Factors Associated with Diabetes-Related Distress in Type 2 Diabetes Mellitus Patients.

Background: Diabetes-related distress is a unique emotional problem that is directly related to the burden and anxieties felt by type 2 diabetes mellitus (T2DM) patients. Diabetes-related distress may lead to pessimism and lower self-efficacy which resulted in a deficiency of self-treatment compliance and can cause further bad glycemic control. Knowing the associated factors of diabetic-related distress and solving them may help T2DM patients improve their glycemic control. Methods: This study is an analytical study with cross-sectional design conducted at Sanglah General Hospital from January to April 2021. The data were taken using the consecutive sampling method; 124 samples were collected according to inclusion and exclusion criteria. The participants filled Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). The data analysis was done using univariate (descriptive), bivariate (chi-square) and multivariate (logistic regression) analysis. Results: Seventy-five subjects out of 124 (60.5%) had diabetes-related distress. The associated factors of diabetes-related distress one among others are the insulin usage as diabetic therapy (OR= 8.30, 95% CI 2.24-30.72; p = 0.002), had a hypoglycaemia in last 3 months (OR=44.59, 95% CI 4.36-455.51; p = 0.001), had diabetes-related retinopathy (OR=10.28, CI 95% 1.54-68.70; p=0.016), and lack of family support (OR=44.791, 95% CI 10.02-200.22; p < 0.001). Conclusion: Our present study revealed that diabetes distress prevalence is predominantly and associated among in type 2 diabetes mellitus. We suggest diabetes-related distress screening and regular health promotion which focus on relationship between diabetes and psychological may be a great potential action to improve public health and patient outcomes.

Challenging Diagnosis of Addison's Disease Presenting with Adrenal Crisis.

Primary adrenal insufficiency, also known as Addison's disease, is a rare but potentially fatal condition resulting from the failure of the adrenal cortex to produce glucocorticoid and/or mineralocorticoid hormones. Unfortunately, the clinical manifestation of primary adrenal insufficiency is not specific and often progresses insidiously, resulting in late diagnosis, or in severe cases, life-threatening circulatory collapse. Adrenal insufficiency should be considered in patients with unexplained vascular collapse. We report the case of a woman who presented to the emergency ward with unexplainable shock that was later diagnosed as adrenal crisis due to Addison's disease. The presence of hyperpigmentation in patients with rapid progression of adrenal insufficiency suggests the diagnosis of Addison's disease presenting with adrenal crisis.

Dyslipidemia in diabetes: a population-based study in Bali.

PURPOSE: To establish the lipid pattern in subjects with diabetes mellitus (DM) and factors that are correlated with insulin resistance and lipid disorders in a population of Bali. METHODS: A cross-sectional population-based study which enrolled 1840 subjects (age 13-100 years) from 7 villages was carried out. Several clinical parameters were measured including age, gender, body mass index, waist circumference (WC), fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A (apoA), apoB, non-HDL-C, T/HDL-C ratio, LDL-C/apoB ratio, apoB/A ratio, plasma insulin, and homeostasis of model assessment-insulin resistance (HOMA-IR). RESULTS: TC, TG, and non-HDL-C levels were higher in DM subjects than in normal glucose tolerance (NGT) subjects in both genders; total/HDL-C ratio was higher in subjects with DM than in NGT subjects only in men; LDL-C levels, apoB levels, and apoB/A ratios were higher and LDL/apoB was lower in subjects with DM than in NGT in women. In subjects with DM, the target for LDL-C (79%), non-HDL-C (85.2%), apoB (80%), HDL-C (34.9%), TG (46.7%), and small-dense low density lipoprotein (42.2%) was not achieved. CONCLUSION: FBG was correlated with TC, TG, LDL-C, apoB, non-HDL-C levels, LDL/apoB, and apoB/apoA ratios. Subjects with DM had higher levels of TC, TG, and non-HDL-C levels in both genders; T/HDL-C ratio only in men; LDL-C, apoB/apoA ratio and lower LDL/apoB ratio only in women. Obesity was correlated with lipid levels. WC was correlated with LDL/apoB ratio, insulin level, HOMA-IR, and TG; highest absolute strength of correlation was with LDL/apoB ratio. Insulin resistance was correlated with lipid levels or ratios, especially in women. In women, HOMA-IR had a positive correlation with total/HDL-C ratio, non-HDL-C, apoB, and a negative correlation with HDL-C levels.

Vaspin in Developing Obesity (Vande-Ob); the Correlation of Waist Circumference and Visceral Fat Percentage with Vaspin Levels in Patients with Type II Diabetes Mellitus.

BACKGROUND: Vaspin concentration was thought to be associated with obesity, impaired insulin sensitivity, and fitness level. The correlation of vaspin and leptin supports the theory of vaspin associated with body fat mass. AIM: To determine the correlation between visceral fat distributions and serum vaspin level in type II DM patients. METHODS: We conduct an observational, analytical cross-sectional study. Sixty subjects with type II diabetes mellitus who came to Diabetes Center of Sanglah General Hospital were included consecutively. Each subject has to sign an informed consent before physical and laboratory examination took place. Spearman correlation test was used to analyse the correlation between waist circumference and visceral fat percentage with serum vaspin level since the data were not distributed normally. RESULTS: Mean laboratory results in all subjects of vaspin levels was 2.389 ± 3.586 ng/ml, mean waist circumference was 94.95 ± 11.78 cm and mean visceral fat percentage was 18.05 ± 23.63%. We found we found no significant correlation between between vaspin with waist circumference (r = -0.044; p = 0.738) and visceral fat percentage (r = -0.103; p = 0.435). CONCLUSIONS: The vaspin level did not significantly correlate with waist circumference and visceral fat percentage in type II diabetes patients.

Underweight is an important risk factor for coronary heart disease in the population of Ceningan Island, Bali.

A study on the prevalence of coronary heart disease (CHD) and its risk factors in Ceningan Island was conducted. The prevalence of CHD was 11.5%. Older age (odds ratio, OR, 27.0), underweight (OR, 3.6), systolic hypertension (OR, 4.6), high total cholesterol (OR, 5.9), and high low-density lipoprotein cholesterol (OR, 3.1) were risk factors for a history of myocardial infarction (MI). By logistic regression analysis, only age (B=3.937) and underweight (B=1.275) consistently appeared to be risk factors for MI. The prevalence of CHD in the population was comparatively high.