Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien diabetes melitus tipe 2
Authors: Widyatmojo Hadian , Samsuria Indranila Kustarini , Triwardhani Ria 
Published: November 2020

Background: Glycemic control in type 2 diabetes mellitus (DM) which can be assessed by examination of fasting blood sugar (FBG) and glycosylated hemoglobin (HbA1c) is thought to be associated with renal complications. Several markers can be used to assess the rate of damage to early kidney function, such as serum creatinine, urine creatinine albumin ratio (uACR), and serum cystatin C. The relationship of glycemic control with early kidney disorder markers in type 2 DM patients still shows controversial results.. The aim of the study to investigate the relationship between glycemic control (FBG and HbA1c) with early kidney disorder markers (serum creatinine, uACR, and cystatin C) in patients with type 2 diabetes mellitus.Methods: Analytic observational study with cross sectional approach conducted in April - June 2019 involved 34 type 2 DM patients in Karang Ayu Health Center who met the inclusion and exclusion criteria. Examination of GDP levels using the hexokinase method, HbA1c levels using the HPLC method, serum creatinine using the Jaffe method, uACR is calculated based on the ratio between urine albumin and creatinine, and cystatin C levels using the ELISA method. Statistical tests using Spearman's non-parametric correlation with p <0.05 were considered significant.Results: The mean Â± SD FBG and HbA1c levels were 130.41 Â± 39.37 mg/ \dL and 8.21 Â± 1.65%. Median (minimum-maximum) serum creatinine levels, uACR and serum cystatin C were 0.63 (0.35-2.79) mg/dL, 16.55 (4.1-29.8) mg/g and 0.72 (0.46 - 1.22) mg/L. The correlation of FBG levels with serum creatinine, uACR, and serum cystatin C were (r = 0.016; p = 0.927), (r = 0.293; p = 0.092), and (r = 0.334; p = 0.053). The relationship of HbA1c with serum creatinine, uACR, and cystatin C was (r = 0.120; p = 0.495), (r = 0.326; p = 0.059); and (r = 0.505; p = 0.002).Conclusions: There is no relationship between FBG with serum creatinine, uACR, and cystatin C. The HbA1c value is positively related to cystatin C but not related to serum creatinine and uACR in patients with type 2 diabetes mellitus.Â Latar belakang: Kontrol glikemik pada diabetes melitus tipe 2 (DM) yang dapat dinilai dengan pemeriksaan gula darah puasa (GDP) dan hemoglobin terglikosilasi (HbA1c) diduga berhubungan dengan komplikasi nefropati. Beberapa petanda dapat digunakan untuk menilai menilai kerusakan fungsi ginjal dini, misalnya kreatinin serum, rasio albumin kreatinin urin (uACR), dan cystatin C serum. Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien DM tipe 2 masih menunjukkan hasil yang kontroversial. Mengetahui hubungan antara kontrol glikemik (GDP dan HbA1c) dengan petanda gangguan ginjal dini (Kreatinin serum, uACR, dan cystatin C) pada pasien diabetes melitus tipe 2.Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan April - Juni 2019 melibatkan 34 pasien DM tipe 2 di Puskesmas Karang Ayu yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kadar GDP menggunakan metode heksokinase, kadar HbA1c menggunakan metode HPLC, kreatinin serum menggunakan metode Jaffe, uACR dihitung berdasarkan rasio antara albumin dan kreatinin urin, dan kadar Cystatin C menggunakan metode ELISA. Uji statistik menggunakan korelasi non parametrik Spearman dengan p < 0,05 dianggap signifikan.Â Hasil: RerataÂ±SD kadar GDP dan HbA1c adalah 130,41Â±39,37 mg/dL dan 8,21Â±1,65%. Median (minimum-maksimum) kadar kreatinin serum, uACR dan cystatin C serum berturut-turut adalah 0,63(0,35-2,79) mg/dL, 16,55(4,1-29,8) mg/g, dan 0,72(0,46 â€“ 1,22) mg/L. Korelasi kadar GDP dengan kreatinin serum, uACR, dan cystatin C serum adalah (r=0,016; p=0,927), (r=0,293; p=0,092), dan (r=0,334; p=0,053). Hubungan HbA1c dengan kreatinin serum, uACR, dan cystatin C adalah (r=0,120; p=0,495), (r=0,326; p= 0,059); dan (r = 0,505; p = 0,002).Simpulan: Tidak terdapat hubungan antara GDP dengan kreatinin serum, uACR, dan cystatin C. Nilai HbA1c berhubungan positif sedang dengan cystatin C namun tidak berhubungan dengan kreatinin serum dan uACR pada pasien diabetes melitus tipe 2.