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Efek glucagon-like peptide-1 terhadap kejadian penyakit kardiovaskular dan ginjal pada pasien diabetes melitus tipe 2

Abstract

Background: Glucagon-like peptide 1 (GLP-1) is a diabetes mellitus drug that has the effect of lowering HbA1C and body weight but has a low risk of hypoglycemia. GLP-1 has the effect of increasing insulin secretion and decreasing glucagon secretion, delaying gastric emptying and can increase satiety. This systematic review aimed to determine the effect of GLP-1 versus placebo on cardiac and renal outcomes in patients with type 2 diabetes.

Methods: The preparation of this systematic review uses the PRISMA method. The search for information sources came from the PubMed, Embase and Cochrane library databases with a limited timeframe for publication of articles from 2015-2022 which focused on clinical trials of type 2 DM patients using GLP-1 therapy and compared with placebo, study publications in English, results in cardiovascular and renal outcomes were assessed by the presence of MACE events (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular or unknown causes) and renal effects (UACR > 300, end-stage renal failure, decreased renal function (worsening eGFR or elevated creatinine), albuminuria, and renal mortality Assessing the quality of the study from the Jadad Score, a risk-of-bias analysis was performed using the Cochrane risk-of-bias-tool.

Results: 11 RCT studies were included in the systematic review. Three studies presented outcomes of cardiovascular events and renal events, 4 studies presented outcomes of cardiovascular events and 4 studies presented outcomes of renal events. Low risk of cardiac and renal events was found in all studies with the GLP-1 intervention. Based on the MACE assessment obtained, all with hazard ratio <1 (P<0.05), and renal assessments such as eGFR, macroalbuminuria and nephropathy obtained by all studies showed lower results than placebo.

Conclusion: GLP-1 can reduce the risk of heart and kidney side effects compared to a placebo in type 2 diabetes patients.

 

Latar Belakang: Glucagon-like peptide 1 (GLP-1) adalah salah satu obat diabetes mellitus yang memiliki efek menurunkan HbA1C dan berat badan namun memiliki resiko hipoglikemia yang rendah. GLP-1 memiliki efek meningkatkan sekresi insulin dan menurunkan sekresi glucagon, menunda pengosongan lambung dan dapat meningkatkan rasa kenyang. Tujuan dari sistematika review ini ialah untuk mengetahui efek GLP-1 dibandingkan plasebo pada hasil kejadian jantung dan ginjal pada pasien DM tipe 2.

Metode: Penyusunan systematic review ini menggunakan metode PRISMA. Pencarian sumber informasi berasal dari database PubMed, Embase dan Cochrane library dengan rentang waktu publikasi artikel dibatasi dari tahun 2015-2022 yang berfokus pada uji klinis pasien DM tipe 2 yang menggunakan terapi GLP-1 dan membandingkan dengan plasebo, publikasi studi dengan Bahasa Inggris, hasil akhir kardiovaskular dan ginjal dinilai dari adanya kejadian MACE (infark miokard nonfatal, nonfatal stroke, atau kematian akibat kardiovaskular atau penyebab yang tidak diketahui) dan pengaruh ke ginjal, (UACR >300, gagal ginjal stadium akhir, penurunan fungsi ginjal (eGFR yang memburuk atau peningkatan kreatinin), albuminuria, dan kematian akibat ginjal. Menilai kualitas studi dari Jadad Score lalu dilakukan analisis risiko bias dengan Cochrane risk-of-bias-tool

Hasil: Terdapat total 11 studi RCT yang di inklusi dalam sistematik review. Terdapat 3 studi yang menampilkan hasil kejadian kardiovaskular dan kejadian ginjal, 4 studi yang menampilkan hasil kejadian kardiovaskular dan 4 studi yang menampilkan hasil kejadian ginjal. Didapatkan hasil risiko kejadian jantung dan ginjal yang rendah dari semua studi dengan intervensi GLP-1. Berdasarkan penilaian MACE diperoleh semua dengan hazard ratio <1 (P<0,05), dan penilaian ginjal seperti eGFR, makroalbuminuria dan nefropati diperoleh semua studi menunjukkan hasil yang lebih rendah dibandingkan plasebo.

Simpulan: GLP-1 mampu menurunkan risiko kejadian efek samping jantung dan kejadian ginjal dibandingkan dengan plasebo pada pasien DM tipe 2. Namun, hal ini perlu dilakukan penelitian lebih lanjut mengenai mekanisme obat tersebut dalam menurunkan kejadian efek samping jantung dan ginjal.

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How to Cite

Ayu Agung Pradnya Paramitha, Wikananda, G. D. D. ., & Lestari, D. N. D. . (2022). Efek glucagon-like peptide-1 terhadap kejadian penyakit kardiovaskular dan ginjal pada pasien diabetes melitus tipe 2. Intisari Sains Medis, 13(3), 843–850. https://doi.org/10.15562/ism.v13i3.1494

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