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ABSTRAK
Latar Belakang. Prevalensi disfungsi tiroid lebih tinggi pada pasien diabetes dibandingkan populasi umum. Hipotiroidisme memperburuk komplikasi, morbiditas, mortalitas, dan kualitas hidup pasien diabetes melitus tipe 2 (DM tipe 2). Faktor risiko hipotiroidisme pada pasien DM tipe 2 selama ini masih kontradiktif dan belum dikaji secara lengkap. Keberadaan sistem skor hipotiroidisme pada pasien DM tipe 2 diperlukan untuk membantu diagnosis dan menapis pasien DM tipe 2 yang memerlukan pemeriksaan laboratorium fungsi tiroid sebagai baku emas diagnosis hipotiroidisme. Tujuan. Mengetahui prevalensi dan determinan hipotiroidisme pada pasien DM tipe 2. Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Divisi Metabolik Endokrin (Poliklinik Diabetes) RSCM pada Juli sampai September 2015 dengan metode sampling konsekutif. Subjek menjalani anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium (TSH dan fT4). Analisis data dilakukan dengan program statistik SPSS Statistics 17.0 untuk analisis univariat, bivariat, multivariat, dan Receiving Characteristics Operator (ROC) dan SPSS Statistics 20.0 untuk analisis bootstrapping pada Kalibrasi Hosmer-Lemeshow. Hasil. Sebanyak 303 subjek dianalisis untuk mendapatkan proporsi disfungsi tiroid dan 299 subjek dianalisis untuk mendapatkan determinan hipotiroidisme. Sebanyak 23 subjek (7,59%) terdiagnosis hipotiroidisme, terdiri dari 43,5% subjek hipotiroid klinis dan 56,5% subjek hipotiroid subklinis berdasarkan Indeks Zulewski dan/atau Indeks Billewicz, dengan 16,7% hipotiroid klinis dan 83,3% hipotiroid subklinis berdasarkan hasil pemeriksaan fT4. Determinan hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga dengan OR sebesar 4,719 (95% Interval Kepercayaan/IK 1,07-20,8, p = 0,04), keberadaan goiter dengan OR sebesar 20,679 (95% IK 3,49122,66, p = 0,001), kontrol glikemik yang buruk dengan OR sebesar 3,460 (95% IK 1,075-11,14, p = 0,037), dan adanya sindrom metabolik OR sebesar 25,718 (95% IK 2,21-299,99, p = 0,01). Simpulan. Proporsi hipotiroidisme pada pasien DM tipe 2 adalah 7,59%. Determinan diagnosis dan komponen sistem skor hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga, keberadaan goiter, kontrol glikemik yang buruk, dan adanya sindrom metabolik. Sistem skor yang diberi nama Skor Hipotiroid RSCM ini diharapkan menjadi alat bantu diagnosis hipotiroidisme pada pasien DM tipe 2. ABSTRACT
Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to general population. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type 2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are still contradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism in T2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergo thyroid function test as a gold standard diagnostic for hypothyroidism. Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients. Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient Clinic Cipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. All subjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysis was done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (Receiving Operator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshow Calibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299 subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as having hypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidism based on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinical hypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination. Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719 (95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95% CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and components of scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease, having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which is called RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism in T2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to general population. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type 2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are still contradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism in T2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergo thyroid function test as a gold standard diagnostic for hypothyroidism. Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients. Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient Clinic Cipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. All subjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysis was done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (Receiving Operator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshow Calibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299 subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as having hypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidism based on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinical hypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination. Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719 (95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95% CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and components of scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease, having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which is called RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism in T2DM patients. ;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to general population. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type 2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are still contradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism in T2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergo thyroid function test as a gold standard diagnostic for hypothyroidism. Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients. Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient Clinic Cipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. All subjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysis was done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (Receiving Operator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshow Calibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299 subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as having hypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidism based on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinical hypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination. Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719 (95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95% CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and components of scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease, having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which is called RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism in T2DM patients.

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Latar Belakang: Beberapa penelitian terakhir menunjukkan adanya hubungan antara diabetes melitus tipe 2 (DMT2) dengan kejadian hipotiroid subklinis (HSK). Penelitian lain menunjukkan bahwa pada DMT2 yang disertai HSK, angka kejadian retinopati ternyata lebih tinggi dibanding pada DMT2 yang tanpa disertai HSK. Pasien HSK sendiri diketahui mempunyai risiko tinggi terhadap kejadian dislipidemia. Bagaimana hubungan antara dislipidemia dengan retinopati pada pasien DMT2 dengan HSK, sampai saat ini masih belum diketahui. Tujuan: Mengetahui proporsi HSK pada pasien DMT2, hubungan antara HSK dengan kontrol glukosa darah, HSK dengan dislipidemia, serta hubungan antara dislipidemia dengan kejadian retinopati pada pasien DMT2 dengan HSK. Metode: Desain penelitian yang digunakan adalah potong lintang. Sampel adalah pasien dewasa yang sudah didiagnosis DMT2 minimal 1 tahun, yang berobat ke poliklinik rawat jalan Divisi Metabolik Endokrin RSCM yang memenuhi kriteria inklusi. Data-data yang dikumpulkan adalah kontrol glukosa (HbA1c), profil lipid (kolesterol total, LDL, HDL, trigliserida), TSHs, fT4 dan data retinopati. Data diambil dari rekam medis maupun pemeriksaan laboratorium. Hasil: Proporsi penyakit HSK pada pasien DMT2 sebesar 7.2 % dan sebagian besar berusia di atas 60 tahun. Tidak didapatkan perbedaan proporsi antara lakilaki dan perempuan. Dari analisis didapatkan pasien DMT2 dengan kontrol gula darah yang buruk (HbA1c >7) memiliki risiko 3,664 kali lebih besar mengalami HSK dibanding dengan pasien DMT2 yang gula darahnya terkontrol baik (p:0,010). Pada pasien DMT2 dengan HSK yang disertai dislipidemia, risiko terkena retinopati 2,76 kali lebih besar dibanding pasien tanpa dislipidemia (p:0,014). Simpulan: Terdapat hubungan bermakna antara HSK dengan kontrol gula darah (HbA1c) pada pasien DMT2. Terdapat hubungan antara HSK dan dislipidemia pada pasien DMT2. Terdapat hubungan antara dislipidemia dengan kejadian retinopati pada pasien DMT2 dengan HSK. ...... Background: Some recent studies suggest that there is a link between type 2 diabetes mellitus (T2DM) and the incidence of subclinical hypothyroid (SCH). Other studies have shown that if a T2DM is accompanied SCH, the incidence of retinopathy was higher than in the T2DM without SCH. SCH patients themselves are known to have a high risk of occurrence of dyslipidemia. The the relationship between the incidence of dyslipidemia and retinopathy in patients with T2DM with SCH, is still unknown. Objective: To determine the proportion of SCH in patients with T2DM, the relationship between SCH and glycemic control (HbA1c), SCH with dyslipidemia, and dyslipidemia with the incidence of retinopathy in T2DM patients with SCH. Methods: The study design used is cross sectional. Sample were adult patients who have been diagnosed with T2DM at least 1 year, who went to the outpatient ward of Metabolic Endocrine Division, Cipto Mangunkusumo Hospital. Collected data include glycemic control (HbA1c), lipid profile (total cholesterol, LDL, HDL, triglycerides), TSHs, FT4 and retinopathy data. Data were retrieved from medical records and laboratory tests. Results: The proportion of SCH in patients with T2DM 7.2%, and mostly aged over 60 years. There were no differences in the proportion between men and women. From the analysis reveals the T2DM patients with poor blood sugar control (HbA1c >7) had 3.664 times greater risk of developing SCH compared with T2DM patients with well-controlled blood sugar (p:0.010). In patients with T2DM with SCH accompanied dyslipidemia, retinopathy risk 2.76 times greater than patients without dyslipidemia (p:0.014). Conclusion: There is a significant relationship between the SCH and glycemic control in patients with T2DM, SCH and dyslipidemia and also between dyslipidemia and retinopathy in T2DM patients with HSK.

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Latar Belakang: Pengukuran Indeks Massa Tubuh tunggal tidak cukup menilai atau mengelola risiko kardiometabolik yang terkait peningkatan adipositas pada dewasa. Lingkar Perut direkomendasikan untuk secara rutin dinilai dalam praktik klinis sehari-hari namun angkanya bervariasi antar ras dan etnis. Tujuan : Penelitian ini bermaksud menentukan nilai titik potong optimal untuk prediksi kejadian Diabetes Mellitus Tipe 2 (DMT2) dan penyakit kardiovaskular pada populasi di Indonesia. Metode : Kami menganalisis data sekunder dari studi Kohort Penyakit Tidak Menular Bogor di tahun 2011-2018, terdiri dari 2077 orang dewasa berusia 25-65 tahun. Nilai titik potong baru yang diusulkan untuk Indeks Massa Tubuh (IMT) dan Lingkar Perut (LP) dihitung menggunakan analisis kurva ROC dan Youden indeks. Hasil : Insidensi Kejadian Diabetes Mellitus dan penyakit Kardiovaskular pada follow up subjek di tahun keenam sejak baseline, didapatkan yaitu sebanyak 13,7% dan 8,9%. Nilai titik potong IMT untuk kejadian diabetes melitus tipe 2 atau penyakit kardiovaskular ialah 23 kg/m2 dengan sensitivitas 72,2 % dan spesifisitas 41,8 %. Nilai titik potong lingkar perut (LP) untuk laki-laki 79 cm dengan sensitivitas 60,9% dan spesivisitas 66,4% sedangkan untuk perempuan ialah 77 cm dengan sensitivitas 74,3% dan spesivisitas 40,5%. Kesimpulan : Nilai titik potong yang baru diusulkan yaitu untuk IMT ialah 23 kg/m2 dan LP 79 cm untuk Laki-Laki dan 77 cm untuk perempuan dapat digunakan untuk penyaring risiko DMT2 dan penyakit Kardiovaskular pada penduduk Indonesia. ......A single Body Mass Index (BMI) measurement does not adequately assess or manage the cardiometabolic risk in adults. Waist circumference (WC) is recommended to be routinely assessed in daily clinical practice but might be differ based on different race or ethnicity. This study aims to determine the optimal cut-off point for predicting the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease in Indonesia. We analyzed secondary data from the Bogor Non-Communicable Disease Cohort study in 2011-2018, consisting of 2077 adults aged 25-65 years. The new proposed cut-off values for BMI and WC were calculated using ROC curve analysis. The incidence of T2DM and CV events in the sixth year followup, was found to be 13.7% and 8.9%, respectively. The cut-off point for BMI for the incidence of T2DM or CV disease was 23 kg/m2 (Sn 72.2% and Sp 41.8%). The cut-off point of WC for men is 79 cm (Sn 60.9% and Sp 66.4%), while for women is 77 cm (Sn 74.3% and a Sp 40.5%). As conclusions The newly proposed cut-off value for BMI is 23 kg/m2 and WC 79 cm for men and 77 cm for women can be used to screen for the risk of T2DM and CV disease in Indonesia.

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Latar Belakang: Normal saline adalah cairan yang selama ini digunakan dan terbukti memiliki efek samping yang merugikan yaitu asidosis metabolik hiperkloremik. Balanced Electrolyte Solution (BES) merupakan cairan kristaloid isotonus yang memiliki kandungan lebih menyerupai plasma darah dan memiliki kandungan klorida lebih rendah. Tujuan: Membandingkan rerata SBE pasien ketoasidosis diabetikum (KAD) yang diresusitasi dengan menggunakan normal saline dan balanced electrolyte solution (BES). Metode: Tiga puluh subyek KAD, usia 18-65 tahun, yang sesuai dengan kriteria inklusi dan tidak dieksklusi, secara berturut-turut dimasukan menjadi sampel penelitian. Pembagian kelompok ditentukan secara acak berdasarkan undian. Sampel dikelompokan menjadi dua, yaitu kelompok kontrol (normal saline) dan kelompok perlakuan (BES). Kedua kelompok kecuali dalam hal jenis cairan resusitasi. Pemeriksaan kesadaran, gula darah sewaktu, dan tanda-tanda vital dilakukan setiap jam selama enam jam pertama, dan setiap 12 jam hingga jam ke 48. Pemeriksaan analisa gas darah, laktat dan elektrolit dilakukan setiap dua jam selama enam jam pertama, dan setiap 12 jam hingga jam ke 48. Pemeriksaan keton dilakukan setiap enam jam hingga jam ke 48. Penelitian ini merupakan penelitian eksperimental terbuka consecutive sampling. Hasil: rerata SBE kelompok BES selalu lebih tinggi daripada kelopok NS. Rerata SBE kelompok BES lebih tinggi bermakna daripada rerata SBE kelompok NS pada jam ke 24 dan 48. SID kelompok BES selalu lebih tinggi secara bermakna di setiap jam yang diukur daripada kelompok NS. Kesimpulan: SBE kelompok BES lebih mendekati normal daripada kelompok NS di setiap jam yang diukur. ......Background: Normal saline is the resuscitation solution which is regularly used in diabetic ketoacidosis management. This solution has negative side effect causes hyperchloremic acidosis. Balanced Electrolyte Solution (BES) is isotoniccrystaloid solution, more resembling plasma than normal saline, and it has less chloride than normal saline. Objectives: This study compares the SBE mean in diabetic ketoacidosis, using normal saline and BES. Methods: Thirty diabetic ketoacidosis patients, 18-65 years age, who full filled the inclusion criteria and were not excluded, were consecutively enrolled to this study. Group was determined by tossed. Both groups received the same treatment except the kind of resuscitation fluid. The consciousness, blood sugar, and vital sign were recorded every hour until first six hour and every 12 hour until 48 hour. the blood gas analysis, lactate, and electrolyte were recorded every two hour until six hour, and every 12 hour until 48 hour. Blood ketones ware recorded every six hour until 48 hour. This is an open experimental consecutive study. Result: Mean SBE value in BES group was higher in every record. Mean SBE value in 24th and 48th hour were significantly higher in BES group than in NS group. Conclusion: SBE in BES group were closer to normal limit than in NS group.

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atar Belakang: Balans energi positif pada obesitas ditandai dengan hiperadipositosis dan merangsang proses inflamasi kronik yang berdampak pada komplikasi penyakit pasien obesitas. Salah satu penatalaksaan obesitas adalah pemberian diet restriksi kalori. Diet restriksi kalori diduga menyebabkan penurunan kondisi inflamasi kronik yang salah satunya ditandai dengan kadar c-reactive protein (CRP). Namun demikian, berbagai studi memberikan hasil yang inkonsisten. Tujuan: Menilai efek diet restriksi kalori terhadap perubahan kadar CRP dan menilai pengaruh durasi diet tertentu terhadap perubahan kadar CRP pasien obesitas. Sumber Data: Pencarian utama dilakukan pada basis data PubMed, ProQuest, EBSCOhost, Embase dan Scopus hingga 30 Oktober 2020. Pencarian sekunder juga dilakukan secara snowballing, Google Scholar, Global Index Medicus, portal basis data nasional, dan perpustakaan digital 40 universitas di Indonesia. Seleksi Studi: Studi uji klinis acak melibatkan pasien dewasa obes yang menilai efek diet restriksi kalori (tanpa mengkombinasikan dengan terapi nondiet lain) terhadap kadar CRP. Tidak ada batasan tahun publikasi dan bahasa. Penilaian terhadap judul, abstrak dan studi dilakukan oleh dua peninjau independen. Dari 2087 artikel, 11 studi diantaranya memenuhi kriteria eligibilitas. Ekstraksi Data: Ekstraksi data dilakukan oleh kedua peninjau. Korespondensi dilakukan dengan menghubungi peneliti dan tidak didapatkan adanya data tambahan. Hasil: Diet restriksi kalori memiliki efek terhadap penurunan kadar CRP pada pasien obesitas dengan nilai Mean Difference -0.22 (IK 95% -0.40 - -0.04, p 0.006). Intervensi restriksi diet ≤ 12 minggu tidak menunjukkan penurunan bermakna pada kadar CRP, sedangkan intervensi restriksi diet > 12 minggu menunjukkan penurunan bermakna pada kadar CRP. Kesimpulan Diet restriksi kalori memiliki efek menurunkan kadar CRP pada pasien obesitas. ......Background: Positive energy balance in obesity is characterized by hyperadipocytosis, which stimulates chronic inflammatory processes in obese patients. Management of obesity includes a calorie restriction diet thought to improve chronic inflammatory conditions, characterized by reduced c-reactive protein (CRP). However, studies have yielded inconsistent results. Objective: To assess the effect of a calorie-restricted diet on changes in CRP levels and the duration of a particular diet that is significant for its effect on changes in CRP levels in obese patients Data Source: We searched PubMed, ProQuest, EBSCOhost, Embase and Scopus through October 30,2020. Secondary searching was done by snowballing method including references of qualifying articles and manual searching through google scholar, global index medicus, national databases, and digital library of 40 universities in Indonesia Study Selection: A randomized controlled trial involving obese adult patients assessed the effect of a calorie-restricted diet (without combination with other nondiet therapy) on CRP levels. No restriction regarding year of publication and language. Titles, abstracts, and articles were reviewed by two independent reviewer. Of the 2087 studies identified in our original search, 11 of them met the eligibility criteria. Data Extraction: Data extraction was done by two reviewers. Correspondence was done by contacting the authors to confirm additional data. No additional data was obtained Result: The calorie restriction diet has an effect on reducing CRP levels in obese patients with a Mean Difference value of -0.22 (95% CI -0.40 - -0.04, p 0.006). Dietary restriction interventions ≤ 12 weeks did not show a significant decrease in CRP levels, while dietary restriction interventions > 12 weeks showed a significant decrease in CRP levels Conclusion: A calorie restriction diet has the effect of lowering CRP levels in obese patients

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Latar Belakang. Pengobatan antiretroviral (ARV) di Indonesia, meliputi dua lini. Lini kedua terdiri dari kombinasi dua NRTI (Nucleoside Reverse Trancriptase Inhibitor) dan satu PI (protease inhibitor). Protease inhibitor adalah salah satu ARV yang diketahui dapat menyebabkan lipodistrofi, yang seringkali berkembang mengalami resistensi insulin, dan berhubungan dengan peningkatan risiko kardiovaskular. Peningkatan FFA (free fatty acids) dan TNF-α akibat lipolisis sel lemak pada lipodistrofi, beberapa sitokin yang dilepaskan oleh jaringan lemak (adipokin), seperti leptin dan adiponektin dipikirkan memiliki peran terhadap resistensi insulin. Leptin dan adiponektin memiliki kaitan erat dengan metabolisme glukosa dan sensitivitas insulin. Tujuan. Mengetahui korelasi leptin, adiponektin dan rasio leptin-adiponektin dengan HOMA-IR pada pasien HIV/AIDS dalam terapi anti retroviral berbasis inhibitor protease. Metode. Studi potong lintang dengan populasi terjangkau adalah pasien HIV/AIDS dewasa yang mendapatkan terapi ARV lini ke dua di RSUPN Cipto Mangunkusumo pada September– Desember 2018. Analisis data digunakan untuk mendapat koefisien korelasi leptin, adiponektin dan rasio leptin-adiponektin dengan HOMA-IR Hasil. Sebanyak 111 subjek penelitian dengan subjek laki – laki sebanyak 91 orang (81%). Median usia subjek penelitian 39 tahun. Median lingkar perut 83,1 cm dan IMT 22,91 ± 3,91 kg/m2. Sebanyak 60,4% dari subjek penelitian mengalami hipertrigliseridemia, dan 85% memiliki kadar HDL yang rendah. Pada penelitian didapatkan median HOMA IR 2,91, median adiponektin 11,4 μg/mL, median leptin 9,9 ng/mL, dan median rasio leptin adiponektin 0,74. Pada penelitian ini didapatkan koefisien korelasi antara leptin dengan HOMA-IR 0.434 dengan p <0,001, adiponektin dengan HOMA IR -0,214 dengan p <0,05 dan rasio leptin-adiponektin dengan HOMA-IR, didapatkan nilai r 0,417 dengan p <0,001. Kesimpulan. Terdapat korelasi positif bermakna antara leptin dan rasio leptin-adiponektin dengan HOMA- IR, sedangkan untuk adiponektin dengan HOMA-IR didapatkan korelasi negatif bermakna. ......Background. Antiretroviral (ARV) treatment in Indonesia includes two lines. The second line consists of a combination of two NRTIs (Nucleoside Reverse Trancriptase Inhibitors) and one PI (protease inhibitor). Protease inhibitors are ARV drugs known to cause lipodystrophy. Patients who are on HAART (highly active antiretroviral therapy), and have lipodystrophy, often develop insulin resistance which is associated with increased risk for cardiovascular disease. Increasing of FFA (free fatty acids) and TNF-α (tumor necrosis factor-alpha) in result of lipodystrophy, also several cytokines (adipokines) released by adipose tissue, such as leptin and adiponectin, also known as adipocytokines or adipokines, may play a role to insulin reistance. Leptin and adiponectin are linked to glucose metabolism and insulin sensitivity. Objective. Knowing the correlation of leptin, adiponectin and leptin-adiponectin ratio with HOMA-IR in HIV/AIDS patient on protease inhibitor based anti retroviral therapy. Methods. Cross sectional study with an affordable population of HIV/ AIDS patient on protease inhibitor- based ARV therapy in Cipto Mangunkusumo Hospital from September – December 2018. Data Analysis was used to obtain the coefficient of correlation of leptin, adiponectin and leptin- adiponectin ratio with HOMA-IR. Results. There were 111 subjects with 91% males. Median’s age of study subject 39 years. Median of abdominal circumference 83,1 cm and median of body mass index 22,91 ± 3,91 kg/m2. Hypertriglyceridemia was found in 60,4% from subjects and 85% had low HDL level. Median of HOMA IR 2,91, Median of adiponectin 11,4 μg/mL, median of leptin 9,9 ng/mL, median of leptin adiponectin ratio 0,74. Coefficient of correlation between leptin and HOMA-IR was 0,434 with p value <0,001, adiponectin and HOMA-IR -0,214 with p value <0.05 and leptin- adiponectin ratio 0,417 with p value <0,001 Conclusion. A significant positive correlation between leptin and leptin-adiponectin ratio with HOMA-IR was obtain, also a significant negative correlation was obtained between adiponectin and HOMA-IR.

Abstrak :
ABSTRAK
Diabetes Melitus Tipe 2 (DMT2) adalah masalah global yang sangat serius. Penyakit ini menyerang pada usia yang paling produktif sehingga dapat menurunkan derajat ekonomi dan mengurangi usia harapan hidup. Patogenesis DM sangat erat kaitannya dengan inflamasi, ditandai dengan peningkatan kadar sitokin proinflamasi seperti IL-6, IL-8 dan TNF. Namun, belum ada agen antiinflamasi yang terbukti berperan dalam tatalaksana DMT2. Butirat merupakan asam lemak rantai pendek yang diproduksi dari fermentasi pati resisten di lumen usus. Dalam kondisi normal butirat diserap dan digunakan sebagai sumber energi bagi sel kolonosit, hati dan otot. Butirat mampu berikatan dengan reseptor GPR41 dan GPR43 pada monosit sehingga mampu mengubah pola ekspresi sitokin, aktivasi, migrasi dan diferensiasi sel. Sehingga menarik untuk meneliti pengaruh butirat terhadap migrasi dan sitokin yang diekspresikan oleh monosit pada pasien DMT2. Kadar sitokin dihitung dari supernatan yang diambil dari kultur monosit . Sebanyak 37 subJek dibagi menjadi dua perlakuan yaitu kontrol dan dengan penambahan butirat. Monosit hari pertama diisolasi dalam gel kolagen tipe 1 untuk dilakukan uji migrasi menggunakan μ-slide chemotaxis IBIDI. Analisis gambar menggunakan software ImageJ dan Chemotaxis tool. Terdapat adanya perbedaan yang bermakna pada rasio TNF/IL 10 antara kelompok sehat dan DMT2. Butirat juga terlihat menekan produksi sitokin TNF dan meningkatkan produksi IL10. Indikator migrasi monosit seperti jarak akumulasi dan kecepatan migrasi memiliki perbedaan bermakna antara kelompok sehat dan DMT2. Butirat dapat menekan laju migrasi monosit diikuti dengan penurunan jarak dan kecepatan migrasi monosit

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ABSTRACT
Type 2 Diabetes Mellitus (DMT2) is a very serious global problem. This disease attacks at the most productive age so that it can reduce economic status and reduce life expectancy. The pathogenesis of DM is very closely related to inflammation. characterized by increased levels of proinflammatory cytokines such as IL-6, IL-8 and TNF. However, no anti-inflammatory agent has been proven to play a role in the management of T2DM. Butyrate is a short chain fatty acid produced from resistant starch fermentation in the intestinal lumen. In normal conditions the butyrate is absorbed and used as an energy source for colonocytes, liver and muscle cells. Butirate is able to bind to GPR41 and GPR43 receptors on monocytes so that it can change the pattern of cytokine expression, activation, migration and cell differentiation. So it is interesting to examine the effect of butyrate on migration and cytokines expressed by monocytes in T2DM patients. Cytokine levels were calculated from supernatants taken from monocyte cultures. A total of 37 subjects were divided into two treatments, namely control and with addition of butyrate. The first day monocytes were isolated in type 1 collagen gel for migration testing using the slide chemotaxis IBIDI. Image analysis using ImageJ and Chemotaxis tool software. There was a significant difference in the TNFα / IL 10 ratio between healthy groups and T2DM. Butyrate also appears to suppress TNF cytokine production and increase IL10 production. Monocyte migration indicators such as accumulation distance and migration speed have significant differences between healthy groups and T2DM. Butirat can reduce inflammation responds and the distance and speed of monocyte migration

Abstrak :
ABSTRAK
Latar belakang : Penyakit jantung koroner (PJK) dan stroke merupakan penyebab kematian utama baik di negara Barat maupun di Indonesia terutama di daerah perkotaan. Setiap tahun lebih banyak orang meninggal karena penyakit kardiovaskular dibandingkan penyakit lain. Diabetes melitus merupakan faktor risiko independen untuk penyakit kardiovaskular. Gangguan aliran darah yang mengakibatkan PJK maupun stroke disebabkan oleh trombosis arteri. Aktivasi trombosit diduga terjadi pada pasien diabetes melitus. Ketika trombosit teraktivasi akanterjadi beberapa perubahan diantaranya pelepasan kandungan granula dan pembentukan tromboksan A2. Pengukuran tromboksan A2 sulit dilakukan karena sifatnya yang tidak stabil, maka dilakukan pengukuran terhadap metabolitnya 11- dehidro tromboksan B2. tujuan penelitian ini adalah menukur kadar 11 dehidro TxB2 di urin pada pasien diabetes melitus sebagai suatu petanda dini aktivasi trombosit dan mengkorelasikannya dengan hemoglobin A1c (HbA1c).

Metoda : Empat puluh lima pasien diabetes melitus tipe 2 dan 30 non diabetes sebagai kontrol diambil pada penelitian ini. Pengukuran kadar 11 dehidro TxB2 di urin dengan tehnik competitive EIA menggunakan reagen dari Cayman Chemical. Kadar 11-dehidro tromboksan B2 urin disajikan dalam bentuk rasio dengan kreatinin urin. Pengukuran HbA1c dilakukan dengan metode akfinitas boronik menggunakan NycocardR.

Hasil : Pada kelompok diabetes melitus median kadar 11 dehidro TxB2 di urin 1216,56 pg/mg kreatinin (70,53 – 12167,72 pg/mg kreatinin). Terdapat perbedaan bermakna dibanding kelompok non diabetes dengan median 200,55pg/mg kreatinin (57,19-602,46 pg/mg kreatinin). Terdapat korelasi yang kuat antara kadar 11 dehidro TxB2 pada kelompok diabetik dengan indeks glikemik (HbA1c).

Kesimpulan : 11 dehidro TxB2 di urin dapat dipakai sebagai petanda dini aktivasi trombosit pada pasien diabetes melitus dan mempunyai korelasi yang kuat dengan HbA1c.

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ABSTRACT
Background: It is widely known that heart disease and stroke are the main cause of death in Western countries. This issue found in Indosesia especially in the urbam ares. Diabetes mellitus is one of the independentbrisk faktor for cardiovaskular. Cirulatory disorder that result in coronary heart disease and stroke is arterial thrombosis. Platelet play an important role in the pathogenesis of arterial thrombosis. Some report stated that platelet activation occurred in diabetes mellitus. When platelet are activated, some change happened, i.e : released of granule content and thromboxane A2 (TxA2) formation. Measurement of TxA2 as a marker for platelet activation was hampered by the instability of this substance. Therefore it is preferred to measure their stable metabolite 11-dehydro thromboxane B2 in urine. The aim of this study is to measure urine 11-dehydro thromboxane B2 in diabetes mellitus as an early of platelet activation and to correlate this value with hemoglobin A1c.

Methode: Forty five patients with type 2 diabetes mellitus and 30 non diabetic as control group were enrolled in this study. Measurement of urine 11 dehidro TxB2 was done by competitive EIA using reagent from Cayman Chemical. The level of urine 11- dehydro TxB2 was expressed as ratio with urine creatinine. Measurement of HbA1c was performed by boronic affinity method using NycocardR.

Result : In diabetics group the median rate for urine 11 dehydro TxB2 was 1216,56 pg/mg creatinine ( 70,53 - 12167,72 pg/mg creatinine). It was significantly higher than that of non diabetic group, which median was 200,55 pg/mg creatinine ( 57,19 - 602,46 pg/ mg creatinine). the level of urine 11-dehydro TxB2 in diabetics group showed a strong correlation with HbA1c as glycemic index.

Conclusion: Urine 11-dehydro TxB2 can be used as an early marker of platelet activation in diabetes mellitus patients and there was a strong correlation with HbA1c.

Abstrak :
Latar belakang - Mikroangiopati serebral merupakan salah satu komplikasi vaskular pada Diabetes Mellitus (DM). Salah satu parameter pada Transcranial Doppler (TCD) yang menilai adanya resistensi distal dari arteri yang diperiksa yang dapat merefleksikan adanya mikroangiopati di otak adalah Pulsatility Index (PI). Penelitian ini menghubungkan antara rerata PI arteri serebri media (Middle Cerebral Artery/MCA) dengan kejadian retinopati diabetik yang merupakan komplikasi yang paling spesifik dan tersering pada DM tipe 2. Tujuan - Untuk mengetahui perbedaan rerata nilai PI MCA pada penyandang DM tipe 2 di otak pada penyandang DM tipe 2 beserta titik potongnya pada kurva ROC dan faktor-faktor yang mempengaruhinya. Metode - Penelitian ini adalah penelitian potong lintang dengan 60 subyek DM tipe 2 tanpa komplikasi makrovaskular, terdiri dari 29 pasien retinopati dan 31 pasien tanpa retinopati dari poliklinik rawat jalan endokrin RS Cipto Mangunkusumo periode November 2013 ? April 2014. Dilakukan pemeriksaan TCD untuk menilai PI MCA. Usia, riwayat hipertensi, dislipidemia, lama menyandang DM tipe 2 dan HbA1c dianalisis sebagai faktor perancu. Hasil - Pada penyandang DM tipe 2 dengan retinopati memiliki nilai rerata PI arteri serebri media yang lebih tinggi secara bermakna (1,17±0,25) dibandingkan dengan penyandang DM tipe 2 tanpa retinopati (1,05±0,26) dengan p=0,001. Usia, riwayat hipertensi, dislipidemia, lama menyandang DM tipe 2 dan HbA1c tidak berhubungan terhadap perubahan rerata PI MCA (p=0,187; p=0,608; p= 0,734; p=0,159; p=0,548). Titik potong nilai PI MCA pada penyandang DM tipe 2 dengan retinopati adalah pada nilai PI ≥ 1,025 dengan sensitifitas 70% dan spesifisitas 54%. Simpulan - Pada penelitian ini, didapatkan perbedaan rerata nilai PI MCA secara bermakana antara kelompok dengan dan tanpa retinopati dengan nilai titik potong nilai PI MCA pada penyandang DM tipe 2 dengan retinopati adalah pada nilai PI ≥ 1,025 dengan sensitifitas 70% dan spesifisitas 54%. ...... Background - Cerebral microangiopathy is one of the most important complications in diabetes mellitus. Elevation in pulsatility index (PI) as measured by Transcranial Doppler (TCD) have been postulated to reflect increased vascular resistance distal of artery being examined. This study correlate PI mean of middle cerebral artery (MCA) with retinal mikroangiopathy which is the most common and specific in diabetic patients. Objective - To determine differences in PI MCA group with and without retinopathy in type 2 diabetic patients and to find the cuttpoint value at ROC curve. Methods - The study was carried out in sixty diabetic patients (with no other vascular abnormality), divided into 2 group, 29 type 2 diabetic patients with retinopathy and 31 diabetic patients without retinopathy. TCD was performed to record pulsatility index of MCA then analyzed to find the cuttpoint value. Ages, duration of diabetes, HbA1c levels, history of hypertension and dyslipidemia was analyzes as a confonding factor. Results - The PI of MCA are significantly higher in diabetic patients with retinopathy than without retinopathy (P=0.001) with cutt of point at PI> 1,025 with 70% sensitivity and 54% spesificity. Age, HbA1c level, diabetes duration, history of hypertension and dislipidemia does not have a meaningful relationship with change cerebral status (p = 1.000, p = 0.657, p = 0.354, p = 0.538). Conclusions - There are significant differences beetwen mean of pulsatility index in diabetic patients with and without retinopaty. The Cuttpoint are at PI > 1,025 with 70% sensitivity and 54% spesifisity.

Abstrak :
Diabetes Melitus tipe 2 merupakan sekumpulan gangguan metabolik dengan karakteristik hiperglikemia. Komplikasi klinis akibat DM berkolerasi dengan status glikemik, sehingga diperlukan upaya pengontrolan status glikemik pasien DM, baik jangka pendek, jangka menengah maupun jangka panjang untuk mencegah atau mengurangi komplikasi progresif akibat penyakit tersebut. Parameter laboratorium untuk pemantauan status glikemik meliputi kadar glukosa darah harian, HbA1c, dan albumin glikat (AG). Penelitian ini bertujuan untuk mendapatkan gambaran kadar HbA1c dan kadar AG pada pasien DM tipe 2 tidak terkontrol, mendapatkan korelasi antara kadar HbA1c dan kadar AG, juga melihat penurunan kadar HbA1c dan AG sesudah terapi 1 dan 3 bulan. Penelitian dilakukan dengan desain studi diagnostik, yang melibatkan 32 subyek penelitian yang diikuti selama 3 bulan mulai bulan Februari hingga Mei 2014. Diagnosis DM tipe 2 ditegakkan oleh dokter Spesialis Penyakit Dalam dan diagnosis DM tipe 2 tidak terkontrol didapatkan dari hasil pemeriksaan HbA1c > 7 %. Hasil penelitian mendapatkan rerata (SD) kadar glukosa darah puasa bulan ke-0, ke-1, dan ke-3 berturut-turut sebesar 170,5(51,6) mg/dL; 162,7(54,6) mg/dL, dan 147,3(45,9) mg/dL. Median (rentang) kadar glukosa darah 2 jam postprandial l(G2PP) bulan ke-0 dan ke-1 sebesar 220 mg/dL (90-544) mg/dL dan 191,5 mg/dL (114-468) mg/dL; rerata(SD) kadar G2PP bulan ke-3 sebesar 201(65,98) mg/dL. Korelasi antara kadar HbA1c dan kadar AG adalah : pada bulan ke-0, r=0,79, p<0,001, bulan ke-1 r=0,74, p<0,001 dan bulan ke-3 r=0,78, p<0,001. Penurunan kadar HbA1c dari baseline (delta-1) dan pada bulan ke-3 (delta-3) adalah median (rentang) delta-1 sebesar 0,43% (0,35-0,74)%, p<0,001 dan median (rentang) delta-3 sebesar 0,89% (0,64-2,30)%, p<0,001. Penurunan kadar AG bulan ke-1 dari baseline (delta-1) dan pada bulan ke-3 (delta-3): median (rentang) delta-1 sebesar 0,94% (0,48-1,64)%, p<0,001, dan median (rentang) delta-3 sebesar 1,79% (0,33-1,40)%, p<0,001. Kami menyimpulkan bahwa terdapat korelasi positif bermakna antara kadar HbA1c dan kadar AG pada bulan ke-0, ke-1, dan ke-3, dengan kekuatan korelasi kuat (r = 0.7-0.8), selain itu terdapat penurunan kadar HbA1c dan AG yang bermakna sesudah terapi 1 dan 3 bulan. ......Type 2 diabetes mellitus (T2DM) is a group of metabolic disorders with hyperglycemic characteristic. Clinical complications of DM correlate with glycemic state, therefore it is necessary to make an effort to control DM glycemic state, in short-, medium-, and long-term to prevent or minimize progressive complications due to the disease. Laboratory parameters to monitor glycemic state include daily blood glucose, HbA1c, and glycated albumin (GA). This study aimed to obtain HbA1c and GA levels in uncontrolled type 2 DM patients, the correlations between HbA1c and GA levels, and also the decrease in HbA1c and GA levels after 1 month and 3 months treatment. This was a diagnostic study involving 32 subjects that were followed for 3 months from February to May 2014. Type 2 DM was diagnosed by the internist in the Department of Internal Medicine and the uncontrolled type 2 DM was confirmed by HbA1c measurement of > 7%. The results showed that mean (SD) fasting blood glucose levels at baseline, 1 month and 3 months were 170.5 (51.6) mg/dL; 162.7 (54.6) mg/dL, and 147.3(45.9) mg/dL, respectively. Median (range) 2 hours postprandial blood glucose levels at baseline and 1 month respectively, were 220 mg/dL (90-544) mg/dL and 191.5 mg/dL, respectively, and mean (SD) at 3 months was 201,7 (65,98) mg/dL. Correlations between HbA1c and GA levels : at baseline r =0.79, p<0.001, at 1 month r=0.74, p<0.001 and at 3 months r=0.78, p<0.001. Decreases of HbA1c level from baseline, at 1 month (delta-1) and at 3 months (delta-3) : median (range) delta-1was 0.43% (0.35-0.74)%, p<0.001 and median (range) delta-3 was 0.89% (0.64-2.30)%, p<0.001. Decreases of GA level from baseline, at 1 month (delta-1) and at 3 months (delta-3) : median (range) delta-1 was 0.94%(0.48-1.64)%, p<0.001, and median (range) delta-3 was 1.79%(0.33-1.40)%, p<0.001. We concluded that there were significant positive correlations between HbA1c and GA levels at baseline,1 month and 3 months, with strong correlations (r=0.7-0.8). In addition, there were also significant decreases in HbA1c and GA levels from baseline at 1 month and 3 months therapy.