Early Detection of Diabetic Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Study.

BACKGROUND: Diabetic Peripheral Neuropathy (DPN) is a chronic complication in Type 2 Diabetes Mellitus (T2DM) patients and is characterized by paresthesia, pain, and hypoesthesia of the extremities. The Diabetic Neuropathy Symptom-Score (DNS) is a quick, inexpensive, and easy-to-perform tool to detect DPN in clinical practice. Biochemical markers like Nitric Oxide (NO) and Vascular Endothelial Growth Factor (VEGF) play a role in the early detection of DPN. This study aims to investigate the relationship between risk factors and these biomarkers. So, it is expected to improve the prevention and treatment of diabetic neuropathy more effectively. METHOD: A cross-sectional method was used for this study. The sample size was 85 patients with T2DM who visited several primary healthcare in Medan, selected by consecutive sampling method based on eligibility criteria. Data collected included DNS, assessment of NO, VEGF, Glycated Hemoglobin (HbA1C), plasma blood glucose (PBG), and lipid profile. The collected data were analyzed using an independent T-test. RESULT: The results showed that most T2DM patients, namely 73 people (85.9%), experienced DPN. From the bivariate analysis results, the risk factors associated with the prevalence of DPN in T2DM patients were found to be increased levels of total cholesterol, HbA1c, NO, and VEGF (p < 0.05). Meanwhile, blood pressure, fasting BGL, HDL-C, LDL-C, and triglycerides were not related to the occurrence of DPN in this study (p> 0.05). CONCLUSION: DNS can be used as a quick and easy initial screening tool implemented in clinical practice for screening DPN. Diabetic patients with DPN tend to have lower NO and increased VEGF; besides, NO levels are also associated with the progression of DPN. Furthermore, education, blood sugar control, and physical exercise, especially leg exercises, can prevent progressive DPN.

Educational Model and Prevention on Prediabetes: A Systematic Review.

BACKGROUND: Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future. METHODS: This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. RESULTS: Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review. CONCLUSION: Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.

Early detection of macrovascular complications in type 2 diabetes mellitus in Medan, North Sumatera, Indonesia: A cross-sectional study.

Background: Macrovascular complications occur very frequently in patients with type 2 diabetes mellitus (T2DM) with a high mortality rate, due to the development of cardiovascular disease (CVD), such as stroke, atherosclerosis acceleration, and atrial fibrillation. T2DM is a significant risk factor for CVD and has become the leading cause of death. The purpose of this study was to detect the early risk of macrovascular complications by using the ankle brachial index (ABI) as a marker. Methods: This study was an analytic study with a cross-sectional approach. The study population was patients with T2DM from several primary health care centers in Medan. In total, 89 subjects who met the inclusion and exclusion criteria were recruited with consecutive sampling. ABI was determined as the ratio of systolic blood pressure in the brachial artery to the posterior tibial artery after the subjects had been relaxed and felt comfortable in a supine position. Examination of vitamin D and lipid profile was derived from examination of venous blood.  Data were processed using SPSS and analyzed with one-way ANOVA. Results: The study found that there was a relationship between LDL-C, triglyceride, and vitamin D (25OH-D) based on the ABI (p > 0.05). Conclusions: ABI can be used for an early detection of macrovascular complications. Apart from being easy to perform, ABI was non-invasive. Some other risk factors that can also be used to assess complications and have relationships with ABI were LDL-C, triglyceride, and vitamin D (25OH-D). Complications in T2DM patients can be prevented with reasonable blood sugar control and lifestyle changes. Education and motivation need to be given to patients so that they become more independent in controlling their disease and improving their quality of life.

The Effectiveness of Acetone Breath Content Using Chitosan Based Sensor in Patients Diabetes Mellitus.

BACKGROUND: The high incidence of diabetes mellitus in Indonesia to encourage researchers to continue to develop detection techniques are easy, inexpensive and minimally invasive. This study is expected to answer the challenge. Detection tool used in this research is the detection devices use traditional breath acetone levels of chitosan-based sensors. Acetone breath sensor works based on the chemical interaction between the breath of patients with diabetes and acetone sensor surface, which causes a change in the electrical response. AIM: This study was cross-sectional using diabetes mellitus patients as research subjects by measuring breath acetone levels and HbA1c and KGD as a comparison. METHODS: Research conducted at the primary health care facilities network services the University Hospital of North Sumatra. A total of 58 diabetic patients who meet the inclusion and exclusion criteria were included in this study. The relationship between the measurements analysed using Pearson correlation test. RESULTS: Measurements showed that statistically there is a great relationship between breath acetone levels with or KGD HbA1c levels in the diabetic patient with each R = 0.05 and p = 0.708 for the relationship acetone breath and HbA1c and R = 0.1 and p = 0.445 for the relationship acetone breath and KGD. However, clinically there is a linear relationship between increased levels consistent acetone in the breath with increased HbA1c levels as well as levels of KGD. CONCLUSION: Examination of breath acetone levels can be considered as an indicator of diabetes detection.

Development and validation of prediabetes risk score for predicting prediabetes among Indonesian adults in primary care: Cross-sectional diagnostic study.

OBJECTIVE: To develop and validate a risk score model for recognizing prediabetes among Indonesian adults in primary care. METHODS: This was a cross-sectional diagnostic study. After excluding subjects with diabetes from Indonesian National Basic Health Survey (INBHS) data set, 21,720 subjects who have completed fasting plasma glucose test and aged >18 years were selected for development stage. About 6,933 subjects were selected randomly from INBHS for validation stage in different diagnostic criteria of prediabetes-based random plasma glucose. Logistic regression was used to determine significant diagnostic variable and the receiver operating characteristic analysis was used to calculate area under the curve (AUC), cutoff point, sensitivity, specificity, and predictive values. RESULTS: Age, sex, education level, family history of diabetes, smoking habit, physical activity, body mass index, and hypertension were significant variables for Indonesian Prediabetes Risk Score (INA-PRISC). The scoring range from 0 to 24, the AUC was 0.623 (95% CI 0.616-0.631) and cutoff point of 12 yielded sensitivity/specificity (50.03%/67.19%, respectively). The validation study showed the AUC was 0.646 (95% CI 0.623-0.669) and cutoff point of 12 yielded sensitivity/specificity (55.11%/65.81%, respectively). CONCLUSION: INA-PRISC, which consists of eight demographical and clinical variables, is a valid and a simple prediabetes risk score in primary care.