Muhamad Shafiq Advani has graduated from Medical School in 2017 from University of Indonesia. He has also completed his Master’s degree in Medical Research in Stem Cells and Regenerative Medicine in 2015 from Newcastle University. He is currently a General Practitioner Intern.
Background: According to International Diabetes Foundation (IDF), there were 9.1 million people in Indonesia have type-2 diabetes in 2014, the fifth biggest in the world. In addition, since diabetes is a multifactorial disease, the treatment needs to be holistic and comprehensive to control the progressiveness of the disease. One of the treatment pillars is controlled diet as diabetic people have hyperglycemia. This raises a question whether ketogenic diet, that only includes low number of carbohydrate which responsible for blood sugar level is superior to conventional low-calorie diet to control blood sugar monitored by HbA1c level. Objective: To compare the effect of ketogenic diet and low-calorie diet in reducing HbA1c among people with type-2 diabetes with overweight to obese weight. Method: PubMed and Cochrane were used for literature browsing. Articles were then selected based on inclusion and exclusion criteria. Selected articles were assessed with Oxford CEBM critical appraisal tools. Result: One quasi-experiment study and one randomized controlled trial were obtained. Both studies are applicable with similar validity and show p-values: <0.0001 and <0.03, respectively in reduction of HbA1c in ketogenic diet group. Conclusion: Ketogenic diet can be applied as an alternative of conventional diet to reduce HbA1c level faster in type-2 diabetes patients with overweight to obese weight.
Uttam Kumar Dey has completed his MBBS from Dhaka Medical College in 2003. He has been serving diabetic patients in BIRDEM Hospital since 2005. He has received Fellowship from American College of Clinical Endocrinology in 2016. He is a Life Member of BSM, ISSM, AACE and has several publications to his credit.
50 cases of acute renal failure aged 21-80 years were prospectively studied in the Department of Nephrology, BIRDEM from November 2009 to September 2010 to know the clinical course and outcome in them. All patients were diabetic, out of them 22 were male and 28 were female. Acute diarrhea and vomiting was found to be the commonest cause of ARF (54%). Other causes being drug induced (34%), septicemia (6%), RPGN (4%) and obstructive uropathy (2%) in order of frequency. Pre-renal cause therefore constituted 80% etiology. Anuria (38%) and oliguria (20%) were the commonest mode of presentation. Gastrointestinal symptoms were present in 54% of cases and about 10% patients had neurological symptoms in the form of drowsiness. Hypertension was also a common accompaniment (24%). Blood biochemistry was the main parameter of diagnosis and management which included blood urea, creatinine and electrolyte estimation. Mean urea and creatinine level on admission being 133.44±80.88 mg/dl and 5.2±2.65mg/dl, respectively. Hyperkalemia was present in 46% cases and acidosis was a constant finding in all cases. Routine urine examination, plain X-ray abdomen, ultrasonography were all useful investigations in some cases for diagnosis. Hemodialysis (done in 52%) along with conservative therapy was the main and effective mode of treatment in our study. Rest of the patients were managed with only conservative therapy which was mainly fluid and electrolyte balance. Out of 50 patients 2 (4%) died. 7 patients suffered irreversible cortical necrosis and was on hemodialysis. 32 (64%) patients gained complete or near complete recovery while remaining 9 (18%) recovered with some residual damage without any renal replacement therapy.