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Analisis rasio profil lipid kolesterol total, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), dan trigliserida pada pasien Diabetes Melitus Tipe 2 (DM-2) dengan dan tanpa komplikasi ulkus kaki diabetik

  • Putri Hidayasyah Purnama Lestari ,
  • Nurahmi Nurahmi ,
  • Tenri Esa ,
  • Liong Boy Kurniawan ,

Abstract

Background: One of the serious macrovascular complications in type 2 diabetes mellitus is a diabetic foot ulcer. Besides causing chronic complications of diabetes, poor glycemic control can also cause dyslipidemia, which plays a role in diabetic foot ulcers' pathophysiology. The ratio of total cholesterol/HDL cholesterol, LDL cholesterol/HDL cholesterol, and triglyceride/HDL ratio play a role in the pathophysiology of endothelial dysfunction closely related to diabetic foot ulcers.

Methods: A retrospective study was performed at the DR. Wahidin Sudirohusodo Hospital, Makassar, by taking secondary data from type 2 DM patient medical records from January 2018 to September 2019. The study sample consisted of forty-seven patients with diabetic foot ulcer complications and 50 patients without diabetic foot ulcers. Chi-Square, Independent T test, and Mann-Whitney test were used as statistical analysis by SPSS version 17 for Windows.

Results: Total cholesterol to HDL ratio and LDL to HDL ratio are significantly greater in type 2 DM patients with diabetic foot ulcer compare to those without diabetic foot ulcers (7.70±6.62 vs. 5.21±1.55, p=0.040 and 4.93±4.75 vs. 3.21±1.16, p=0.014, respectively). There is no significant difference in triglycerides to HDL ratio in type 2 DM with and without diabetic foot ulcers (7.73±8.82 vs. 4.43±3.44, p=0.053). Receiver Operating Curve (ROC) analysis has found cut-off of Total Cholesterol to HDL ratio is 7.13 and LDL to HDL ratio is 3.58.

Conclusion: Total cholesterol to HDL ratio and LDL to HDL ratio are show more relationship with diabetic foot ulcer events.

 

 

Latar Belakang: Komplikasi makrovaskuler yang serius dari dari diabetes melitus tipe 2 salah satunya adalah ulkus kaki diabetik. Kontrol glikemik yang buruk, selain dapat menyebabkan komplikasi kronik dari diabetes, juga dapat menyebabkan dislipidemia yang berperan dalam patofisiologi terjadinya ulkus kaki diabetik. Rasio kolesterol total/kolesterol HDL, kolesterol LDL/kolesterol HDL, dan rasio trigliserida/HDL berperan dalam patofisiologi disfungsi endotel yang erat kaitannya dengan komplikasi ulkus kaki diabetik.

Metode: Penelitian retrosepektif ini dilakukan pada Rumah Sakit DR. Wahidin Sudirohusodo Makassar dengan mengambil data rekam medis pasien diabetes melitus tipe 2 periode Januari 2018 sampai September 2019. Sampel penelitian terdiri dari empat puluh tujuh pasien diabetes melitus dengan komplikasi ulkus kaki diabetik dan lima puluh pasien tanpa komplikasi ulkus kaki diabetik. Uji statistik yang digunakan adalah Chi Square, uji T tidak berpasangan, dan uji Mann-Whitney dengan SPSS versi 17 untuk Windows.

Hasil: Rasio kolesterol total/HDL dan LDL/HDL berturut-turut lebih besar pada pasien DM tipe 2 dengan ulkus kaki diabetik dibandingkan tanpa ulkus kaki diabetik (7,70±6,62 vs 5,21±1,55, p = 0,040 dan 4,93±4,75 vs 3,21±1,16, p=0,014). Tidak terdapat perbedaan bermakna rasio trigliserida/HDL pasien DM tipe 2 dengan ulkus kaki diabetik (7,73±8,82 vs 4,43±3,44, p=0,053). Menurut analisis Receiver Operating Curve (ROC) cutoff rasio kolesterol total/HDL sebesar 7,13 sedangkan untuk rasio LDL/HDL dipilih cutoff 3,58.

Kesimpulan: Rasio Kolesterol total/HDL dan rasio LDL/HDL menunjukkan hubungan dengan kejadian ulkus kaki diabetik.

References

  1. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-S31.
  2. Cho NH, Shaw JE, Karuranga S, Huang Y, Fernandes JDR, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281.
  3. Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?. Indian J Endocrinol Metab. 2016;20(4):546-551.
  4. Aumiller WD, Dollahite HA. Pathogenesis and management of diabetic foot ulcers. JAAPA. 2015;28(5):28-34.
  5. Noor S, Zubair M, Ahmad J. Diabetic foot ulcer--A review on pathophysiology, classification and microbial etiology. Diabetes Metab Syndr. 2015;9(3):192-199.
  6. Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):1-15.
  7. Artha IMJR, Bhargah A, Dharmawan NK, Pande UW, Triyana KA, Mahariski PA, et al. 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.
  8. Mulyani WRW, Sanjiwani MID, Sandra, Prabawa IPY, Lestari AAW, Wihandani DM, et al. Chaperone-Based Therapeutic Target Innovation: Heat Shock Protein 70 (HSP70) for Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2020;13:559-568.
  9. Kunutsor SK, Zaccardi F, Karppi J, Kurl S, Laukkanen JA. Is High Serum LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death? Findings from the KIHD Study. J Atheroscler Thromb. 2017;24(6):600-608.
  10. Olamoyegun MA, Oluyombo R, Asaolu SO. Evaluation of dyslipidemia, lipid ratios, and atherogenic index as cardiovascular risk factors among semi-urban dwellers in Nigeria. Ann Afr Med. 2016;15(4):194-199.
  11. Castelli WP, Abbott RD, McNamara PM. Summary estimates of cholesterol used to predict coronary heart disease. Circulation. 1983;67(4):730-734.
  12. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497.
  13. Sagitania D, Sujatno P, Fenty F. The Difference in The Total Cholesterol/HDL-C Ratio In Type-2 DM Patients With Diabetic Ulcers and Without Diabetic Ulcers in Bethesda Hospital Yogyakarta. Jurnal Farmasi Sains dan Komunitas. 2018;15(1):16-22.
  14. Ain QU, Asif M, Gilani M, Noreen, Sheikh W, Akram A. To Determine Cutoff Value of Triglycerides to HDL Ratio in Cardio Vascular Risk Factors. Biochem Anal Biochem. 2018;7(2):1-4.
  15. Aryal M, Poudel A, Satyal B, Gyawali P, Pokharel BR, Raut BK, et al. Evaluation of non-HDL-c and total cholesterol: HDL-c ratio as cumulative marker of cardiovascular risk in diabetes mellitus. Kathmandu Univ Med J (KUMJ). 2010;8(32):398-404.
  16. Salazar MR, Carbajal HA, Espeche WG, Sisnieguez CEL, March CE, Balbin E, et al. Comparison of the abilities of the plasma triglyceride/high-density lipoprotein cholesterol ratio and the metabolic syndrome to identify insulin resistance. Diab Vasc Dis Res. 2013;10(4):346-352.
  17. Teddy, Sylvia E. Hubungan Kadar Hemoglobin Aic (HbA1c) dengan Ulkus Kaki Diabetik pada Penderita Diabetes Melitus Tipe 2 di Rumah Sakit Umum Daerah Dr. H. Abdul Moeloek Provinsi Lampung Periode September 2014-Maret 2015. Jurnal Ilmu Kedokteran dan Kesehatan, 2015;2(3):1-11.
  18. Madina TS, Djallalluddin, Yasmina A. Hubungan kadar HbA1c dengan kejadian kaki diabetik pada pasien diabetes mellitus. Jurnal Berkala Kedokteran, 2013;9(2):211-217.
  19. Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications. Osong Public Health Res Perspect. 2018;9(4):167-174.
  20. Almobarak AO, Awadalla H, Osman M, Ahmed MH. Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?. Ann Transl Med. 2017;5(17):340.
  21. Kirojan D, Pandelaki K, Wongkar MC. Perbedaan Kadar uHDL dan Trigliserida antara Penderita Ulkus Diabetik dan Tanpa Ulkus Diabetik pada Pasien DM Tipe 2 di RSUP Prof. Dr. RD Kandou Manado. Jurnal e-CliniC. 2017;5(2):1-6.
  22. Pei E, Li J, Lu C, Xu J, Tang T, Ye M, et al. Effects of lipids and lipoproteins on diabetic foot in people with type 2 diabetes mellitus: a meta-analysis. J Diabetes Complications. 2014;28(4):559-564.
  23. Bleda S, de Haro J, Varela C, Esparza L, Rodriguez J, Acin F. Improving Total-Cholesterol/HDL-Cholesterol Ratio Results in an Endothelial Dysfunction Recovery in Peripheral Artery Disease Patients. Cholesterol. 2012;2012:895326.
  24. Bandeali S, Farmer J. High-density lipoprotein and atherosclerosis: the role of antioxidant activity. Curr Atheroscler Rep. 2012;14(2):101-107.
  25. Quispe R, Elshazly MB, Zhao D, Toth PP, Puri R, Virani SS, et al. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study. Eur J Prev Cardiol. 2020;27(15):1597-1605.
  26. Manda V, Sreedharan J, Muttappallymyalil J, Das R, Hisamatsu E. Foot ulcers and risk factors among diabetic patients visiting Surgery Department in a University Teaching Hospital in Ajman, UAE. International Journal of Medicine and Public Health. 2012;2(3):34-38.
  27. Gao S, Liu J. Association between circulating oxidized low-density lipoprotein and atherosclerotic cardiovascular disease. Chronic Dis Transl Med. 2017;3(2):89-94.
  28. Itabe H, Obama T, Kato R. The Dynamics of Oxidized LDL during Atherogenesis. J Lipids. 2011;2011:418313.
  29. Jenab Y, Afsaneh M, Younes N, Alireza F, Jalil MA. Diabetic Foot Ulcer is a Significant Predictor of Silent Myocardial Ischemia in Women with Type 2 Diabetes. J Diabetes Metab. 2011;2(161):2.
  30. Kajikawa M, Higashi Y. Triglycerides and endothelial function: molecular biology to clinical perspective. Curr Opin Lipidol. 2019;30(5):364-369.
  31. Jiang R, Schulze MB, Li T, Rifai N, Stampfer MJ, Rimm EB, et al. Non-HDL cholesterol and apolipoprotein B predict cardiovascular disease events among men with type 2 diabetes. Diabetes Care. 2004;27(8):1991-1997.
  32. Wengrofsky P, Lee J, Makaryus AN. Dyslipidemia and Its Role in the Pathogenesis of Atherosclerotic Cardiovascular Disease: Implications for Evaluation and Targets for Treatment of Dyslipidemia Based on Recent Guidelines. In: Dyslipidemia. IntechOpen. 2019.
  33. Singla S, Kaur K, Kaur G, Kaur H, Kaur J, Jaswal S. Lipoprotein (a) in type 2 diabetes mellitus: Relation to LDL:HDL ratio and glycemic control. Int J Diabetes Dev Ctries. 2009;29(2):80-84.
  34. Schmitt JK, Poole JR, Lewis SB, Shore VG, Maman A, Baer RM, et al. Hemoglobin A1 correlates with the ratio of low-to high-density-lipoprotein cholesterol in normal weight type II diabetics. Metabolism. 1982;31(11):1084-1089.
  35. Keles N, Aksu F, Aciksari G, Yilmaz Y, Demircioglu K, Kostek O, et al. Is triglyceride/HDL ratio a reliable screening test for assessment of atherosclerotic risk in patients with chronic inflammatory disease?. North Clin Istanb. 2016;3(1):39-45.
  36. Chen C, Dai JL. Triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio and arterial stiffness in Japanese population: a secondary analysis based on a cross-sectional study. Lipids Health Dis. 2018;17(1):130.
  37. Turak O, Af?ar B, Ozcan F, Oksuz F, Mendi MA, Yayla C, et al. The Role of Plasma Triglyceride/High-Density Lipoprotein Cholesterol Ratio to Predict New Cardiovascular Events in Essential Hypertensive Patients. J Clin Hypertens (Greenwich). 2016;18(8):772-777.

How to Cite

Lestari, P. H. P., Nurahmi, N., Esa, T., & Kurniawan, L. B. (2020). Analisis rasio profil lipid kolesterol total, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), dan trigliserida pada pasien Diabetes Melitus Tipe 2 (DM-2) dengan dan tanpa komplikasi ulkus kaki diabetik. Intisari Sains Medis, 11(3), 1333–1340. https://doi.org/10.15562/ism.v11i3.764

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Putri Hidayasyah Purnama Lestari
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Nurahmi Nurahmi
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Tenri Esa
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Liong Boy Kurniawan
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