Kontrol Glikemik dan Prevalensi Gagal Ginjal Kronik pada Pasien Diabetes Melitus Tipe 2 di Puskesmas Wilayah Provinsi DIY Tahun 2015

Vitarani D. A. Ningrum; Zullies Ikawati; Ahmad H. Sadewa; Mohammad R. Ikhsan

doi:10.15416/ijcp.2017.6.2.78

Kontrol Glikemik dan Prevalensi Gagal Ginjal Kronik pada Pasien Diabetes Melitus Tipe 2 di Puskesmas Wilayah Provinsi DIY Tahun 2015

Vitarani D. A. Ningrum, Zullies Ikawati, Ahmad H. Sadewa, Mohammad R. Ikhsan

Abstract

Pengendalian glikemik yang baik pada diabetes melitus tipe 2 (DMT2) terbukti dapat mencegah penyakit komplikasi akibat DMT2. Puskesmas sebagai sarana pelayanan kesehatan primer merupakan garda terdepan yang diharapkan dapat memberikan pelayanan pengelolaan DMT2 dengan baik untuk mencegah penyakit komplikasi seperti penyakit gagal ginjal kronik (GGK). Kejadian GGK yang seringkali tanpa gejala spesifik serta keterbatasan pemeriksaan diagnostik di puskesmas menyebabkan keterlambatan diagnosis GGK maupun pengelolaan terapi yang sub-optimal. Penelitian ini bertujuan menganalisis kontrol glikemik dan kejadian GGK pada pasien DMT2 di puskesmas serta faktor pasien yang memengaruhi kontrol glikemik dan kejadian GGK. Penelitian potong-lintang pada 6 puskesmas di Yogyakarta tahun 2015 ini melibatkan pasien DMT2 dewasa tanpa riwayat gagal hati kronik. Parameter kontrol glikemik menggunakan Glukosa-Darah-Puasa (GDP), Glycated-Albumin (GA), atau hemoglobin terglikasi (HbA1C), sedangkan nilai eLFG digunakan sebagai dasar klasifikasi GGK. Sebanyak 101 pasien dengan rata-rata usia 50,75±6,73 tahun terlibat dalam penelitian. Kontrol glikemik kategori baik ditemukan hanya pada 13,86% pasien, sedangkan 12,87% pasien mengalami GGK. Tidak ada faktor pasien yang memengaruhi kontrol glikemik. Sementara itu, usia dan durasi DMT2 berkorelasi dengan kejadian GGK (p<0,01). Berdasarkan penelitian ini, kontrol glikemik yang buruk dapat meningkatkan kemungkinan kejadian GGK sebesar 63,64%. Oleh karena itu, diperlukan strategi pengelolaan DMT2 maupun pencegahan GGK yang lebih baik termasuk penyediaan fasilitas pemeriksaan yang memadai untuk meminimalkan kejadian clinical inertia di puskesmas.

Kata kunci: Faktor-pasien, gagal ginjal kronik, kontrol glikemik, puskesmas

Glycemic Control and Prevalence of Chronic Kidney Disease in Type-2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015

Abstract
Good glycemic control in type-2 diabetes mellitus (T2DM) has proven to be able to prevent complications. Primary healthcare is at the forefront being expected to provide good services in T2DM management for preventing such complication as chronic kidney disease (CKD). The incidence of CKD that often shows no specific symptoms and the limitations in diagnostic examinations at primary healthcare centers has caused delay in diagnosis and suboptimal therapy management. This study aimed to determine glycemic controls and prevalence of CKD in patients with T2DM in primary healthcare centers as well as to assess patient’s factors related to the glycemic controls and prevalence of CKD. This cross-sectional study in six primary healthcare centers in Yogyakarta in 2015 involved adult T2DM patients without a history of chronic liver disease. The glycemic control parameters comprised of Fasting-Blood-Glucose (FBG), Glycated-Albumin (GA), or glycated-hemoglobin (HbA1C), while the estimated Glomerular-Filtration-Rate (eGFR) was used as the basis for CKD classification. A total of 101 patients with an average age of 50.75±6.73 years old engaged in the research. Good glycemic control was found in only 13.86% patients, while 12.87% of them had CKD. No patient factors affected the glycemic control. Meanwhile, age and T2DM duration are correlated with the prevalence of CKD (p<0.01). The research found that poor glycemic control was likely to increase the occurrence of CKD amounting to 63.64%. Therefore, better strategies for T2DM management as well as CKD prevention were required, including the provision of adequate examination facilities to minimize the incidence of clinical inertia in primary healthcare centers.

Keywords: Chronic kidney disease, glycemic control, patient factors, primary healthcare centers

Keywords

Faktor-pasien, gagal ginjal kronik, kontrol glikemik, puskesmas

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