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Saco-Indonesia.com,- Satu demi satu misteri penyebab diabetes melitus tipe 2 mulai terungkap. Para peneliti Harvard School of Public Health (HSPH) baru saja memublikasikan temuan mereka bahwa ada satu jenis protein atau hormon khusus yang ditemukan dalam sel-sel lemak yang terbukti membantu mengatur bagaimana gula darah dikendalikan dan dimetabolisasi untuk energi di dalam hati. Ini dikatakan akan membuka salah satu jalan bagi pengobatan diabetes tipe 2 yang menjangkiti ratusan juta penduduk dunia.

Diabetes tipe ini tidak bergantung pada insulin dan terjadi pada orang-orang dewasa (adult onset), berbeda dengan diabetes tipe 1 yang bergantung pada insulin dan terjadi sejak bayi. Diabetes tipe 2 dapat didefinisikan sebagai suatu kelainan metabolik yang ditandai dengan tingginya kadar glukosa darah akibat terjadinya kekurangan dan resistansi insulin. Kemampuan sel-sel beta pankreas berkurang bahkan rusak sehingga pasien mulai mengalami diabetes, dengan gejala-gejala seperti banyak makan (polifagia), banyak minum (polidipsia), dan banyak kencing (poliuria).

Jumlah kasus diabetes tipe 2 hampir sepuluh kali lipat kasus diabetes tipe 1 yang terjadi karena kerusakan pankreas sejak bayi. Hingga sekarang diyakini bahwa kegemukan menjadi penyebab utama terjadinya diabetes tipe 2 pada orang-orang yang memang secara genetis sudah membawa gen pembawa penyakit ini.

Dua-tiga dekade lalu sudah diketahui adanya hubungan antara kegemukan dan diabetes tipe 2, tetapi belum jelas apakah kegemukan memicu diabetes jenis ini ataukah hanya mempercepat terjadinya. Riset di Amerika Serikat menunjukkan, orang-orang dengan obesitas tiga kali lebih mudah terjangkit diabetes dibandingkan dengan mereka yang tidak kegemukan. Makin tua seseorang, risiko terkena diabetes tipe 2 juga kian besar. Orang-orang berusia 65 tahun, misalnya, lebih mungkin terserang dibandingkan dengan mereka yang berusia di bawah 20 tahun.

Diabetes tipe 2 juga diketahui erat hubungannya dengan faktor keturunan. Jika dalam keluarga Anda ada yang mengidap diabetes, kemungkinan Anda terjangkit diabetes cukup besar.

Jika ayah atau ibu Anda dan kakek atau nenek serta bibi atau paman Anda menderita penyakit ini, peluang Anda mengalami diabetes tipe 2 mendekati 85 persen. Jika ayah dan nenek mengidap diabetes, risiko Anda cuma 60 persen. Jika hanya ibu yang menderita, maka 22 persen risikonya bagi Anda akan menderita pula.

Diabetes tipe 2 umumnya terjadi pada orang dewasa akibat perubahan gaya hidup, berkurangnya kegiatan jasmani, dan jenis makanan/minuman yang serba fast food dan soft drink. Namun, saat ini diabetes tipe 2 ditemukan juga pada anak- anak dan remaja di Asia.

Penyakit kronis ini diyakini menyebabkan usia harapan hidup bagi penderitanya sepuluh tahun lebih pendek dibandingkan dengan orang-orang non-diabetik akibat komplikasi penyakit jantung koroner, stroke, dan gagal ginjal. Diabetes tipe 2 juga menyebabkan kecacatan, seperti kebutaan akibat komplikasi retinopati dan meningkatnya risiko sebesar 20 kali amputasi tungkai bawah. Pengidap diabetes ini mudah lupa dan mengalami impotensi.

Multipatologi

Selama berpuluh tahun para peneliti dan dokter dihadapkan pada misteri: tidak semua orang yang kegemukan atau resistan terhadap insulin mengidap diabetes tipe 2. Bahkan, cukup banyak orang yang amat gemuk tak terserang penyakit ini. Para ilmuwan lalu berteori bahwa ada suatu faktor yang tak dikenal yang terlibat dalam metabolisme glukosa dalam hati, dan mungkin kehadiran atau absennya elemen ini, dapat menentukan siapa yang terkena diabetes tipe 2.

Dalam jurnal Cell Metabolism edisi 7 Mei 2013, para peneliti HSPH mengungkapkan, dunia ilmiah sudah lama mengetahui bahwa salah satu peristiwa kunci bagi berkembangnya diabetes tipe 2 adalah produksi glukosa yang tak terkontrol dari hati.

”Namun, mekanisme yang mendasarinya tetap masih sukar dipahami,” kata Gökhan S Hotamisligil, Kepala Departemen Genetika dan Penyakit-penyakit Kompleks, dan JS Simmons, profesor genetika dan metabolisme di HSPH. ”Kami sekarang berhasil mengidentifikasi aP2 sebagai suatu hormon baru yang dikeluarkan dari sel-sel lemak yang mengontrol fungsi kritis ini.”

Lewat percobaan dengan mencit di laboratorium memakai teknologi mutakhir ditemukan bahwa jika jumlah aP2 berlebih, timbullah diabetes. Sebaliknya, jika hormon ini diblok atau di- switch-off, produksi glukosa dari hati dapat dikontrol lebih baik sehingga manifestasinya berupa diabetes tipe 2 dan penyakit-penyakit metabolik lainnya pun dapat dicegah.

Kemampuan sebuah organ—dalam hal ini jaringan lemak—begitu langsung dan menentukan dalam mengendalikan tindakan organ lain, yaitu hati, amat menarik, kata Hotamisligil. ”Kami menduga sistem komunikasi antara jaringan lemak dan hati telah berevolusi untuk membantu sel-sel lemak memberi komando kepada hati untuk menyuplai tubuh dengan glukosa pada saat-saat terjadinya kekurangan nutrien. Betapa pun, ketika sel-sel lemak yang membesar kehilangan kendali terhadap sinyal ini karena kondisi obesitas, tingkat aP2 dalam darah naik, glukosa diguyurkan ke dalam aliran darah dan tidak dapat dibersihkan oleh jaringan-jaringan lain. Hasilnya adalah tingginya kadar glukosa darah dan diabetes 2.”

Guru Besar FK UI yang mendalami diabetes, Sidartawan Soegondo, menyatakan, temuan para ilmuwan Harvard ini merupakan sumbangan berarti bagi perkembangan ilmu kedokteran. ”Akhir-akhir ini saya mengajarkan bahwa diabetes tipe 2 adalah penyakit dengan multipatologi,” ujarnya ketika dihubungi pada Selasa (21/5). Kini, selain organ pankreas, diabetes tipe 2 diketahui pula dipicu juga oleh metabolisme sembilan organ lain, antara lain hati dan ginjal.

 

Sumber :Kompas Cetak/http://health.kompas.com/read/2013/05/22/06524140/Harapan.Baru.untuk.Terapi.Diabetes.Tipe.2
Editor :Liwon Maulana
Ada Harapan Baru untuk Terapi Diabetes Tipe 2

UNITED NATIONS — Wearing pinstripes and a pince-nez, Staffan de Mistura, the United Nations envoy for Syria, arrived at the Security Council one Tuesday afternoon in February and announced that President Bashar al-Assad had agreed to halt airstrikes over Aleppo. Would the rebels, Mr. de Mistura suggested, agree to halt their shelling?

What he did not announce, but everyone knew by then, was that the Assad government had begun a military offensive to encircle opposition-held enclaves in Aleppo and that fierce fighting was underway. It would take only a few days for rebel leaders, having pushed back Syrian government forces, to outright reject Mr. de Mistura’s proposed freeze in the fighting, dooming the latest diplomatic overture on Syria.

Diplomacy is often about appearing to be doing something until the time is ripe for a deal to be done.

 

 

Now, with Mr. Assad’s forces having suffered a string of losses on the battlefield and the United States reaching at least a partial rapprochement with Mr. Assad’s main backer, Iran, Mr. de Mistura is changing course. Starting Monday, he is set to hold a series of closed talks in Geneva with the warring sides and their main supporters. Iran will be among them.

In an interview at United Nations headquarters last week, Mr. de Mistura hinted that the changing circumstances, both military and diplomatic, may have prompted various backers of the war to question how much longer the bloodshed could go on.

“Will that have an impact in accelerating the willingness for a political solution? We need to test it,” he said. “The Geneva consultations may be a good umbrella for testing that. It’s an occasion for asking everyone, including the government, if there is any new way that they are looking at a political solution, as they too claim they want.”

He said he would have a better assessment at the end of June, when he expects to wrap up his consultations. That coincides with the deadline for a final agreement in the Iran nuclear talks.

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Whether a nuclear deal with Iran will pave the way for a new opening on peace talks in Syria remains to be seen. Increasingly, though, world leaders are explicitly linking the two, with the European Union’s top diplomat, Federica Mogherini, suggesting last week that a nuclear agreement could spur Tehran to play “a major but positive role in Syria.”

It could hardly come soon enough. Now in its fifth year, the Syrian war has claimed 220,000 lives, prompted an exodus of more than three million refugees and unleashed jihadist groups across the region. “This conflict is producing a question mark in many — where is it leading and whether this can be sustained,” Mr. de Mistura said.

Part Italian, part Swedish, Mr. de Mistura has worked with the United Nations for more than 40 years, but he is more widely known for his dapper style than for any diplomatic coups. Syria is by far the toughest assignment of his career — indeed, two of the organization’s most seasoned diplomats, Lakhdar Brahimi and Kofi Annan, tried to do the job and gave up — and critics have wondered aloud whether Mr. de Mistura is up to the task.

He served as a United Nations envoy in Afghanistan and Iraq, and before that in Lebanon, where a former minister recalled, with some scorn, that he spent many hours sunbathing at a private club in the hills above Beirut. Those who know him say he has a taste for fine suits and can sometimes speak too soon and too much, just as they point to his diplomatic missteps and hyperbole.

They cite, for instance, a news conference in October, when he raised the specter of Srebrenica, where thousands of Muslims were massacred in 1995 during the Balkans war, in warning that the Syrian border town of Kobani could fall to the Islamic State. In February, he was photographed at a party in Damascus, the Syrian capital, celebrating the anniversary of the Iranian revolution just as Syrian forces, aided by Iran, were pummeling rebel-held suburbs of Damascus; critics seized on that as evidence of his coziness with the government.

Mouin Rabbani, who served briefly as the head of Mr. de Mistura’s political affairs unit and has since emerged as one of his most outspoken critics, said Mr. de Mistura did not have the background necessary for the job. “This isn’t someone well known for his political vision or political imagination, and his closest confidants lack the requisite knowledge and experience,” Mr. Rabbani said.

As a deputy foreign minister in the Italian government, Mr. de Mistura was tasked in 2012 with freeing two Italian marines detained in India for shooting at Indian fishermen. He made 19 trips to India, to little effect. One marine was allowed to return to Italy for medical reasons; the other remains in India.

He said he initially turned down the Syria job when the United Nations secretary general approached him last August, only to change his mind the next day, after a sleepless, guilt-ridden night.

Mr. de Mistura compared his role in Syria to that of a doctor faced with a terminally ill patient. His goal in brokering a freeze in the fighting, he said, was to alleviate suffering. He settled on Aleppo as the location for its “fame,” he said, a decision that some questioned, considering that Aleppo was far trickier than the many other lesser-known towns where activists had negotiated temporary local cease-fires.

“Everybody, at least in Europe, are very familiar with the value of Aleppo,” Mr. de Mistura said. “So I was using that as an icebreaker.”

The cease-fire negotiations, to which he had devoted six months, fell apart quickly because of the government’s military offensive in Aleppo the very day of his announcement at the Security Council. Privately, United Nations diplomats said Mr. de Mistura had been manipulated. To this, Mr. de Mistura said only that he was “disappointed and concerned.”

Tarek Fares, a former rebel fighter, said after a recent visit to Aleppo that no Syrian would admit publicly to supporting Mr. de Mistura’s cease-fire proposal. “If anyone said they went to a de Mistura meeting in Gaziantep, they would be arrested,” is how he put it, referring to the Turkish city where negotiations between the two sides were held.

Secretary General Ban Ki-moon remains staunchly behind Mr. de Mistura’s efforts. His defenders point out that he is at the center of one of the world’s toughest diplomatic problems, charged with mediating a conflict in which two of the world’s most powerful nations — Russia, which supports Mr. Assad, and the United States, which has called for his ouster — remain deadlocked.

R. Nicholas Burns, a former State Department official who now teaches at Harvard, credited Mr. de Mistura for trying to negotiate a cease-fire even when the chances of success were exceedingly small — and the chances of a political deal even smaller. For his efforts to work, Professor Burns argued, the world powers will first have to come to an agreement of their own.

“He needs the help of outside powers,” he said. “It starts with backers of Assad. That’s Russia and Iran. De Mistura is there, waiting.”

With Iran Talks, a Tangled Path to Ending Syria’s War

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