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.

Update in the management of obesity.

Significant increase of obesity prevalence in almost all countries in the world recently has had obesity as a global health problem, and WHO in 1998 defined it as "the global epidemic". Simply, obesity is defined as an excessive fat accumulation in fat tissue due to imbalance of energy intake and expenditure. Body mass index is a simple method for defining the degree of overweight and obesity, however, waist circumference is the preferred measure of abdominal obesity because it has greater relationship with the risk of metabolic and cardiovascular diseases. Body fatness reflects the interactions of development, environment and genetic factors. The role of genetic factors has already existed, nevertheless, environment factors are likely more important in developing obesity. Increased mortality among the obese is evident for several life-threatening diseases including type 2 diabetes, cardiovascular disease, gallbladder disease, and hormone-sensitive and gastrointestinal cancers. Risks are also higher for some non-fatal conditions such as back pain, arthritis, infertility and, in many westernized countries, poor psychosocial functioning. Obesity is not only threatening health, also impacts on high economic and social cost. Effective prevention of obesity should be focused to high risk individuals or groups. Individuals who have some existing weight-related problems and those with a high risk of developing obesity co-morbidity such as cardiovascular disease and type 2 diabetes should be a key priority in this prevention strategy. Although weight loss in obese persons of any age can improve obesity-related medical complications, physical function, and quality of life, the primary purpose for weigh-loss therapy may differ across age group. The current therapeutic tools available for weight management are: (1) lifestyle intervention involving diet, physical activity, and behavior modification; (2) pharmacotherapy; and (3) surgery. Moderate weight loss (5-10% of initial weight) by any programs is a realistic target in management of obesity associated with improvement of risk factors of metabolic and cardiovascular diseases.