The DiabCare Asia 2008 study – Outcomes on control and complications of type 2 diabetic patients in Indonesia.

Aim: To collect information on diabetes management, diabetes complications, and awareness of self-control in diabetic population of the country. This study also evaluated the physician perspectives, psychological aspects, and quality of life of diabetic patients. Methods: This was a non-interventional, cross-sectional study, which recruited 1832 patients from secondary and tertiary medical centers across Indonesia. Data on demography, medical history, risk factors and clinical examination reports including laboratory assessments were collected from medical records of patients. Blood samples of all patients were collected for centralized HbA1c measurements. Results: Among 1832 patients, 1785 individuals were eligible for analysis. The mean age of the patients was 58.9+9.6 years. The mean duration of diabetes was 8.5+7.0 years. Majority (97.5%) of the patients had type 2 diabetes. 67.9% had poor control of diabetes (A1c:8.1 ± 2.0%). 47.2% had FPG>130 mg/dL (161.6±14.6 mg/dL). Dyslipidemia was reported in 60% (834/1390) and 74% (617/834) of those received lipid lowering treatment. Neuropathy was most common complication (63.5%); other complications were: Diabetic retinopathy 42%, nephropathy 7.3%, severe late complications 16.9%, macrovascular complications 16%, microvascular complications 27.6%. About 81.3% of patients were on OADs (± insulin), 37.7% were on insulin (±OADs). Majority used biguanides followed by sulfonylureas. Human insulin was used by 73.2%, premix regimen 58.5%, analogues usage was 24.9%. Majority of the WHO-5 well being index responses fell in positive territory. Conclusion: Poor glycaemic control in majority of patients is a concern. There is a need for a large proportion of patients to be adjusted to more intensive pharmacotherapy and a multi-disciplinary approach for management should be adopted. The study fi ndings should be communicated to policymakers and physicians to help them provide proper healthcare and its facilities in Indonesia.

Diabetes and stroke.

Diabetes mellitus is a well-established independent risk factor for stroke and is associated with high mortality. Risk factors or risk markers for a first stroke were classified according to their potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Some of parameters are usefull as screening test to predict the incidence of stroke in diabetic patients in the future, such as UKPDS Risk Engine, incidence of carotid bruit featuring the stenosis of carotid artery, QTc interval prolongation and proteinuria. The real action must be taken to prevent the stroke when high risk patient is found. The modifiable and potentially modifiable risk factors that have been recommended by numbers of expert committee have to be modified immediately. In case with stenosis of carotid artery, the endarterectomy and carotid stenting have become popular and acceptable treatment in USA and Europe. It must be considered by Indonesian physicians to decrease the incidence of stroke.

Effects of high-carbohydrate and high fat diet on formation of foam cells and expression of TNF-alpha in Rattus novergicus.

AIM: to examine the role of high carbohydrate and high fat diet on formation of foam cells and expression of TNFalpha, an early stage of atherosclerosis. METHOD: three months old male Rattus Novergicus strain Wistar were allocated into 3 groups, normal diet group (GI, n=8), high carbohydrate diet group (GII, n=8), and high fat diet group (G III, n=8). Those groups received an isoenergetic diet but contained different percentage of carbohydrate and fat for 12 weeks. The rest of the food was measured daily to calculate the calorie intake. The body weight was measured weekly. At the end of study, blood samples were taken using cardiac puncture to examine lipid profiles and random blood sugars. RESULTS: levels of blood glucose significantly increased in GII compared to the GI (281.87 +/- 39.66 mg/dl vs 192.5 +/- 1.4 mg/dl, p=0.002). Group II and G III showed increased of triglyseride compared to GI (138.0 +/- 47.15 vs 85.5 +/-20.3, p=0.02; 163.62 +/- 41.77 vs 85.5 +/- 20.3, p=0.00, respectively). Level of LDL significantly increased in G III compared to GI (72 +/- 35.6 vs 27.0 +/- 8.9, p=0.00). No statistical difference in level of HDL among the three groups. Level of TNFalpha significantly increased in GII and G III compared to GI (19.13 +/- 3.68 vs 2.5 +/- 1.4, p=0.00; 23.6 +/- 5.58 vs 2.5 +/- 1.4, p=0.00, respectively). The number of foam cells was significantly increased in GII and G III compared to GI (7.18 +/- 5.28 vs 1.2 +/- 1.4, p=0.00; 9.91 +/- 6.26 vs 1.2 +/- 1.4, p=0.00, respectively). The foam cell had strong correlation with triglyseride level and TNFalpha (r=0.696, p=0.00; r=0.618, p=0.00, respectively). CONCLUSION: this result shows that high carbohydrate and high fat diet potentially increase the risk factor of atherosclerosis. Both diets induced the inflammatory process and increase foam cells formation, are in the early stage of atherosclerosis.