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

DEWI FITRI RAHMA, dr. Luthfan Budi Purnomo Sp.PD-KEMD; dr. Hemi Sinorita Sp.PD-KEMD

2015 | Tesis | SP Ilmu Penyakit Dalam

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. Valsartan termasuk angiotensin receptor blocker mempunyai efek anti hipertensi sekaligusmemperbaiki resistensi insulin. Valsartan 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 valsartan terhadap resistensi insulin pada pasien sindrom metabolik dengan terapi insulin. Metode penelitian : menggunakan before-after design.Penelitian dilakukan di poliklinik penyakit dalamsub bagian endokrinologi RSUP Dr. Sardjito Yogyakarta.Subyek penelitian adalah pasien yang memenuhi diagnosis sindroma metabolik berdasar IDF 2006, hipertensi dan mendapat terapi insulin. Subyek diberikan terapi metformin dan valsartan 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 22 subyek. Analisis data dilakukan terhadap 12 subyek. Kadar glukosa darah puasa mengalami penurunan bermakna setelah terapi (p<0,001). Kadar insulin puasa mengalami penurunan setelah terapi tetapi tidak bermakna (p=0,994). HOMA IR mengalami penurunan bermakna setelah terapi {p<0,001 (2,97-7,84), IK 95%}. Kesimpulan : terdapat penurunan resistensi insulin yang bermakna secara statistik pada pasien sindrom metabolik dengan terapi insulin yang mendapat metformin dan valsartan.

Background: Recommendations for therapy of insulin resistance are metformin and thiazolidindion. Side effects of thiazolidindion due to peripheral edema occurs to 25% and increased 5-15% when combined with insulin therapy. Valsartan, an angiotensin receptor blocker, has anti-hypertensive effects and improve insulin resistance. Valsartan 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 valsartan and metforminon 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 2006, hypertension and received insulin therapy. Subjects given metformin and valsartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The average decrease in HOMAIR was tested by paired t-test or Wilcoxontests. P value <0.05 was considered significant. Result: total sample were 22 subjects. Data analysis was only performed on 12 subjects. Fasting blood glucose before and after treatment was significantly decreased (p<0.001). Fasting insulin levels decreased but insignificantly (p=0,994). HOMA IR was significantly decreased after treatment {p<0.001, (2,97�7,84) CI 95%}. Conclusion: this study found decreased insulin resistance significantly in patients with the metabolic syndrome of insulin therapy who received metformin and valsartan.

Kata Kunci : sindrom metabolik, terapi insulin, metformin, valsartan, HOMA IR, metabolic syndrome, insulin therapy, metformin, valsartan, HOMA IR