Relationship between HbA1c Levels with eGFR and Blood Pressure in Type 2 Diabetes Mellitus Patients in the Department of Internal Medicine Dr. Soetomo General Hospital Surabaya

Abstract

Introduction: Diabetes mellitus is a non-transmitted pandemic disease which had spreaded on a global scale. The prevalence of diabetes mellitus in the world according to the International Diabetes Federation (IDF) is 1.9% and diabetes mellitus is ranked seventh as the cause of death in the world, around 95% in the world is type 2 diabetes mellitus. According to Riset Kesehatan Dasar (Riskesdas) in 2013, the prevalence of diabetes mellitus in Indonesia is 6,9%. Type 2 diabetes mellitus that is not well controlled will increase the risk of chronic complications, both microangiopathies such as nephropathy, and macroangiopathy such as hypertension. The aim of the study was to determine correlation between HbA1c levels with eGFR (Estimated Glomerulus Filtration Rate) and blood pressure (systolic and diastolic).Methods: An analytic observational cross-sectional study, collecting the data from 94 patients with type 2 diabetes mellitus, Dr. Soetomo General Hospital, Surabaya, from January to May 2018. The variables were collected from patient’s medical records. Analysis using Spearman’s Rank Correlation test. To determine normality of the data, we use Kolmogorov-smirnov test.Results: The results showed that there are 134 (57,8%) patients with type 2 diabetes mellitus are female more than male. Patients with greater than or equal to 45 years old were 203 (87,5%) patients, more than under 45 years old. The correlation test showed that there was no significant correlation between HbA1c and systolic blood pressure (r=-0,127; p=0,054). Also there was no significant correlation between HbA1c and diastolic blood pressure (r=-0,111; p=0,093). Analysis on other factor showed a significant correlation between HbA1c and eGFR (r=0.341; p=0.000).Conclusion: There was no significant correlation between HbA1c and systolic blood pressure, also there was no significant correlation between HbA1c and diastolic blood pressure. But, there was a significant correlation between HbA1c and eGFR. This is because the data retrieval does not consider the drug consumption and therapy that has been done by the patient, as well as examination of HbA1c, serum creatinine eGFR, and blood pressure not at the same time.

Hubungan antara Diabetes Melitus Tipe 2 terhadap Luaran Pasien COVID-19 di Rumah Sakit Sanglah pada Tahun 2020-2022

“…14 Menurut Sugondo, dkk. 15 hiperglikemia dapat menyebabkan glikosilasi protein yang mengaktivasi sitokin transforming growth factor-beta (TGF-β). Kondisi ini memicu hiperfiltrasi glikoprotein pada mesangium glomerulus dan menghasilkan ROS, sehingga mengaktivasi PKC dan jalur mitogen-activated protein kinase (MAPK).…”

“…14 Selain itu, korelasi antara penerima terapi dialisis dapat menurunkan kadar HbA1c yang dikaitkan dengan penurunan GFR. 14,15 Namun, beberapa penelitian menyebutkan bahwa terdapat korelasi yang lebih buruk dan tingkat keparahan infeksi SARS-CoV-2 lebih tinggi pada pasien dengan komorbid DM tipe 2. End-stage renal disease (ESRD) pada hemodialisis kronis dikaitkan dengan mortalitas jangka pendek yang lebih tinggi, evolusi klinis yang lebih buruk seperti memerlukan ventilasi mekanik, rawat inap berkepanjangan, dan komplikasi.…”

“…End-stage renal disease (ESRD) pada hemodialisis kronis dikaitkan dengan mortalitas jangka pendek yang lebih tinggi, evolusi klinis yang lebih buruk seperti memerlukan ventilasi mekanik, rawat inap berkepanjangan, dan komplikasi. 15,16 Pada penelitian ini angka mortalitas pasien COVID-19 dengan komorbiditas DM tipe 2 menunjukkan hasil yang bermakna (p=0,010). Virus COVID-19 menarik perhatian dunia sebagai penyakit kegawatdaruratan medis yang memiliki angka mortalitas tinggi.…”

Hubungan Kadar Hemoglobin Terglikosilasi (HbA1c) dengan Estimasi Laju Filtrasi Glomerulus (eLFG) Pasien DM Tipe II di Fasilitas Kesehatan Tingkat Pertama

“…Distribusi karakteristik responden penelitian menunjukkan bahwa jumlah responden perempuan berjumlah 38 (59,4%), lebih banyak bila dibandingkan responden lakilaki yang berjumlah 26 (40,6%). Hal ini sejalan dengan studi oleh Sugondo et al [12], yang menunjukkan persentase perempuan lebih tinggi dibandingkan pria. Perempuan lebih beresiko mengalami diabetes melitus tipe 2 disebabkan beberapa faktor seperti otot yang lebih sedikit sehingga berkurangnya uptake glukosa darah, juga kadar hormon estrogen dan progesteron yang relatif lebih tinggi sehingga mengurangi sensitivitas insulin [13].…”

Beta Cell Death Mechanism in Type 2 Diabetes: An Overview

“…Approximately 90 -95% of patients with DM suffer from T2D [2]. T2D is mostly experienced by female [3,4] and elderly patients [5,6]. T2D occurs due to the loss of beta cell function with previous condition of insulin resistance [7].…”