PENGARUH INTENSIFIKASI TERAPI TERHADAP PENURUNAN KADAR HbA1c PADA PASIEN DIABETES MELITUS TIPE 2 PESERTA PROLANIS PT ASKES REGIONAL 6

INAYAH, DR. Erna Kristin, M.Si., Apt.; Dr. Jarir Atthobari, PhD.

2013 | Tesis | S2 Ilmu Kedokteran Dasar dan Biomedis

Latar Belakang. Kegagalan terapi antidiabetik terjadi karena penatalaksanaan Diabetes melitus tipe 2 (DMT2) yang tidak efektif dan atau karena progresifitas penyakit DMT2 yang terus berlanjut. Beberapa penelitian di luar negeri menunjukkan bahwa intensifikasi terapi (IT) bermanfaat menurunkan dan mempertahankan kadar HbA1c < 7% dalam jangka lama, sehingga mencegah dan menghambat progresifitas DMT2 serta komplikasi makrovaskuler dan mikrovaskuler. Tujuan Penelitian. Untuk mengetahui pengaruh IT terhadap penurunan kadar HbA1c pada pasien DMT2. Metode. Rancangan penelitian adalah cohort retrospective, menggunakan data peresepan pasien DMT2 peserta Asuransi Kesehatan (Askes) Regional 6 cabang Yogyakarta, Boyolali dan Surakarta yang mengikuti program pengelolaan penyakit kronis (Prolanis), yang memiliki kadar HbA1c awal ≥ 7% dan mendapatkan resep antidiabetik dalam 3 bulan sebelum pemeriksaan HbA1c. Subyek dikelompokkan IT jika pada periode terapi kedua mulai menggunakan insulin atau penukaran golongan obat hipoglikemik oral (OHO) atau penambahan golongan OHO atau penambahan define daily dose. Data dianalisis menggunakan chi-square, paired t-test, pearson test, independet t-test dan regresi linier. Hasil Penelitian. Dari 359 subyek, 163 mendapatkan IT dengan rincian penambahan define daily dose 31,2%, penambahan OHO 17,8%, penggunaan insulin dan penukaran OHO 3,3% dibanding total subyek. Rerata kadar HbA1c awal subyek IT 9,9 ± 2,0%, subyek tidak IT 9,0 ± 1,6%. Setelah rerata follow up 6,6 bulan terjadi penurunan rerata kadar HbA1c subyek IT lebih tinggi 1,0% bermakna dibanding tidak IT (1,3 ± 2,0% vs 0,3 ± 1,6%) dengan p=0,000. Analisis regresi linier adjusted HbA1c awal quartile dan new starter antidiabetik didapatkan koefisien regresi -0,43 (95%CI -0,77, -0,08 dan p=0,016). Kesimpulan. Intensifikasi terapi pada pasien DMT2 peserta Prolanis Askes Regional 6 menurunkan kadar HbA1c lebih tinggi dibandingkan tidak mendapatkan IT. Hal ini terjadi pada DMT2 yang memiliki kadar HbA1c awal tinggi dan new starter antidiabetik.

Background. Antidiabetic therapy failure is usually caused by ineffective type 2 diabetes management and or continuation of type 2 diabetes progression. Several foreign studies show therapy intensification effectively lowers ang keep HbA1c level <7% in the long term. Thus prevent and hinders type 2 diabetes progressionand its macrovascular and microvasculer complication. Objective. To study the impact of therapy intensification on reducing HbA1c level. Methods. Using cohort retrospective design, prescription data of type 2 diabetes patient that are covered by Asuransi Kesehatan (Askes) Regional 6 in Yogyakarta, Boyolali, and Surakarta whom are listed in Program Pengelolaan Penyakit Kronis (Prolanis), with HbA1c baseline > 7% and had received antidiabetic within 3 months before HbA1c measurement. Subjects were grouped in intensified therapy (IT) group if started using insulin, were switched onto different oral antidiabetic class, or received add on oral antidiabetic medication, or increased define daily dose on second therapy period. Data were analysed with Chi-square, paired t-test, independent t-test, pearson test and linear regression. Results. Of 359 subjects, 163 were IT group. Among all subjects, 31.2% were treated with increased define daily dose, 17.8% received add on oral antidiabetic medication, 3.3% started using insulin and 3.3% switched onto different oral antidiabetic class. Mean HbA1c baseline of IT group were 9.9 ± 2.0% and non-IT group were 9.0 ± 1.6%. After about 6.6 months follow up, reduction of HbA1c level of IT group were significantly higher than non-IT group (1.3 ± 2.0% vs 0.3 ± 1.6%) with p=0.000. Linear regression analysis adjusted with HbA1c baseline quartile and new starter antidiabetic showed coefficient of regression = -0.43 (95%CI -0.77, -0.08 and p= 0.016). Conclusions. Intensified therapy could reduce mean HbA1c level better than patients without therapy intensification, on patient type 2 diabetes Prolanis Askes Regional 6 who had initial HbA1c high and new starter antidiabetic

Kata Kunci : intensifikasi terapi, HbA1c, diabetes melitus tipe 2, prolanis