PERANAN GLYCOSILATED HAEMOGLOBIN (HbA1c) TERHADAP DERAJAT NEUROPATI DIABETES MELITUS

Ervina Susanti Harahap, Prof. Dr. dr. Samekto Wibowo, P.Far.K, Sp.FK(K), Sp.S(K).

2013 | Tesis | S2 Ilmu Penyakit Saraf

Latar belakang: prevalensi neuropati diabetes melitus yang tinggi dan efek buruk yang ditimbulkan, serta pengaruhnya terhadap kualitas hidup membutuhkan terapi yang bertujuan mencegah progresifitas neuropati dan memperbaiki gejala dengan mengontrol kadar gula darah menggunakan glycosylated haemoglobin (HbA1c). Belum banyak penelitian tentang hubungan buruknya kontrol gula darah dan derajat neuropati Diabetes Melitus (DM). Tujuan penelitian: membuktikan bahwa neuropati DM paling banyak terjadi pada HbA1c yang tinggi, membuktikan bahwa HbA1c berkorelasi dengan derajat neuropati DM, dan membandingkan derajat neuropati DM yang dinilai dengan HbA1c dan kadar gula darah. Metode penelitian: cross sectional terhadap pasien DM di Poli Endokrin RSUP Dr. Sardjito Yogyakarta dari Februari sampai Mei 2013. Sampel diperiksa NSS, NDS, laboratorium darah, dan pemeriksaan elektrodiagnostik, lalu dilakukan analisis statistik. Hasil: didapatkan 38 sampel dengan rerata HbA1c kelompok neuropati 9,6±2,9% dan tanpa neuropati 7,4±0,9% (p=0,008). HbA1c kelompok neuropati berat 9,5±2,7%, neuropati sedang 8,7±1,8%, neuropati ringan 8,6±2,5%, dan tanpa neuropati 7,4±0,9% (p=0,022, r=0,381). Rerata durasi DM kelompok neuropati berat, sedang, ringan, dan tanpa neuropati 94,3±71,6, 80,8±85,2, 52,0±13,9, dan 31,0±41,9 bulan (p=0,030, r=0,353). MCS yang mempunyai hubungan signifikan dengan HbA1c adalah kecepatan hantaran saraf N. Medianus dextra dan sinistra (p=0,046, r=0,326; p=0,049, r=0,322), amplitudo distal N. Tibialis posterior dextra (p=0,018, r=0,388), sedangkan SCS adalah latensi distal N. Medianus dextra (p=0,045, r=0,388). Analisis multivariat menunjukkan durasi DM signifikan berhubungan dengan derajat neuropati DM (p=0,030, r=0,341). Kesimpulan: neuropati DM lebih sering terjadi pada pasien DM dengan HbA1c yang tinggi. HbA1c dan durasi DM yang lama berhubungan dengan derajat neuropati DM. HbA1c berkorelasi positif dengan derajat neuropati DM secara klinis dan elektrodiagnostik. Terdapat perbedaan penilaian derajat neuropati DM antara HbA1c dan kadar gula darah.

Background: high prevalence of diabetic neuropathy, poor of effects, and influence quality of life requires a therapy aimed to prevent progression of neuropathy and improve symptoms by controlling blood sugar levels using glycosylated hemoglobin (HbA1c). Research on the relationship of poor blood sugar control and severity of diabetic neuropathy was still few. Objective: to prove that diabetic neuropathy was most common in high HbA1c, proving that HbA1c was correlated with severity of diabetic neuropathy, and compare the severity of diabetic neuropathy was assessed by HbA1c and blood sugar levels. Method: cross sectional method in patients with diabetes mellitus in Endocrine Polyclinic Dr. Sardjito Hospital Yogyakarta from February to May 2013. Samples were examined NSS, NDS, blood laboratory, electrodiagnostic examination, and performed statistical analysis. Results: 38 samples obtained with a mean HbA1c in neuropathy group was 9,6±2,9% and without neuropathy was 7,4±0,9% (p=0,008). HbA1c in severe neuropathy group was 9,5±2,7%, moderate neuropathy was 8,7±1,8%, mild neuropathy was 8,6±2,5%, and without neuropathy was 7,4±0,9% (p=0,022 , r = 0,381). Mean duration of diabetic in severe, moderate, mild, and without neuropathy was 94,3±71,6, 80,8±85,2, 52,0±13,9 and 31,0±41,9 months (p=0,030, r=0,353). Right and left median nerve conduction velocity and right posterior tibial nerve distal amplitude had a significant relationship with HbA1c (p=0,018, r=0,388) and (p=0,046, r=0,326, p=0,049, r=0,322), whereas for SCS was the right median nerve distal latency (p=0,045, r=0,388). In multivariat analysis showed significant relationship between diabetic duration and severity of neuropathy (p=0,030, r=0,341). Conclusion: diabetic neuropathy was more common in diabetic patients with high HbA1c. HbA1c and long duration of diabetes were associated with severity of diabetic neuropathy. HbA1c had positive correlation with severity of neuropathy clinically and electrodiagnostically. There were difference assesment in severity of diabetic neuropathy between HbA1c and blood sugar levels.

Kata Kunci : glycosylated haemoglobin, faktor risiko vaskuler, derajat neuropati, diabetes melitus