PENAMPILAN DIAGNOSTIK HOMEOSTASIS MODEL ASSESSMENT FOR INSULIN RESISTANCE (HOMA-IR) UNTUK PENEGAKAN DIAGNOSIS DIABETES MELLITUS GESTASIONAL

PRIMALIA S., dr. Windarwati, M.Sc, Sp.PK(K).; dr. Usi Sukorini, M.Kes, Sp.PK(K)

2021 | Tesis-Spesialis | PATOLOGI KLINIK

Latar belakang: Diabetes melitus gestasional (DMG) merupakan komplikasi kehamilan yang paling umum terjadi. Prevalensi DMG di dunia berkisar antara 1- 36%. Diabetes mellitus gestasional meningkatkan mortalitas dan morbiditas baik bagi ibu maupun bayi. Hingga saat ini terdapat beberapa metode penegakan diagnosis DMG. Metode TTGO 75 gram dengan one step approach direkomendasikan oleh IADPSG dan sesuai dengan WHO namun metode ini memiliki beberapa kekurangan. Indeks Homeostasis model assessment for insulin resistance (HOMA-IR) merupakan parameter yang digunakan untuk menilai keparahan resistensi insulin yang merupakan salah satu patofisiologi utama terjadinya DMG. Terdapat beberapa cut-off value HOMA-IR dalam menegakkan diagnosis DMG pada berbagai negara. Di Indonesia sendiri, belum ada studi untuk penentuan cut-off value HOMA-IR untuk menegakkan diagnosis DMG. Tujuan : Untuk mengetahui cut-off value terbaik dan performa diagnostik HOMA-IR untuk menegakkan diagnosis diabetes mellitus gestasional. Metode: Penelitian ini merupakan studi observasional analitik dengan desain potong lintang. Penelitian ini melibatkan wanita hamil usia gestasi 24-28 minggu yang dikelompokkan pada ibu hamil non-DMG dan DMG berdasarkan kriteria IADPSG dan diukur indeks HOMA-IR nya serta diukur penampilan diagnostik HOMA-IR dalam mendiagnosis DMG. Hasil: Penelitian ini melibatkan 214 subjek memenuhi kriteria inklusi dan ekslusi. Kelompok DMG sejumlah 26 subjek dan non DMG sebanyak 188 subjek. Kurva ROC didapatkan nilai AUC 0,802, p<0,001, menunjukkan HOMA-IR mempunyai kekuatan diagnostik baik. Cut-off HOMA-IR sebesar 1,26 memiliki sensitivitas 80,8% dan spesifisitas 70,7%. Simpulan: HOMA-IR dengan cut-off value 1,26 memiliki AUC 0,802 p<0,001 dengan sensitivitas 80,8% dan spesifisitas 70,7% untuk mendiagnosis diabetes mellitus gestasional.

Background: Gestational diabetes mellitus (GDM) is the most common pregnancy complication. The prevalence of GDM varies from 1-36%. Gestational diabetes mellitus increases mortality and morbidity for both mother and baby. Until now there are several methods for diagnosing DMG. WHO recommends a 75 gram TTGO method with a one step approach, in accordance with IADPSG recommendations, but this method has several shortcomings. The Homeostasis Index assessment model for insulin resistance (HOMA-IR) is a parameter used to assess the severity of insulin resistance which is one of the main DMG pathophysiology. There are several cut-off values (COV) of HOMA-IR in establishing the diagnosis of DMG in several countries. In Indonesia, there was no studies for determining the cut-off value of HOMA-IR in establishing the diagnosis of GDM Objective: To determine the best cut-off value and diagnostic performance of HOMA-IR to diagnose gestational diabetes mellitus. Method: This was an observational analytic study with a cross-sectional design. This study involved pregnant women with gestational age of 24-28 weeks grouped in non-GDM and GDM pregnant women based on IADPSG criteria and measured their HOMA-IR index and measured the diagnostic performance of HOMA-IR in diagnosing GDM. Results: This study involved 214 subjects meeting the inclusion and exclusion criteria. The DMG group consisted of 26 subjects and non-DMG as many as 188 subjects. The ROC curve obtained an AUC value of 0.802, p <0.001, indicating that HOMA-IR has good diagnostic power. The HOMA-IR cut-off of 1.26 had a sensitivity of 80,8% and a specificity of 70,7%. Conclusion: HOMA-IR has good diagnostic power with AUC 0.802 p <0.001. HOMA-IR with a cut-off value of 1.26 had a sensitivity of 80,8% and specificity of 70,7% for diagnosing gestational diabetes mellitus.

Kata Kunci : DMG, diagnosis, HOMA-IR, resistensi insulin, GDM, diagnosis, HOMA-IR, insulin resistance