Oleh Admin Kalbe Medical pada December 30, 2016 07:30

Cara Terbaik Memprediksi Risiko Prediabetes

Pemeriksaan hemoglobin terglikosilasi atau HbA1c merupakan salah satu cara yang baik dalam mendiagnosis pasien apakah dia sudah masuk ke kondisi prediabetes. Dengan menggunakan HbA1c sebagai parameternya, maka nantinya dapat memperbaiki proses identifikasi orang-orang dengan risiko komplikasi kesehatan yang berat selama lebih dari 10 tahun ke depan. Hal tersebut didapatkan berdasarkan analisis terakhir dari studi Atherosclerosis Risk in Communities (ARIC) yang berbasis komunitas, di mana telah dipublikasikan secara online bulan November ini di jurnal Lancet Diabetes & Endocrinology. Tujuan dari studi ini adalah untuk mencari tahu siapa-siapa saja yang memiliki risiko tertinggi, dilihat dari mereka yang menderita diabetes di kemudian hari, ataupun dari mereka yang akan mengalami komplikasi serius di kemudian hari.
    
Panduan American Diabetes Association (ADA) merekomendasikan cut off glukosa darah puasa adalah berkisar dari 100-125 mg/dL, untuk cut off dari HbA1c adalah dari 5,7% - 6,4%, atau cut off dari GD2PP adalah berkisar dari 140-199 mg/dL. WHO merekomendasikan cut off yang sama seperti ADA kecuali cut off untuk glukosa darah puasa yang lebih tinggi dibandingkan ADA, yaitu berkisar dari 110-125 mg/dL. Dengan adanya batasan tersebut maka dapat dipergunakan untuk mengetahui apakah pasien terindikasi prediabetes atau tidak. Di lain pihak, the International Expert Committee (IEC) merekomendasikan bahwa cut off HbA1c adalah dari 6,0% - 6,4%, untuk mengidentifikasi apakah mereka memiliki risiko intermediate/menengah untuk menderita diabetes.

   
Partisipan pada studi ARIC ini yaitu dewasa usia menengah dari 4 komunitas di Carolina Utara, Mississippi, Minnesota, dan Maryland. Partisipan diikuti selama lebih dari 2 dekade. Peneliti mengikuti 10.844 orang yang memiliki kadar glukosa puasa dan HbA1c antara tahun 1990 dan 1992, serta sebanyak 7194 orang dengan GDP dan GD2PP dari tahun 1996 dan 1998. Kemudian mereka membandingkan seberapa baik definisi prediabetes menggunakan ADA, WHO, dan IEC dengan cut off yang terprediksi untuk risiko 10 tahun ke depan mengalami insidens diabetes, penyakit ginjal kronis, CVD, penyakit arteri perifer dan kematian akibat semua sebab.

   
Hasil menunjukkan bahwa cut off HbA1c ADA dan IEC serta GDP WHO dapat mengidentifikasi hanya sedikit jumlah kasus prediabetes dibandingkan cut off GDP ADA dan GD2PP berdasarkan ADA dan WHO. Sebagai contoh, jika menggunakan cut off GDP berdasarkan ADA maka 38% orang yang di dalam studi akan menderita prediabetes, dibandingkan dengan 19% pasien yang menggunakan cut off HbA1c berdasarkan ADA. Namun, dengan cut off HbA1c secara umum akan menghasilkan risiko relatif yang lebih tinggi untuk komplikasi kesehatan jangka panjang dibandingkan cut off kadar glukosa darah.

   
Para peneliti menemukan bahwa dengan penggunaan definisi berdasarkan HbA1c, maka mereka yang telah teridentifikasi memiliki prediabetes memiliki risiko 50% lebih besar untuk menderita penyakit ginjal, dan dua kali lipat menderita penyakit kardiovaskular, serta 60% lebih tinggi untuk meninggal akibat penyebab apapun dibandingkan dengan mereka yang memiliki HbA1c normal. (PMD)


Image : Ilustrasi
Referensi:
Hackethal V. HbA1c better than glucose for predicting prediabetes risk [Internet]. 2016 [cited 2016 Dec 19]. Available from : http://www.medscape.com/viewarticle/872233

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