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Abstrak :
ABSTRACT
Multidiscipline care is defined as a care consisting of at least a physician, a nurse, and other healthcare worker (eg. dietician). Multidiscipline care has generated benefits, both in medical aspects (eg. increasing patients compliance) and nonmedical aspects (eg. more cost-effective than conventional treatment). There are several models of multidiscpline care; however, which model is more suitable for type 2 diabetes care is not clear yet. In this review, we aimed to identify and compare multidiscipline care method for reducing glycated hemoglobin ( HbA1C) levels in type 2 diabetes patients, particularly Asian patients because they have greater tendency to develop type 2 diabetes at lower degrees of obesity and at younger ages than Caucasian ethnic group. There were limited number of studies examining multidiscipline care for type 2 diabetes patients, moreover for Asian patients. They showed mixed results on the efficacy of multidiscipline care in achieving HbA1C target. Healthcare personnel visit, either personal or group session, appeared effective both for general and Asian T2DM patients. It needs further studies to clarify which models are most effective for practices of varying cultures, socio-economic condition, and healthcare settings.

Abstrak :
Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK. ......Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG.

Abstrak :
Diabetes Melitus tipe 2 merupakan sekumpulan gangguan metabolik dengan karakteristik hiperglikemia. Komplikasi klinis akibat DM berkolerasi dengan status glikemik, sehingga diperlukan upaya pengontrolan status glikemik pasien DM, baik jangka pendek, jangka menengah maupun jangka panjang untuk mencegah atau mengurangi komplikasi progresif akibat penyakit tersebut. Parameter laboratorium untuk pemantauan status glikemik meliputi kadar glukosa darah harian, HbA1c, dan albumin glikat (AG). Penelitian ini bertujuan untuk mendapatkan gambaran kadar HbA1c dan kadar AG pada pasien DM tipe 2 tidak terkontrol, mendapatkan korelasi antara kadar HbA1c dan kadar AG, juga melihat penurunan kadar HbA1c dan AG sesudah terapi 1 dan 3 bulan. Penelitian dilakukan dengan desain studi diagnostik, yang melibatkan 32 subyek penelitian yang diikuti selama 3 bulan mulai bulan Februari hingga Mei 2014. Diagnosis DM tipe 2 ditegakkan oleh dokter Spesialis Penyakit Dalam dan diagnosis DM tipe 2 tidak terkontrol didapatkan dari hasil pemeriksaan HbA1c > 7 %. Hasil penelitian mendapatkan rerata (SD) kadar glukosa darah puasa bulan ke-0, ke-1, dan ke-3 berturut-turut sebesar 170,5(51,6) mg/dL; 162,7(54,6) mg/dL, dan 147,3(45,9) mg/dL. Median (rentang) kadar glukosa darah 2 jam postprandial l(G2PP) bulan ke-0 dan ke-1 sebesar 220 mg/dL (90-544) mg/dL dan 191,5 mg/dL (114-468) mg/dL; rerata(SD) kadar G2PP bulan ke-3 sebesar 201(65,98) mg/dL. Korelasi antara kadar HbA1c dan kadar AG adalah : pada bulan ke-0, r=0,79, p<0,001, bulan ke-1 r=0,74, p<0,001 dan bulan ke-3 r=0,78, p<0,001. Penurunan kadar HbA1c dari baseline (delta-1) dan pada bulan ke-3 (delta-3) adalah median (rentang) delta-1 sebesar 0,43% (0,35-0,74)%, p<0,001 dan median (rentang) delta-3 sebesar 0,89% (0,64-2,30)%, p<0,001. Penurunan kadar AG bulan ke-1 dari baseline (delta-1) dan pada bulan ke-3 (delta-3): median (rentang) delta-1 sebesar 0,94% (0,48-1,64)%, p<0,001, dan median (rentang) delta-3 sebesar 1,79% (0,33-1,40)%, p<0,001. Kami menyimpulkan bahwa terdapat korelasi positif bermakna antara kadar HbA1c dan kadar AG pada bulan ke-0, ke-1, dan ke-3, dengan kekuatan korelasi kuat (r = 0.7-0.8), selain itu terdapat penurunan kadar HbA1c dan AG yang bermakna sesudah terapi 1 dan 3 bulan. ......Type 2 diabetes mellitus (T2DM) is a group of metabolic disorders with hyperglycemic characteristic. Clinical complications of DM correlate with glycemic state, therefore it is necessary to make an effort to control DM glycemic state, in short-, medium-, and long-term to prevent or minimize progressive complications due to the disease. Laboratory parameters to monitor glycemic state include daily blood glucose, HbA1c, and glycated albumin (GA). This study aimed to obtain HbA1c and GA levels in uncontrolled type 2 DM patients, the correlations between HbA1c and GA levels, and also the decrease in HbA1c and GA levels after 1 month and 3 months treatment. This was a diagnostic study involving 32 subjects that were followed for 3 months from February to May 2014. Type 2 DM was diagnosed by the internist in the Department of Internal Medicine and the uncontrolled type 2 DM was confirmed by HbA1c measurement of > 7%. The results showed that mean (SD) fasting blood glucose levels at baseline, 1 month and 3 months were 170.5 (51.6) mg/dL; 162.7 (54.6) mg/dL, and 147.3(45.9) mg/dL, respectively. Median (range) 2 hours postprandial blood glucose levels at baseline and 1 month respectively, were 220 mg/dL (90-544) mg/dL and 191.5 mg/dL, respectively, and mean (SD) at 3 months was 201,7 (65,98) mg/dL. Correlations between HbA1c and GA levels : at baseline r =0.79, p<0.001, at 1 month r=0.74, p<0.001 and at 3 months r=0.78, p<0.001. Decreases of HbA1c level from baseline, at 1 month (delta-1) and at 3 months (delta-3) : median (range) delta-1was 0.43% (0.35-0.74)%, p<0.001 and median (range) delta-3 was 0.89% (0.64-2.30)%, p<0.001. Decreases of GA level from baseline, at 1 month (delta-1) and at 3 months (delta-3) : median (range) delta-1 was 0.94%(0.48-1.64)%, p<0.001, and median (range) delta-3 was 1.79%(0.33-1.40)%, p<0.001. We concluded that there were significant positive correlations between HbA1c and GA levels at baseline,1 month and 3 months, with strong correlations (r=0.7-0.8). In addition, there were also significant decreases in HbA1c and GA levels from baseline at 1 month and 3 months therapy.