Research Article

Perbedaan petanda osteoporosis dan inflamasi pada pasien diabetes melitus tipe 2 terkontrol dan tidak terkontrol

Emi Setianingsih , Imam Budiwiyono, Meita Hendrianingtyas

Emi Setianingsih
Residen Patologi Klinik Fakultas Kedokteran Universitas Diponegoro. Email: dr.emilovely@gmail.com

Imam Budiwiyono
Staf Bagian Patologi Klinik Fakultas Kedokteran Universitas Diponegoro

Meita Hendrianingtyas
Staf Bagian Patologi Klinik Fakultas Kedokteran Universitas Diponegoro
Online First: August 01, 2020 | Cite this Article
Setianingsih, E., Budiwiyono, I., Hendrianingtyas, M. 2020. Perbedaan petanda osteoporosis dan inflamasi pada pasien diabetes melitus tipe 2 terkontrol dan tidak terkontrol. Intisari Sains Medis 11(2): 511-516. DOI:10.15562/ism.v11i2.648


Background: Prolonged hyperglycemia cause further complications in patients with Type 2 Diabetes Mellitus (T2DM). Examination of HbA1c as a glycemic control can determine the risk of complications. N-Mid osteocalcin (N-Mid Oc) is used as a marker for early detection of osteoporosis. Increased neutrophil lymphocyte ratio (NLR) is a sign of simple inflammation that contributes to the progression and chronic complications in T2DM. The aim of the study is to analyze the differences between osteoporosis and inflammation markers in controlled and uncontrolled T2DM.

Methods: Analityc observational study with  cross sectional approach was conducted in June – July 2019 involving 58 DMT2 patients at Diponegoro National Hospital Semarang. The level of N-Mid Oc level were measured by ELISA method and NLR was measured by hematology analyzer, NLR values were obtained after manually calculated. Different test between research variables were using Mann-Whitney U test

Results: The median (min - max) N-Mid Oc levels of controlled and uncontrolled T2DM patients were 16.17 (4.98 – 37.28) ng / ml and 12.29 (3.54 – 37.28) ng/ml with a value of p = 0.004. Median (min - max) NLR of DMT2 patients controlled and uncontrolled were 1.82 (0.64 – 3.94) and 2.41 (1.08 – 6.46) with p = 0.007.

Conclusion: There is a significant differences between N-Mid O level and NLR in controlled and uncontrolled T2DM patients.

 

Latar belakang: Hiperglikemia berkepanjangan dapat menimbulkan komplikasi lebih lanjut pada pasien Diabetes Melitus Tipe 2 (DMT2). Pemeriksaan HbA1c sebagai kontrol glikemik dapat mengetahui risiko komplikasi. N-Mid osteocalcin (N-Mid Oc) dipakai sebagai salah satu petanda deteksi dini osteoporosis. Peningkatan neutrophil lymphocyte ratio (NLR) merupakan petanda inflamasi sederhana untuk memantau progresivitas dan komplikasi kronik pada DMT2. Tujuan dari penelitian ini adalah untuk membuktikan adanya perbedaan petanda osteoporosis dan inflamasi antara DMT2 terkontrol dan tidak terkontrol.

Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan Juni - Juli 2019 melibatkan 58 pasien DMT2 di Rumah Sakit Nasional Diponegoro Semarang yang memenuhi kriteria inklusi dan eksklusi. Pemeriksaan N-Mid Oc diperiksa dengan metode ELISA dan Pemerikasaan NLR menggunakan hematology analyser, nilai NLR didapatkan setelah dihitung secara manual. Uji beda antar variabel penelitian mengunakan Mann-Whitney U test’s.

Hasil: Median (min – maks) kadar N-Mid Oc pasien DMT2 terkontrol dan tidak terkontrol berturut-turut adalah 16,17 (4,98 – 37,28) ng/ml dan 12,29 (3,54 – 37,28) ng/ml dengan nilai p=0,004. Median (min – maks) NLR pasien DMT2 terkontrol dan tidak terkontrol berturut-turut adalah 1,82 (0,64 – 3,94) dan 2,41 (1,08 – 6,46) dengan nilai p=0,007.

Simpulan: terdapat perbedaan bermakna dari N-Mid Oc dan NLR antara pasien DMT2 terkontrol dan tidak terkontrol.

References

Sudoyo AW, Setiyohadi B, Alwi I, K. MS, Setiati S. Buku ajar ilmu penyakit dalam. Jakarta: Pusat Penerbit Ilmu Penyakit Dalam; 2014.

Hadisaputro S, Setyawan H. Epidemiologi dan faktor-faktor risiko terjadinya diabetes mellitus tipe 2. Semarang: Penerbit Universitas Diponegoro; 2007: p.133-54.

Rudijanto A, Yuwono A, Shahab A, Manaf A, Pramono B. Konsensus pengelolaan dan pencegahan diabetes melitus Tipe 2 di Indonesia. Jakarta: PB PERKENI; 2015.

Badan penelitian dan pengembangan kesehatan kementerian kesehatan RI. Riset kesehatan dasar. Jakarta: 2013.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Standar of Medical Care In Diabetes 2018:41:562-9.

International Diabetes Federation. IDF diabetes atlas. 8th ed; 2017.

World Health Organization. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus. Geneva; 2011.

American Diabetes Association. Diagnosis and classification of diabetes melitus. Diabetes Care. 2012;35:64-71.

Carlos M, Luyten FP, Bart VS, Greet K, Katleen V. The impact of type 2 diabetes. Front Endocrinol (Lausanne). 2018;6:1-17 .

Starup LJ. Diabetes mellitus biochemical markers of bone turnover, diabetes control, and Bone. Front Endocrinol (Lausanne). 2013;4:1-17.

Priyana A. Peran pertanda tulang dalam serum pada tatalaksana osteoporosis. Univ med. 2007;26:152-9.

Halimah E , Rositawati W, Pratiwi I. N-MID Osteocalsin (N-MID Oc) dan β-Crosslaps (β-CTx) sebagai penanda biokimia Bone Turn Over pada wanita menopause. IJCP. 2016;5:67–74.

Öztürk ZA. Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people. Arch Gerontol Geriatr. 2013;57:81-5.

Hussain M, Babar MZM, Akhtar L, Hussain MS. Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in type 2 diabetic patients. Pak J Med Sci. 2017;33:1366-70.

Lou M, Luo P, Tang R, Peng Y, Yu S, Huang W. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocr Disord. 2015;15:9.

Oh Y, Kwon GC, Koo SH, Kim J. Association between glycemic control and hematolical indices in type 2 diabetic patients. Lab Med Online. 2016;6:134–9.

Demirtas L, Degirmenci H, Akbas EM, Ozcicek A, Timuroglu A, Gurel A, et al. Association of hematological indices with diabetes, impaired glucose regulation and microvascular complications of diabetes. Int J Clin Exp Med. 2015;8:11420–7.

Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet lymphocyte ratio, and mean platelet volume in healthy adults in south korea. Med (Baltimore). 2018;97:26-31.

Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. Hasil utama riset kesehatan dasar 2018. Jakarta: Kemenkes; 2018.

Starup-Linde J, Hygum K, Langdahl BL. Skeletal fragility in type 2 diabetes mellitus. Endocrinol Metab (Seoul). 2018;33(3):339–51.

Salindeho A., Mulyadi, Rottie J. Pengaruh senam diabetes mellitus terhadap kadar gula darah penderita diabetes melitus tipe 2 di sanggar senam persadia kabupaten gorontalo. 2016;4:12-18.

Wang Q, zhang B, Xu Y, Xu H, Zhang N. The Relationship between serum osteocalsin concentration and glucose metabolism in patients with type 2 diabetes mellitus. J Endocrinology. 2013;2:1-7

Räkel, Sheehy O, Rahme E,LeLorier J. Osteoporosis among patients with type 1 and type 2 diabetes. J Diabet. 2008;22:193-205.

Kindblom JM, Ohlsson C., Ljunggren O.. Plasma osteocalcin is inversely related to fat mass and plasma glucose in elderly Swedish men. J Bone and Mineral Research. 2009:21:785–91.

Im JA, Yu BP, Jeon JY, KimSH. Relationship between osteocalcin and glucose metabolism in postmenopausal women. Clinica Chimica Acta. 2008;22:66-9

Yeap BB, Chubb SAP. Reduced serum total osteocalcin is associated with metabolic syndrome in older men via waist circumference, hyperglycemia, and triglyceride levels. J Endocrinology. 2010;12:265–72.

Shiny A, Bibin YS, Shanthirani CS, Regin. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Tech Ada. 2014;12:524–30.

Roy B. Biomolecular basis of the role of diabetes mellitus in osteoporosis and bone fractures. W J Diabetes. 2013;12:101-13.


No Supplementary Material available for this article.
Article Views      : 37
PDF Downloads : 16