PERBANDINGAN ANTARA PEMILIHAN OHO DAN NILAI CREATININE CLEARANCE SERTA HUBUNGANNYA PADA PASIEN DM TIPE 2 DI PUSKESMAS TERARA, LOMBOK, NTB

Abstract

Pendahuluan: Kabupaten Lombok Timur menduduki peringkat teratas dalam jumlah pasien diabetes melitus tertinggi di Nusa Tenggara Barat pada tahun 2023. Diabetes mellitus (DM) merupakan penyebab utama dari gagal ginjal. Tujuan penelitian ini untuk mengetahui perbandingan antara pemilihan obat hipoglikemik oral (OHO) dan nilai creatinine clearance (CrCl) serta hubungannya pada pasien DM tipe 2. Metode:  Penelitian potong lintang terhadap 66 pasien DM tipe 2 yang menjalani pengobatan OHO di Puskesmas Terara.  Analisis hubungan penggunaan jenis OHO terhadap penurunan fungsi ginjal dilakukan menggunakan uji Chi-Square. Analisis lebih lanjut dilakukan untuk melihat perbedaan rerata kadar CrCl berdasarkan golongan OHO dilakukan dengan uji T-independent dan perbedaan kadar serum kreatinin dianalisis dengan uji Mann-Whitney U. Hasil: Pasien DM tipe 2 dengan jenis OHO sulfonilurea memiliki penurunan fungsi ginjal yang lebih berat (p=0,031; OR 5,143 ((IK 95%) 1,284-20,601). Selain itu, didapatkan perbedaan bermakna pada kadar serum kreatinin antara kelompok biguanid dan sulfonilurea (p=0,029). Meskipun, rerata nilai CrCl tidak berbeda secara statistik (p=0,301).  Kesimpulan: Terdapat hubungan antara jenis OHO terhadap penurunan fungsi ginjal dan perbedaan bermakna kadar serum kreatinin antara kelompok biguanid dan sulfonilurea. Akan tetapi, tidak didapatkan perbedaan rerata nilai creatinine clearance (CrCl). Pemilihan jenis OHO sebaiknya tetap mempertimbangkan parameter fungsi ginjal.

Kata kunci: Creatinine Clearance, Diabetes Mellitus, Obat Hipoglikemik Oral, Penurunan Fungsi Ginjal

Background: The East Lombok Regency occupies the top rank in the highest number of diabetes mellitus patients in West Nusa Tenggara in 2023. Diabetes mellitus (DM) is the primary cause of kidney failure. The aim of this study is to determine the comparison between the selection of oral hypoglycemic agents (OHA) and creatinine clearance (CrCl) values and their relationship in type 2 diabetes mellitus (T2DM) patients. Method: A cross-sectional study involving 66 type 2 diabetes mellitus (T2DM) patients undergoing oral hypoglycemic agent (OHA) treatment at the Terara Health Center. The analysis of the relationship between the use of different types of OHAs and the decreased kidney function was performed using the Chi-Square test. Further analysis was carried out to see the difference in mean CrCl levels based on OHAs class using the T-independent test and differences in serum creatinine levels were analysed using the Mann-Whitney U test. Result:  Type 2 diabetes mellitus (DM) patients using sulfonylurea exhibited a more pronounced decline in kidney function (p=0.031; OR 5.143 (95% CI: 1.284-20.601)). Additionally, there was a significant difference in serum creatinine levels between the biguanide and sulfonylurea groups (p=0.029). However, the mean CrCl values were not statistically different (p=0.301). Conclusions: There was an association between the type of OHAs and the decline in renal function and a significant difference in serum creatinine levels between the biguanide and sulfonylurea groups. However, there was no statistically significant difference in the mean creatinine clearance (CrCl) values. The choice of OHA type should still consider renal function parameters.

Keywords:  Creatinine Clearance, Diabetes Mellitus, Oral Hypoglycemic Agents, Kidney Impairment