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Abstrak :
Latar belakang: Hipertensi dan prediabetes adalah komponen mayor sindroma metabolik dan juga faktor risiko penyakit kardiovaskular. Variabilitas tekanan darah menjadi salah satu faktor untuk penyakit kardiovaskular, beberapa data menunjukan peningkatan variabilitas tekanan darah berhubungan dengan meningkatnya kejadian stroke, penyakit jantung koroner, dan semua penyebab kematian. Variabilitas tekanan darah pada populasi prediabetes memiliki variabilitas yang lebih tinggi dibandingkan populasi normal. Tujuan: Mengetahui efek pemberian metformin pada lisinopril selain sebagai obat oral antidiabetes memiliki efek antihipertensi dan pengaruh terhadap variabilitas tekanan darah pada populasi hipertensi dan prediabetes. Metode: Penelitian ini merupakan uji klinis acak yang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) pada karyawan yang hipertensi dengan prediabetes. Dibagi 2 kelompok yang mendapat Lisinopril 5 mg (terbuka) dan Metformin 2 x 500 mg (tersamar) atau plasebo selama 8 minggu. Dilakukan pemeriksaaan Home Blood Pressure Monitoring (HBPM) sebelum dan setelah terapi diberikan. Hasil: Total terdapat 64 pasien menyelesaikan penelitian (31 kelompok plasebo, 33 kelompok metformin). Setelah 8 minggu follow up, variabilitas tekanan darah kelompok metformin memiliki variabilitas tekanan darah yang lebih rendah (3,8 ± 2,2 mmHg, p 0,03) dibandingkan kelompok plasebo. Perubahan rerata mean tekanan darah sistolik dan diastolik pagi kelompok metformin mengalami penurunan signifikan (p < 0,05 ) Kesimpulan: Penambahan metformin pada Subyek hipertensi dengan prediabetes yang mendapat lisinopril mengalami penurunan variabilitas tekanan darah pagi dan rerata tekanan darah pagi yang bermakna secara statistik. ......Background: Hypertension and prediabetes are major components of metabolic syndrome and also risk factors for cardiovascular disease. Variability of blood pressure is one factor for cardiovascular disease, some data show an increase in blood pressure variability associated with increased incidence of stroke, coronary heart disease, and all causes of death. Blood pressure variability in the prediabetes population has a higher variability than the normal population. Objective: To determine the effect of adding metformin to lisinopril as well as an oral antidiabetic drug that has antihypertensive effects and influence on blood pressure variability in the hypertensive population and prediabetes. Method: This study was a randomized clinical trial conducted at National Cardiac Center Harapan Kita Hospital (NCCHK) in hypertensive employees with prediabetes. Divided into 2 groups that received Lisinopril 5 mg (open) and Metformin 2x500 mg (disguised) or placebo for 8 weeks. Examination of Home Blood Pressure Monitoring (HBPM) is carried out before and after therapy is given. Results: A total of 64 patients completed the study (31 placebo groups, 33 metformin groups). After 8 weeks of follow-up, the blood pressure variability of the metformin group had lower blood pressure variability (3.8±2.2 mmHg, p=0.03) than in the placebo group. The mean change in mean systolic and diastolic blood pressure in the metformin group decreased significantly (p<0.05) Conclusion: Addition of metformin to hypertensive subjects with prediabetes who received lisinopril decreased morning blood pressure variability and morning mean blood pressure which was statistically significant.

Abstrak :
Prediabetes merupakan keadaan berisiko tinggi untuk perkembangan diabetes melitus tipe 2 yang ditandai dengan hiperglikemia. Fasting-Mimicking Diet (FMD) baru-baru ini telah ditemukan sebagai alternatif pendekatan terapi untuk hiperglikemia, tetapi FMD menggunakan bahan-bahan yang tersedia di Indonesia belum diteliti. Penelitian ini bertujuan untuk mengevaluasi pengaruh FMD terhadap glukosa darah puasa (GDP), berat badan (BB), dan kadar kolesterol total pada 16 tikus jantan galur Sprague-Dawley. Tikus model hiperglikemia diinduksi dengan high-fat diet (HFD) selama 4 minggu dan streptozotosin dosis rendah (35 mg/kg) 2 tahap. Sedangkan, kelompok kontrol diberikan pakan normal diet (ND). Kelompok HFD (n=4) diberikan perlakuan secara oral sehari sekali dengan 0,5% CMC, metformin (250 mg/kg), setiap siklus FMD diberikan 4 hari FMD dan ND selama 10 hari. GDP, BB, dan kadar kolesterol total diamati selama 4 minggu. Setelah itu, tikus dikorbankan pada 10 minggu. Hasil penelitian menunjukkan pemberian FMD tidak secara signifikan menurunkan GDP pra-perlakuan dan setelah perlakuan (p=0,055), tetapi mengalami trend penurunan. Data menunjukkan pemberian FMD tidak memberikan perbedaan bermakna terhadap BB dan cenderung menurunkan kadar kolesterol total sehingga nilainya mirip kelompok ND. Sebagai kesimpulan, pemberian FMD menggunakan bahan-bahan yang tersedia di Indonesia menyebabkan tren penurunan terhadap GDP, cenderung menurunkan kadar kolesterol total, tetapi tidak menurunkan BB secara signifikan. ......Prediabetes is high-risk state for the development of type 2 diabetes mellitus, and it is characterized by hyperglycemia. Fasting-mimicking diet (FMD) has recently been found to be an alternative treatment of hyperglycemia, however FMD with Indonesian ingredients haven’t been studied. This study aimed to evaluate effect of FMD on fasting blood glucose (FBG), body weight (BW) and total cholesterol (TC) in 16 male Sprague-Dawley rats. The hyperglycemic model was induced by 4 weeks of high-fat diet (HFD) and multiple low doses of streptozotocin (35 mg/kg). Meanwhile, normal rats fed a normal diet (ND). HFD group (n=4) were assigned to one-daily oral treatment with 0,5% CMC, metformin (250 mg/kg), and each FMD cycle entails 4-day FMD and 10 days of refeeding ND. FBG, BW and TC were monitored in 4 weeks. Rats were sacrificed at 10 weeks. Results showed that GDP didn’t decrease significantly before and after FMD treatment (p=0,055) but showed a downward trend. Data showed that FMD not significantly difference in BW and decrease in TC, so the value was similar to the ND group. In conclusion, FMD treatment with available materials in Indonesia resulted in downward trend in FBG, tended to lower TC but not significantly lower BW.

Abstrak :
Prediabetes adalah toleransi glukosa terganggu, kadar glukosa darah puasa berkisar dari 100- 125 mg/dl dan kadar glukosa darah 2 jam pasca pembebanan 75 gr berkisar 140-199 mg/dl. Skrining pada prediabetes diperlukan dapat rangka pengobatan dini serta pencegahan komplikasi. Peningkatan lingkar perut meningkatkan risiko mengalami kondisi prediabetes Penelitian ini bertujuan menganalisis pengaruh obesitas sentral terhadap kejadian prediabetes. Pendekatan studi menggunakan desain kohort retrospektif. Diagnosis obesitas sentral menggunakan ukuran lingkar perut pria: ³ 90 cm wanita: ³ 80 cm sedangan diagnosis prediabetes menggunakan kadar gula darah pasca pembebanan 75 gr: 140-199 mg/dL dengan data studi kohor faktor risiko PTM yang dikelola oleh Balitbangkes Kemenkes RI di Kecamatan Bogor Tengah dalam enam tahun pemantauan. Hasil penelitian ini menunjukkan bahwa iniden kumulatif : 31,4% dan insiden rate: 49 per 1000 orang/tahun. Analisis bivariat menunjukkan terdapat pengaruh yang bermakna secara statistik antara obesitas sentral dengan kejadian prediabetes dengan HR: 1,67 (95% CI: 1,42 -1,97) dengan p-value = < 0,00. Pengaruh yang bermakna secara statistik antara obesitas sentral terhadap kejadian prediabetes dengan nilai 1,7 (95% CI 1,1-2,4) p-value = < 0,001 setelah dikontrol oleh variabel counfounder yaitu IMT dan adanya interaksi dengan variabel trigliserida dan status perkawinan. Trigliserida dan status perkawinan memberikan pengaruh pada obesitas sentral terhadap kejadian prediabetes. Trigliserida pada kategori kadar trigliserida tinggi nilai HR 1,7 (1,1-2,4). Status perkawinan pada kategori tidak menikah/janda/duda berkontribusi dalam meningkatkan risiko prediabetes untuk responden yang memiliki obesitas sentral dengan nilai HR 1,8 (95% CI: 1,2-2,9). Rekomendasi pencegahan prediabetes dilakukan dengan pemeriksaan trigliserida pada obesitas sentral supaya prognosis tidak jelek dan mudah diintervensi untuk dapat kembali ke keadaan normal. ......Prediabetes is defined by a reduced ability to process glucose, with fasting blood glucose levels between 100-125 mg/dl and 2-hour post-load blood glucose levels of 140-199 mg/dl following the consumption of 75 grams of glucose. Early detection and treatment of prediabetes through screening is crucial in order to avert problems. An increase in waist circumference increases the risk of developing prediabetes. The study revealed that an increase in waist circumference is directly linked to a greater likelihood of developing prediabetes. The objective of this study is to examine the impact of central adiposity on an individual's ability to resist the development of prediabetes. The study employed a retrospective cohort design. The diagnosis of central obesity was established based on waist circumference measurements, with a threshold of ≥ 90 cm for men and ≥ 80 cm for women. Prediabetes was diagnosed by analyzing post-load blood glucose levels (ranging from 140-199 mg/dL) obtained from the 75-gram glucose load test. These diagnostic criteria were derived from a six-year monitoring of a cohort study on non-communicable disease risk factors, which the Health Research and Development Agency conducted under the Ministry of Health of the Republic of Indonesia in Central Bogor District. The results of this study show a cumulative incidence of 31.4% and an incidence rate of 49 per 1000 people/year. Bivariate analysis indicated a statistically significant association between central obesity and the incidence of prediabetes, with an HR of 1.67 (95% CI: 1.42-1.97) and a p-value ≤ 0.00. After controlling for confounding variables such as BMI and interactions with triglyceride levels and marital status, central obesity remained significantly associated with the incidence of prediabetes, with an HR of 1.7 (95% CI: 1.1-2.4) and a p-value ≤ 0.001. Triglyceride levels and marital status influenced the impact of central obesity on the incidence of prediabetes. High triglyceride levels had an HR of 1.7 (1.1-2.4), while being unmarried/widowed/divorced contributed to an increased risk of prediabetes in respondents with central obesity, with an HR of 1.8 (95% CI: 1.2-2.9). The recommendation is that prevention of prediabetes should involve monitoring triglyceride levels in individuals with central obesity to improve prognosis and facilitate interventions aimed at returning to a normal state.