Kadar faktor Von Willebrand pada penderita diabetes mellitus tipe 2 terkendali dan tak terkendali yang dipantau dengan HbA1c

IRWAN, Prof.dr. H. Ahmad Husain Asdie, SpPD-KEMD.,SpOG

2005 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar Belakang. Kondisi hiperglikemia pada penderita diabetes mellitus (DM) tipe 2 menyebabkan terjadinya stres oksidatif yang antara lain melalui proses glikosilasi non enzimatik pada akhirnya menyebabkan disfungsi endotel. Komplikasi kronik DM masih menjadi masalah penting pada penderita DM. Salah satu kriteria pengendalian DM jangka panjang yakni dengan menilai kadar HbA1c yang menunjukkan rerata gula darah dalam 2-3 bulan terakhir. Rekomendasi American Diabetes Association (ADA) dan dari berbagai penelitian menunjukkan target kendali glikemia optimal adalah HbA1c < 7% dan diharapkan dapat menurunkan risiko komplikasi mikrovaskuler. Hemoglobin A1c terjadi melalui proses glikosilasi non enzimatik. Salah satu penanda disfungsi endotel adalah Faktor von Willebrand (vWF) yang kadarnya meningkat bila terjadi disfungsi endotel. Tujuan Penelitian. Mengetahui rerata kadar vWF pada penderita DM tipe 2 yang terkendali dan tak terkendali. Subyek dan Metode. Penelitian dilakukan dengan cara studi potong lintang (cross sectional) pada penderita DM tipe 2 di Poliklinik endokrin RS. Dr. Sardjito, Yogyakarta, Poliklinik Penyakit Dalam RSUD Kodya Yogyakarta dan RSUP Dr. Suradji Tirtonegoro Klaten. Penelitian dilakukan pada bulan Maret sampai September 2004. Subyek yang memenuhi kriteria inklusi dan eksklusi, dikelompokkan menjadi 2 kelompok yakni DM terkendali (HbA1c < 7 %) dan tak terkendali (HbA1c > 7 %). Hasil. Jumlah subyek yang memenuhi kriteria penelitian dan setuju mengikuti penelitian adalah 48 orang, terdiri dari laki-laki 25 orang (52,1 %) dan perempuan 23 orang (47,9 %), rerata umur 58,75 ± 10,30 tahun. Lama terdiagnosis DM keseluruhan penderita 67,23 ± 61,01 bulan, IMT 23,13 ± 2,27 kg/m2, rerata kadar gula darah puasa 146,06 ± 58,83 mg/dl, HbA1c 7,23 ± 2,01 %, vWF 147,15 ± 43,56 %. Ada perbedaan bermakna rerata kadar vWF pada kelompok DM terkendali (HbA1c < 7 %) dan tak terkendali (HbA1c > 7 %) (132,96 ± 31,97 % : 161,33 ± 49,324; p=0,02; IK - 52,53 – -4,22). Ada korelasi positif lemah antara vWF dengan HbA1c (r=0,273; p=0,060). Kesimpulan. Kadar vWF penderita DM tipe 2 tak terkendali lebih tinggi dibandingkan dengan kadar vWF penderita DM tipe 2 terkendali.

Background. Hyperglicaemia condition in type 2 diabetes mellitus (DM) patients causes oxydative stress. The oxydative stress could occur by so many mechanism. One of these mechanisms is through non enzymatic glycosilated process. This oxydative stress could cause the endothel dysfunction, eventually. Chronic complication of DM is still become important issue in DM patients. HbA1c level is one of criteria of long term glycemic control in DM patients. The value of HbA1c shows the mean of blood glucose in last 2-3 month. American Diabetes Association (ADA) recommendation and the result from some studies show the optimal control of blood glucose is HbA1c < 7 %. This level expected could decreased micro vascular complication risk. Hemoglobin A1c occur through non enzymatic glycated. One of these micro vascular complication is endothelial dysfunction. The level of von Willebrand Factor (vWF) is a marker for endothelial dysfunction. Objective. To know the average of vWF level in type 2 DM patients, both in controlled and uncontrolled DM. Subject and Method. The study design is cross sectional. The subjects are type 2 DM patients that control to Endocrine polyclinic Dr. Sardjito General Hospital Yogyakarta, Kodya Yogyakarta General Hospital and Dr. Suradji Tirtonegoro General Hospital Klaten, from March – September 2004. The subjects were divided to 2 group; one group as controlled DM (HbA1c< 7 %) and another group as uncontrolled DM (HbA1c > 7 %). Results. Forty and eight patients, 25 male (52,1%) and 23 (47,9%) female, were eligible to study criteria. Mean of age 58,75 ± 10,30 years old. Duration of DM diagnosed is 67,23 ± 61,01 months, average of BMI is 23,13 ± 2,27 kg/m2, mean of blood glucose level is 146,06 ± 58,83 mg/dl, mean of HbA1c is 7,23 ± 2,01 % and mean of vWF level is 147,15 ± 43,56 %. There is significant difference in vWF level between controlled DM group and uncontrolled DM group (132,96 ± 31,97 %, and 161,33 ± 49,324), p=0,02, CI –52,53 – -4,22. There is positive and weak correlation between vWF with HbA1c, but this correlation is not significant, r=0,273, p=0,06. Conclusion. Level of vWF in uncontrolled type 2 DM is higher than controlled type 2 DM.

Kata Kunci : DM Tipe II,Hemoglobin A1c,Faktor Von Willebrand, type 2 diabetes mellitus – hemoglobin A1c – von Willebrand Factor