Hubungan antara resistensi insulin dengan dislipidemia pada penderita diabetes mellitus tipe 2

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

2006 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang. Diabetes Mellitus tipe 2 mempunyai morbiditas serta mortalitas penyakit kardiovaskuler yang tinggi. Pada DM tipe 2 terjadi resistensi insulin yang menyebabkan penurunan sekresi insulin dan hiperglikemia. Defek insulin dan hiperglikemia melatarbelakangi terjadinya abnormalitas lipoprotein atau dislipidemia pada DM tipe 2, meliputi peningkatan kadar trigliserida (TG) dan low density lipoprotein (LDL), dan penurunan kadar high density lipoprotein (HDL). Keduanya, resistensi insulin dan dislipidemia merupakan faktor risiko penyakit kardiovaskuler aterosklerosis. Tujuan penelitian. Mengetahui hubungan antara resistensi insulin dengan dislipidemia pada penderita DM tipe 2. Subyek dan metode. Penelitian dilakukan secara potong lintang pada penderita DM tipe 2 yang periksa di Poliklinik Penyakit Dalam RS Dr. Sardjito, RSUD Kota Yogyakarta dan RSUP Dr. Soeradji Tirtonegoro Klaten pada bulan Maret sampai dengan September 2004. Subyek yang memenuhi kriteria inklusi dan eksklusi dikelompokkan menjadi dua, kelompok resistensi insulin dan tidak resistensi insulin berdasarkan HOMA IR. Hasil. Didapatkan 66 subyek, terdiri dari 23 orang (34,85%) laki-laki dan 43 orang (65,15%) perempuan. Rerata umur 57,65 ± 9,69 tahun, lama terdiagnosis DM 58,12 ± 52,79 bulan, IMT 23,04 ± 2,69 kg/m2, tekanan darah sistolik 120,38 ± 9,58 mmHg, tekanan darah diastolik 78,41 ± 7,40 mmHg, kadar kolesterol total 206,65 ± 33,69 mg/dl, TG 123,08 ± 53,18 mg/dl, LDL 124,67 ± 29,57 mg/dl, HDL 56,40 ± 22,25 mg/dl, HbA1c 8,57 ± 2,51%, glukosa puasa 173,86 ± 82,71 mg/dl, insulin puasa 7,16 ± 3,57 μUnit/ml, HOMA IR 3,16 ± 2,47, dan dislipidemia didapatkan pada 61 (92,42%) subyek, resistensi insulin dan dislipidemia pada 29 (43,94%) subyek. Terdapat perbedaan bermakna IMT (p=0,017), glukosa puasa (p<0.0001) dan insulin puasa (p<0,0001) antara kelompok resistensi insulin dan tidak resistensi insulin. Terdapat korelasi positif dan bermakna antara resistensi insulin dengan IMT (r=0,292; p=0,009), glukosa puasa (r=0,440; p<0.0001) dan insulin puasa (r=0,651; p<0,0001), korelasi positif dan tidak bermakna dengan TG (r=0,159, p=0,101), korelasi negatif dan tidak bermakna dengan kadar kolesterol total (r=-0,095, p=0,223), LDL (r=-0,157, p=0,104), dan HDL (r=-0,032, p=0,400). Simpulan. Pada penelitian ini tidak terdapat hubungan antara resistensi insulin dengan dislipidemia pada penderita DM tipe 2.

Background. Type 2 Diabetes Mellitus have high morbidity and mortality in cardiovascular diseases. In type 2 DM occurred insulin resistance leading to decreasing of insulin secretion and hyperglycemia. Insulin defect and hyperglycemia will cause lipoprotein abnormality or dyslipidemia in type 2 DM, include increasing levels of trigliserida and LDL, and decreasing level of HDL. Both, insulin resistance and dyslipidemia are risk factors for atherosclerosis cardiovascular disease. Objective . The purpose of this study was to assess the relationship between insulin resistance and dyslipidemia in type 2 DM. Subjects and methods. Design of this study was cross sectional study. Patients with type 2 DM were recruited from 3 hospitals: Dr. Sardjito Hospital, General Hospital city of Yogyakarta and Dr. Soeradji Tirtonegoro Centre General Hospital, Klaten, from March until September 2004. Subjects with fulfill inclusion and exclusion criteria were devided into 2 groups, insulin resistance and not insulin resistance groups, based on HOMA IR. Results. Sixty six subjects, 23 (34,85%) males and 35 (65,15%) females were included. Mean of age was 57,65 ± 9,69 years, duration of D M was 58,12 ± 52,79 months, body mass index (BMI) 23,04 ± 2,69 kg/m2, systolic blood pressure 120,38 ± 9,58 mmHg, diastolic blood pressure 78,41 ± 7,40 mmHg, total cholesterol level 206,65 ± 33,69 mg/dl, TG 123,08 ± 53,18 mg/dl, LDL 124,67 ± 29,57 mg/dl, HDL 56,40 ± 22,25 mg/dl, HbA1c 8,57 ± 2,51%, fasting glucose 173,86 ± 82,71 mg/dl, fasting insulin 7,16 ± 3,57 μUnit/ml, HOMA IR 3,16 ± 2,47, and 61 (92,42%) subjects were dyslipidemia , 29 (43,94%) subjects were insulin resistance and dyslipidemia . There were significant ly differences in BMI (p=0,017), fasting glucose (p<0,0001) and fasting insulin (p<0,0001) between insulin resistance and not insulin resistance groups. Insulin resistance was significantly correlated with BMI (r=0,292; p=0,009), fasting glucose (r=0,440; p<0,0001) and fasting insulin (r=0,651; p<0,0001), not significantly correlated with TG (r=0,159, p=0,101), and was not significantly inversely correlated with levels of total cholesterol (r=-0,095, p=0,223), LDL (r=-0,157, p=0,104), and HDL (r=-0,032, p=0,400). Conclusion. In this study there w as no relationship between insulin resistance and dyslip idemia in type 2 DM patients.

Kata Kunci : DM Tipe II,Resistensi Insulin,Dislipidemia, Type 2 DM-insulin resistance-dyslipidemia