Objective: To evaluate the anti-diabetic potential of leaf extract from Urena lobata (U. lobata) through dipeptidyl peptidase IV (DPP-IV) inhibitory activity. Methods: U. lobata leaf was extracted in hot water and ethanol. The activity of DPP-IV inhibitor was tested by in vitro study using gly-pro-p-nitroanilide as substrat of DPP-IV and vildagliptin, as standard reference. A product of the reactions between gly-pro-pnitroanilide and DPP-IV, was observed by microplate readers with λ = 405 nm. All data were expressed as mean ± SD and the IC50 value was determined by non linear regression curve fit. Active substances in leaf extract of U. lobata was analyzed by liquid chromatography-mass spectrometry. DPP-IV inhibitory activity of active compounds was evaluated in silico using docking server. Results: The ethanolic extract of U. lobata showed stronger DPP-IV inhibitor activity than water extract with the IC50 values of 1 654.64 and 6 489.88 mg/mL, respectively. Vildagliptin, based on standard reference for DPP-IV inhibitor activity, has IC50 value of 57.44 μg/mL. Based on in silico analysis, mangiferin, stigmasterol and β-sitosterol in U. lobata extract have a strong inhibitory activity on DPP-IV. Conclusions: The results showed that DPP-IV inhibitory activity of U. lobata is related to its active compounds such as mangiferin, stigmasterol and β-sitosterol.

Background: Indonesia is amongst the top 10 countries with the highest prevalence of Type 2 Diabetes Mellitus (T2DM) at 10.8%. However, the distinguishable features of T2DM in Indonesia remain obscure. Therefore, the DISCOVER study aimed to describe the characteristics of T2DM patients, associated vascular complications and treatment in Indonesia. Methodology: DISCOVER study is a multi-country, multicenter, prospective, cohort study over 3 years. In the present study, the data were collected from 13 sites from clinical practice, hospitals and public health facilities in Indonesia. Results: A total of 221 subjects were recruited with a mean age of 55.6 ± 9.8 years and body mass index (BMI) of 26.4 ± 4.4 kg/m2. Over 40% of patients had hypertension and/or hyperlipidemia. The mean duration of T2DM was 58.3 ± 62.0 months while the mean HbA1c levels was 9.2 ± 2%. In total, 82.4% completed the study within a 36-month follow-up period. BMI remained elevated i.e., >25 kg/m2. A significant reduction was observed in HbA1c levels as compared to baseline (9.2 ± 2% to 8.1 ± 1.8%). T2DM-associated microvascular complications such as peripheral neuropathy, albuminuria and chronic kidney disease were observed in 17.2%. Macrovascular complications including coronary artery disease and heart failure were seen in 26.2% of patients. We also found that more than 70% of patients were on metformin and/or sulfonylurea. Conclusion The features of patients with T2DM in Indonesia were high BMI, with hypertension and hyperlipidemia as co-morbidities. Metformin and sulfonylureas were the most common treatment. HbA1c reduction during follow-up did not reach recommended target. Thus, early detection and intervention using available glucose-lowering medications and aggressive management of risk factors and complications are essential to improve outcomes of diabetes management in Indonesia.
diabetes type 2 ; vascular complications ; Indonesia

Acute adrenal insufficiency (AI) is a life-threatening condition. While Addison’s disease (AD) is rare, in developing countries, tuberculosis (TB) still remains as the primary cause in 7 to 20% of cases. Urinary TB is also the third most common form of extrapulmonary disease. We report a case of 37-year-old male who presented with weakness, anorexia, weight loss, dysuria, flank pain and low grade fever. Examination revealed hypotension, hyperpigmentation, hyponatremia, hypoglycemia and low serum cortisol. He was diagnosed to have adrenal crisis due to Addison’s disease and extrapulmonary TB manifesting as urinary tract infection (UTI). He was treated with corticosteroids and anti-TB medications. Urologic reconstructive surgery was subsequently planned.
Addison Disease ; Tuberculosis