EVALUASI PENGGUNAAN ANTIDIABETIKA PADA ULKUS DIABETIK (STUDI KASUS DI RS PKU MUHAMMADIYAH YOGYAKARTA)

Recta Olivia Umboro, Prof. Dr. Djoko Wahyono, SU., Apt

2012 | Tesis | S2 Mag.Farmasi Klinik

Ulkus dan gangren diabetes merupakan kasus DM yang paling sering dirawat di rumah sakit. Beberapa penelitian di Indonesia menunjukkan 17-23% angka kematian diakibatkan ulkus atau gangren dan 15-30% karena amputasi. Kontrol glukosa darah merupakan faktor integral yang mempengaruhi keberhasilan pengelolaan ulkus diabetika. Kontrol glukosa darah dapat dilakukan dengan penatalaksanaan terapi farmakologik, baik dalam bentuk terapi antidiabetika oral, insulin, atau kombinasi keduanya. Penelitian ini merupakan penelitian noneksperimental dengan rancangan deskriptif evaluatif melalui penelusuran data kuantitatif secara retrospektif terhadap rekam medik pasien DMT2 dengan diagnosa ulkus diabetika. Dilakukan di RS.PKU Muhammadiyah Yogyakarta periode Januari 2010-Desember 2011. Data yang diperoleh dianalisis dengan analisis deskriptif dan analisis evaluatif chi-square terhadap hubungan antara jenis terapi dengan kadar glukosa darah, dan hubungan antara kadar glukosa darah dengan outcome klinik ulkus diabetika pasien DMT2. Hasil penelitian menunjukkan bahwa pola penggunaan antidiabetika pada pasien DMT2 di RS.PKU Muhammadiyah yogyakarta menggunakan insulin (46,7%), obat hipoglikemik oral (OHO) 18,1%, terapi kombinasi OHO-OHO (20,5%), terapi kombinasi insulin-OHO (13,9%), terapi kombinasi insulin-insulin (0,8%). Untuk jenis insulin yang terbanyak digunakan insulin rapid acting (67,9%), golongan OHO yang terbanyak digunakan biguanid (68,2%). Sedangkan untuk terapi kombinasi antara OHO-OHO yang terbanyak digunakan biguanidsulfonilurea (94%), jenis terapi kombinasi insulin-OHO yang terbanyak digunakan insulin-biguanid, dan untuk terapi kombinasi insulin-insulin yang terbanyak digunakan adalah long acting-rapid acting insulin (100%). Hasil analisis chi-square antara jenis terapi dengan kadar glukosa darah menunjukkan bahwa ada hubungan yang signifikan (p = 0,016), sedangkan untuk analisis chisquare antara kadar glukosa darah dengan outcome klinik ulkus diabetika menunjukkan bahwa ada hubungan yang signifikan (p = 0,00).

Diabetic ulcers and gangrene are the most frequent cases of diabetes were hospitalized. Several studies in Indonesia showed that 17-23% mortality rate due to ulcers or gangrene and 15-30% due to amputation. Blood glucose control is an integral factor which is affecting the successful management of diabetic ulcers. Blood glucose control can be done by the management of pharmacologic therapy, either in the form of oral antidiabetics therapy, insulin, or a combination of both. This is a noneksperimental research with descriptive design evaluative and search by a retrospective quantitative data through of the medical records of patients with a T2DM diabetic ulcers diagnosis. This research implemented in PKU Muhammadiyah Yogyakarta hospital period January 2010-December 2011. Data were analyzed with descriptive analysis and chi-square evaluative on the correlation between the type of therapy with blood glucose levels, and the correlation between blood glucose levels with the clinical outcome of patients T2DM diabetic ulcers. The results showed that the pattern of use antidiabetics in patients with T2DM in PKU Muhammadiyah Yogyakarta hospital whom using insulin (46.7%), oral hypoglycemic drugs (OHD) 18.1%, the combination therapy of OHD-OHD (20.5%), the combination therapy of insulin-OHO (13.9%), the combination therapy of insulin-insulin (0.8%). For the type of insulin which is the most used is rapid acting insulin (67.9%), for the OHD is biguanid most used (68.2%). As for the combination therapy which most used OHD-OHD is biguanid-sulfonylurea (94%), the type of combination therapy of insulin-OHD most used is insulinbiguanid, and for the insulin-insulin combination therapy most used is the rapid acting-long acting insulin (100%). The results of chi-square analysis between the type of therapy with blood glucose levels showed that there were significant (p = 0.016), whereas for the chi-square analysis between blood glucose levels with diabetic ulcer clinical outcome suggests that there is a significant relationship (p = 0, 00).

Kata Kunci : ulkus diabetika, antidiabetika, kadar glukosa darah, outcome klinik