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"ABSTRACTBACKGROUND:proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. METHODS:an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels.RESULTS:a total of 47 patients were enrolled in this study and 32 (68.1%) of them were women. Median vitreous AGEs level was 11.0 (3.0 - 48.0) µg/mL; whereas median vitreous D-dimers level was 5,446.0 (44.0 - 37,394.0 ) ng/mL. The median vitreous AGEs levels was significantly higher in patients with uncontrolled vs. controlled hyperglycemia (14.0 vs. 4.0 mg/mL; p<0.001). There was a significant positive correlation with moderate strength between blood HbA1c level and vitreous AGEs level (r=0.524; r2=0.130; p=0.0001). Blood HbA1c level could be used to predict vitreous AGEs level by using the following calculation: vitreous AGEs = -1.442+ (1.740xblood HbA1c). Vitreous D-dimer levels were not significantly different between uncontrolled and controlled hyperglycemia (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). There was a positive significant correlation between blood HbA1c and vitreous D-dimer levels (r = 0.342; p = 0.019); however the correlation was weak. Vitreous AGEs level had a positive significant correlation with vitreous D-dimer levels (r = 0.292; p = 0.046) and the correlation strength was also weak.CONCLUSION:median vitreous AGEs levels were significantly higher in proliferative DR patients with uncontrolled than those with controlled hyperglycemia. Blood HbA1c level can be used to assess vitreous AGEs level in patients with proliferative DR by using the following calculation: vitreous AGEs = -1.442+(1.740 x HbA1c). However, the blood HbA1c level can not be used to predict vitreous D-dimer level in patients with proliferative DR."

"Diabetes melitus Tipe 2 (DMT2) merupakan suatu kelompok penyakit metabolik dengan komplikasi yang sering terjadi adalah ulkus kaki. Salah satu penyebab terjadinya ulkus kaki adalah keterbatasan lingkup gerak sendi (LGS) pada pasien DMT2 akibat kerusakan jaringan ikat tendon yang dipengaruhi oleh produksi Advanced Glycation End Products (AGE) secara cepat pada kondisi hiperglikemia. AGE merupakan zat yang membentuk suatu ikatan dengan kolagen yang dapat merubah struktur tendon. Produksi yang berlebihan dapat menyebabkan penebalan struktur periartikuler seperti tendon, ligamen, dan kapsul sendi, menyebabkan terjadi penyempitan sehingga menimbulkan kekakuan sendi dan kemudian terjadi keterbatasan LGS. Penelitian ini bertujuan Mengetahui hubungan antara LGS pergelangan kaki dengan derajat ulkus kaki pada pasien DMT2 sebagai salah satu dasar tindakan promotif dan preventif terhadap ulkus kaki diabetik.Penelitian menggunakan studi potong lintang. Kami melaporkan ada 34 sampel (laki-laki 55,9% dan perempuan 44,1%)ulkus kaki pada pasien DMT2 yang memiliki ulkus kaki di regio hindfoot (26,5%), midfoot (5,9%) dan forefoot (67,6%).Pengukuran lingkup gerak sendi pada pergelangan kaki menggunakan goniometri digital untuk gerakan dorsifleksi, plantarfleksi, inver­si dan eversi. Kemudian dihubungkan dengan usia, Indeks Massa Tubuh (IMT), level aktivitas fisik, lama ulkus, lama DM. Terdapat korelasi negatif bermakna signifikan antara lingkup gerak sendi dengan indeks masa tubuh (p=0,019; r=-0,401) dan korelasi positif bermakna signifikan dengan level aktivitas fisik (p=0,004; r=0,484). Semakin meningkat IMT, maka akan menurunkan LGS dan semakin rendah level aktivitas fisik maka akan menurunkan LGS.Tidak terdapat hubungan bermakna signifikan antara LGS dengan usia, lama ulkus dan derajat ulkus. Didapatkan hubungan yang bermakna pada semua gerakan LGS dengan lama DM dengan p-value <0.05. Semua sampel tidak memiliki kejadian yang tidak diinginkan selama penelitian. Kesimpulan dari studi ini adalah tidak ada hubungan antara LGS pergelangan kaki dengan derajat ulkus kaki pada penderita DMT2.

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Type 2 diabetes mellitus (T2DM) is a group of metabolic diseases with the most common complication being foot ulcers. One of the causes of foot ulcers is the limited range of joint motion in T2DM patients due to damage of tendons connective tissue which is affected by the rapid production of Advanced Glycation End Products (AGE) in hyperglycemia conditions. AGE is a substance that forms a bond with collagen that can change the structure of the tendon. Excessive production can cause thickening of periarticular structures such as tendons, ligaments and joint capsules, causing narrowing to occur resulting in joint stiffness and then limiting the range of joint motion. This study aims to determine the relationship between the range of motion of the ankle joint and the degree of foot ulcers in T2DM patients as one of the basic promotive and preventive measures for diabetic foot ulcers. This study is a cross-sectional study. We reported that there were 34 samples (55.9% males and 44.1% females) foot ulcers in T2DM patients who had foot ulcers in the hindfoot (26.5%), midfoot (5.9%) and forefoot (67.6%) regions. Measurement of the range of motion at the ankle using digital goniometry for dorsiflexion, plantarflexion, inversion and eversion. It is related to age, body mass index (BMI), level of physical activity, time of ulcer,time of DM.There was a significant negative correlation between range of motion and body mass index (p=0.019; r=-0.401) and a significant positive correlation with the level of physical activity (p=0.004; r=0.484). The higher of BMI, the range of motion of the joints is lower and the lower level of physical activity, the lower the range of motion of the joints. There was no significant relationship between the range of motion of the joints and age, ulcer duration and degree of ulcer. A significant relationship was found in all range of motion range of motion with duration of DM with p-value <0.05. All samples did not have major adverse events. The conclusion of this study is that there is no relationship between the range of motion of the ankle joint and the degree of foot ulcers in T2DM patients."