Advance Search

KETERCAPAIAN TARGET GLIKEMIK DAN ANALISIS FAKTORFAKTOR TERKAIT PADA PASIEN DIABETES TIPE 2

Putu Dian Marani Kurnianta Bio | Pande Made Desy Ratnasari | Heny Dwi Arini
DOI: https://doi.org/10.20956/mff.v25i2.13037
Article History

Submited : February 25, 2021
Published : August 31, 2021

Keywords:
Bukti-bukti ilmiah menunjukkan keterkaitan antara rendahnya ketercapaian target glikemik selama pengobatan DM tipe 2 dengan risiko komplikasi kronik. Apabila kegagalan pengobatan tersebut diabaikan, maka ancaman global yang dihadapi akan terus meningkat. Oleh karena itu, penelitian cross sectional ini bertujuan untuk menyelidiki kegagalan pengobatan, khususnya ketercapaian target glikemik berupa tingkat kejadian dan faktor-faktor yang mempengaruhinya pada pasien DM tipe 2 di daerah Gianyar. Data rekam medik dari salah satu rumah sakit di Gianyar, Bali, selama periode 2016-2020, diseleksi berdasarkan kriteria inklusi yang meliputi pasien rawat jalan berusia ≥18 tahun, terdiagnosis DM tipe 2 pertama kali, tidak berpindah fasilitas kesehatan selama enam bulan, dan memperoleh antidiabetika oral atau insulin secara konsisten. Penentuan status kegagalan pengobatan berdasarkan target kontrol glikemik oleh ADA. Pada sejumlah total 145 subjek yang terlibat, proporsi kegagalan pengobatan DM tipe 2 mencapai 64,83%. Hasil analisis deskriptif enam faktor pada penelitian ini menunjukkan bahwa kegagalan pengobatan cenderung terjadi pada laki-laki (59,57%), usia ≤60 tahun (75,53%), subjek yang tidak bersekolah (39,36%), subjek dengan komplikasi (7,45%), subjek berpenyakit penyerta (51,06%), dan pengguna insulin (58,51%). Berdasarkan Uji χ2 atau Uji Fisher’s Exact (p<0,05, 95%), penelitian ini mempresentasikan hubungan signifikan antara faktor usia dan faktor penggunaan antidiabetika terhadap tingginya kegagalan pencapaian target glikemik selama pengobatan.

References

  1. International Diabetes Federation. IDF diabetes atlas, 9th ed. Brussels, Belgium: International Diabetes Federation; 2019.
  2. Perkumpulan Endokrinologi Indonesia. Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia. Jakarta: Pengurus Besar Perkumpulan Endokrinologi Indonesia; 2019.
  3. Kementerian Kesehatan Republik Indonesia. Situasi dan analisis diabetes. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia; 2014.
  4. Dinas Kesehatan Kabupaten Gianyar. Profil kesehatan kabupaten Gianyar tahun 2017. Gianyar: Dinas Kesehatan Kabupaten Gianyar; 2017.
  5. American Diabetes Association. Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S61–70. https://doi.org/10.2337/dc19-S006
  6. Ramadhan N, Hanum S. Kontrol glikemik pada penderita diabetes mellitus tipe 2 di Puskesmas Jayabaru Kota Banda Aceh. Sel J Penelit Kesehat. 2017;3(1):1–9. https://doi.org/https://doi.org/10.22435/mpk.v28i4.63
  7. Tunceli K, Goldshtein I, Yu S, Sharon O, Brodovicz K, Gadir N, et al. Adherence to treatment guidelines in type 2 diabetes patients failing metformin monotherapy in a real-world setting. Diabetes Manag. 2015;5(1):17–24. https://doi.org/10.2217/dmt.14.45
  8. Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW, Tjokroprawiro A. The DiabCare Asia 2008 study – outcomes on control and complications of type 2 diabetic patients in Indonesia. Med J Indones. 2010;4(19):235–44. https://doi.org/10.13181/mji.v19i4.412
  9. Nitiyanant W, Tandhanand S, Mahtab H, Zhu XX, Pan CY, Raheja BS, et al. The Diabcare-Asia 1998 study - Outcomes on control and complications in type 1 and type 2 diabetic patients. Curr Med Res Opin. 2002. https://doi.org/10.1185/030079902125000822
  10. Mafauzy M. Diabetes control and complications in public hospitals in Malaysia. Med J Malaysia. 2006;4(61):477–83.
  11. American Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S13–28. https://doi.org/10.2337/dc19-S002
  12. Daniel WW, Cross CL. Biostatistics: A foundation for analysis in the health sciences. 9th ed. USA: Wiley; 2009. 128–129 p.
  13. Sugiyono. Metode penelitian kombinasi (mixed methods). Bandung: Alfabet; 2018.
  14. American Diabetes Association. Older adults: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S139–47. https://doi.org/10.2337/dc19-S012
  15. Hemalatha K, Karthikeyan K, Kavitha G, Ayachandran N. Impact of adherence to lifestyle factors on glycemic control among individuals with type 2 diabetes. Natl J Res Community Med. 2017;6(1):037–42.
  16. Digssie A, Tiruneh SA, Ayele AA, Getachew H, Tegegn, Ayele BA, et al. Level of glycemic control and its associated factors among type II diabetic patients in Debre Tabor General Hospital, Northwest Ethiopia. J Diabetes Endocrinol Res. 2020;2(1):1–7.
  17. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with Type 2 diabetes. J Diabetes Complications. 2010;24(2):84–9. https://doi.org/10.1016/j.jdiacomp.2008.12.008
  18. Saghir SA, Alhariri AE, Alkubati SA, A A, Almiamn, Aladaileh SH, et al. Factors associated with poor glycemic control among type-2 diabetes mellitus patients in Yemen. Trop J Pharm Res. 2019;18(7):1539–46. https://doi.org/http://dx.doi.org/10.4314/tjpr.v18i7.26
  19. Fiseha T, Alemayehu E, Kassahun W, Adamu A, Gebreweld A. Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia. BMC Res Notes. 2018;11:316. https://doi.org/10.1186/s13104-018-3423-5
  20. Bakhsh EA, Qutub ST Al. Levels and barriers of glycemic control and self-management among diabetic patients in primary health care in Jeddah: A cross-sectional study. Int J Adv Res. 2017;5(12):1721–33.
  21. Sakari FL, William KK. Utilization of diabetes knowledge and glycemic control, a case of Butere Subcounty Hospital, Kakamega County, Kenya. Asian J Res Reports Endocrinol. 2019;2(1):1–10.
  22. Siddiqui MA, Siddiqui AUH, Rwelly F, Clay A. Frequency of diabetes, complications and vascular risk factors in male and female population of Al-Jouf, Saudi Arabia. Int J Med Dev Ctries. 2018;2(1):27–32.
  23. Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, et al. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med. 2019; https://doi.org/10.1186/s12916-019-1373-y
  24. American Diabetes Association. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S90–102. https://doi.org/10.2337/dc19-S009
  25. Ji H, Chen R, Huang Y, Li W, Shi C, Zhou J. Effect of simulation education and case management on glycemic control in type 2 diabetes. Diabetes Metab Res Rev. 2019;35: e3112. https://doi.org/10.1002/dmrr.3112
  26. Rachmawati N, Safitri Dyan NK, Jurusan Keperawatan M, Kedokteran F, Diponegoro U, Pengajar Departemen Keperawatan Dewasa Jurusan Keperawatan S. Gambaran kontrol dan kadar gula darah pada pasien diabetes melitus di poliklinik penyakit dalam RSJ Prof. Dr. Soerojo Magelang. Jurnal Jurusan Keperawatan. 2015;1(1):1-8.
  27. Ramadhan N, Marissa N, Fitria E, Wilya V. Pengendalian Diabetes Melitus Tipe 2 pada Pasien di Puskesmas Jayabaru Kota Banda Aceh. Media Penelit dan Pengemb Kesehat. 2018;28(4):239–46. https://doi.org/10.22435/mpk.v28i4.63
  28. Arosemena CM, Sánchez AJ, Tettamanti MD, Vasquez CD, Chang A, Navaro CM. Prevalence and risk factors of poorly controlled diabetes mellitus in a clinical setting in Guayaquil, Ecuador: A cross-sectional study. Int J Diabetes Clin Res. 2015;2:034. https://doi.org/10.23937/2377-3634/1410034
  29. Berhie MA, Negewo AN, Malik T. Factors related to good glycemic control among type 2 diabetic patients at Jimma Medical Center and Shanan Gibe Hospital, Jimma, Ethiopia. Indian J Public Heal Res Dev. 2019;10(6):721–6. https://doi.org/10.5958/0976-5506.2019.01363.9
  30. Alaqil A, Alkahtani M, Algahtani M. Prevalence and predictors of glycemic control in hospitalized patients with diabetes. Indian J Public Heal Res Dev. 2020;11(11):409–15.
  31. Goyal J, Kuma N, Sharma M, Raghav S, Lal B, Bhatia PS. Factors affecting glycemic control among patients with type 2 diabetes at a tertiary health care center of western up region: A cross-sectional study. Int J Heal Sci Res. 2019;9(3):12–20.
  32. Ahmad NS, Islahudin F, Paraidathathu T. Factors associated with good glycemic control among patients with type 2 diabetes mellitus. J Diabetes Investig. 2014;5(5):563–9. https://doi.org/10.1111/jdi.12175
  33. Rudi A, Kwureh HN. Faktor risiko yang mempengaruhi kadar gula darah puasa pada pengguna layanan laboratorium. J Ilm Ilmu Kesehat Wawasan Kesehat. 2017;3(2):33–9. https://doi.org/10.31227/osf.io/d3kes
  34. Haghighatpanah M, Thunga G, Jha A, Mallayasamy S. Study on prescribing pattern of anti-diabetic drugs among type 2 diabetes patients with complication in South Indian teaching hospital. Asian J Pharm Clin Res. 2016;9(1):194–7.
  35. Vos RC, Rutten GEHM. Oral hypoglycemic agents added to insulin monotherapy for type 2 diabetes. JAMA - J Am Med Assoc. 2017;318(15):1489–90. https://doi.org/10.1001/jama.2017.13463
  36. Fekadu G, Bula K, Bayisa G, Turi E, Tolossa T, Kasaye HK. Challenges and factors associated with poor glycemic control among type 2 diabetes mellitus patients at nekemte referral hospital, Western Ethiopia. J Multidiscip Healthc. 2019;12:963–74. https://doi.org/10.2147/JMDH.S232691
  37. Radwan M, Elsous A, Al-Sharif H, Abu MA. Glycemic control among primary care patients with type 2 diabetes mellitus in the Gaza Strip, Palestine. Ther Adv Endocrinol Metab. 2018;9(1):3–14. https://doi.org/10.1177/2042018817742070
  38. Sazlina SG, Mastura I, Cheong AT, Bujang MA, Jamaiyah H, Lee PY, et al. Predictors of poor glycaemic control in older patients with type 2 diabetes mellitus. Singapore Med J. 2015;56(5):284–90. https://doi.org/10.11622/smedj.2015055
  39. Kumar L, Gupta S, Prakash A. Assessment of the prescription pattern of anti-diabetic drugs in type-2 diabetes mellitus patients. Pharma Innov J. 2018;7(5):392–4.
  40. Bayoumy I El, Dawood W. Identifying and addressing the barriers of insulin use in type II diabetes patients. EC Diaebetes Metab Res. 2018;2(2):38–46.
  41. Kruger DF, LaRue S, Estepa P. Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes, Metab Syndr Obes Targets Ther. 2015;8:49–56. https://doi.org/10.2147/DMSO.S71923
  42. Alkhaifi M, Khusaibi G Al, Theodorson T, Ward MA, Mazrou’I A Al. Barriers ininitiating insulin treatment in type 2 diabetes mellitus among physicians in Wilayat of Bowsher in Oman. J Fam Med Community Heal. 2015;2(3):1034.
  43. Harper W, Clement M, Goldenberg R, Hanna A, Main A, Retnakaran R, et al. Pharmacologic management of type 2 diabetes. Can J Diabetes. 2013;37:S61–8. https://doi.org/10.1016/j.jcjd.2013.01.021
  44. Cahn A, Cefalu WT. Clinical considerations for use of initial combination therapy in type 2 diabetes. Diabetes Care. 2016;39(2):S137–45. https://doi.org/10.2337/dcS15-3007
  45. Karthikeyan V, Maadhusudhan S, Selvamuthukumran S. Studies on prescribing pattern in the management of diabetes mellitus in rural teaching hospital. Saudi J Med Pharm Sci. 2016;2(5):100–7.
  46. Nadukkandiyil N, Hamad HK Al, Kunnummal NK, Ramadan MB, Obaidely M Al, Saleh H, et al. A retrospective study of medication utilization pattern and clinical outcome in middle-aged and older patients with type 2 diabetes mellitus in Qatar. J Diabetes Metab. 2018;9(12):1000815. https://doi.org/10.4172/2155-6156.1000815
  47. Kapur A, Rehan HS, Gupta LK, Yadav M. Pattern of anti-diabetic drugs prescribed for type 2 diabetes mellitus patients in a tertiary care hospital of India: an observational study. Int J Basic Clin Pharmacol. 2019;8(7):1657–61. https://doi.org/http://dx.doi.org/10.18203/2319-2003.ijbcp20192667
  48. Cook MN, Girman CJ, Stein PP, Alexander CM. Initial monotherapy with either metformin or sulphonylureas often fails to achieve or maintain current glycaemic goals in patients with Type 2 diabetes in UK primary care. Diabet Med. 2007;24:350–8. https://doi.org/10.1111/j.1464-5491.2007.02078.x
  49. Desai U, Kirson NY, Kim J, Khunti K, King S, Trieschman E, et al. Time to treatment intensification after monotherapy failure and its association with subsequent glycemic control among 93,515 patients with type 2 diabetes. Diabetes Care. 2018;41(10):2096–104. https://doi.org/10.2337/dc17-0662
  50. Yin Y, Han W, Wang Y, Zhang Y, Wu S, Zhang H, et al. Identification of risk factors affecting impaired fasting glucose and diabetes in adult patients from northeast China. Int J Environ Res Public Health. 2015;12:12662–78. https://doi.org/10.3390/ijerph121012662
  51. Rasheed M, Islam N, Mahjabeen W. Factors associated with uncontrolled type 2 diabetes mellitus. J Islam Med Dent Coll. 2015;4(2):68–71.
  52. Khoda M, Shimu I, Mitra P, Hossain M, Sarkar M, Saha A, et al. Modifiable factors associated with uncontrolled type 2 diabetes mellitus: Experience in a tertiary care hospital of Bangladesh. Birdem Med J. 2017;8(3):229–34.
  53. Yu MK, Lyles CR, Bent-Shaw LA, Young BA. Sex disparities in diabetes process of care measures and self-care in high-risk patients. J Diabetes Res. 2013;1–8. https://doi.org/10.1155/2013/575814
  54. Younis BB, Arshad R, Yousuf H, Salman F, Masood J, Khurshid S. Impact of type 2 diabetes mellitus on quality of life in people with diabetes presenting to a specialist diabetes clinic. Turkish J Med Sci. 2017;47:123–6. https://doi.org/10.3906/sag-1508-3
  55. Kassahun T, Eshetie T, Gesesew H. Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: A cross-sectional survey in Ethiopia endocrine disorders. BMC Res Notes. 2016;8:78. https://doi.org/10.1186/s13104-016-1896-7
  56. Odili VU, Isiboge PD, Eregie A. Patients’ knowledge of diabetes mellitus in a Nigerian city. Trop J Pharm Res. 2011;10(5):637–42. https://doi.org/10.4314/tjpr.v10i5.13
  57. Demoz GT, Gebremariam A, Yifter H, Alebachew M, Niriayo YL, Gebreslassie G, et al. Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia. BMC Res Notes. 2019;12:207. https://doi.org/10.1186/s13104-019-4248-6
  58. Ratnasari PMD, Andayani TM, Endarti D. Analisis luaran klinik pasien diabetes melitus tipe 2 berdasarkan peresepan antidiabetik dan komplikasi. Maj Farm. 2020;16(2):163–9. https://doi.org/10.22146/farmaseutik.v16i2.50566
  59. Sanal TS, Nair NS, Adhikar P. Factors associated with poor control of type 2 diabetes mellitus: A systematic review and meta-analysis. J Diabetol. 2011;3:1–10.
  60. Gallagher EJ, LeRoith D, Karnieli E. The metabolic syndrome-from insulin resistance to obesity and diabetes. Med Clin North Am. 2011;95(5):855–73. https://doi.org/10.1016/j.mcna.2011.06.001
  61. Kayar Y, Ilhan A, Kayar NB, Unver N, Coban G, Ekinci I, et al. Relationship between the poor glycemic control and risk factors, life style and complications. Biomed Res. 2017;28(4):1581–6.
  62. Poznyak A, Grechko AV, Poggio P, Myasoedova VA, Alfieri V, Orekhov AN. The diabetes mellitus–atherosclerosis connection: The role of lipid and glucose metabolism and chronic inflammation. Int J Mol Sci. 2020;21:1835. https://doi.org/10.3390/ijms21051835
  63. Aouacheri O, Saka S, Krim M, Messaadia A, Maidi I. The investigation of the oxidative stress-related parameters in type2 diabetes mellitus. Can J Diabetes. 2015;39:44–9. https://doi.org/10.1016/j.jcjd.2014.03.002
  64. Adejoh SO. Diabetes knowledge, health belief, and diabetes management among the Igala, Nigeria. SAGE Open. 2014;1–8. https://doi.org/10.1177/2158244014539966
  65. Goie TT, Naidoo M. Awareness of diabetic foot disease amongst patients with type 2 diabetes mellitus attending the chronic outpatients department at a regional hospital in Durban, South Africa. African J Prim Heal care Fam Med. 2016;8(1):a1170. https://doi.org/10.4102/phcfm.v8i1.1170
  66. Alramadan MJ, Afroz A, Hussain SM, Batais MA, Almigbal TH, Al-Humrani HA, et al. Patient-related determinants of glycaemic control in people with type 2 diabetes in the gulf cooperation council countries: A systematic review. J Diabetes Res. 2018; https://doi.org/10.1155/2018/9389265
  67. Lauffenburger JC, Lewey J, Jan S, Lee J, Ghazinouri R, Choudhry NK. Association of potentially modifiable diabetes care factors with glycemic control in patients with insulin-treated type 2 diabetes. JAMA Netw open. 2020;3(1):e1919645. https://doi.org/10.1001/jamanetworkopen.2019.19645
  68. American Diabetes Association. Cardiovascular disease and risk management: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S103–23. https://doi.org/10.2337/dc19-S010
  69. Cummings DM, Kirian K, Howard G, Howard V, Yuan Y, Muntner P, et al. Consequences of comorbidity of elevated stress and/or depressive symptoms and incident cardiovascular outcomes in diabetes: Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Diabetes Care. 2016;39:101–9. https://doi.org/10.2337/dc15-1174
  70. Larkin ME, Walders-Abramson N, Hirst K, Keady J, Ievers-Landis CE, Venditti EM, et al. Effects of comorbid conditions on health-related quality of life in youth with Type 2 diabetes: the TODAY clinical trial. Diabetes Manag. 2015;5(6):431–439. https://doi.org/10.2217/dmt.15.35
  71. Alba IGF de, Gimeno‑Miguel A, Poblador‑Plou B, Gimeno‑Feliu LA, Ioakeim‑Skoufa, Ignatios, et al. Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients. Sci Rep. 2020;10:19583. https://doi.org/10.1038/s41598-020-76546-9
  72. DiPiro JT, Yee GC, Matzke GR, Posey LM, Haines ST, Nolin TD, Ellingrod, editors. Pharmacotherapy: a pathophysiologic approach. 11th ed. United States: McGraw-Hill; 2020.
  73. Abougalambou SSI, Hassali MA, Sulaiman SAS, Abougalambou AS. Prevalence of vascular complications among Type 2 diabetes mellitus outpatients at teaching hospital in Malaysia. J Diabetes Metab. 2011;2(1):1000115. https://doi.org/10.4172/2155-6156.1000115
  74. Ali A, Naeem F. Complication rates in diabetes mellitus in relation to duration of diabetes. J Med Sci. 2019;27(3):165–8.
  75. Maifitrianti M, Wulandari N, Haro M, Lestari SF, Fitriani A. Glycemic control and its factor in type 2 diabetic patients in Jakarta. Indones J Clin Pharm. 2020;9(3):198–204. https://doi.org/10.15416/ijcp.2020.9.3.198
  76. Badan Penyelenggara Jaminan Sosial Kesehatan. Manfaat Program JKN-KIS Makin Luas (Internet). 2017 (cited 2020 Dec 5). Available from: https://bpjs-kesehatan.go.id/Bpjs/index.php/post/read/2017/535/Manfaat-Program-JKN-KIS-Makin-Luas
Kurnianta, P. D. M., Ratnasari, P. M. D., & Arini, H. D. (2021). KETERCAPAIAN TARGET GLIKEMIK DAN ANALISIS FAKTORFAKTOR TERKAIT PADA PASIEN DIABETES TIPE 2. Majalah Farmasi Dan Farmakologi, 25(2), 44-50. https://doi.org/10.20956/mff.v25i2.13037

Copyright (c) 2021 Array

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Downloads

Download data is not yet available.
Fulltext
PDF