EFEK PEMBERIAN METFORMIN DAN TELMISARTAN TERHADAP HBA1C PADA PASIEN SINDROMA METABOLIK DENGAN TERAPI INSULIN

DHINAR KEMAS ARIAWIDJAJA, 1 dr. Luthfan Budi Purnomo, SpPD-KEMD; 2 Hemi Sinorita, SpPD-KEMD

2015 | Tesis | SP Ilmu Penyakit Dalam

Latar belakang: Sindroma metabolik adalah terdiri dari obesitas sentral, hipertensi, DM dan dislipidemia. Hiperglikemia mempunyai peran penting terhadap terjadinya sindrom metabolik. HbA1c sebagai alat mendiagnosis maupun melihat kontrol gula darah jangka panjang. Metformin menurunkan gula darah plasma dengan mengaktivasi AMPK dan memperbaiki sensitivitas insulin perifer. Telmisartan merupakan agonis PPAR Gamma dan obat ini diharapkan memperbaiki sensitivitas insulin. Tujuan penelitian: Mengetahui efek pemberian terapi metformin dan telmisartan terhadap penurunan kadar HbA1c pada pasien sindroma metabolik dengan terapi insulin. Metode: Penelitian ini menggunakan before-after design. Subyek penelitian yaitu pasien dengan sindroma metabolik (obesitas sentral, DM dan hipertensi) berdasarkan IDF 2006. Pasien diberikan perlakuan terapi metformin dan telmisartan selama 12 minggu. Dosis obat telmisartan 80 mg/hari dan dosis obat metformin dimulai dari 500 mg/hari dan dosis maksimal 2 g/hari, Data diolah secara komputerisasi dengan uji paired t-test dan kemaknaan nilai p= <0,05 (CI95%). Hasil: Terdapat 23 subyek penelitian. usia rata-rata 57,1 tahun. Terdapat penurunan HbA1c sebelum terapi, rerata 8,99 persen dengan standar deviasi kurang lebih 1,88 persen dan rerata setelah terapi 8,09 persen dengan standar deviasi kurang lebih 1,41 persen, [p=0,001(95%CI0,400-1,400)]. Terdapat hasil tekanan darah yang tidak berbeda bermakna, namun terdapat perbaikan pada indeks masa tubuh, lingkar pinggang, glukosa darah puasa sebelum dan sesudah terapi walaupun tidak bermakna. Simpulan: Terdapat penurunan HbA1c sesudah pemberian telmisartan dan metformin pada pasien sindroma metabolik.

Background : Metabolic syndrome is cluster of conditions that consist of central obesity, hypertension, diabetes and dyslipidemia. Hyperglycemia has an important role to the occurrence of the metabolic syndrome. HbA1c can be useful in diagnosis and long-term blood sugar control. Metformin lowers plasma blood sugar by activating AMPK and improve peripheral insulin sensitivity. Telmisartan is an agonist of PPAR Gamma and the drug is expected to improve insulin sensitivity. Objective : Knowing the effects of metformin therapy and telmisartan on reducing HbA1c levels in patients with the metabolic syndrome on insulin therapy. Methods : This study used a before-after design. The subjects of the study are patients with metabolic syndrome (central obesity, diabetes and hypertension) based on the IDF 2006. The patients were treated with metformin and telmisartan for 12 weeks. The dose of telmisartan was 80 mg/day and the dose of metformin was 500 mg/day with the maximum dose of 2 g/ day. Data analysis were performed computerized using paired t-test with significance value of p <0.05 (CI 95%). Results : Twenty three subjects were included in this study with mean age of 57.1 years. There was a decrease in HbA1c before treatment (mean of 8.99 with standart deviation 1.88 percent) and after treatment (mean of 8.09 with standart deviation 1.41 percent), [p = 0.001 (95% CI; 0.4-1.4)]. The decrease of the blood pressure was not significantly different, but there were improvements in body mass index, waist circumference, fasting blood glucose before and after therapy, although not significant. Conclusion : There was a decrease in HbA1c after administration of telmisartan and metformin in patients with metabolic syndrome.

Kata Kunci : Sindroma Metabolik, Metformin, Telmisartan, Hba1c