[ABSTRAK
Penelitian mengenai efektivitas pengobatan diabetes melitus dan kaitannyadengan pencegahan komplikasi masih menujukkan hasil yang beragam. Penelitianini bertujuan untuk membandingkan efektivitas hipoglikemik dan fungsi ginjaldari sulfonilurea, kombinasi sulfonilurea dan biguanid serta injeksi insulin. Disainpenelitian adalah kohort retrospektif pada pasien diabetes melitus tipe 2 rawatjalan yang mengkonsumsi obat yang sama selama empat bulan terakhir di RSKDr. Sitanala Tangerang. Penelitian ini dilaksanakan pada kurun waktu April-Juni2015, dan sudah mendapatkan lulus kaji etik dari Komite Etik rumah sakit ini.Subyek penelitian dibagi kedalam tiga kelompok yaitu yang menggunakan injeksiinsulin (n = 30), yang menggunakan obat sulfonilurea tunggal (n = 30), dankombinasi sulfonilurea dan biguanid (n = 45). Efektivitas hipoglikemik dilihatdari nilai HbA1C pasien dan komplikasi nefropati diabetik dilihat dari nilai eLFGyang dihitung dari angka serum kreatinin. Rerata usia keseluruhan pasien adalah54,98±7,47, sebagian besar adalah wanita (72%) dan cenderung overweight(rerata IMT 25,47±4,77). Ada perbedaan yang bermakna (p = 0,042 ) pada nilaiHbA1C pasien kelompok kombinasi sulfonilurea-biguanid (rerata HbA1C7,28±0,09) dibandingkan dengan kelompok insulin (rerata HbA1C 8,10±0,09),sementara dengan kelompok sulfonilurea tunggal tidak ada perbedaan yangbermakna. Sedangkan nilai eLFG untuk setiap kelompok obat tidak ditemukanperbedaan yang bermakna. Subyek yang memiliki riwayat diabetes melitus dalamkeluarga mempunyai peluang 4,512 kali (interval kepercayaan 95%, p = 0,010)lebih besar dibandingkan dengan yang tidak memiliki riwayat diabetes dalamkeluarga untuk memiliki nilai HbA1C lebih dari 7%. Pasien dengan IMT >30kg/m2 mempunyai peluang sebesar 21,631 (p = 0,012) dibandingkan pasiendengan IMT < 18,5 kg/m2 untuk memiliki nilai HbA1C yang tidak terkontrol ataudiatas 7%. Pengobatan dengan kombinasi antidiabetik oral sulfonilurea danbiguanid lebih efektif dalam menurunkan nilai HbA1C pasien DM tipe 2dibandingkan dengan insulin atau sulfonilurea tunggal, dan tidak ada perubahanbermakna dalam penurunan fungsi ginjal ABSTRACT Research on effectiveness of therapy on diabetes mellitus associated withprevention of its complication still remain varied in results. The hypoglycemiceffectiveness and the kidney function were compared between sulfonylurea,sulfonylurea and biguanide combination and insulin, with the retrospective cohortstudy design, on patients that use those agents in last four months and came toout-patient clinic of RSK Dr. Sitanala Tangerang. This research had the EthicalClearance from the Ethical Committee of this hospital. Subjects were classify intothree groups, i.e insulin group (n = 30), sulfonylurea group (n = 30) andsulfonylurea and biguanide combination group (n = 45). Hypoglycemiceffectiveness is measured with the HbA1C level and diabetic nephrophaty withthe eGFR which calculated from the measured serum creatinin. Mean age of allsubjects was 54,98±7,47 (p=0,157), most were women (72%, p=0,235), and tendto overweight (mean BMI is 25,49±4,84; p = 0,59). Mean HbA1C level from thesulfonylurea-biguanide (7,28±0,09) group were significantly different (p = 0,042)with those from the insulin group (8,10±0,09), and there was no significantdifference with the sulfonylurea group. There was no significant difference indiabetic nephropathy between groups. Subject with diabetic family history has4,512 times chance to have the HbA1C level > 7% compare to those withoutdiabetic family history. Subjects with BMI >30 kg/m2 have 21,631 times chanceto get the HbA1C >7% compare to subjects with BMI <18,5 kg/m2. Sulfonylureaand biguanide combination was more effective compare to insulin or sulfonylureamonotherapy on decreasing HbA1C level of type 2 DM patients, withoutsignificant difference in effect of lowering kidney functionH;Research on effectiveness of therapy on diabetes mellitus associated withprevention of its complication still remain varied in results. The hypoglycemiceffectiveness and the kidney function were compared between sulfonylurea,sulfonylurea and biguanide combination and insulin, with the retrospective cohortstudy design, on patients that use those agents in last four months and came toout-patient clinic of RSK Dr. Sitanala Tangerang. This research had the EthicalClearance from the Ethical Committee of this hospital. Subjects were classify intothree groups, i.e insulin group (n = 30), sulfonylurea group (n = 30) andsulfonylurea and biguanide combination group (n = 45). Hypoglycemiceffectiveness is measured with the HbA1C level and diabetic nephrophaty withthe eGFR which calculated from the measured serum creatinin. Mean age of allsubjects was 54,98±7,47 (p=0,157), most were women (72%, p=0,235), and tendto overweight (mean BMI is 25,49±4,84; p = 0,59). Mean HbA1C level from thesulfonylurea-biguanide (7,28±0,09) group were significantly different (p = 0,042)with those from the insulin group (8,10±0,09), and there was no significantdifference with the sulfonylurea group. There was no significant difference indiabetic nephropathy between groups. Subject with diabetic family history has4,512 times chance to have the HbA1C level > 7% compare to those withoutdiabetic family history. Subjects with BMI >30 kg/m2 have 21,631 times chanceto get the HbA1C >7% compare to subjects with BMI <18,5 kg/m2. Sulfonylureaand biguanide combination was more effective compare to insulin or sulfonylureamonotherapy on decreasing HbA1C level of type 2 DM patients, withoutsignificant difference in effect of lowering kidney functionH;Research on effectiveness of therapy on diabetes mellitus associated withprevention of its complication still remain varied in results. The hypoglycemiceffectiveness and the kidney function were compared between sulfonylurea,sulfonylurea and biguanide combination and insulin, with the retrospective cohortstudy design, on patients that use those agents in last four months and came toout-patient clinic of RSK Dr. Sitanala Tangerang. This research had the EthicalClearance from the Ethical Committee of this hospital. Subjects were classify intothree groups, i.e insulin group (n = 30), sulfonylurea group (n = 30) andsulfonylurea and biguanide combination group (n = 45). Hypoglycemiceffectiveness is measured with the HbA1C level and diabetic nephrophaty withthe eGFR which calculated from the measured serum creatinin. Mean age of allsubjects was 54,98±7,47 (p=0,157), most were women (72%, p=0,235), and tendto overweight (mean BMI is 25,49±4,84; p = 0,59). Mean HbA1C level from thesulfonylurea-biguanide (7,28±0,09) group were significantly different (p = 0,042)with those from the insulin group (8,10±0,09), and there was no significantdifference with the sulfonylurea group. There was no significant difference indiabetic nephropathy between groups. Subject with diabetic family history has4,512 times chance to have the HbA1C level > 7% compare to those withoutdiabetic family history. Subjects with BMI >30 kg/m2 have 21,631 times chanceto get the HbA1C >7% compare to subjects with BMI <18,5 kg/m2. Sulfonylureaand biguanide combination was more effective compare to insulin or sulfonylureamonotherapy on decreasing HbA1C level of type 2 DM patients, withoutsignificant difference in effect of lowering kidney functionH;Research on effectiveness of therapy on diabetes mellitus associated withprevention of its complication still remain varied in results. The hypoglycemiceffectiveness and the kidney function were compared between sulfonylurea,sulfonylurea and biguanide combination and insulin, with the retrospective cohortstudy design, on patients that use those agents in last four months and came toout-patient clinic of RSK Dr. Sitanala Tangerang. This research had the EthicalClearance from the Ethical Committee of this hospital. Subjects were classify intothree groups, i.e insulin group (n = 30), sulfonylurea group (n = 30) andsulfonylurea and biguanide combination group (n = 45). Hypoglycemiceffectiveness is measured with the HbA1C level and diabetic nephrophaty withthe eGFR which calculated from the measured serum creatinin. Mean age of allsubjects was 54,98±7,47 (p=0,157), most were women (72%, p=0,235), and tendto overweight (mean BMI is 25,49±4,84; p = 0,59). Mean HbA1C level from thesulfonylurea-biguanide (7,28±0,09) group were significantly different (p = 0,042)with those from the insulin group (8,10±0,09), and there was no significantdifference with the sulfonylurea group. There was no significant difference indiabetic nephropathy between groups. Subject with diabetic family history has4,512 times chance to have the HbA1C level > 7% compare to those withoutdiabetic family history. Subjects with BMI >30 kg/m2 have 21,631 times chanceto get the HbA1C >7% compare to subjects with BMI <18,5 kg/m2. Sulfonylureaand biguanide combination was more effective compare to insulin or sulfonylureamonotherapy on decreasing HbA1C level of type 2 DM patients, withoutsignificant difference in effect of lowering kidney functionH, Research on effectiveness of therapy on diabetes mellitus associated withprevention of its complication still remain varied in results. The hypoglycemiceffectiveness and the kidney function were compared between sulfonylurea,sulfonylurea and biguanide combination and insulin, with the retrospective cohortstudy design, on patients that use those agents in last four months and came toout-patient clinic of RSK Dr. Sitanala Tangerang. This research had the EthicalClearance from the Ethical Committee of this hospital. Subjects were classify intothree groups, i.e insulin group (n = 30), sulfonylurea group (n = 30) andsulfonylurea and biguanide combination group (n = 45). Hypoglycemiceffectiveness is measured with the HbA1C level and diabetic nephrophaty withthe eGFR which calculated from the measured serum creatinin. Mean age of allsubjects was 54,98±7,47 (p=0,157), most were women (72%, p=0,235), and tendto overweight (mean BMI is 25,49±4,84; p = 0,59). Mean HbA1C level from thesulfonylurea-biguanide (7,28±0,09) group were significantly different (p = 0,042)with those from the insulin group (8,10±0,09), and there was no significantdifference with the sulfonylurea group. There was no significant difference indiabetic nephropathy between groups. Subject with diabetic family history has4,512 times chance to have the HbA1C level > 7% compare to those withoutdiabetic family history. Subjects with BMI >30 kg/m2 have 21,631 times chanceto get the HbA1C >7% compare to subjects with BMI <18,5 kg/m2. Sulfonylureaand biguanide combination was more effective compare to insulin or sulfonylureamonotherapy on decreasing HbA1C level of type 2 DM patients, withoutsignificant difference in effect of lowering kidney functionH] |
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