The Role of Clinical

Pathologist and
Laboratory Medicine
in SDGs
Ida Parwati

President of Indonesian Association of

Clinical Pathologist and Laboratory
Medicine
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outline
• Sustainable Development Goals (Tujuan Pembangunan Berkelanjutan)
• Kesehatan dalam SDGs
• Situasi Kesehatan di Indonesia
• CD vs NCD
• Peran PDSPatKLIn dalam pencapaian SDGs

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AGENDA KESEHATAN YANG BELUM SELESAI

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 Epidemiology
of Multi
Drugs
Resistant
Organisms

B. Allegranzi1, N. Damani1, A. Gayet-Ageron2, A. Stewardson3, S. Wallace4, D. Pittet, 2014.

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Double Burden of
NCD & Infectious
Diseases in
Developing
Countries:
Indonesia

Nafsiah Mboi et al.

Lancet 2018; 392: 581–91
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NCDs
• Noncommunicable diseases (NCDs), also known as chronic diseases, tend
to be of long duration and are the result of a combination of genetic,
physiological, environmental and behaviours factors.
• The main types of NCDs are cardiovascular diseases (like heart attacks and
stroke), cancers, chronic respiratory diseases (such as chronic obstructive
pulmonary disease and asthma) and diabetes.
• NCDs disproportionately affect people in low- and middle-income countries
where more than three quarters of global NCD deaths – 32million – occur.

Detection, screening and treatment of NCDs, as well as palliative care, are

key components of the response to NCDs.
WHO, CDC
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 Basic diagnostic tests in primary care facilities

Four main NCDs International Journal of Hypertension, 2012

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Prevalence of any DM in TB patients
25.0
23.0
20.0 18.6 DM
17.6 17.5
Prevalence %

15.0 14.8 13.3 DM

13.4 12.3 DM
11% HIV
10.0 9.0 DM 9.7
8.2

5.0 6% HIV
5.6

2% HIV
0.0 0.4% HIV
Indonesia Peru Romania South Africa

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 TB Worsen DM - DM Worsen TB
• Lung TB is the 9th most frequent complication of • Diabetes effect on the TB burden is equal or even
diabetes. greater than AIDS.2
• Individuals with TB can develop changes in • Patients with T1DM are more susceptible than T2DM.2
carbohydrate metabolism such as:
• Poor glycemic control has been significantly associated
Insulin deficiency with the occurrence of TB.3
Impaired glucose tolerance3 • TB is correlated with the level of HbA1c (hazard ratio
• Some anti-TB drug may cause hyperglycaemia.3 1.39, 95% CI: 1.18-1.63 per unit increase).3
• Some anti-DM drug needs to be given in higher dose • Some anti-TB drug was found in lower level in the
in patients with TB.3 plasma of DM.4
• Diabetic nephropathy can cause anti-TB drug toxicity.4
• The pooled risk of death among TB patients with DM
was nearly 5 times greater than those without DM.5
References:
1. Gut Pathogens, 2013; 5(4): 7 pages. • Unusual presentation of renal TB in T2DM had been
2. Research and Reports in Tropical Medicine, 2014; 5: 35–44. reported.6
3. Globalization and Health, 2009; 5(9): 9 pages.
4. Globalization and Health, 2009; 5(9): 9 pages.
5. J Mycobac Dis, 2014; 4(2): 6 pages.
6. Nigerian Journal of Clinical Practice, 2012; 15(4): 498-499.

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The role of clinical laboratory: how to prevent?

Laboratory screening for TB in DM patients

- screened for latent TB (LTBI): TST or IGRA should be done at
time of DM diagnosis
- Patients with DM who are found to have LTBI should be
take INH for 9 months + vit B6 to prevent INH induced neuropathy

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The role of clinical laboratory; how to screen?
Laboratory screening for DM in TB patients
• Every patient with TB over the age of 18 should be screened for DM
Screening method?HbA1c?
Best time to screen? (at time of diagnosis or later during treatment?)
• Too early: temporary hyperglycemia?
• Too late: missed opportunity for interventions?
• Abnormal glucose values should be repeated in patients who have no
symptoms of DM
• Glucose should be repeated after 2-4 weeks of TB Rx or if symptoms of
hyperglycemia develop
• Rifampin and INH can markedly elevate glucose levels
• Use the same criteria to diagnose DM as at initial evaluation
20181101 PIT XVII_Konker IX PDS PatKLIn_Bali. Riza, Pearson et al. Lancet Diabetes 2014;2:740-753
Criteria for the Diagnosis of Diabetes

A1C ≥6.5%
OR
Fasting plasma glucose (FPG)
≥126 mg/dl (7.0 mmol/l)
OR
Two-hour plasma glucose ≥200 mg/dl (11.1 mmol/l)
during an OGTT
OR
A random plasma glucose ≥200 mg/dl (11.1 mmol/l)

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ADA. I. Classification and Diagnosis. Diabetes Care 2015;34(suppl 1):S11. Table 2.
The role of clinical laboratory; how to monitor?

Laboratory monitoring for DM in TB patients

• Frequent blood glucose checking: glucose meter in every TB clinic
• Monitor Liver function
• Monitor Renal function: Check creatinine for diabetic nephropathy
• Upon completion of therapy, obtain smear and culture for AFB
Follow up the patient at 6 months and one year after treatment completion
Observe closely for treatment failure
• Be aware of poor absorption of some TB medications in DM

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What is the impact of delayed laboratory diagnosis?

Delayed Diagnosis
Methods: too long, insensitive, expensive

Prolonged unnecessary Th/ or

empirical antibiotic th/
AMR

Prolonged LOS
HAI >> antibiotics> AMR Mortality rate 

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Peran Patologi Klinik dan Kedokteran
Laboratorium dalam pencapaian SDGs
• Pelayanan (untuk agenda kesehatan yang belum selesai)
- Skrining DM pada TB
- Skrining TB pada HIV
- Test cepat molekular pada TB, HIV, Malaria
• Penelitian
- Pengembangan vaksin TB, HIV, Malaria
- Pengembangan uji diagnostic cepat untuk CD & NCD
• Pendidikan
- SDGs di semua lini pendidikan PK: S1, Sp1, Sp2
• PKM
- Pendidikan untuk masyarakat ttg pola hidup sehat

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 Terimakasih

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