Ketut Suastika

First insulinization with basal insulin in patients with Type 2 diabetes in a real-world setting in Asia

Background:  The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin‐naïve Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation.

Uncoupling protein 2 gene polymorphisms are associated with obesity

BackgroundUncoupling protein 2 (UCP2) gene polymorphisms have been reported as genetic risk factors for obesity and type 2 diabetes mellitus (T2DM). We examined the association of commonly observed UCP2 G(−866)A (rs659366) and Ala55Val (C > T) (rs660339) single nucleotide polymorphisms (SNPs) with obesity, high fasting plasma glucose, and serum lipids in a Balinese population.MethodsA total of 603 participants (278 urban and 325 rural subjects) were recruited from Bali Island, Indonesia. Fasting plasma glucose (FPG), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were measured. Obesity was determined based on WHO classifications for adult Asians. Participants were genotyped for G(−866)A and Ala55Val polymorphisms of the UCP2 gene.ResultsObesity prevalence was higher in urban subjects (51%) as compared to rural subjects (23%). The genotype, minor allele (MAF), and heterozygosity frequencies were similar between urban and rural subjects for both SNPs. All genotype frequencies were in Hardy-Weinberg equilibrium. A combined analysis of genotypes and environment revealed that the urban subjects carrying the A/A genotype of the G(−866)A SNP have higher BMI than the rural subjects with the same genotype. Since the two SNPs showed strong linkage disequilibrium (D’ = 0.946, r2 = 0.657), a haplotype analysis was performed. We found that the AT haplotype was associated with high BMI only when the urban environment was taken into account.ConclusionsWe have demonstrated the importance of environmental settings in studying the influence of the common UCP2 gene polymorphisms in the development of obesity in a Balinese population.

Association of beta3-adrenergic receptor (ADRB3) Trp64Arg gene polymorphism with obesity and metabolic syndrome in the Balinese: a pilot study

BackgroundPrevalence of obesity is increasing all over the world. ADRB3 Trp64Arg gene polymorphism was proposed to be associated with obesity, although inconsistent findings and differences of the Arg64 allele frequency among various ethnics were reported. Westernization was reported to increase the prevalence of obesity in developing world. In this study we determined the prevalence of obesity and metabolic syndrome among urban and rural Balinese, and studied the association of ADRB3 Trp64Arg polymorphism with obesity and MetS.FindingsA total of 528 Balinese (urban 282, rural 246) were recruited. Body mass index (BMI) and waist circumference (WC) were determined; high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic and diastolic blood pressure (SBP and DBP), and fasting plasma glucose (FPG) were measured using standard procedures. BMI and WC classifications were based on WHO classifications for Asian. Metabolic syndrome (MetS) was defined as described in the Joint Interim Statement. Chi-square test was employed to test the association between the ADRB3 Trp64Arg genotype and disease traits.Urban have higher BMI (p = 2.8 × 10-13), WC ( p < 2.2 × 10-16), TG (p = 0.0028), DBP (p = 1.8 × 10-5), and lower HDL-C (p = 0.0376) when compared to rural. Abdominal obesity and MetS prevalence were significantly higher in urban as compared to rural (both p < 0.001). The Arg64 allele frequency was similar between urban (0.06) and rural (0.05). The Arg64 rural female carriers have higher BMI and WC as compared to their Trp64 counterparts (p = 0.041 for BMI and p = 0.012 for WC), and consequently higher abdominal obesity prevalence (p = 0.007). Comparison between male and female, as well as urban and rural, showed different prevalence of MetS co-morbidities. Abdominal obesity and hypertriglyceridaemia were consistently appeared in all groups, suggesting to play a role as determinant of MetS in both urban and rural.ConclusionsPrevalence of obesity and MetS in urban were two times higher when compared to rural. Abdominal obesity and hypertriglyceridaemia appears to be the key determinant of MetS in both urban and rural Balinese. Our results indicated an association of the ADRB3 Trp64Arg gene polymorphism with obesity in the rural female.

Coronary Heart Disease in a Remote Area

A study on coronary heart disease (CHD) in a remote area, Ceningan Island,was conducted.The nutrition states based on BMI were underweight,19.3%; normoweight, 54.9%; and overweight at risk, 13.3%; obese I, 9.5%; and obese II, 3.0%. The prevalence of impaired fasting glycemia (IFG), 15.1%; diabetes mellitus (DM), 6.9%; metabolic syndrome (MetS), 6.8%; and CHD, 11.5%. Age, systolic and diastolic blood pressure, levels of total cholesterol; low-density lipoprotein (LDL) cholesterol, apolipoprotein (Apo)A, ApoB, Apo B/A ratio were found higher among subjects with old myocardial infarction (OMI) than subjects without CHD; while BMI and waist circumference were lower among subjects with OMI than subjects without CHD. Conclusion: traditional risk factors such as age, blood pressure, and cholesterol, and Apo were related to CHD in the remote area.

Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases

© 2012 Suastika et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases

Polymorphisms of Aldose Reductase (ALR2) Regulatory Gene are Risk Factors for Diabetic Retinopathy in Type-2 Diabetes Mellitus Patients in Bali, Indonesia

Aim: The study aimed to elucidate whether the polymorphisms of the aldose reductase regulatory gene were risk factors for Diabetic Retinopathy (DR) in type-2 diabetes mellitus (T2DM) patients in Bali. Methods: This is a case-control study including 35 cases of T2DM patients with DR paired with 35 cases with non-DR as controls. PCR analysis and DNA-sequencing were carried out to detect the C(-106)T and C(-12)G polymorphisms at the regulatory region of Aldose Reductase (ALR2) gene. Genotype and allele distributions were analyzed by Chi-squared test and independent t-and Mann-Whitney U tests were used to analyze other data. Results: Among all subjects in both groups, the baseline characteristics were homogenous except for systolic blood pressure, fasting blood glucose and 2-hours post-prandial blood glucose. This study found two polymorphisms, C(-104)T and C(-9)G, in the regulatory region of ALR2 gene. The result showed that the C(-104)T polymorphism was a risk factor for DR (OR=36; 95% CI = 4.43-292.85; p=0.001), but not the C(-9)G polymorphism (OR=1.28; 95% CI=0.48-3.38; p=0.621). Other findings in the study revealed that CC/CC haplotype is a protective factor for DR (OR=0.198; p=0.002), whereas CT/CC and CT/CG haplotypes as risk factors for DR with OR=15.58; p=0.002 and OR=2.29; p=0.005 respectively. Conclusion: It can be concluded that C(-104)T polymorphism in the regulatory region of Aldose Reductase (ALR2) gene was the risk factor for DR among T2DM patients in Bali, Indonesia. However, small sample size, systolic blood pressure, fasting blood glucose and 2-hours post-prandial blood glucose could affect our finding.

Transcription factor 7-like 2 single nucleotide polymorphisms are associated with lipid profile in the Balinese

Transcription factor 7-like 2 (TCF7L2) protein plays an important role in glucose and lipid metabolisms. Single nucleotide polymorphisms (SNPs) in the TCF7L2 gene contribute to increased fasting plasma glucose (FPG) and body mass index (BMI), and altered lipid concentrations in various population. We investigated whether the TCF7L2 SNPs were associated with obesity, high FPG and altered lipid profile in the Balinese. A total of 608 Balinese from rural and urban Bali, Indonesia, were recruited. Triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and FPG were measured, and BMI was calculated. Ratios of TG/HDL-C, LDL-C/HDL-C, and TC/HDL-C were determined. Genotyping of SNPs rs7903146, rs10885406, and rs12255372 were done in all samples. Genetic association analyses under a dominant model showed that the rs7903146 (OR 5.50, 95% CI 2.34–12.91, p = 8.5 × 10−5), rs12255372 (OR 4.15, 95% CI 1.66–10.33, p = 0.003) and rs10885406 (OR 2.43, 95% CI 1.39–4.25, p = 0.003) were significantly associated with high TC/HDL-C ratio. The rs10885406 also presented a significant association with high TG (OR 2.21, 95% CI 1.29–3.81, p = 0.004) and low HDL-C (OR 3.02, 95% CI 1.58–5.80, p = 0.001) concentrations, as well as high TG/HDL-C ratio (OR 1.95, 95% CI 1.16–3.27, p = 0.013). None of the SNPs exhibited significant association with obesity or high FPG. SNPs in the TCF7L2 gene are associated with altered lipid profile in the Balinese.

Expert opinion on the applicability of dyslipidemia guidelines in Asia and the Middle East

Cardiovascular disease (CVD) is a growing burden across the world. In Asia and the Middle East, in particular, CVD is among the most prevalent and debilitating diseases. Dyslipidemia is an important factor in the development of atherosclerosis and associated cardiovascular events, and so effective management strategies are critical to reducing overall cardiovascular risk. Multiple dyslipidemia guidelines have been developed by international bodies such as the European Society of Cardiology/European Atherosclerosis Society and the American College of Cardiology/American Heart Association, which all have similarities in practice recommendations for the optimal management of dyslipidemia. However, they differ in certain aspects including pharmacological treatment, lifestyle modification and the target levels used for low-density lipoprotein cholesterol. The evidence behind these guidelines is generally based on data from Western populations, and their applicability to people in Asia and the Middle East is largely untested. As a result, practitioners within Asia and the Middle East continue to rely on international evidence despite population differences in lipid phenotypes and CVD risk factors. An expert panel was convened to review the international guidelines commonly used in Asia and the Middle East and determine their applicability to clinical practice in the region, with specific recommendations, or considerations, provided where current guideline recommendations differ from local practice. Herein, we describe the heterogeneous approaches and application of current guidelines used to manage dyslipidemia in Asia and the Middle East. We provide consensus management recommendations to cover different patient scenarios, including primary prevention, elderly, chronic kidney disease, type 2 diabetes, documented CVD, acute coronary syndromes and family history of ischemic heart disease. Moreover, we advocate for countries within the Asian and Middle East regions to continue to develop guidelines that are appropriate for the local population.

Polymorphism of exon 13 lgr8 gene as risk factors for cryptorchidism in children

Cryptorchidism refers to incomplete descend of the testes into the scrotum with the testes located in the normal tracts. The incident is 3-5% among infants born at term. The complications are infertility and testicular cancer. Cryptorchidism has a multifactorial aetiology and the role of exon 13 lgr8 gene polymorphism remains unclear. This study aims to find the frequency polymorphism of exon 13 lgr8 gene in children with cryptorchidism and to prove as a risk factor for cryptorchidism. This study is an observational case control study, conducted at the children’s in two general hospital and one maternity clinic from September 2010 until March 2011, with 31 children cryptorchidism as cases and 31 healthy children as controls who were matched by gestational age and age of the child. Polymorphism of exon 13 lgr8 gene was evaluated by sequencing of PCR results at YAYASAN GENEKA Eijkman Molecular Biology Institution Jakarta. Frequency was analyzed by percentage, polymorphism was analyzed by paired odds ratio and analyzed by computerized programmes, hypothesis with a confidence interval (a) was accepted if p<0,05. This study found a percentage of intraabdominal cryptorchidism of 41,94%, inguinal cryptorchidism of 41,94%, and prescrotal cryptorchidism of 16,12%. This study also found a frequency polymorphismof exon13 lgr8 gene (S337A = 54,84%; P340P = 41,94%; H345P = 61,29%; K346K = 90,32%; Q354K = 16,13%; Q356P = 29,03%; S357S = 48,39%). Polymorphisms S337A (TCA→ GCA) p = <0,001; H345P (CAC → CCC) p = 0,03; Q356P (CAG → CCG) p = 0,004; and S357S (TCT → TCC) p = <0,001 of exon 13 lgr8 gene were found significantly more often in cases. In summary polymorphism S357S is associated with a new marker; polymorphisms S337A; Q356P are associated with an increased risk; polymorphism H345P is associated with an increased risk or new marker of cryptorchidism in boys. This study is expected to be used in the determination of therapeutic decisions, as a guide for prognosis and as a foundation for further studies.

Hypomagnesemia is a risk factor for metabolic syndrome and type 2 diabetes mellitus in native Balinese

Objective To determine the prevalence of hypomagnesemia and the risk of hypomagnesemia on metabolic syndrome and type 2 diabetes mellitus events in native Balinese. Methods A cross-sectional population-based study was conducted in 111 subjects among native Balinese. Chi-square test was used to determine the prevalence risk (OR) of hypomagnesemia for metabolic syndrome and diabetes. Results Prevalence of hypomagnesemia was 17.1%. The prevalence of hypomagnesemia was higher in subjects with metabolic syndrome and type 2 diabetes mellitus than those without (34.7% vs. 12.5%, P = 0.025; and 60.0% vs. 15.1%, P = 0.035). Hypomagnesemia was a risk factor for metabolic syndrome (OR = 3.7; 95% CI, 1.28-10.83) and type 2 diabetes mellitus (OR = 8.4; 95% CI, 1.30-54.50). Conclusion The prevalence of hypomagnesemia is very high among native Balinese and hypomagnesemia is an important risk factor for metabolic syndrome and type 2 diabetes mellitus events in the population.