Impaired Carbohydrate Metabolism Research Articles

Association between childhood obesity, trace elements, and heavy metals: Recent discoveries and future perspectives.

Trace elements and heavy metals play pivotal roles in health status by regulating a myriad of vital biological functions. Abnormal metal homeostasis has been linked to a constellation of pathogenic complications, including oxidative stress, inflammatory processes, dyslipidemia, and impaired insulin-mediated metabolism of carbohydrates, thereby increasing the odds of developing childhood obesity and related comorbidities. Herein, we provide a comprehensive revision of recent literature on the association between childhood obesity, trace elements, and heavy metals. Further, we emphasize on the crucial importance of addressing the influence that interindividual variability factors (e.g., sex, age, genetic determinants, concomitance of comorbidities, and environmental factors) may have in modulating the susceptibility to disease development. Altogether, this review article represents a concise guide to better understand the involvement of metals in childhood obesity pathogenesis and discusses future needs with the aim of establishing robust biomarkers in the context of precision medicine.

Targeting Insulin- and Calcium-related Pathways for Potential Treatments for Alzheimer's Disease and Diabetes

Abstract: Alzheimer's disease and diabetes are common disorders among the elderly population and have emerged as a major health concern. Both diseases pose considerable risks to one another. Diabetics have a significantly increased probability of getting Alzheimer's disease throughout their lifetime. These diseases are linked because, both share common risk factors such as impaired carbohydrate metabolism, insulin resistance, oxidative stress, inflammatory response, mitochondrial dysfunction, and amyloidosis. Insulin is a vital hormone responsible for bringing extremely high glucose levels back to normal and its receptors available in the hippocampus help in enhancing cognitive function. Insulin resistance consequently serves as a link between both diabetes and AD. Similarly, amylin is another hormone secreted by the pancreas along with insulin. During diabetes, amylin gets oligomerized and forms a neurotoxic complex with Aβ inside the brain, which causes AD to develop. Along with these, another main mechanism influencing AD development is Ca2+ dyshomeostasis. Insulin production from the pancreas is generally aided by Ca2+, but in excess, it can cause dysregulation of many signaling pathways such as CaMKK2, CAMP, CREB, MAPK, STIM\Orai, etc. which can ultimately result in the pathogenesis of AD in diabetic people. In this review, we discussed in detail the pathogenesis of AD associated with diabetes and the mechanisms initiating their progression.

Serum metabolism alteration behind different etiology, diagnosis, and prognosis of disorders of consciousness

BackgroundPatients with disorders of consciousness (DoC) exhibit varied revival outcomes based on different etiologies and diagnoses, the mechanisms of which remain largely unknown. The fluctuating clinical presentations in DoC pose challenges in accurately assessing consciousness levels and prognoses, often leading to misdiagnoses. There is an urgent need for a deeper understanding of the physiological changes in DoC and the development of objective diagnostic and prognostic biomarkers to improve treatment guidance.MethodsTo explore biomarkers and understand the biological processes, we conducted a comprehensive untargeted metabolomic analysis on serum samples from 48 patients with DoC. Patients were categorized based on etiology (TBI vs. non-TBI), CRS-R scores, and prognosis. Advanced analytical techniques, including PCA and OPLS-DA models, were employed to identify differential metabolites.ResultsOur analysis revealed a distinct separation in metabolomic profiles among the different groups. The primary differential metabolites distinguishing patients with varying etiologies were predominantly phospholipids, with a notable decrease in glycerophospholipids observed in the TBI group. Patients with higher CRS-R scores exhibited a pattern of impaired carbohydrate metabolism coupled with enhanced lipid metabolism. Notably, serum concentrations of both LysoPE and PE were reduced in patients with improved outcomes, suggesting their potential as prognostic biomarkers.ConclusionsOur study underscores the critical role of phospholipid metabolism in the brain’s metabolic alterations in patients with DoC. It identifies key biomarkers for diagnosis and prognosis, offering insights that could lead to novel therapeutic targets. These findings highlight the value of metabolomic profiling in understanding and potentially treating DoC.

Impaired Carbohydrate Metabolism among Women with Chronic Low Back Pain and the Role of Dietary Carbohydrates: A Randomized Controlled Cross-Over Experiment.

Background: Impaired glucose regulation is suggested to be related to chronic low back pain (CLBP), although it is not clear how they interact with each other. Thus, the primary aim of this study was to investigate differences in postprandial glycemic responses (PPGRs) (the first sign of impaired glucose metabolism) to high- (sucrose) and low-glycemic index (GI) (isomaltulose) beverages in normoglycemic women with CLBP and healthy controls (HCs) and explore whether any group that showed greater PPGRs to high-GI beverage intake would benefit when the high-GI beverage was replaced with a low-GI beverage. Secondly, this study aimed to explore the association between PPGR and pain in patients with CLBP. Methods: This study was registered at clinicaltrials.org (NCT04459104) before the start of the study. In this study, 53 CLBP patients and 53 HCs were recruited. After 11-12 h of fasting, each participant randomly received isomaltulose or sucrose. Blood glucose levels were measured during the fasting state and 15, 30, 45, 60, 90, and 120 min after the beverage intake, and each participant underwent experimental pain measures. Results: Compared to the HCs, the CLBP group showed significantly higher PPGRs to sucrose (p < 0.021). Additionally, the CLBP group showed a significantly higher decrease in PPGR (p = 0.045) when comparing PPGR to sucrose with PPGR to isomaltulose. Correlation analysis revealed a positive association between self-reported pain sensitivity and PPGR to sucrose, while there was no association found between any experimental pain measures and glycemic responses. Conclusions: Overall, these findings suggest that normoglycemic CLBP patients might have a higher risk of developing impaired glucose tolerance than the HCs and might benefit more when high-GI foods are replaced with low-GI ones.

Gut microbiota – a new link in the pathogenesis of osteoarthritis (literature review)

The intestinal microbiota (IMB) can indirectly affect the course of ostearthritis (OA) at the systemic level by stimulating a chronic nonspecific inflammatory reaction in the synovial membrane and subchondral bone, the cause of which is an increase in the amount of circulating lipopolysaccharides (LPS) of the bacterial wall, as well as provoke the development of metabolic syndrome, which links the two necessary components of the pathogenesis of OA. The result of direct exposure is the formation of leaky gut syndrome with the activation of LPS of the bacterial wall of mild inflammation, provoking the production of proinflammatory cytokines, the effect of which on synoviocytes and chondrocytes leads to their activation with subsequent production of IL-6 and IL-8, which contributes to the persistence of inflammation. By correlation analysis, the relationship of three taxa with OA joint damage was proved, namely, the order Desulfovibrionales and the genus Ruminiclostridium 5 – with knee joint OA, Methanobacteriaceae – with knee joint OA, and OA of any localization, and the appearance and degree of contamination with the genus Streptococcus correlated with the severity of pain syndrome. The metabolic syndrome itself can provoke the development of dysbiosis, so it can also be its consequence. A change in the composition of the microbiota in the form of the predominance of the genus Clostridium and the species Staphylococcus aureus with a decrease in the diversity of microorganisms is associated with an increase in the amount of adipose tissue in the body, dyslipidemia, insulin resistance with impaired carbohydrate metabolism. Low levels of LPS in the blood are found in obese patients even in the absence of an obvious focus of infection due to violations in the CMB, they signal TLR-4, triggering systemic inflammation. Studies have shown a positive effect of prescribing proand prebiotics on the course of OA, which makes IMB a promising target for the treatment and prevention of OA.

Pre-silking water deficit in maize induced kernel loss through impaired silk growth and ovary carbohydrate dynamics.

Both carbon limitation and developmentally driven kernel failure occur in the apical region of maize (Zea mays L.) ears. Failed kernel development in the basal and middle regions of the ear often is neglected because their spaces usually are occupied by adjacent ovaries at harvest. We tested the spatial distribution of kernel losses and potential underlying reasons, from perspectives of silk elongation and carbohydrate dynamics, when maize experienced water deficit during silk elongation. Kernel loss was distributed along the length of the ear regardless of water availability, with the highest kernel set in the middle region and a gradual reduction toward the apical and basal ends. Water deficit limited silk elongation in a manner inverse to the temporal pattern of silk initiation, more strongly in the apical and basal regions of the ear than in the middle region. The limited recovery of silk elongation, especially at the apical and basal regions following rescue irrigation was probably due to water potentials below the threshold for elongation and lower growth rates of the associated ovaries. While sugar concentrations increased or did not respond to water deficit in ovaries and silks, the calculated sugar flux into the developing ovaries was impaired and diverged among ovaries at different positions under water deficit. Water deficit resulted in 58% kernel loss, 68% of which was attributable to arrested silks within husks caused by lower water potentials and 32% to ovaries with emerged silks possibly due to impaired carbohydrate metabolism.

An Overview of Differential miRNA Profile of Patients with Latent Autoimmune Diabetes in Adults (LADA)

Diabetes mellitus (DM) is a metabolic and chronic disease characterized by hyperglycemia developing with impaired pancreatic beta cell activity, decreased insulin secretion, icreased insulin resistance, and accordingly impaired carbohydrate, protein and lipid metabolism. DM is classified as type 1, type 2, gestational and other forms of diabetes according to the characteristic properties such as age of onset, insulin dependency, micro- and macrovascular complications. Latent autoimmune diabetes in adults (LADA) is an autoimmune diabetes that begins in adulthood without insulin dependency for glycemic control at least in the first six months after diagnosis. Owing to the common genetic, immunologic, and metabolic features LADA is misdiagnosed with type 1 or type 2 diabetes. Therefore, it is need a biomarkers that ease the diagnosis of LADA. MicroRNAs are small non-coding RNAs involved in biological processes and regulate the response of target tissues to insulin as well as insulin production, signaling and release, insulin resistance, and glucose homeostasis. Dysregulation in miRNA expression can lead to impairment of glucose metabolism. Circulating miRNA are associated with different types of diabetes and have a potential to discriminate them. So, we reviewed the miRNAs that gene expressions levels which change in LADA compared to type 1 and type 2 diabetes.

Low-intensity inflammation as a manifestation of comorbidity and a factor in the unfavorable clinical course of heart failure with preserved ejection fraction

Aim. To analyze the prognostic significance of clinical, anamnestic and paraclinical parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease.Material and methods. The study included 54 patients. Cardiac and lung ultrasound was performed. In addition, the level of N-terminal pro-brain natriuretic peptide (NT-proBNP), interleukin-1β, interleukin-18, growth differentiation factor 15 (GDF-15), and cryopyrin was determined. The level of quality of life, anxiety and depression, and adherence to treatment were analyzed.Results. The patients were divided into 2 following groups: group 1 (n=22) with an unfavorable course and group 2 (n=32) with a favorable disease course. Basic echocardiographic parameters, as well as the number of B-lines in lungs, were comparable in both groups. An unfavorable HFpEF course was associated with a longer history of hypertension — 17,5 [10;20] and 7 [5;15] years (p=0,03), smoking — 36,4 and 9,4% (p=0,035), impaired carbohydrate metabolism — 54,5 and 15,6% (p=0,003) and lower adherence to treatment (p=0,02). In group 1, GDF-15 levels were higher than in group 2 — 1841 [1237;3552] vs 1709,5 [1158;2492] pg/ml (p=0,026).Conclusion. Low-intensity subclinical inflammation, the predisposing factors of which are smoking, impaired carbohydrate metabolism, and a long history of hypertension, is associated with higher GDF-15 values in patients with HFpEF and, along with low patient adherence to treatment, has an adverse effect on the clinical course of heart failure.

Assessment of two-year survival rate after acute myocardial infarction in patients with impaired carbohydrate metabolism during novel coronavirus infection pandemic

Relevance. There are limited data on the long-term outcomes of patients with myocardial infarction (MI) and impaired glucose tolerance (IGT) during the novel coronavirus disease (COVID-19) pandemic in 2020.&#x0D; Objective. To assess the 24-month survival rate among patients with IGT and previous myocardial infarction in 2020 during the COVID-19 pandemic compared to the same period in 2019.&#x0D; Materials and methods. We assessed the two-year survival rate of patients with MI and IGT from 10/1/2020 to12/10/2020 during the indirect influence of the pandemic compared to the same period in pre-pandemic 2019. The study was single-center, retrospective.&#x0D; Results. 179 persons in 2020 and 261 persons in 2019 with MI and IGT applied to a regional center to perform percutaneous coronary intervention (PCI center). There was an increase in mortality from MI and IGT from 4.1 % in 2019 to 9.9 % (p = 0.04) in the “pandemic” year of 2020. The relapse-free survival of patients was analyzed using the Kaplan – Meier curve method. By the end of the first year in 2020, 82.1 % of patients remained from the original, and in 2019 – 88.1 %, (p = 0.001), at the end of the 24-month observation period – 78.2 % among patients with MI in 2020 and 83.5 % in 2019, (p = 0.0015).&#x0D; Conclusions. A retrospective analysis of cases with MI and IGT during a pandemic in Russia showed the worst prognoses for the two-year survival rate among patients, more severe heart attacks with increased number of complications.

Changes in the synthesis of short-chain fatty acids under the influence of various factors in healthy people and patients with type 2 diabetes mellitus

Short-chain fatty acids (SCFAs) are an important link in the maintenance and normalization of some important body functions. Recently, the metabolic component of the SCFAs effects has also been actively studied; the effect on body weight, insulin resistance and glycemia is of particular interest in the context of the prevention and treatment of carbohydrate metabolism disorders. In this regard, it is relevant to study the characteristics of SCFAs' production in patients with impaired carbohydrate metabolism, mainly with type 2 diabetes mellitus (T2DM). The purpose of the research was to study the modern data on the synthesis peculiarities of SCFAs in healthy people and patients with impaired carbohydrate metabolism. Material and methods. The data of domestic and foreign literature presented in PubMed, Google Scholar, ResearchGate, Elsevier, eLibrary, CyberLeninka databases, published mainly over the past 10 years, have been analyzed. Results. According to the concept of the philometabolic nucleus, bacteria of certain species, which are of the greatest importance compared to the rest, are responsible for the synthesis of specific SCFAs. The gut microbiota (GM) has the property of plasticity - the ability to change its composition under the influence of various factors. Most studies describe the effect of GM and its metabolites on the carbohydrate metabolism, but an equally important aspect of this process is the effect of carbohydrate metabolism disorders on GM and its functional activity. In case of disorders of carbohydrate metabolism, some altered components of homeostasis negatively affect GM and its production of SCFAs. As a result, the total amount and variety of SCFAs decrease, which exacerbate the imbalance in relation to carbohydrate metabolism. There is evidence that in patients with T2DM, the concentration of butyrate, which has a positive effect on insulin resistance, body weight, fasting glycemia and postprandial glycemia, decreases. The concentration of propionate and acetate, which didn't show such a pronounced positive effect in studies on carbohydrate metabolism, on the contrary, increases. Conclusion. The production of SCFAs by GM representatives depends on many factors, such as nutrition, physical activity, medication intake and the presence of chronic diseases. Numerous studies have confirmed the difference in the characteristics of the production of SCFAs in patients with T2DM and healthy people. The study of the peculiarities of GM metabolism in patients with T2DM is a tool in understanding the basics of therapy and lifestyle correction in both patients with T2DM and healthy people in order to prevent disorders of carbohydrate metabolism.

Level of biochemical parameters in patients with type 2 diabetes mellitus depending on the genotype of the FokI polymorphism in the vitamin D3 receptor (VDR gene).

Diabetes mellitus type 2 (T2DM) is a multifactorial and polygenic disorder characterised by chronic hyperglycaemia accompanied by impaired lipid, carbohydrate, and protein metabolism. The disease is associated with several genetic polymorphisms, including the FokI polymorphism in the vitamin D receptor (VDR) gene. We conducted a study of 327 probands (191 T2DM patients, 136 controls), with a mean age 65.06 (SD ± 10.88) years of patients with T2DM and 58.89 (SD ± 6.59) years in the healthy probands. We investigated the association between FokI polymorphism and biochemical parameters in T2DM patients in the Slovak population. Anthropometric measurements, biochemical, and genetic analysis were statistically evaluated by Statistica ver.13 software using t-tests. Biochemical analysis confirmed significantly higher mean values of total cholesterol (TC), triglyceride (TG), glucose (GLU), and uric acid (UA) (p < 0.001) in T2DM probands and statistically significantly lower values of high-density lipoprotein (HDL), cholesterol and vitamin D (p < 0.001). Allele frequencies and genotype distributions of the FokI (rs2228570) polymorphism were not significantly different between T2DM patients and controls (p = 0.909). Patients with T2DM and TT genotype had the highest glucose level of 11.39 (SD ± 2.32) uU/ml (p < 0.001). Our study did not provide evidence for an association of the investigated FokI polymorphism of the VDR gene with T2DM in the Slovak population. Further research is needed to evaluate the impact of single nucleotide polymorphisms (SNPs) in the VDR gene, focusing on related genetic analyses in a larger T2DM cohort.

Comparative assessment of human salivary α-amylase inhibitor from Indonesian herbs

Diabetes mellitus (DM) is a multifactorial disease defined by persistent hyperglycemia and impaired carbohydrate, lipid, and protein metabolism due to a lack of insulin secretion. The objective of this study was to assess the Indonesian herbs which have the ability to act as human salivary α-amylase inhibitors, thus, that they can be implemented for medical purposes. In this study, fifteen Indonesian herbs were assessed for their capability as α-amylase inhibitor. The water-reflux method was used to extract all potential water-soluble active components. The Fuwa technique was used to test α-amylase activity. There were significant variations in the effects of herbs on salivary α-amylase activity, according to the statistical using one-way ANOVA and Post Hoc Tukey between the with and without inhibitors. According to the findings, Turmeric (Curcuma longa L.) and pandan leaf (Pandanus amaryllifolius Roxb) had the highest inhibitory power (80%).

BLOOD SUGAR EXAMINATION AS EARLY DETECTION OF DIABETES MELLITUS IN COMMUNITIES KUTHI, SUMURGUNG, TUBAN

Hyperglycemia is a state of increased blood glucose levels above 200 mg/dl and is an early symptom of diabetes mellitus (DM). Hyperglycemia is caused by a lack of insulin in the body. Diabetes Mellitus is a disease characterized by hyperglycemia and impaired metabolism of carbohydrates, fats and proteins associated with absolute or relative deficiencies in insulin action and/or secretion. The purpose of this study was to find out if there is a relationship between high blood sugar levels and the incidence of diabetes in Dusun Kuthi residents. Sumurgung. The type of research used was by going directly to the RW 08 community. Sampling was done by random sampling, namely changing the criteria from "elderly" to "elderly". Consuming foods that are low in sugar levels can suppress diabetes cases Health checks in the form of measuring blood sugar were carried out by KKN IIKNU Tuban students. The results of this study showed that there were 5 people with high blood sugar levels, 14 people with the prediabetes category and 4 people with the normal category.&#x0D; &#x0D; Keyword:Blood Sugar, Blood Sugar Detection, Diabetes

A Narrative Literature Review on the Role of Exercise Training in Managing Type 1 and Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia associated with impaired carbohydrate, lipid, and protein metabolism, with concomitant absence of insulin secretion or reduced sensitivity to its metabolic effects. Patients with diabetes mellitus have a 30% more risk of developing heart failure and cardiovascular disease compared to healthy people. Heart and cardiovascular problems are the first cause of death worldwide and the main complications which lead to high healthcare costs. Such complications can be delayed or avoided by taking prescribed medications in conjunction with a healthy lifestyle (i.e., diet and physical activity). The American College of Sports Medicine and the American Diabetes Association recommend that diabetic people reduce total sedentary time by incorporating physical activity into their weekly routine. This narrative literature review aims to summarize and present the main guidelines, pre-exercise cardiovascular screening recommendations, and considerations for patients with diabetes and comorbidities who are planning to participate in physical activity programs.

Hubungan Manajemen Diri Dengan Kadar Gula Darah Puasa Pada Penderita Diabetes Melitus Tipe 2 Di Puskesmas Andalas Kota Padang

Diabetes Mellitus (DM) type 2 is a metabolic disorder characterized by hyperglycemia or high blood sugar levels and impaired carbohydrate, protein and fat metabolism caused by insulin resistance. One of the factors that influence the control of fasting blood sugar levels is self-management. The purpose of this study was to determine the relationship between self-management and fasting blood sugar in patients with type 2 diabetes mellitus at the Andalas Public Health Center, Padang City. This research is a descriptive correlational study with a cross sectional approach, carried out in January-August 2022 at the Andalas Health Center, Padang City. The number of samples is 44 people with the Accidental Sampling method. Univariate analysis is shown in the frequency distribution table and bivariate with Spearman's test. The results of this study showed that 50% of respondents had poor self-management. The average fasting blood sugar level was 197 mg/dl with a standard deviation of 61.3 mg/dl. There is a relationship between self-management and fasting blood sugar levels in patients with type 2 diabetes mellitus at Andalas Public Health Center, Padang City with p value = 0.000.. It is recommended to health workers to make self-management as one of the nursing interventions in controlling fasting blood sugar levels in patients with type 2 diabetes mellitus.

Predictive calculator of the risk of perinatal complications in women with pregestational diabetes mellitus

Background. The prevalence of impaired carbohydrate metabolism among women of reproductive age is increasing worldwide. Despite tremendous progress in the treatment and management of blood glucose levels, pregnancy in women with pregestational diabetes still carries risks for the fetus.&#x0D; This study aims to develop a calculator for predicting perinatal complications in women with pregestational diabetes mellitus by mathematical modeling.&#x0D; Materials and Methods. This observational analytical study with a case-control design was conducted at the Altai Regional Clinical Perinatal Center DAR (Barnaul). The study included 147 women, with the main group comprising 95 pregnant women, including 47 with type 1 diabetes mellitus (group 1A) and 48 with type 2 diabetes mellitus (group 1B). No carbohydrate metabolism disorders were detected in 52 patients of the control group. All patients in the main group received insulin therapy. Medical documentation was analyzed, and statistical processing of the data was performed using mathematical modeling methods with appropriate software.&#x0D; Results. In order to predict the combined indicator of perinatal complications, logistic regression analysis was used to calculate coefficients (b) for each of the indicators that have the most significant influence on the formation of complications.&#x0D; The calculated values of regression coefficients can be utilized to predict the risk of perinatal complications in women with type 1 diabetes mellitus. For more practical use, a calculator for assessing the risk of perinatal complications in type 1 and type 2 diabetes mellitus was created using a computer program.&#x0D; Diagnostic evaluation of the prognostic scale (calculator) for assessing perinatal complications risk assessment in type 2 diabetes mellitus demonstrated a sensitivity of 97.6%, specificity of 87.5%, and a prognostic value of positive risk assessment of 97.5%. Therefore, the calculator enables the prediction of the risk of perinatal complications in 97.5% of cases. At the same time, the prognostic scale of perinatal complications risk and the Perinatal Complications Risk Calculator for type 1 diabetes mellitus created on its basis showed 100% sensitivity and specificity.&#x0D; Conclusion. The frequency of perinatal complications remains high, so the creation of a sufficiently effective prognostic model will make it possible to predict perinatal complications and influence the tactics of management of pregnant women and their newborns.

Efektivitas rimpang kunyit hitam (curcuma caesia roxb.) Terhadap penurunan glukosa darah dan perbaikan ginjal tikus diabetes nefropati

Background: Diabetes Mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. Diabetic nephropathy is a degenerative kidney vascular disorder that has a relationship with impaired carbohydrate metabolism or sugar intolerance (Diabetes Mellitus). Black turmeric (Curcuma Caesia Roxb.) is widely used by the community as a traditional medicine and has potential as an antidiabetic.Objective: This study aims to determine the effect of black turmeric extract on decreasing blood glucose levels and its effect on improving kidney histopathology in diabetic nephropathy rats.Method: This research was conducted at the Laboratory of the Center for Food and Nutrition Studies, University of Gajah Mada for the period October-November 2022 consisting of 6 groups. STZ-Na induced rats to obtain a state of hyperglycemia. Examination of blood glucose levels using the GOD-PAP method (enzymatic photometric test).Results: The percentage of blood glucose is decreased levels was 16.75% and repaired kidney histopathology was 6.67% as a score mild damage category (1).Conclusion: Black turmeric rhizome extract (Curcuma Caesia Roxb.) can reduce blood glucose levels and improve kidney function at a dose of 400 mg/kg BW.

Perbandingan Efektivitas Antara Metformin dan Glimepiride Berdasarkan Kadar Gdp pada Pasien Dm Tipe 2 di Rsud Dr.M.Soewandhie pada Tahun 2019

Diabetes Mellitus is a chronic metabolic disease characterized by elevated blood sugar levels and impaired carbohydrate, lipid, and protein metabolism due to betta pancreatic-cell dysfunction or insulin resistance in body cells. The prevalence of diabetes mellitus continues to increase worldwide. Indonesia itself has a prevalence of type 2 diabetes mellitus reaching 90% of all diabetes (WHO, 2016) (Riskesdas, 2018). The management of type 2 diabetes mellitus is very diverse, ranging from non-pharmacological therapy to pharmacological therapy such as insulin injection and oral anti-diabetes. Each anti-diabetic drug has a variety of ways of working, administration, and side effects. This study aims to analyze the comparison of the effectiveness of anti-diabetic medications based on blood sugar levels from the use of metformin and glimepiride (sulfonylureas) or a combination of both in patients with type 2 diabetes mellitus at Dr. Soewandhie Regional Public Hospital. This research is an analytic retrospective observational using secondary data in the form of medical records of patients with type 2 Diabetes Mellitus (outpatient) at Dr. Soewandhie Regional Public Hospital in 2019. The sample of this study consisted of 121 samples that met the inclusion criteria (43 patients on metformin therapy, 40 patients on glimepiride therapy, and 38 patients on combination therapy). The analysis of this study used data on FBG (Fasting Blood Glucose) before and three months after receiving metformin or sulfonylurea (glimepiride) therapy or a combination of both in the medical record. Data analysis of this study was performed using the Friedman test. This study showed that there was no significant difference in glycemic control (∆FBG) of metformin, glimepiride, and combination therapy in patients with type 2 diabetes mellitus (p value=0.575). There was no significant difference in the effectiveness of metformin, glimepiride, and combination therapy in patients with type 2 diabetes mellitus in Dr. Soewandhie Regional Public Hospital in 2019. In a study conducted in Japan showed that there’s efficacy of high-dose metformin use in patients with type 2 diabetes mellitus in Japan. The efficacy and safety of metformin are similar when used either twice daily or thrice daily. Further research needs to be done to assess the glycemic control (∆FBG) rate of metformin, glimepiride, and combination therapy in patients with type 2 diabetes mellitus by taking into account other factors such as medication adherence, diet, and physical activity.

Acrochordons as a cutaneous sign of impaired carbohydrate metabolism, hyperlipidemia, liver enzyme abnormalities and hypertension: A case-control study.

Acrochordons are common and benign skin tumours. A few studies with contradictory results have been reported regarding the abnormalities of carbohydrate and/or lipid metabolisms in patients with acrochordons. We aimed to determine if the presence of acrochordons could be a marker of diabetes, hyperlipidemia, liver enzyme abnormalities and hypertension by comparing with a control group. A total of 110 patients having two or more acrochordons and age- and gender-matched 110 controls were included in the study. Localization, size and the total number of acrochordons were recorded in the patient group. Fasting plasma glucose (FPG), serum lipids and liver enzyme levels were tested in patient and controls. All participants underwent a standard 2-h oral glucose tolerance test with 75 g glucose. Diabetes mellitus and impaired glucose intolerance were diagnosed according to the American Diabetes Association criteria. Arterial blood pressures were measured in two groups. A total of 56 patients and 10 controls were diagnosed with overt DM. Thirteen per cent of the patients and 9% of controls had an impaired glucose tolerance test. The difference was statistically significant for the diagnosis of DM and not significant for the impaired glucose tolerance. The mean levels of FPG, total cholesterol, LDL cholesterol, triglyceride, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase were significantly higher in patients than those in controls. Furthermore, serum levels of HDL were less in patients. Patients with acrochordons had higher systolic and diastolic blood pressures than controls. The results of our study suggest that acrochordons may represent a cutaneous sign for impaired carbohydrate or lipid metabolism, liver enzyme abnormalities and hypertension.

Glycemic control in children receiving glucocorticoid therapy

Hyperglycemia is a well-known side effect of glucocorticoid (GC) therapy. GC treatment can lead to steroid diabetes mellitus (DM) manifestation. Glycemic control is essential for patients receiving GC. Three clinical cases of carbohydrate metabolism impairment (hyperglycemia) in children receiving GC needing glycemic control were described. In the 1st case transient fasting hyperglycemia up to 8.3 mmol/l (while normal data after meals) was detected during 3 days after start of GC pulse-therapy of bronchial asthma. Normalization of glycaemia was evident since the 4th day in spite of GC therapy continuing for 6 days. In the 2nd case transient hyperglycemia while pulse-therapy of juvenile arthritis with systemic onset was detected on the 3rd day (7.25 mmol/l), GC in tablets was added, pulse-therapy with gradually dose reduction continued 9 days else. Hyperglycemia (up to 11.7 mmol/l) persisted for 4 days, then glycaemia normalization was detected in spite of continuing GC therapy (50 mg or 0.7 mg/kg). In the 3rd case steroid DM in a patient with juvenile systemic scleroderma, familial history of DM type 2, and obesity manifested after 2 months of treatment with GC tablets (35 mg or 0.6 mg/kg), metformin was prescribed. While reduction of GC dose trend to glycaemia normalization was seen. In 4 months after cessation of GC impaired glucose tolerance and insulin resistance were diagnosed.Glycemic control is essential for patients receiving GC. Hyperglycemia while receiving GC can be both transient or persistent. Risk of steroid DM is higher in cases of family history of DM type 2, obesity, high doses, and prolonged GC treatment. In patients at-risk of DM type 2 impairment of carbohydrate metabolism can persist after cessation of GC; this needs repeated examination.