Cost of illness of diabetes mellitus in Indonesia: a systematic review.

OBJECTIVES: Diabetes Mellitus (DM) is a group of insulin metabolism disorder that affects the socio-economic conditions of the community. The cost of treating diabetes in 2019 was USD 760 billion and by 2045 there are predicted to be 700 million people living with diabetes. The purpose of this systematic review was to provide an overview of the economic burden caused by Diabetes Mellitus for the government, health care providers, and for the community. METHODS: This systematic review was carried out by considering the related studies about the cost of illness, evaluation of disease costs, or therapeutic costs for various types of diabetes mellitus that were published in both English and Indonesian. The search engines PUBMED, DOAJ, SCOPUS, SCIENCE DIRECT, and GOOGLE SCHOLAR were used without date published restrictions. RESULTS: A systematic search identifies 18 eligible studies conducted in various regions in Indonesia. The study was retrospective with variation in their perspectives and methods to estimate the diabetes cost. Drug cost was the major contributor to direct medical cost followed by complications cost while other cost was affected by transportation cost, productivity losses, and time spent by family accompanying patients. CONCLUSIONS: Diabetes mellitus creates a significant financial burden and affects the health care system as well as the individual and society as a whole. Research about the cost of diabetes in the future should be carried out on a large scale in order to get a more specific cost estimation.

Neuropathy optic glaucomatosa induced by systemic hypertension through activation endothelin-1 signaling pathway in central retinal artery in rats.

AIM: To evaluate effect of hypertension on retinal ganglion cell (RGC) apoptosis, intraocular pressure (IOP), and the activation of endothelin-1 (ET-1) signaling pathway in central retinal artery (CRA) in rats. METHODS: The experimental study was performed on 20 male Sprague Dawley rats that were divided into control group, and hypertension groups. The hypertension was induced by subcutaneous deoxycorticoacetate (DOCA) 10 mg/kg twice a week and administered 0.9% NaCl solution daily for 2, 6, and 10wk. Blood pressure (BP) was measured using animal BP analyzer. IOP was measured by handheld tonometry. Retinal tissue preparations by paraffin blocks were made after enucleation. The expression of ET-1, eNOS, ET-1 receptor A (ETRA), ET-1 receptor B (ETRB), and phosphorylated myosin light chain kinase (MLCK), and caldesmon (CaD) in CRA and RGC apoptosis were evaluated through immunofluorescent staining method then observed using laser scanning confocal microscopy. RESULTS: BP significantly increased in all of the hypertension groups compared to control (P=0.001). Peak IOP elevation (7.78±4.14 mm Hg) and RGC apoptosis (576.15±33.28 Au) occurred on 2wk of hypertension. ET-1 expression (1238.6±55.1 Au) and eNOS expression (2814.2±70.7 Au) were found highest in 2wk of hypertension, although the ratio of ET-1/eNOS decreased since 2wk. ETRA reached peak expression in 10wk of hypertension (1219.4±6.3 Au), while ETRB significantly increased only in 2 weeks group (1069.2±9.6 Au). The highest MLCK expression (1190.09±58.32 Au), CaD (1670.28±18.36 Au) were also found in 2wk of hypertension. CONCLUSION: Hypertension effects to activation of ET-1 signaling pathway significantly in CRA, elevation of IOP, and RGC apoptosis. The highest value was achieved at 2wk, which is the development phase of hypertension.