Clinicodemographic Profile and Outcomes of Type 2 Diabetes Mellitus in the Indonesian Cohort of DISCOVER: A 3-Year Prospective Cohort Study.

Background: Indonesia is amongst the top 10 countries with the highest prevalence of Type 2 Diabetes Mellitus (T2DM) at 10.8%. However, the distinguishable features of T2DM in Indonesia remain obscure. Therefore, the DISCOVER study aimed to describe the characteristics of T2DM patients, associated vascular complications and treatment in Indonesia. Methodology: DISCOVER study is a multi-country, multicenter, prospective, cohort study over 3 years. In the present study, the data were collected from 13 sites from clinical practice, hospitals and public health facilities in Indonesia. Results: A total of 221 subjects were recruited with a mean age of 55.6 ± 9.8 years and body mass index (BMI) of 26.4 ± 4.4 kg/m2. Over 40% of patients had hypertension and/or hyperlipidemia. The mean duration of T2DM was 58.3 ± 62.0 months while the mean HbA1c levels was 9.2 ± 2%. In total, 82.4% completed the study within a 36-month followup period. BMI remained elevated i.e., >25 kg/m2. A significant reduction was observed in HbA1c levels as compared to baseline (9.2 ± 2% to 8.1 ± 1.8%). T2DM-associated microvascular complications such as peripheral neuropathy, albuminuria and chronic kidney disease were observed in 17.2%. Macrovascular complications including coronary artery disease and heart failure were seen in 26.2% of patients. We also found that more than 70% of patients were on metformin and/or sulfonylurea. Conclusion: The features of patients with T2DM in Indonesia were high BMI, with hypertension and hyperlipidemia as co-morbidities. Metformin and sulfonylureas were the most common treatment. HbA1c reduction during follow-up did not reach recommended target. Thus, early detection and intervention using available glucose-lowering medications and aggressive management of risk factors and complications are essential to improve outcomes of diabetes management in Indonesia.

Expert Opinion on Diabetes Management Challenges and Role of Basal Insulin/GLP-1 RA Fixed-Ratio Combination in People with Type 2 Diabetes from Indonesia.

Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.

Early Recognition of Type 2 Diabetes Complications and Use of SGLT2i in Multidisciplinary Approach: Indonesian Perspective - An Expert Opinion.

Indonesia ranks seventh with the highest number of cases of type 2 diabetes mellitus (T2DM). T2DM is associated with major undesirable complications including cardiovascular disease and chronic kidney disease. Kidneys play a major role in maintaining glucose homeostasis, leading the development of sodium glucose transporter inhibitors (SGLT2i). These inhibitors block renal sodium and glucose reabsorption. Several cardiovascular trials proved that SGLT2i have cardioprotective and renoprotective roles and have been suggested  as a drug of choice in primary and secondary prevention and management of cardiorenal complications associated with T2DM. This review highlights the need for a multidisciplinary recommendation for T2DM management in Indonesian population. Additionally, it is vital to provide the perspective of Indonesian medical experts in terms of screening, diagnosis and treatment as the outcome differs geographically. An expert panel of 6 members from Indonesia was convened to review the existing literature and develop an expert-based review/ summary on this topic. Members were chosen for their proficiency in diabetes, kidney disease and cardiovascular disease. The experts opined that the early use of SGLT2i will be effective in preventing and minimising the progression of cardiorenal complications. Moreover, a consistent multidimensional approach is necessary for improved outcomes.

Genetics of Graves' disease: the lost concept.

A key issue of Really Significant Genes (RSG) that caused Graves Disease is unresolved. RSGs are considered likely major contributors to genetic risk for a disease. These genes should be strongly linked within families and they could become clinically useful as predictors of disease. Some Graves Disease susceptibility genes have been identified. The first identified was the Human-Leucocyte-Antigen DR (HLA-DR) gene locus, then a non-HLA genes as cytotoxic T lymphocyte antigen (CTLA-4), CD40, protein tyrosine phosphatase-22 (PTPN22), thyroglobulin, and thyroid-stimulating hormone receptor (TSHR) gene. The sites observed in different populations were not always the same. With the completion of the HapMap, which provided the geography of thousands single nucleotide polymorphisms (SNPs), the search of more minor associated genes started again although studies never revealed stronger candidates, meanwhile, the role of the environment in disease development remains poorly understood. The importance of the environment with the mechanisms involved including genetic factors is needed to be decided.