peran kontrol glikemik dan lama sakit terhadap kejadian DOK.

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Cardiovascular autonomic dysfunction (CAD) is a type 1 diabetes mellitus (T1DM) complication which becomes the most common cause of death in adults. Subclinical symptoms may have occurred since adolescence, yet early detection using cardiovascular autonomic function examination has not been performed routinely. Previous studies showed that glycemic control and duration of illness affected CAD progressivity. However, there is still no data regarding this issue in Indonesia. This study aimed to determine the prevalence of CAD in pediatric T1DM patients and the correlation between CAD and average length of illness, as well as HbA1C levels. Thirty-eight children aged 10-18 years who had been diagnosed with T1DM for more than 5 years underwent a series of three cardiovascular reflex test (CRT) at the Pediatric Endocrinology Polyclinic RSCM Kiara. Cardiovascular autonomic dysfunction which was defined by one abnormal CRT value was found in 36.8% children. No significant correlation was found between CAD and the average length of illness and HbA1C levels. Based on the study, CAD prevalence in adolescents is substantially high, which emphasize the need of routine early detection. Further research with a longer duration of illness and serial HbA1C data need to be carried out to evaluate the role of glycemic control and illness duration in CAD occurrence."

"The prevalence of coronary heart disease in the adult population with diabetes mellitus (DM) is far greater (55%) than in the general public (2-4%). There is an acknowledged correlation between type I hidden ischemia and the incidence of myocardiac infarct. There needs to be a way to determine the presence or absence of ischemia. An alternative examination method is the Dobutamine Stress Echocardiography (DSE).This study was conducted at the Metabolic-Endocrine and the Cardiology Out-Patient Clinics of the Department of Internal Medicine ofCipto Mangunkusumo Central Public General Hospital, Jakarta, from February to August 2001.The aim of the study is to detect undetected myocardiac ischemia using the electrocardiography among patients with type 2 diabetes mellitus and podiatric abnormality and testing the correlation between certain factors (sex, age, body mass index, lipid profile, fasting blood glucose, post prandial blood glucose, HbAlc, peripheral vascular disease, smoking, retinopathy, and neuropathy) with myocardiac ischemia.Methodology: The study was designed as a comparative study of the incidence of myocardiac ischemia between type 2 diabetes mellitus patients with and without podiatric abnormalities. The sample consisted of 28 patients. Samples underwent the dobutamine stress echocardiographyResults: dobutamine stress echocardiography examination using Apogee on 14 patients with type 2 diabetes mellitus with podiatric abnormality demonstrated a positive ischemic response in 4 people (28.6%). No positive findings were found in type 2 diabetes mellitus patients without podiatric abnormality.Conclusion: 1. DSE could detect myocardiac ischemia in 28.6% of type 2 diabetes mellitus undetected with electrocardiography. 2. Other factors that influenced a positive dobutamine stress echocardiography were autonomic neuropathy, diabetic retinopathy, the duration of diabetes mellitus, fasting blood glucose, and podiatric abnormality."

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Penyakit komorbid Diabetes Melitus (DM) yang umum dan paling sering adalah hipertensi. DM dan hipertensi terdapat secara bersamaan pada 40%-60% penderita DM tipe 2. Tujuan penelitian ini adalah untuk mengetahui unmodifiable factors dan modifiable factors pada penderita DM tipe 2 sebagai faktor risiko hipertensi. Desain penelitian ini adalah cross sectional. Sampel penelitian adalah pasien DM tipe 2 yang berobat di poli penyakit dalam RSUD dr. Chasbullah Abdulmadjid Kota Bekasi pada tanggal 30 September-19 Oktober 2019 dengan total sampel sebanyak 292 responden. Unmodifiable factors meliputi gender, umur, pendidikan, status perkawinan, lama menderita DM, hereditas DM, hereditas hipertensi dan golongan darah. Sedangkan modifiable factors terdiri dari indeks massa tubuh, pekerjaan, aktifitas fisik dan merokok. Hipertensi adalah keadaan tekanan darah sistolik ≥ 140 mm Hg dan/atau tekanan darah diastolik ≥ 90 mm Hg. Analisis data dengan Cox regression menggunakan Stata versi 15. Persentase hipertensi pada penderita DM tipe 2 adalah 46,57%. Dari analisis multivariat faktor risiko hipertensi yang signifikan untuk unmodifiable factors adalah faktor umur > 50 tahun (Pv= 0,02; PR= 1,93) dan kelompok dengan hereditas DM yang berasal dari kakek/nenek (Pv= 0,04; PR= 1,86) dan orang tua (Pv= 0,04; PR= 1,54). Sedangkan dari modifiable factors, Indeks Massa Tubuh berat badan lebih (Pv= 0,01; PR=1,81) dan obesitas (Pv=0,02; PR=1,81), merupakan faktor risiko hipertensi yang signifikan. Disarankan agar terhadap pasien DM tipe 2 terutama bila disertai dengan berat badan berlebih atupun obesitas perlu diberikan informasi lengkap tentang faktor risiko hipertensi.

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The most common Diabetes Mellitus (DM) comorbid disease is hypertension. DM and hypertension are present simultaneously in 40% -60% of people with type 2 diabetes. The purpose of this study is to know unmodifiable factors and modifiable factors of type 2 DM patients as risk factors for hypertension, The design of this study was cross sectional. The sample of study was type 2 DM patients those seeking treatment at Department of Internal Medicine-dr Chasbullah Abdulmadjid Hospital-Bekasi on September 30-October 19, 2019 with a total of 292 respondents. Unmodifiable factors include gender, age, education, marital status, duration of DM, heredity of DM, heredity of hypertension and ABO blood group. While modifiable factors consist of body mass index, occupation, physical activity and smoking. Hypertension is a state of systolic blood pressure ≥140 mm Hg and /or diastolic blood pressure ≥90 mm Hg, Data were analysed with Cox regression using Stata versi 15.The precentage of hypertension in patients with type 2 DM was 46.57%. Multivariate analysis revealed that the significant hypertension risk factors for unmodifiable factors are age > 50 years (Pv= 0,02; PR= 1,93) and DM heredity from grandfather/grandmother (Pv= 0,04; PR= 1,86) and parents (Pv= 0,04; PR= 1,54). While from modifiable factors, Body Mass Index overweight (Pv= 0,01; PR=1,81) and obesity (Pv=0,02; PR=1,81) were the significant risk factors for hypertension. It is recommended that patients of type 2 diabetes especially when accompanied by overweight or obesity need to be given complete information about risk factors for hypertension

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"Diabetes mellitus is a serious longstanding disease, which will cause chronic complications in several target organs throughout the body if left untreated. Subsequently, death might ensue. Prevention againts the occurrence of such a grave outcome should be done in the first priority at all levels of health authority. Several large-scale epidemiological studies (Diabetes Complication Control Trial = DCCT in Type 1 DM and United Kingdom Prospective Diabetes Survey = UKPDS in Type 2 DM) have given proof that chronic complications of diabetes could be prevented through an effort to keep blood glucose within desirable optima) levels. In UKPDS, the incidence of retinopathy, neuropathy and nephropathy were significantly lower in the intensively treated group (HbAl c 7.1 %) as compared to the conventionally treated group (HbAlc 7.9%)."

"To determine the differences in mean plasma values of von willebrand factor and platelet agregation in type 2 DM patient with or without peripheral artirial disease...."

"Pendahuluan –Diabetes Mellitus tipe 2 (DMT2) merupakan sindrom inflamasi progresif dengan peningkatan risiko komplikasi kardiovaskular berupa Atherosclerotic Cardiovascular Disease (ASCVD). Proses thromboinflamasi pada DMT2 ASCVD dikaitkan dengan perubahan pada jumlah serta fungsi leukosit dan trombosit. Rasio leukosit (Neutrophil-Lymphocyte Ratio, Monocyte-Lymphocyte Ratio, Platelet-Lymphocyte Ratio) serta penanda biologis dari netrofil (Peptydil Arginine Deiminase-4), monosit/makrofag (Interleukin-6), dan trombosit (Platelet Glycoprotein 1b-α) dikenali sebagai penanda biologis yang dapat memprediksi perubahan plak stabil dan tidak stabil pada pasien DMT2 ASCVD. Studi ini dilakukan untuk menganalisis hubungan antara klasifikasi pasien DMT2 2 risiko sangat tinggi (Very High Risk / VHR) dan risiko tinggi (High Risk / HR) dan pada pasien DMT2 dengan Acute Coronary Syndrome (ACS) terhadap parameter inflamasi NLR, MLR, PLR, GPIbα, PAD4, dan IL-6. Metodologi – 75 pasien DMT2 ACSVD yang menjalani pengobatan di rawat jalan dan unit gawat darurat Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita dilibatkan dalam studi ini. Pasien dikategorikan sebagai DMT2 risiko tinggi, DMT2 risiko sangat tinggi, dan DMT2 ACS. Parameter metabolisme dan inflamasi diukur dan dianalisis pada ketiga kelompok DMT2 ASCVD tersebut. Hasil dan Diskusi – Nilai parameter metabolisme kolesterol total dan Low Density Lipoprotein (LDL) serta parameter inflamasi NLR, MLR, PLR, dan IL-6 ditemukan lebih tinggi dan signifikan pada kelompok DMT2 ACS. Nilai Gp1bα ektodomain (Glikokalisin) ditemukan lebih tinggi pada kelompok DMT2 risiko tinggi dan DMT2 risiko sangat tinggi menggambarkan hubungan Gp1bα dan ADAM17 yang terkait dengan keseimbangan pembentukan dan pembersihan trombosit. Nilai PAD4 yang lebih tinggi pada kelompok DMT2 risiko tinggi dan DMT2 risiko sangat tinggi menggambarkan proses perbaikan jaringan dan induksi polarisasi makrofag menjadi fenotip antiinflamasi yang berperan terhadap perbaikan fungsi kardiovaskular. Penelitian ini menunjukkan bahwa nilai NLR dan kolesterol total yang tinggi serta nilai PAD4 yang rendah merupakan prediktor terjadinya keadaan ACS (plak tidak stabil) pada pasien DMT2 ASCVD.

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Introduction – Diabetes Mellitus type 2 (T2DM) is a progressive inflammatory syndrome with an increased risk of cardiovascular complications in the form of Atherosclerotic Cardiovascular Disease (ASCVD). The thromboinflammatory process in T2DM ASCVD is associated with changes in the number and function of leukocytes and platelets. The leukocyte ratio (Neutrophil-Lymphocyte Ratio, Monocyte-Lymphocyte Ratio, Platelet-Lymphocyte Ratio) as well as biological markers of neutrophils (Peptydyl Arginine Deiminase-4), monocytes/macrophages (Interleukin-6), and platelets (Platelet Glycoprotein 1b-α) are recognized as a biological marker that can predict stable and unstable plaque changes in T2DM with ASCVD. This study was conducted to analyze the relationship between the classification of T2DM patients with very high risk (VHR), high risk (HR), and early onset ACS on the inflammatory parameters NLR, MLR, PLR, GPIbα, PAD4, and IL-6.

Methodology – This study included 75 ACSVD T2DM patients being treated at Harapan Kita Heart and Blood Vessel Center Hospital's outpatien and emergency unit. Patients were classified as having high risk T2DM, extremely high risk T2DM, or ACS T2DM. In the three T2DM ASCVD groups, metabolic and inflammatory parameters were evaluated and studied.

Results and Discussion – The metabolic indices total cholesterol and Low Density Lipoprotein (LDL), as well as the inflammatory markers NLR, MLR, PLR, and IL-6, were shown to be greater and significant in the T2DM ACS group. Gp1b ectodomain (Glycocalysin) values were found to be greater in the high risk T2DM and very high risk T2DM groups, demonstrating the relationship between Gp1b and ADAM17, which is associated to platelet production and clearance balance. Higher PAD4 values in the high risk T2DM and very high risk T2DM groups represent tissue repair and the activation of macrophage polarization into an anti-inflammatory phenotype, which contributes to improved cardiovascular function. According to this study, high NLR and total cholesterol levels, as well as low PAD4 levels, are predictors of ACS (unstable plaque) in ASCVD T2DM patients."