Pengaruh Rosella (Hibiscus sabdariffa Linn) Terhadap Resistensi Insulin Pasien Diabetes Melitus Tipe 2: Kajian Kadar Glukosa Darah, Insulin, HOMA-IR dan Variasi Genetik Uncoupling Protein-2

DWI SARBINI, Dr. dr. Emy Huriyati, M.Kes; dr. Ahmad Hamim Sadewa, Ph.D; Prof. Dr. Mae Sri Hartati Wahyuningsih, M.Si., Apt

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Diabetes Melitus Tipe 2 ditandai tingginya kadar glukosa darah puasa, kurangnya insulin puasa dan meningkatnya HOMA-IR akibat insufisiensi fungsi insulin dan resistensi insulin dikaitkan dengan gen UCP2. Penggunaan obat-obatan untuk DMT2 dalam jangka lama dapat menyebabkan resisten. Rosella (Hibiscus sabdariffa Linn) dapat digunakan sebagai obat herbal komplementer DMT2 untuk pencegahan komplikasi. Penelitian ini melihat pengaruh pemberian Rosella terhadap kadar glukosa darah dan kadar insulin puasa serta nilai HOMA-IR pasien DMT2 dengan variasi genetik UCP2. Desain penelitian menggunakan randomized clinical trial dengan 53 pasien DMT2 rawat jalan di 5 puskesmas Dinkes Kota DIY yang memenuhi kriteria inklusi dan eksklusi. Pemberian kapsul Rosella selama 8 minggu. Kadar glukosa darah puasa diukur menggunakan metode Glucose Oxidase-Para Amino Phenazone, kadar insulin puasa diukur dengan Microparticle Immunoassay Enzyme, nilai HOMA-IR ditetapkan dari kadar glukosa darah dan kadar insulin plasma, variasi genetik UCP2 diukur dengan RFLP-PCR. Analisis pengaruh Rosella terhadap kadar glukosa darah puasa, kadar insulin puasa dan nilai HOMA-IR pasien DMT2 dalam 1 kelompok menggunakan Wilcoxon Signed Rank Test dan pengaruh antar kelompok menggunakan Mann Whitney U-Test serta analisis pengaruh Rosella dan variasi gen UCP2 menggunakan ANCOVA, dengan taraf signifikansi 95%. Penurunan kadar glukosa darah puasa post intervensi pada kelompok Rosella (-29,2 mg/dL) lebih rendah dibandingkan kelompok kontrol (p=0,845), tertinggi pada pada genotip GA pada masing-masing kelompok. Peningkatan kadar insulin plasma post intervensi pada kelompok Rosella (3,9 mikro IU/mL) lebih besar dibandingkan kelompok kontrol (p=0,400), tertinggi pada genotip AA pada kelompok Rosella. Penurunan nilai HOMA-IR post-intervensi pada kelompok Rosella (-0,67) lebih besar dibanding kelompok kontrol (p=0,080), tertinggi pada genotif GG pada kelompok Rosella.

Type 2 diabetes mellitus is characterized by high level of fasting blood glucose, low of fasting insulin and high of HOMA-IR values due insufficient insulin function and insulin resistance which associated by UCP2 gene. Long-time consumption of diabetes drugs will be resistant. Rosella (Hibiscus sabdariffa Linn) can be used as a complementary drug to prevent T2DM complications. This study aimed to identify the effects of consuming Rosella capsule on fasting blood glucose, fasting insulin and HOMA-IR in T2DM patients with UCP2 polymorphism. The study was a randomized clinical trial with intervention (placebo and Rosella) for 8 weeks. The sample consisted of 53 T2DM outpatients at the Health Office Yogyakarta City. Fasting blood glucose was measured through Glucose oxidase-para amino phenazone method, fasting insulin was measured by Microparticle Immunoassay Enzyme, HOMA-IR was calculated with HOMA Calculator 2.2.3 Version and polymorphism of UCP2 was measured by RFLP-PCR. Analysis of the influence of Rosella on fasting blood glucose, fasting insulin and HOMA-IR level in one group were tested with the Wilcoxon Signed Test and the effect between groups were tested through Mann Whitney U Test. Analysis of the influence of Rosella and polymorphism of the UCP2 gene interaction were tested using ANCOVA with a significance level of 95%. The decreasing of fasting blood glucose on post-intervention in the Rosella group (-29,2 mg/dL) was lower than the control group (p=0,845), the highest of decreasing in fasting blood glucose levels was in the GA genotype in Rosella group. The increasing of insulin on post-intervention in the Rosella group (3,9 mikro IU/mL) was greater than the control group (p=0,400), the highest increasing of fasting insulin was in the AA genotype in the Rosella group. The decreasing of HOMA-IR values on post-intervention in the Rosella group (-0,67) was greater than the control group (p=0,080), the highest decreasing of HOMA-IR values was in the genotype of GG in the Rosella group.

Kata Kunci : diabetes tipe 2, glukosa, Hibiscus sabdariffa Linn, HOMA-IR, insulin, Rosella, uncoupling protein 2