Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.
Investigating the function of combining induced rat monocytes-derived bone marrow-haemopoietic stem cell (rat BM-HSCs) with LPS and rat bone marrow-mesenchymal stem cell (rat BM-MSCs) wasto analyze the acceleration of homing process mechanism in injured pancreas. Mononucleated stem cells were isolated from aspirated whole rat BM using ficoll and cultured in α-MEM complete growth medium in 10 cm petridish. After two days, adherent cells after washing twice in petridish were added α-MEM growth medium and then mesenchymal cells were characterized using CD105 marker in third passage and labeled PKH26. Then haemopoietic stem cells (HSCs) were isolated with magnetic beads CD34+ and differentiated in vitro, and then induced monocytes with LPS. Animal experiment used 28 male Wistar rats, and divided them into 4 groups. After transplantation combined, both cells between monocyte derived HSc (mHSCs) and rat BM-MSC were analyzed expression of pair box gen 4 (Pax4), pancreatic and duodenal homeobox (Pdx1), C-peptide using immunohistochemistry, then secretion of insulin and C-peptide analyzed using in-direct ELISA. Results showed that the expressions of Pax4, Pdx1, C-peptide found in the surface membrane cell F. A. Rantam et al. 334 of pancreatic cell, and secreted C-peptide and insulin were shown significant (P < 0.05) in transplanted group 2, 3 and 4, but in group 3 were transplanted with combined cells more dominant than non-combined cells. Conclusions suggested that combining of induced monocytes-derived HSCs and rat BM-MSCs has accelerated homing MSCs into injured pancreatic tissue.
BackgroundRecent evidence has demonstrated that the increased risk of mortality in rheumatoid arthritis (RA) patients is largely related to cardiovascular disease (CVD). Overall, RA increases the risk of cardiovascular (CV) mortality by up to 50% for reasons which are insufficiently understood. Chronic inflammation may impair vascular function and lead to increase of arterial stiffness. Measurement of arterial stiffness provide an independent risk factor of CV mortality and morbidity. Brachial pulse-wave velocity (BPWV) is a reproducible method to estimate of arterial stiffness. Whether the disease activity or duration of illness has more contribution in arterial stiffness of RA patients is still controversial.ObjectivesTo investigate the correlation of disease activity and duration of illness in RA patients with pulse-wave velocity as a measure of arterial stiffness, free of cardiovascular disease and risk factors.MethodsRA patients aged 55 years-old or younger were screened for the absence of clinical cardiovascular disease or risk factors (diabetes mellitus, dyslipidemia, hypertension, chronic kidney disease, smoking, obesity, cancer, prolong infections, excessive steroid use, or other inflammatory diseases). Patients were subjected to full history taking, clinical examination, and laboratory investigations including serum lipid profile, CRP, and ESR. Then they were recorded for their brachial pulse-wave velocity using PWV Sphygmograph.ResultsThere were 30 suitable patients (all were female, mean age was 44.17 ± 7.98 years-old, mean duration of illness was 1.88 ± 0.94 years). Average systolic blood pressure was 121.67 ± 7.46 mmHg, mean diastolic pressure was 74.00 ± 4.98 mmHg. Average body mass index was 22.43 ± 1.18. Mean DAS28-ESR was 3.29 ± 1.32, and mean DAS28-CRP was 3.30 ± 4.02. Average of BPWV was 14.44 ± 3.86 m/s. This study did not show any correlation between duration of illness and arterial stiffness (p=0.832). But it revealed moderate correlation between disease activity (either DAS28-ESR or DAS28-CRP) with arterial stiffness (r=0.441 with p=0.015 and r=0.501 with p=0.005).ConclusionThis preliminary suggests that disease activity of RA is correlated with arterial stiifness free of cardiovascular disease or risk factors. But duration of illnes does not show any correlation with arterial stiffness as believed before, it may need more sample size to determine that. This findings support the importance of inflammation control in RA patients not just to improve quality of life but also to decrease cardiovascular mortality in RA.References[1] Klocke R, Cockcroft JR, Taylor GJ, Hall IR, Blake DR. Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Ann Rheum Dis2003; 62:414-418.[2] Provan SA, Angel K, Semb AG, Mowinckel P, Agewall S, Star D, Kvien TK. Early prediction of increased arterial stiffness in patients with chronic inflammation: A 15-year followup study of 108 patients with rheumatoid arthritis. The J of Rheumatol 2011; 38:606-612.[3] Avina-...
BACKGROUND: Perspectives of diabetes mellitus patients on family support received during the treatment of their disease at home has high complexity. The family’s intention to help patients to take care of themselves at home can lead to misperceptions or is not well accepted by diabetes mellitus patients. AIM: The aim of the study was to explore the support provided by families in the care of diabetes mellitus patients at home based on the patient’s perspective. METHODS: A phenomenological study using semi-structured questions was chosen as a design in this study. A total of 19 participants were recruited using criteria including being diagnosed with diabetes mellitus for at least 1 year, outpatient, and willing to participate in the study. Data analysis used seven steps of descriptive phenomenological analysis from Colaizzi including data recognition, identification of significant statements, formulating meanings, grouping themes, developing complete descriptions, producing fundamental structures, and seeking verification of fundamental structures. RESULTS: This research shows that the support needed by participants comes from the nuclear family. The first theme identified is the family function as participants’ perceived support. The second theme identified is the family role as participants’ perceived support. The fourth third theme identified is perceptions of family support received. Moreover, the final theme found in this study is perception of spiritual support by the family. CONCLUSION: This research implies that diabetes mellitus patients need support from their families to accept the disease and eventually volunteer to carry out their disease care at home.
Introduction: Diabetes mellitus is a metabolic syndrome that is marked by higher blood glucose. The uncontrolled high blood glucose can lead to complication, such as diabetic foot. Diabetic foot is the most reason why diabetic patients are hospitalized. Diabetic foot that cannot heal may lead to lower extremity amputation. The purpose of this study was to describe the risk factors of lower extremity amputation in diabetic foot ulcer patients.Methods: This study used a case-control study of diabetic foot patients in Dr. Soetomo General Hospital from January 2015 to December 2017. This study used the data from medical records in Inpatient Installation Department of Internal Medicine. Patients with diabetic foot ulcer and lower extremity amputation due to diabetes were included in this study. Incomplete medical records were excluded. Data of samples were divided to two groups, i.e. the amputation group and the non-amputation group with a ratio of 1:1. Risk factors of amputation that were analyzed were male, old age, and the history of ulcer/lower extremity amputation.Results: Based on the data of 36 samples, there were 11 male patients (61.1%) and 7 female patients (38.9%) who experienced lower extremity amputation. The average age of amputation group was 59.61 years old with a range of ages from 39 to 72 years old. This study found the risk factors for lower extremity amputation in diabetic foot ulcer patients was the history of ulcer/amputation due to diabetes (OR 5.0, 95% CI 1.065-23.464, p = 0.034). Conclusion: The risk factor for lower extremity amputation in diabetic foot ulcer patients was the history of ulcer/amputation due to diabetes.
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