EFEK PEMBERIAN METFORMIN DAN TELMISARTAN TERHADAP RESISTENSI INSULIN PADA PASIEN SINDROM METABOLIK DENGAN TERAPI INSULIN

Siswi Oktariani, Dr. R. Bowo Pramono, SpPD-KEMD

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar belakang : Rekomendasi terapi untuk resistensi insulin adalah metformin dan thiazolidindion. Efek samping udem perifer akibat thiazolidindion terjadi 2-5% dan meningkat menjadi 5-15% bila dikombinasi dengan terapi insulin. Telmisartan termasuk angiotensin receptor blocker mempunyai efek anti hipertensi sekaligus memperbaiki resistensi insulin. Telmisartan berefek agonis terhadap peroxisome proliferator activated receptor γ dan mempunyai struktur yang sama dengan pioglitazon dari golongan thiazolidindion. Tujuan penelitian adalah mengetahui efek pemberian metformin dan telmisartan terhadap resistensi insulin pada pasien sindrom metabolik dengan terapi insulin. Metode penelitian : menggunakan before-after design. Penelitian dilakukan di poliklinik penyakit dalam sub bagian endokrinologi RSUP Dr. Sardjito Yogyakarta. Subyek penelitian adalah pasien yang memenuhi diagnosis sindroma metabolik berdasar IDF 2005, hipertensi dan mendapat terapi insulin. Subyek diberikan terapi metformin dan telmisartan selama 12 minggu. Subyek diperiksa HOMA IR sebelum dan sesudah terapi. Rata-rata penurunan HOMA IR diuji dengan paired t-test atau tes Wilcoxon.Kemaknaan p <0,05 dianggap signifikan. Hasil penelitian : jumlah sampel penelitian 27 subyek. Analisis data dilakukan terhadap 11 subyek. Kadar glukosa darah puasa mengalami penurunan bermakna setelah terapi (p<0,001) namun kadar insulin puasa mengalami kenaikan. HOMA IR mengalami penurunan setelah terapi {p = 0,004 (5,79 – 20,26), IK 95%}. Kesimpulan : terdapat penurunan resistensi insulin yang bermakna secara statistik pada pasien sindrom metabolik dengan terapi insulin yang mendapat metformin dan telmisartan.

Background: Recommendations for therapy of insulin resistance are metformin and thiazolidindion. Side effects of thiazolidindion due to peripheral edema occurs to 2- 5% and increased 5-15% when combined with insulin therapy. Telmisartan, an angiotensin receptor blocker, has anti-hypertensive effects and improve insulin resistance. Telmisartan effect on peroxisome proliferator activated receptor γ agonist and has the same structure of the group thiazolidindion, pioglitazone. The research objective was to determine the effects of telmisartan and metformin on insulin resistance in metabolic syndrome patients with insulin therapy. Methods: using a before-after design. The study was conducted in the internal medicine clinic of the department of endocrinology Dr. Sardjito Hospital Yogyakarta. Subjects were patients who met the diagnosis of metabolic syndrome based on the IDF 2005, hypertension and received insulin therapy. Subjects given metformin and telmisartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The average decrease in HOMA IR was tested by paired t-test or Wilcoxon tests. P value < 0.05 was considered significant. Result: total sample were 27 subjects. Data analysis was performed on 11 subjects. Fasting blood glucose before and after treatment was significantly decreased (p<0,001) whereas the fasting insulin levels increased. HOMA IR was significantly decreased after treatment {p = 0,004 (5,79 – 20,26), CI 95%}. Conclusion: this study found decreased insulin resistance significantly in patients with the metabolic syndrome of insulin therapy who received metformin and telmisartan.

Kata Kunci : sindrom metabolik, terapi insulin, metformin, telmisartan, HOMA IR