PARAMETER KOMPOSISI TUBUH SEBAGAI FAKTOR RISIKO BARU RETINOPATI DIABETIKA PADA PENDERITA DIABETES MELLITUS TIPE 2 DI YOGYAKARTA

MUHAMMAD BAYU SASONGKO, dr. Agus Supartoto, Sp.M(K); Prof. dr. Suhardjo, SU, Sp.M(K)

2015 | Tesis | SP ILMU PENYAKIT MATA

Pendahuluan: Retinopati diabetika (RD) merupakan komplikasi mikrovaskuler yang paling sering dijumpai pada penderita diabetes. Berbagai penelitian telah dilakukan untuk mengenali faktor-faktor risiko terjadinya RD (misal tekanan darah tinggi, kadar gula darah tinggi, obesitas), namun pengendalian dan penanganan RD masih belum optimal. Secara teori, obesitas memiliki peran cukup kuat dalam patofisiologi RD, tetapi beberapa penelitian terdahulu menunjukkan hasil yang kurang konsisten. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara parameter komposisi tubuh dengan kejadian RD pada penderita diabetes tipe 2 di komunitas. Metode: Penelitian ini merupakan penelitian cross-sectional, melibatkan 492 penderita diabetes tipe 2 berusia di atas 30 tahun dari 9 puskesmas di DIY, yaitu Puskesmas Gondomanan, Wirobrajan, Kotagede, Depok 1, Ngemplak 1, Wonosari, Bantul 1, Bambanglipuro, dan Pajangan. Data yang diambil berupa data klinis, riwayat lama menderita diabetes, tekanan darah, kadar gula darah, foto fundus untuk diagnosis RD, dan ukuran antropometri dan komposisi tubuh, yaitu usia tubuh, persentase lemak, lemak sub-kutan, otot skelet, lemak viseral, dan laju metabolik. Analisa data dilakukan dengan regresi logistik, dengan analisa tambahan estimasi korelasi parsial dan grafik receiver operating characteristics (ROC). Hasil : Subyek total penelitian ini berjumlah 492 penderita diabetes tipe 2, dengan rerata usia 57 (11,9) tahun. Prevalensi RD pada populasi penelitian ini adalah 36,6%, dengan distribusi 9,8% mild, 17,9% moderate non proliferative diabetic retinopathy (NPDR) dan 8,9% vision-threatening diabetic retinopathy (VTDR). Pada analisis, tidak didapatkan hubungan yang bermakna antara kenaikan usia tubuh (Odds ratio [OR] 0,77; 95% Confidence Interval [CI] 0,56 �¢ï¿½ï¿½ 1,05; P=0,50), persentase lemak tubuh (OR 0,90; 95% CI 0,68 �¢ï¿½ï¿½ 1,21; P=0,50), lemak sub-kutan (OR 0,87; 95% CI 0,63 �¢ï¿½ï¿½ 1,21; P=0,43), otot skelet (OR 1,07; 95% CI 0,81 �¢ï¿½ï¿½ 1,43; P=0,62), lemak viseral (OR 0,79; 95% CI 0,59 �¢ï¿½ï¿½ 1,05; P=0,10), laju metabolik (OR 0,91; 95% CI 0,65 �¢ï¿½ï¿½ 1,27; P=0,57) dengan kejadian RD. Peningkatan parameter komposisi tubuh juga tidak menunjukkan hubungan yang bermakna dengan peningkatan tingkat keparahan RD. Parameter komposisi tubuh hanya berkontribusi sebesar 0,1% - 0,8% terhadap kejadian RD, dengan perubahan area di bawah kurva ROC sebesar 8% namun tidak bermakna secara statistik. Kesimpulan: Pada populasi penderita diabetes tipe 2 di Yogyakarta, parameter komposisi tubuh tidak berhubungan dengan kejadian RD dan hanya memiliki kontribusi minimal terhadap kejadian RD. Hasil ini menunjukkan bahwa interaksi antara faktor patologis lain seperti kadar gula darah tinggi, tekanan darah tinggi, dan lama menderita diabetes lebih berperan dalam patofisiologi RD pada penderita diabetes tipe 2.

Background: Diabetic Retinopathy (DR) is the most common diabetes microvascular complications. Studies have attempted to investigate various risk factors for DR (e.c. high blood pressure, hyperglycemica, obesity), yet the management of DR is still far inadequate. Theoretically, obesity has an important role in the pathophysiology of DR, nevertheless previous studies failed to demonstrate consistent associations. Objective: This study aimed to investigate the associations of body composition parameters (body age, body fat, sub-cutaneous fat, skeletal muscle percentage, visceral fat and resting metabolic rate) with DR in type 2 diabetes in the community. Methods: This was a cross-sectional study, involving nearly 500 diabetes participants aged �¢ï¿½�¥ 30 years. Those participants were recruited from 9 primary health centres (PHC), Gondomanan, Wirobrajan, Kotagede, Depok 1, Ngemplak 1, Wonosari, Bantul 1, Bambanglipuro, and Pajangan. All clinical data, history of systemic diseases, fundus photograph, anthropometry and body composition measurements were collected. Logistic regression with semi-partial correlation and post-hoc estimation to determine the receiver operating characteristics (ROC) curve were used. Results: There were 492 persons with diabetes included in this analysis. The mean age was 57 (11.9) years. The prevalence of DR in this population was 36,6% (9,8% mild, 17,9% moderate non-proliferative DR (NPDR) and 8,9% vision-threatening DR). After adjusting for age, gender, diabetes duration, fasting blood glucose, systolic blood pressure, smoking, and body mass index, there were no significant associations of increasing body age (Odds ratio [OR] 0,77; 95% Confidence Interval [CI] 0,56 �¢ï¿½ï¿½ 1,05; P=0,50), body fat (OR 0,90; 95% CI 0,68 �¢ï¿½ï¿½ 1,21; P=0,50), sub-cutaneous fat (OR 0,87; 95% CI 0,63 �¢ï¿½ï¿½ 1,21; P=0,43), skeletal muscle (OR 1,07; 95% CI 0,81 �¢ï¿½ï¿½ 1,43; P=0,62), visceral fat (OR 0,79; 95% CI 0,59 �¢ï¿½ï¿½ 1,05; P=0,10), metabolic rate (OR 0,91; 95% CI 0,65 �¢ï¿½ï¿½ 1,27; P=0,57) with DR. Increasing each of these parameters was also not significantly associated with increasing severity of DR, and only had very smal contribution to DR (0,1% - 0,8% with 8% overall change in the area under ROC curve). Comclusion: In this study, body composition parameters were not associated with DR, and only had very small contribution to DR, therefore less likely as risk factors for DR in type 2 diabetes. These findings suggest that hyperglycemia, high blood pressure and long diabetes duration remain the most important factors in the pathophysiology of DR.

Kata Kunci : Retinopati diabetika, antropometri, komposisi tubuh