Waafi, Affa Kiysa and dr. Putu Moda Arsana, Sp.PD, K-EMD and dr. Novi Khila Firani, M. Kes, Sp.PK (2022) Pengaruh Kontrol Glukosa Darah Terhadap Profil Hemostasis Dengan Menggunakan Metode Tromboelastografi Pada Pasien Diabetes Mellitus Tipe 2. Magister thesis, Universitas Brawijaya.
Abstract
LATAR BELAKANG: Secara global, penyakit Diabetes Mellitus (DM) menyebabkan kematian sebesar 5% per tahun. DM tipe 2 disebabkan oleh resistensi insulin. Gangguan hemostasis pada DM diakibatkan oleh disfungsi endothel, aktivasi faktor koagulasi, dan hiper-reaktivitas platelet akibat hiperglikemia dan resistensi insulin. Pemeriksaan tromboelastografi (TEG) dapat menilai keseluruhan profil hemostasis namun belum rutin digunakan pada pasien DM tipe 2. TUJUAN PENELITIAN: Mengetahui pengaruh kontrol glukosa darah terhadap profil hemostasis yang diperiksa menggunakan metode TEG pada pasien DM tipe 2 METODE: Penelitian ini adalah survey dengan analisis case control. Subyek penelitian adalah pasien DM tipe 2 di poliklinik Endokrin RSUD dr. Saiful Anwar yang memenuhi kriteria inklusi. Subyek terbagi dalam 2 kelompok yakni kelompok DM terkontrol dan tidak terkontrol sesuai HbA1c, GDP (glukosa darah puasa), dan GD2PP (glukosa darah 2 jam post-prandial). Profil hemostasis dianalisis menggunakan TEG dan terbagi dalam hemostasis primer (MA), sekunder (R dan sudut-), dan tersier (LY30). Uji statistik dilakukan dengan analisis korelasi dan regresi logistik menggunakan software SPSS 24.0. Nilai p signifikan bila <0.05. HASIL: Terdapat 57 subyek yang memenuhi kriteria inklusi dengan mayoritas subyek berada dalam kelompok DM tidak terkontrol. Sebagian besar subyek berada dalam kondisi normokoagulabel. Uji regresi logistik menunjukkan kontrol glukosa darah berpengaruh signifikan terhadap profil hemostasis sekunder (p 0.041). GDP berkorelasi negatif terhadap nilai MA (p 0.042; r -0.278). HbA1c berkorelasi positif dengan nilai R dan sudut-, berkebalikan dengan GDP dan GD2PP. GD2PP berkorelasi positif dengan LY30 (p 0.037; r 0.285). KESIMPULAN: Kontrol glukosa darah berpengaruh signifikan terhadap hemostasis sekunder pasien DM tipe 2. Hiperglikemia kronis terkait dengan penguatan clot yang lebih cepat sedangkan hiperglikemia akut terkait dengan pembentukan clot awal yang lebih cepat. Kontrol glukosa darah tidak berpengaruh signifikan terhadap hemostasis primer dan berhubungan kontradiktif terhadap hemostasis tersier.
English Abstract
BACKGROUND: Diabetes mellitus (DM) caused 5% death of all death per year globally. Type 2 DM is caused by insulin resistance. Insulin resistance and hyperglycemia in DM induce hemostasis abnormalities by generating endothelial dysfunction, coagulation factors activation, and platelet hyper-reactivity. Thromboelastography (TEG) could potentially measure hemostasis profile comprehensively but it has not been routinely applied for patients with type 2 DM. OBJECTIVE: This study aimed to investigate the impact of blood glucose control towards hemostasis profile by using thromboelastography in patients with type 2 DM. METHOD: This research is a survey with a case-control analysis. The subjects of this study were all patients with type 2 DM in Endocrinology Outpatient Clinic at Saiful Anwar Hospital which fulfilled inclusion criteria. Subjects were grouped into controlled and uncontrolled DM according to HbA1c, FPG (fasting plasma glucose), and 2hPPG (2h post-prandial glucose). Hemostasis profiles were analyzed using TEG and grouped into primary hemostasis (MA), secondary hemostasis (R and -angle), and tertiary hemostasis (LY30). Data were analyzed with correlation and logistic regression analysis. Statistical analysis was performed by using SPSS 24.0 with p<0.05 was considered significant. RESULTS: There were 57 participants which fulfilled the inclusion criteria with the majority of participants were classified into uncontrolled DM. The majority of participants were also classified into normocoagulable groups. Logistic regression revealed a significant association between blood glucose control and secondary hemostasis (p 0.041). FPG was negatively correlated with MA (p 0.042; r -0.278). HbA1c had a positive correlation with R-value and -angle, in contrary with FPG and 2hPPG. 2hPGG was positively correlated with LY30 (p 0.037; r 0.285). CONCLUSION: Blood glucose control was significantly associated with secondary hemostasis in type 2 DM. Chronic hyperglycemia corresponded with faster clot strengthening and acute hyperglycemia was related to faster initial clot formation. Blood glucose control was not significantly associated with primary hemostasis and had a contradictive association with tertiary hemostasis.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060015 |
| Uncontrolled Keywords: | diabetes mellitus, tromboelastografi, hemostasis |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Penyakit Dalam, Fakultas Kedokteran |
| Depositing User: | Budi Wahyono Wahyono |
| Date Deposited: | 15 Jun 2022 01:51 |
| Last Modified: | 11 Dec 2023 07:17 |
| URI: | http://repository.ub.ac.id/id/eprint/191143 |
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