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All Journal Eureka Herba Indonesia Sriwijaya Journal of Internal Medicine
Daphne Marshall
Department of Neuroscience, Savusavu Institute Center, Savusavu, Fiji
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing

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Glycated Hemoglobin (HbA1c) as a Predictor of Periodontal Disease Progression in Patients with Type 2 Diabetes: A Longitudinal Study in Surabaya, Indonesia Alexander Mulya; Muhammad Ashraf; Muhammad Yoshandi; Ayesh Mahmood; Daphne Marshall
Sriwijaya Journal of Internal Medicine Vol. 3 No. 1 (2025): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v2i2.178

Abstract

Introduction: Periodontal disease is a prevalent complication of type 2 diabetes mellitus (T2DM), and poor glycemic control is a known risk factor. This longitudinal study aimed to investigate the predictive value of glycated hemoglobin (HbA1c) for periodontal disease progression in a cohort of T2DM patients in Surabaya, Indonesia. Methods: A prospective cohort study was conducted at private hospital, Surabaya, Indonesia, from January 2021 to January 2023. 180 patients with T2DM and pre-existing chronic periodontitis were enrolled. Periodontal parameters, including probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and plaque index (PI), were assessed at baseline, 12 months, and 24 months. HbA1c was measured at each visit. Multivariate linear regression and mixed-effects models were used to analyze the association between HbA1c and changes in periodontal parameters over time, adjusting for potential confounders. Results: The mean age of participants was 58.5 ± 8.2 years, and 55% were female. Baseline mean HbA1c was 8.2 ± 1.5%. After adjusting for age, gender, smoking status, diabetes duration, and baseline periodontal parameters, higher baseline HbA1c was significantly associated with greater increases in PPD (β = 0.15 mm per 1% HbA1c increase, 95% CI: 0.08-0.22, p < 0.001) and CAL (β = 0.18 mm per 1% HbA1c increase, 95% CI: 0.10-0.26, p < 0.001) over 24 months. Furthermore, sustained elevation of HbA1c (average HbA1c over 24 months) was a stronger predictor of periodontal disease progression than baseline HbA1c alone. A significant interaction between HbA1c and time was observed (p < 0.001), indicating that the effect of HbA1c on periodontal parameters increased over time. Conclusion: HbA1c is a significant independent predictor of periodontal disease progression in patients with T2DM. Sustained glycemic control is crucial for preventing and managing periodontal complications in this population. These findings highlight the importance of interdisciplinary collaboration between internists and dentists in the comprehensive care of T2DM patients.
Modulation of the Cognition–Sleep Nexus in Subjective Cognitive Decline: A 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial of a Standardized Cordyceps militaris Extract Vita Amanda; Daphne Marshall; Zahra Amir; Husin Sastranagara; Danniel Hilman Maulana; Karina Chandra; Fachrudin Sani
Eureka Herba Indonesia Vol. 6 No. 2 (2025): Eureka Herba Indonesia
Publisher : HM Publisher in collaboration with CMHC Research Center

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v6i2.130

Abstract

Background: Subjective cognitive decline (SCD) and sleep disturbance form a self-reinforcing cycle that accelerates neurodegeneration. Cordyceps militaris (CM), a medicinal fungus rich in nucleosides, has neuroprotective and adenosinergic (sleep-promoting) properties. Objective: To evaluate the efficacy of a standardized CM extract on the cognition–sleep nexus in adults with SCD. Methods: In a 12-week, single-center, randomized, double-blind, placebo-controlled, parallel-group trial in Palembang, Indonesia, 120 adults aged 45–65 years with SCD received 300 mg/day of a standardized CM mycelial extract (3% cordycepin) or matching placebo. The primary outcome was change in the Montreal Cognitive Assessment–Indonesian (MoCA-INA) score. Bonferroni-corrected key secondary outcomes were the Pittsburgh Sleep Quality Index (PSQI), Rey Auditory Verbal Learning Test (RAVLT) delayed recall and polysomnography-derived sleep efficiency (SE). Intention-to-treat analyses used a linear mixed-effects model (LMM). Results: A significant group-by-time interaction favored CM for MoCA-INA (adjusted mean difference [AMD] +1.95; 95% confidence interval [CI] 1.10, 2.80; p < 0.001). All three key secondary outcomes improved: PSQI (AMD −2.90; 95% CI −3.81, −1.99), RAVLT delayed recall (AMD +2.15; 95% CI 1.30, 3.00) and SE (AMD +5.8%; 95% CI 3.1, 8.5); all p < 0.001. After false discovery rate (FDR) correction, benefits were also seen for processing speed, rapid eye movement (REM) sleep percentage, serum brain-derived neurotrophic factor (BDNF) and high-sensitivity C-reactive protein (hs-CRP). The extract was well tolerated. Conclusion: Twelve weeks of standardized C. militaris extract improved cognitive function, episodic memory and both subjective and objective sleep in adults with SCD, with changes in neuroplasticity and inflammation markers consistent with a multi-target mechanism.
Co-Authors Alexander Mulya Ayesh Mahmood Danniel Hilman Maulana Fachrudin Sani Husin Sastranagara Karina Chandra Muhammad Ashraf Muhammad Yoshandi Vita Amanda Zahra Amir