PENGARUH PEMBERIAN METFORMIN DAN VALSARTAN TERHADAP KADAR INSULIN PUASA PADA PASIEN SINDROMA METABOLIK DENGAN NON ALCOHOLIC FATTY LIVER DISEASE

FAJAR YUWANTO, dr. Neneng Ratnasari SpPD-KGEH.; dr. Hemi Sinorita, SpPD-KEMD

2015 | Tesis-Spesialis | SP Ilmu Penyakit Dalam

LATAR BELAKANG : sindrom metabolik dalah suatu sindrom terdiri obesitas sentral, hipertensi, diabetes mellitus, dan dislipidemia. Non alcoholic fatty liver disease (NAFLD) adalah sindroma metabolik pada hati. Resistensi insulin menyebabkan terjadinya NAFLD, ini dihubungkan dengan kadar insulin puasa yang meningkat. Penelitian melaporkan pemakaian metformin dan valsartan memberikan perbaikan resistensi insulin dan inflamasi hati. Ini dihubungkan dengan turunnya insulin puasa. Tujuan : penelitian untuk mengetahui pengaruh pemberian metformin dan valsartan terhadap insulin puasa pada pasien sindroma metabolik dengan NAFLD. METODE : penelitian ini menggunakan before-after design. Penelitian dikerjakan di poliklinik penyakit dalam RSUP Dr. Sardjito, Yogyakarta.Waktu penelitian Mei 2012 sampai Maret 2013. Subyek penelitian merupakan pasien dengan sindroma metabolik berdasar IDF tahun 2005, hipertensi dan NAFLD. Pasien diberikan perlakuan terapi metformin dan valsartan selama 12 minggu. Kadar insulin puasa diukur sebelum dan setelah terapi. Insulin puasa diuji dengan paired-t test jika data terdistribusi normal atau uji Wilcoxon jika data tidak terdistribusi normal. HASIL : terdapat 15 subyek penelitian, rerata usia 56,3 tahun. Terdapat peningkatan kadar insulin puasa sebelum terapi dengan rerata 8,51+-8,05 mcgIU/L dan insulin puasa setelah terapi 14,47+-10,74 mcgIU/L, p= < 0,003. KESIMPULAN : tidak terdapat penurunan kadar insulin puasa sesudah pemberian metformin dan valsartan selama 12 minggu pada sindroma metabolik dengan NAFLD.

BACKGROUND: Metabolic syndrome is a syndrome consisting central obesity, hypertension, diabetes mellitus, and dyslipidemia. Non-alcoholic fatty liver disease (NAFLD) is the metabolic syndrome in the liver. Insulin resistance leads to NAFLD, is associated with increased fasting insulin levels. Studies have reported the use of metformin and valsartan deliver improved insulin resistance and liver inflammation. It is connected with the decrease in fasting insulin. The aim of research to determine the effect of metformin and valsartan against fasting insulin in patients with NAFLD metabolic syndrome. METHODS: This study used before-after design. The study done at the clinic of the department of internal medicine Dr. Sardjito, Yogyakarta. The study began in May 2012 until March 2013. The subjects of the study are patients with metabolic syndrome based on the IDF in 2005, hypertension and NAFLD. Patients given metformin and valsartan therapy treatment for 12 weeks. Fasting insulin levels were measured before and after treatment. Fasting insulin was tested with paired-t test if normally distributed data or Wilcoxon test if the data were not normally distributed. RESULTS: There are 15 subjects, mean age of 56.3 years. There is an increase in fasting insulin levels before therapy with a mean of 8.05+- 8.51 mcgIU / L and fasting insulin after treatment 14.47 +- 10.74 mcgIU / L, p = <0.003. CONCLUSION: there is no decrease in fasting insulin levels after administration of metformin and valsartan for 12 weeks on metabolic syndrome with NAFLD.

Kata Kunci : metabolic syndrome, NAFLD, fasting insulin, metformin, valsartan