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Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien diabetes melitus tipe 2



Abstract

Background: Glycemic control in type 2 diabetes mellitus (DM) which can be assessed by examination of fasting blood sugar (FBG) and glycosylated hemoglobin (HbA1c) is thought to be associated with renal complications. Several markers can be used to assess the rate of damage to early kidney function, such as serum creatinine, urine creatinine albumin ratio (uACR), and serum cystatin C. The relationship of glycemic control with early kidney disorder markers in type 2 DM patients still shows controversial results.. The aim of the study to investigate the relationship between glycemic control (FBG and HbA1c) with early kidney disorder markers (serum creatinine, uACR, and cystatin C) in patients with type 2 diabetes mellitus.

Methods: Analytic observational study with cross sectional approach conducted in April - June 2019 involved 34 type 2 DM patients in Karang Ayu Health Center who met the inclusion and exclusion criteria. Examination of GDP levels using the hexokinase method, HbA1c levels using the HPLC method, serum creatinine using the Jaffe method, uACR is calculated based on the ratio between urine albumin and creatinine, and cystatin C levels using the ELISA method. Statistical tests using Spearman's non-parametric correlation with p <0.05 were considered significant.

Results: The mean ± SD FBG and HbA1c levels were 130.41 ± 39.37 mg/ \dL and 8.21 ± 1.65%. Median (minimum-maximum) serum creatinine levels, uACR and serum cystatin C were 0.63 (0.35-2.79) mg/dL, 16.55 (4.1-29.8) mg/g and 0.72 (0.46 - 1.22) mg/L. The correlation of FBG levels with serum creatinine, uACR, and serum cystatin C were (r = 0.016; p = 0.927), (r = 0.293; p = 0.092), and (r = 0.334; p = 0.053). The relationship of HbA1c with serum creatinine, uACR, and cystatin C was (r = 0.120; p = 0.495), (r = 0.326; p = 0.059); and (r = 0.505; p = 0.002).

Conclusions: There is no relationship between FBG with serum creatinine, uACR, and cystatin C. The HbA1c value is positively related to cystatin C but not related to serum creatinine and uACR in patients with type 2 diabetes mellitus.

 

Latar belakang: Kontrol glikemik pada diabetes melitus tipe 2 (DM) yang dapat dinilai dengan pemeriksaan gula darah puasa (GDP) dan hemoglobin terglikosilasi (HbA1c) diduga berhubungan dengan komplikasi nefropati. Beberapa petanda dapat digunakan untuk menilai menilai kerusakan fungsi ginjal dini, misalnya kreatinin serum, rasio albumin kreatinin urin (uACR), dan cystatin C serum. Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien DM tipe 2 masih menunjukkan hasil yang kontroversial. Mengetahui hubungan antara kontrol glikemik (GDP dan HbA1c) dengan petanda gangguan ginjal dini (Kreatinin serum, uACR, dan cystatin C) pada pasien diabetes melitus tipe 2.

Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan April - Juni 2019 melibatkan 34 pasien DM tipe 2 di Puskesmas Karang Ayu yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kadar GDP menggunakan metode heksokinase, kadar HbA1c menggunakan metode HPLC, kreatinin serum menggunakan metode Jaffe, uACR dihitung berdasarkan rasio antara albumin dan kreatinin urin, dan kadar Cystatin C menggunakan metode ELISA. Uji statistik menggunakan korelasi non parametrik Spearman dengan p < 0,05 dianggap signifikan. 

Hasil: Rerata±SD kadar GDP dan HbA1c adalah 130,41±39,37 mg/dL dan 8,21±1,65%. Median (minimum-maksimum) kadar kreatinin serum, uACR dan cystatin C serum berturut-turut adalah 0,63(0,35-2,79) mg/dL, 16,55(4,1-29,8) mg/g, dan 0,72(0,46 – 1,22) mg/L. Korelasi kadar GDP dengan kreatinin serum, uACR, dan cystatin C serum adalah (r=0,016; p=0,927), (r=0,293; p=0,092), dan (r=0,334; p=0,053). Hubungan HbA1c dengan kreatinin serum, uACR, dan cystatin C adalah (r=0,120; p=0,495), (r=0,326; p= 0,059); dan (r = 0,505; p = 0,002).

Simpulan: Tidak terdapat hubungan antara GDP dengan kreatinin serum, uACR, dan cystatin C. Nilai HbA1c berhubungan positif sedang dengan cystatin C namun tidak berhubungan dengan kreatinin serum dan uACR pada pasien diabetes melitus tipe 2.

Keywords: GDP HbA1c Kreatinin uACR Cystatin C DM tipe 2

References

  1. PERKENI. Konsensus pengendalian dan pencegahan diabetes melitus Tipe 2 di Indonesia. Jakarta: PERKENI; 2015.
  2. Papatheodoru K, Papanas N, Banach M, Papazoglu D, Edmonds M. Complications of diabetes. J of Diabetes Res. 2016;1(2):1-3.
  3. Dabla P. Renal function in diabetic nephropathy. World J Diabetes. 2010;1(2): 48-56.
  4. World Health Organization. Use of glycated hemoglobin in the diagnosis of diabetes mellitus. Geneva: World Health Organization; 2011.
  5. Suryaatmadja M. Pemeriksaan kadar HbA1c untuk diagnosis prediabetes. In : Pendidikan Berkesinambungan Patologi Klinik 2013. Jakarta: FKUI;2013. P.57-69.
  6. Deepa K, Manjunatha G, Oinam S, Devaki R, Bhavna N, Asha P, et al. Serum urea, creatinine in relation to fasting plasma glucose levels in type 2 diabetes. Int J Pharm Bio Sci. 2011;1(1):279-83.
  7. Bloomgarden Z. Diabetic nephropathy. Diabetes care. 2005;28(1):745-51.
  8. Eddy A. Proteinuria and interstitial injury. Nephrol Dial Transplant. 2004;19(1):277-81.
  9. Bassiouny K, Khalil H, Abed-Elmaghed W, El-Halfawey H. Serum cystatin c as an early and efficacious biomarker of diabetic nephropathy. American Journal of Medicine and Medical Sciences. 2015, 5(5): 246-252
  10. Zhou B, Zou H, Xu G. Clinical utility of serum cystatin c in predicting diabetic nephropathy among diabetes mellitus patients. Kidney Blood Press Res. 2016;41:919-928.
  11. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia. Riskesdas 2018. Jakarta: Kementerian Kesehatan Republik Indonesia. 2018.
  12. Selvin E, Parrinello C. Age-related differences in glycaemic control in diabetes. Diabetologia. 2013; 56(12):1-5.
  13. Lee P, Halter J. The pathophysiology of hyperglycemia in older adults:clinical considerations. Diabetes Care. 2017;40(4):444-452.
  14. World Health Organization. Appropriate body-mass index for Asian population and its implications for policy and itervention strategies. Lancet. 2004;363(1):157-163.
  15. Mihardja L, Soetrisno U, Soegondo S. Prevalence and clinical profile of diabetes mellitus in productive aged urban Indonesians. J Diabetes Investig. 2014;5(5):507-512.
  16. Ganz M, Wintfeld N, Li Q, Alas V, Langer J, Mete H. The association of body mass index with the risk of type 2 diabetes: a case control study nested in an electronic health records system in the united states. Diabetology & Metabolic Syndrome. 2014;50(6):1-8
  17. Day C, Bailey C. Obesity in the pathogenesis of type 2 diabetes. Br J Diabetes Vasc Dis. 2011;11(2):55-61.
  18. Pedrini M. Human Trigliseride-rich lipoproteins impair glukose metabolism and insulin signalling in IL 6 skletal muscle cells independently of non esterified fatty acid levels. Diabetologia. 2010;48(4):756-66
  19. El-Kafrawy N, Shohaib A, El-Deen S, El Babbary H, Seleem A. Evaluation of serum cystatin c as an indicator of early renal function decline in type 2 diabetes. Menoufia Med J. 2014;27(2):60-65.
  20. Cheng D, Fei Y, Liu Y, Li J, Xue Q, Wang X. HbA1c variability and the risk of renal status progression in diabetes mellitus: A Meta Analysis. PloS One. 2014;9(12):1-13.
  21. Sherwani S, Khan H, Ekhzaimy A, Masood A, Sakharkar M. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insight. 2016;11(7):95-104.
  22. Sulaiman M. Diabetic nephropathy:recent advances in pathophysiology and challenges in dietary management. Diabetol Metab Syndr. 2019;11(7):1-5.
  23. Toth-Manikowski S, Atta M. Diabetic kidney disease:Pathophysiology and therapeutic targets. J Diabetes res 2015;5(5):1-16.
  24. Kolset S, Reinholt F, Jenssen T. Diabetic nephropathy and extracellular matrix. J Histochem Cytochem. 2012;60(12):976-986.
  25. Jeon Y, Kim M, Kang S. Cystatin C as an early marker of diabetic nephropathy in patients with type 2 diabetes. Clin Lab. 2013;59(11):1221-1229.
  26. Futrakul N, Futrakul P. Biomarker for early renal microvascular and diabetic kidney disease. Renal Failure. 2017;39(1):505-511.
  27. Gamayanti K, Ratnasari N, Bhargah A. Pola penggunaan insulin pada pasien diabetes mellitus tipe 2 di poli penyakit dalam RSU Negara Periode Juli – Agustus 2018. Intisari Sains Medis.2019;9(3):68-73. DOI:10.15562/ism.v9i3.306
  28. Artha IMJR, Bhargah A, Dharmawan NK, Pande UW, Triyana KA, Mahariski PA, Yuwono J, Bhargah V, Prabawa IPY, Manuaba IBAP, Rina IK. High level of individual lipid profile and lipid ratio as a predictive marker of poor glycemic control in type-2 diabetes mellitus. Vasc Health Risk Manag. 2019;15:149-157. doi: 10.2147/VHRM.S209830. PMID: 31239693; PMCID: PMC6560183.
  29. Pertiwi GAR, Aryawangsa AAN, Prabawa IPY, Manuaba IBAP, Bhargah A, Budiana IPG. Factor associated with visit-to-visit variability of blood pressure in hypertensive patients at primary health care service, Tabanan, Bali, Indonesia. FMCH. 2018;6(4):191-199. DOI: https://doi.org/10.15212/FMCH.2018.0124.

How to Cite

Widyatmojo, H., Samsuria, I. K., & Triwardhani, R. (2020). Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien diabetes melitus tipe 2. Intisari Sains Medis, 11(2), 476–480. https://doi.org/10.15562/ism.v11i2.609
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Hadian Widyatmojo
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Indranila Kustarini Samsuria
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Ria Triwardhani
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