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W. Riski Widya Mulyani,1 Made Indira Dianti Sanjiwani,1 Sandra,1 I Putu Yuda Prabawa,2 Anak Agung Wiradewi Lestari,2 Desak Made Wihandani,3 Ketut Suastika,4 Made Ratna Saraswati,4 Agha Bhargah,1,5 Ida Bagus Amertha Putra Manuaba6,7 1Faculty of Medicine, Universitas Udayana, Bali, Indonesia; 2Department of Clinical Pathology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia; 3Department of Biochemistry, Faculty of Medicine, Universitas Udayana, Bali, Indonesia; 4Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia; 5Cardiology Department, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital, Bali, Indonesia; 6International Ph.D Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 7Medical and Health Education Unit, Faculty of Medicine, Universitas Udayana, Bali, IndonesiaCorrespondence: Anak Agung Wiradewi LestariDepartment of Clinical Pathology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, IndonesiaEmail wiradewilestari@gmail.comAbstract: Type 2 diabetes mellitus (T2DM) is still a global health problem. Current T2DM treatments are limited to curing the symptoms and have not been able to restore insulin sensitivity in insulin-sensitive tissues that have become resistant. In the past decade, some studies have shown the significant role of a chaperone family, heat shock protein 70 (HSP70), in insulin resistance pathogenesis that leads to T2DM. HSP70 is a cytoprotective molecular chaperone that functions in protein folding and degradation. In general, studies have shown that decreased concentration of HSP70 is able to induce inflammation process through JNK activation, inhibit fatty acid oxidation by mitochondria through mitophagy decrease and mitochondrial biogenesis, as well as activate SREBP-1c, one of the lipogenic gene transcription factors in ER stress. The overall molecular pathways are potentially leading to insulin resistance and T2DM. Increased expression of HSP70 in brain tissues is able to improve insulin sensitivity and glycemic control specifically. HSP70 modulation-targeting strategies (including long-term physical exercise, hot tub therapy (HTT), and administration of alfalfa-derived HSP70 (aHSP70)) in subjects with insulin resistance are proven to have therapeutic and preventive potency that are promising in T2DM management.Keywords: type 2 diabetes mellitus, HSP70, insulin resistance

Ketut Suastika,1 I Made Siswadi Semadi,1 I Made Pande Dwipayana,1 Made Ratna Saraswati,1 Wira Gotera,1 Anak Agung Gde Budhiarta,1 Kinuyo Matsumoto,2 Naemi Kajiwara,2 Hiroshi Taniguchi31Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia; 2Graduate School of Life Science, Kobe Women’s University, Kobe, Japan; 3Department of Diabetology, Graduate School of Health Sciences, Kobe University, Kobe, JapanCorrespondence: Ketut SuastikaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah Hospital, Jalan Kamboja, Denpasar, Bali, IndonesiaTel +62 81 138 0916Email ksuas@unud.ac.idPurpose: To establish the lipid pattern in subjects with diabetes mellitus (DM) and factors that are correlated with insulin resistance and lipid disorders in a population of Bali.Methods: A cross-sectional population-based study which enrolled 1840 subjects (age 13–100 years) from 7 villages was carried out. Several clinical parameters were measured including age, gender, body mass index, waist circumference (WC), fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A (apoA), apoB, non-HDL-C, T/HDL-C ratio, LDL-C/apoB ratio, apoB/A ratio, plasma insulin, and homeostasis of model assessment-insulin resistance (HOMA-IR).Results: TC, TG, and non-HDL-C levels were higher in DM subjects than in normal glucose tolerance (NGT) subjects in both genders; total/HDL-C ratio was higher in subjects with DM than in NGT subjects only in men; LDL-C levels, apoB levels, and apoB/A ratios were higher and LDL/apoB was lower in subjects with DM than in NGT in women. In subjects with DM, the target for LDL-C (79%), non-HDL-C (85.2%), apoB (80%), HDL-C (34.9%), TG (46.7%), and small-dense low density lipoprotein (42.2%) was not achieved.Conclusion: FBG was correlated with TC, TG, LDL-C, apoB, non-HDL-C levels, LDL/apoB, and apoB/apoA ratios. Subjects with DM had higher levels of TC, TG, and non-HDL-C levels in both genders; T/HDL-C ratio only in men; LDL-C, apoB/apoA ratio and lower LDL/apoB ratio only in women. Obesity was correlated with lipid levels. WC was correlated with LDL/apoB ratio, insulin level, HOMA-IR, and TG; highest absolute strength of correlation was with LDL/apoB ratio. Insulin resistance was correlated with lipid levels or ratios, especially in women. In women, HOMA-IR had a positive correlation with total/HDL-C ratio, non-HDL-C, apoB, and a negative correlation with HDL-C levels.Keywords: HOMA-IR, dyslipidemia, diabetes

BackgroundDiabetes is a metabolic disease that caused by insulin disturbances that leads to hyperglycemia.AimsThis meta-analysis intends to evaluate remission, either partial or complete of T2DM, from bariatric surgery compared to control group.MethodEligible publication was screened using inclusions: 1) minimal 1 month participant follow up post intervention; 2) compared to a control group; 3) carried with English language; 4) published at least from 2008, and; 5) involved clinical studies phase 1 until 3. Any situation which altered endocrinologic status was made the study invalid, thus not included. Abstracts only papers, case reports, letters, comments, or reviews; animal studies; duplicate studies; no surgical intervention; and no population of interest were the exclusions. Studies were searched using keywords: (Diabetes mellitus) AND (Remission) AND (Bariatric Surgery, RYGB) in several database of Cochrane Central Register of Controlled trials, Current Controlled Trials,ClinicalTrials.gov, EMBASE, Elsevier, Nature and Google Scholar. All papers were reviewed using critical appraisal for clinical trials by Centre for Evidence Based Medicine Oxford University while risk of bias determined by Cochrane Handbook for Systematic Reviews of Interventions. The final eleven literatures were entered into review manager 5.3 and Graph Prism 8. The mean value of HbA1c before and after treatment, and prevalence remission between treated with untreated group were compared. Data was analysed using mean and risk difference with fixed and random effects model to avoid heterogeneity, according to guidelines for statistical reporting and the Cochrane Handbook for Systematic Reviews of Interventions. Heterogeneity was determined as significant at P

ABSTRACTBackgroundThere is general agreement to ensure promising result of mesenchymal stem cell therapy in diabetes, considering the risk and benefit based on evidence.AimsThis meta analysis aimed to evaluate clinical effect of mesenchymal stem cell in diabetes mellitus in both type.MethodsScreening of eligible publication was done independently by authors, in accordance inclusion criterias such as: 1) written in English; 2) participants were being supervised for at least 1 month; 3) compared to standard treatment group; 4) study was published from 2008 and onwards; 5) the paper employed randomized controlled trials method, and; 6) any situation which altered endocrinology status was excluded. All studies were reviewed using critical appraisal for clinical trials made by Centre for Evidence-Based Medicine Oxford University and risk of bias was determined using Cochrane Handbook for Systematic Reviews of Interventions. Selected papers was entered into Review Manager 5.3 and Graph Prism 8. Mean value of HbA1c was compared between before and after treatment, while u226550% decrease of insulin requirement was compared between a control group and the intervention group. Data was analyzed using mean and risk difference with fixed effects model to avoid heterogeneity. Heterogeneity was determined as significant at P