Ende Diabetes Study: diabetes and its characteristics in rural area of East Nusa Tenggara.

Background: There are only few studies about diabetes in rural area in Indonesia. Epidemiological study are needed to formulate health policy of disease management in specific area. The aim of this study was to find the prevalence of diabetes and knowledge of diabetes among the community in Nangapanda Village, Ende District, East Nusa Tenggara. Methods: A cross-sectional study “Ende Diabetes Study” was conducted in Nangapanda Village. This study use cluster random sampling method to a total number of 19756 residents in Nangapanda village. From the sampling frame of 1800 adult subjects who underwent screening with glucometer in 2008 and 2009, 125 subjects have been diagnosed as diabetes or impaired fasting glucose (IFG). All of the subjects who were diagnosed as diabetes or IFG from the previous screening and 218 subjects from control (normal subjects in the 2008 and 2009 screening) were included in the present study. Each subject underwent general anamnesis, nutritional interview, complete physical examinations, and laboratory test (blood and urine). The data were analyzed using SPSS 13.0. Ressult: There were 343 subjects in this study. The prevalence of diabetes in Nangapanda using blood glucose criteria (using fasting and post-glucose load values) was 2%; using post glucose load criteria, the prevalence of DM was 1.56%; while with HbA1c criteria, the prevalence was 2.83%. The prevalence of impaired glucose tolerance (IGT) was 2.2%, and IFG was 6.2%. A number of 71.1% Nangapanda residents have sufficient knowledge about diabetes. Conclusion: Prevalence of diabetes in Nangapanda (using fasting and post-glucose load criteria) was 2% and 1.56% (using post-glucose load values). As much as 71.1% of Nangapanda residents have sufficient knowledge about diabetes.

Correlation between free thyroxin levels and left ventricular ejection fraction in Graves' disease (preliminary study).

AIM: to determine the correlation between free thyroid hormone level and left ventricular ejection fraction in newly diagnosed Graves' patients. METHODS: this is a preliminary study with an initial cross-sectional design using free thyroxine level as a parameter of thyroid hormone state and left ventricular ejection fraction (LVEF) as a parameter of left ventricular systolic function. Free thyroxine level was measured in the laboratory and the LVEF was assessed by Simpson's methods of echocardiography study. RESULTS: ten patients (7 men and 3 women; age 18-52 years old) were studied. Their average of fT4 was 5.75 (SD 0.96) ng/dL and their average of LVEF was 70.57 (SD 4.50)%. There was positive correlation coefficient between free thyroxine level and left ventricular ejection fraction (r=0.711, p=0.021) in newly diagnosed Graves' patients. CONCLUSION: in this study strong positive correlation was found between free thyroxine (fT4) and left ventricular ejection fraction (LVEF) in newly diagnosed Graves' patients.

The proportion of dyslipidemia in systemic lupus erythematosus patient and distribution of correlated factors.

AIM: To understand the proportion of dyslipidemia in systemic lupus erythematosus (SLE) patients and the influencing factors of dyslipidemia. METHODS: AN observational, cross-sectional study was conducted on new and longstanding SLE patients who had been diagnosed based on ARA criteria 1982 with 1997 revision. They had been hospitalized and treated at Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital and the other private Hospitals in Jakarta, i.e. Kramat Hospital in July - November 2003. The sample was selected by non probability sampling method with consecutive sampling technique. Every participant underwent history taking, physical and laboratory examination. RESULTS: There were 77 patients satisfying the inclusion criteria. The proportion of dyslipidemia in this study was 75.3%. By confidence interval of 95%, the dyslipidemia in SLE patient was 65.3% - 84.6%. The distribution of lipid profile in sample population were 43% with total cholesterol > or = 200 mg/dL, 26% with HDL cholesterol level < 40 mg/dL, 26.4% with LDL cholesterol level > or = 130 mg/dl and 44.2% with triglycerides serum level > or = 150 mg/dL. The characteristics of influencing factors in dyslipidemia prevalence for sample population consisted of 24.7% with renal involvement, 53.2% with > or = 3 years illness periods, 26% had received > or = 30 mg/day prednisone, 94.8% had not received chloroquines, and 58.4% had illness activity of Mex-SLEDAI > or = 2. By bivariate analysis, we found that illness period < 3 years tends to affect dyslipidemia with OR value of 12.04 (CI 95%, 2.54-57.05, p = 0.001). After conducting multivariate analysis by backward methods, it appears that only one significant influencing factor of dyslipidemia prevalence in SLE patient i.e. Illness period od < 3 years with OR value 12.04 (CI 95% 2.54 - 57.05, p = 0.001). CONCLUSION: Illness period of 3 years is represent a significant correlative factor for dyslipedemia prevalence. Prednisone > or = 30 mg/dL is the correlative factor for total cholesterol > or = 200 mg.dL and triglycerides > or = 150 mg/dL. Mex-SLEDAI > or = 2 is the corrective factor for HDL cholesterol < 40 mg/dL.

Correlation of neuropathy with corneal sensitivity and lacrimal gland secretion in type 2 diabetes mellitus patient.

AIM: To evaluate correlation between blood glucose control, corneal sensitivity and lacrimal secretion in type 2 DM with peripheral neuropathy. METHODS: A cross sectional study has been conducted in 20 type DM with peripheral neuropathy and 20 without peripheral neuropathy at the Department of Internal Medicine and Ophthalmology, Ciptomangunkusumo Hospital, Faculty of Medicine University of Indonesia, from August through November 2002. All subject underwent a comprehensive medical examination, including esthesiometer Semmes-Weinstein 10 g, HbA1c, Schirmer test, and corneal sensitivity measurements. RESULTS: The mean corneal sensitivity was significantly lower in diabetic patients with neuropathy (p=0.000). HbA1(c) was related to corneal sensitivity (p=0.016). CONCLUSION: In type 2 DM with peripheral neuropathy, corneal sensitivity was demonstrated to be significantly decrease, all of which seems to be due to the status of blood glucose control.

The efficacy of repaglinide monotherapy and in combination with metformin in Indonesian type 2 diabetes mellitus patients.

AIM: To investigate the efficacy and safety of repaglinide alone and in combination with metformin therapy. METHODS: Seventy-two type 2 diabetes patients who were oral anti-diabetic drugs (OAD)-naive or currently on OAD for </=36 months with HbA1c </=9% and fasting plasma glucose (FPG) pound 13 mmol/L were recruited. Patients were titrated for 6 weeks to a dose level which maintained fasting blood glucose at 4.4-7.0 mmol/L and continued treatment for 8 weeks. Dose regimen started with 0.5 mg repaglinide each main meal, progressing to 1.0 mg repaglinide, 1.0 mg repaglinide + metformin 500 mg b.i.d. and 1.0 mg repaglinide + metformin 500 mg t.i.d., depending on patients' glycaemic status. Patients' glycaemic control (HbA(1c) and FPG), body weight and other safety parameters were evaluated. RESULTS: Thirty-seven patients completed the trial. Patients were overweight (mean BMI 25.5 +/- 4.1 kg/m(2)) with mean age 52.5 +/- 8.8 years and mean diabetes duration of 2.4 +/- 3.8 years. Mean HbA1c (2.26 +/- 0.22%, [p <0.05]) and FPG (3.31 +/- 0.47 mmol/L, [p <0.05]) decreased significantly from baseline. Body weight did not change significantly (0.85 +/-0.45 kg, p=0.068). Of the 33 patients who had baseline FPG >7.0 mmol/L, it appeared that repaglinide alone at doses 0.5 or 1.0 mg achieved FBG <7.0 mmol/L in 67% of patients. The majority of the treatment emergent adverse events were mild and unlikely related to trial product. Episodes of symptomatic hypoglycaemia were low (9.3%) in frequency. The changes in haematology, clinical biochemistry and urinalysis were mostly minor or remained unchanged. Vital signs and the results of physical examination also remained unchanged. Three of the four withdrawals were due to adverse events but were unlikely related to trial product. CONCLUSION: treatment with repaglinide alone and in combination with metformin was efficacious in glycaemic control in OAD-naive or previous users. Most of the patients appeared to achieve good control with repaglinide alone. The treatment regimens were safe (317 words).