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"Up to this moment, there urn various oral anti-hypergly-cemic (OAH) known, such ax the insulin secretagogue group of drugs, which in essence aims to increase insulin secretion by (J pancreatic culls, and the group of drags thai increases tissue sensitivity to insulin. Administration of a single drug from one of these two groups will eventually fail to achieve euglycemic control level. Instead, a combination of two kinds of OAH with different mechanism of action has been proven to significantly achieve glycemic control compared to administration of a .single agent. In addition to reducing side effects, administration of a combination nj two kinds of OAH can also postpone, the need for insulin, which is generally disliked by patients. Sulphonilurea and metformin art; among the most common drugs to be combined, but other combinations could also produce the same satisfactory effect. Combination of sulphonilurea and troghiatone does not produce expected euglycemic effect, even though ii can reduce the Hh Ah-level.Administration of 3 types of OAH is not advisable, since generally, a combination of 2 kinds oj drugs at maximum dose could no longer achieve glycemic control, even with the addition of another OAH. In addition to more side effects and higher cost, such treatment is not practical, and insulin secretion bv beta cells generally can no longer be increased Patients that fail lo demonstrate satisfactory results with a combination of 2 types of 0.4 fix are advised to be treated wilh moderate-acting insulin at night ax an additional treatment, with a dose titered to achieve euglycemic control Patients receiving single treatment that could not achieve euglycemic control may receive combined treatment before reaching the maximum dose, since at maximum dose, there is generally more side-effects."

"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%)."

"ABSTRAKLatar Belakang: Pencapaian target glikemik pada pasien DM tipe2 yang masih rendah khususnya di Indonesia mengakibatkan berbagai komplikasi termasuk gangguan fungsi kognitif.. Padahal untuk menerapkan manajemen mandiri pada pasien DM, dibutuhkan fungsi kognitif yang kompleks. Pada berbagai penyakit kronis, fungsi kognitif khususnya domain memori yang buruk telah dihubungkan dengan ketidakpatuhan penggunaan obat. Meskipun demikian, belum ada studi yang mencari hubungan keduanya pada pasien DM tipe 2.Tujuan: Mengetahui hubungan gangguan fungsi kognitif dengan ketidakpatuhan penggunaan obat pada pasien DM tipe 2Metodologi: Desain studi ini adalah potong lintang terhadap 96 subjek penelitian dengan DM tipe 2 berusia >18 tahun di unit rawat jalan RSUD Tebet. Karakteristik demografi, parameter klinis, penilaian fungsi kognitif, dan kepatuhan penggunaan obat didokumentasikan secara lengkap. Penilaian fungsi kognitif menggunakan Montreal Cognitive Assessment versi Indonesia (MoCA-Ina). Penilaian kepatuhan penggunaan obat dinilai menggunakan penghitungan pil. Studi ini menggunakan analisis distribusi frekuensi dan proporsi, analisis bivariat dengan uji Chi-Square.Hasil: Terdapat 69,8% subjek penelitian dengan gangguan fungsi kognitif dengan faktor tingkat pendidikan sebagai faktor yang mempengaruhi. Analisa mendapatkan kejadian penurunan fungsi domain memori 96,9%;, eksekutif 78%, visuospasial 78%; atensi 30%; bahasa 26%; dan orientasi 4,2%. Ketidakpatuhan penggunaan obat didapatkan pada 26% subjek penelitian. Analisa bivariat tidak menunjukkan adanya hubungan antara gangguan fungsi kognitif dengan ketidakpatuhan penggunaan obat (OR 0,757 95% CI [0,280-2,051] p=0,58).Kesimpulan: Gangguan fungsi kognitif didapatkan pada 69,8% pasien DM tipe 2, dan ketidakpatuhan ditemukan pada 26% pasien. Tidak ada hubungan yang didapatkan antara gangguan fungsi kognitif dengan ketidakpatuhan penggunaan obat pada pasien DM tipe 2

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ABSTRACTBackground: Poor glycemic control in Type 2 Diabetes Mellitus patients, especially in Indonesia, results in a variety of complications including a cognitive impairment. In fact, to implement self-management in DM patients, intact cognitive function is necessary. In a variety of chronic diseases, cognitive impairment, especially the memory domain has been associated with medication nonadherence. Nonetheless, no studies have looked for the relationship between the two in type 2 DM patientsObjective: This study aims to determine the relationship of cognitive impairment with medication nonadherence in type 2 DM patients.Methodology: The design of this study was cross-sectional with 96 study subjects with type 2 DM, > 18 years old in the outpatient unit at RSUD Tebet. Demographic characteristics, clinical parameters, cognitive function assessment, and medication adherence use were fully documented. Cognitive function assessed with the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina). Medication adherence was assessed using pill count. This study uses the analysis of frequency and proportions distribution, and bivariate analysis with the Chi-Square test.Results: There were 69.8% of the research subjects with cognitive impairment with education level as an associated factor. Analysis of the occurrence of impairment of the function of memory domain 96.9%; executive 78%, visuospatial 78%; attention 30%; language 26%; and 4.2% orientation. Oraal medication nonadherence was found in 26% of the study subjects. Bivariate analysis did not show an association between cognitive impairment and medication nonadherence (OR 0.757 95% CI [0.280-2.051] p=0.58).Conclusion: Cognitive impairment was found in 69.8% Type 2 DM patients, and medication nonadherence was found in 26% patients. Cognitive impairment was not associated with medication nonadherence in type 2 DM patients."

"Latar Belakang: Pencapaian target glikemik pada pasien DM tipe2 yang masih rendah khususnya di Indonesia mengakibatkan berbagai komplikasi termasuk gangguan fungsi kognitif.. Padahal untuk menerapkan manajemen mandiri pada pasien DM, dibutuhkan fungsi kognitif yang kompleks. Pada berbagai penyakit kronis, fungsi kognitif khususnya domain memori yang buruk telah dihubungkan dengan ketidakpatuhan penggunaan obat. Meskipun demikian, belum ada studi yang mencari hubungan keduanya pada pasien DM tipe 2.Tujuan: Mengetahui hubungan gangguan fungsi kognitif dengan ketidakpatuhan penggunaan obat pada pasien DM tipe 2Metodologi: Desain studi ini adalah potong lintang terhadap 96 subjek penelitian dengan DM tipe 2 berusia >18 tahun di unit rawat jalan RSUD Tebet. Karakteristik demografi, parameter klinis, penilaian fungsi kognitif, dan kepatuhan penggunaan obat didokumentasikan secara lengkap. Penilaian fungsi kognitif menggunakan Montreal Cognitive Assessment versi Indonesia (MoCA-Ina). Penilaian kepatuhan penggunaan obat dinilai menggunakan penghitungan pil. Studi ini menggunakan analisis distribusi frekuensi dan proporsi, analisis bivariat dengan uji Chi-Square.Hasil: Terdapat 69,8% subjek penelitian dengan gangguan fungsi kognitif dengan faktor tingkat pendidikan sebagai faktor yang mempengaruhi. Analisa mendapatkan kejadian penurunan fungsi domain memori 96,9%;, eksekutif 78%, visuospasial 78%; atensi 30%; bahasa 26%; dan orientasi 4,2%. Ketidakpatuhan penggunaan obat didapatkan pada 26% subjek penelitian. Analisa bivariat tidak menunjukkan adanya hubungan antara gangguan fungsi kognitif dengan ketidakpatuhan penggunaan obat (OR 0,757 95% CI [0,280-2,051] p=0,58).Kesimpulan: Gangguan fungsi kognitif didapatkan pada 69,8% pasien DM tipe 2, dan ketidakpatuhan ditemukan pada 26% pasien. Tidak ada hubungan yang didapatkan antara gangguan fungsi kognitif dengan ketidakpatuhan penggunaan obat pada pasien DM tipe 2

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Background: Poor glycemic control in Type 2 Diabetes Mellitus patients, especially in Indonesia, results in a variety of complications including a cognitive impairment. In fact, to implement self-management in DM patients, intact cognitive function is necessary. In a variety of chronic diseases, cognitive impairment, especially the memory domain has been associated with medication nonadherence. Nonetheless, no studies have looked for the relationship between the two in type 2 DM patients

Objective: This study aims to determine the relationship of cognitive impairment with medication nonadherence in type 2 DM patients.

Methodology: The design of this study was cross-sectional with 96 study subjects with type 2 DM, > 18 years old in the outpatient unit at RSUD Tebet. Demographic characteristics, clinical parameters, cognitive function assessment, and medication adherence use were fully documented. Cognitive function assessed with the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina). Medication adherence was assessed using pill count. This study uses the analysis of frequency and proportions distribution, and bivariate analysis with the Chi-Square test.

Results: There were 69.8% of the research subjects with cognitive impairment with education level as an associated factor. Analysis of the occurrence of impairment of the function of memory domain 96.9%; executive 78%, visuospatial 78%; attention 30%; language 26%; and 4.2% orientation. Oraal medication nonadherence was found in 26% of the study subjects. Bivariate analysis did not show an association between cognitive impairment and medication nonadherence (OR 0.757 95% CI [0.280-2.051] p=0.58).

Conclusion: Cognitive impairment was found in 69.8% Type 2 DM patients, and medication nonadherence was found in 26% patients. Cognitive impairment was not associated with medication nonadherence in type 2 DM patients"

"Sialolithiasis is a common disease of the submandibular glands or its duct but rare in parotids of patients, especially in male adults. The accessory of salivary glands are small, unsheathed masses with a small canaliculi. The irritant factors might be due to inflammation of the inner layer of the canaliculi, that often concomitant to saliva stasis. This process leads to development of calculus that it is related to secretive specificity of the submandibular gland. The essential factor for its calcification is the stagnation of secretory material rich in calcium. The accumulation of this material would cause swelling, further obstruction and atrophy until there is widespread inflammation that has been termed sialadenitis. Diabetes mellitus is one of the medically compromised diseases. Although there are many associations between diabetes mellitus and oral health, lack of investigation in this area has been done to study salivary gland alterations. Many diabetic patient complained xerostomia, a decreasing salivary flow and enlargement if the parotid gland due to a compensatory mechanism to xerostomia that has been termed sialadenosis. This review article summarized that there is no relationship between sialolithiasis and poorly controlled type 2 diabetes mellitus. "

"Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients."

"ABSTRAKMetformin-sulfonilurea dan metformin-akarbose adalah kombinasi terapi yang memiliki mekanisme kerja yang menguntungkan juga diperuntukan dalam pemilihan pengobatan diabetes melitus tipe 2. Review ini bertujuan untuk merangkum perkembangan studi terkini mengenai efektivitas kedua kombinasi obat tersebut. Pencarian literatur artikel penelitian dilakukan secara sistematis dengan melakukan pencarian data melalui Summons Search LIB UI dan didapatkan artikel dari beberapa database yaitu ScienceDirect, ProQuest, Springerlink, dan PubMed. Artikel penelitian yang digunakan dalam review adalah literatur primer yang diterbitkan selama 10 tahun terakhir. Terdapat 6 artikel penelitian yang memenuhi kriteria inklusi. Masing-masing penelitian membahas efek pengobatan dan efektivitas terapi kombinasi dari nilai HbA1c, kejadian hipoglikemia, mean amplitude of glycemic excursions, tingkat stress oksidatif, dan manfaat terapi kombinasi pada risiko kejadian kardiovaskular. Terjadi penurunan nilai HbA1c pada setiap terapi kombinasi dan tidak ada perbedaan nilai yang signifikan pada keduanya, tetapi dari kombinasi metformin-sulfonilurea lebih besar dalam menurunkan nilai HbA1c. Namun, pada terapi kombinasi metformin-akarbose dilaporkan dapat menurunkan nilai dari mean amplitude of glycemic excursions (MAGE), berat badan, dan serum trigliserida, serta terjadi peningkatan serum adiponektin tanpa efek signifikan pada stres oksidatif. Kombinasi metformin-akarbose juga lebih cenderung memiliki manfaat yang lebih baik terutama pada pasien diabetes yang memiliki komplikasi pada kardiovaskular dan tidak meningkatkan risiko terjadinya hipoglikemia.

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ABSTRACT

Metformin-sulfonylurea and metformin-acarbose are combination therapy that has a beneficial mechanism action for treating type 2 DM. This review aims to summarize the recent studies regarding the effectiveness of the two drug combinations. The literature search was carried out through Summons Search LIB UI. The research articles used in the review are the primary literature published over the past 10 years. There were 6 research articles that met the inclusion criteria. Each study discussed the effectiveness of combination therapy from HbA1c values, incidence of hypoglycemia, mean amplitude of glycemic excursions, levels of oxidative stress, and benefits of combination therapy on the risk of cardiovascular events. There was a decrease in the value of HbA1c in each combination therapy and there was no significant difference in the value, but the combination of metformin-sulfonylurea was greater in reducing the HbA1c value. However, metformin-acarbose combination therapy was reported to reduce the mean amplitude of glycemic excursions, body weight, and serum triglycerides, as well as increased the serum adiponectin without a significant effect on oxidative stress. The metformin-acarbose combination is more likely to have a better benefit in diabetic patients who have cardiovascular complications and also not increasing the risk of developing hypoglycemia."