Oleh Admin Kalbe Medical pada January 03, 2017 07:30

Regimen Sitagliptin plus Insulin Glargine untuk Perawatan Pasien DM di RS

Berdasarkan suatu studi yang terbaru berjudul Sita-Hospital, yang melibatkan penggunaan obat sitagliptin dan insulin basal, disebutkan bahwa sitagliptin plus insulin basal ini efektif dan aman bagi pasien DM tipe 2 yang dirawat di bangsal medis umum dan bedah. Studi tersebut telah dipublikasikan secara online pada tanggal 7 Desember di jurnal the Lancet Diabetes & Endocrinology. Oleh dr. Guillermo Umpierrez dari Emory University di Atlanta, mengatakan bahwa mereka mempercayai bahwa kombinasi satu tablet sekali sehari sitagliptin dan satu kali injeksi insulin basal lebih mudah untuk diterapkan dibandingkan regimen injeksi insulin multipel.
   
Panduan pengobatan pasien DM tipe 2 non-kritis yang dirawat di rumah sakit adalah merekomendasikan penggunaan regimen insulin basal-bolus, yang berarti perawatan ini memang bersifat intensif, namun sayangnya tetap dibayangi oleh risiko hipoglikemia. Pada studi klinik Sita-Hospital, terapi dengan DPP-4 inhibitor, sitagliptin dan insulin basal sekali sehari memiliki efikasi yang mirip dan aman dibandingkan dengan regimen multidosis dengan insulin basal sekali sehari dan insulin rapid-acting sebelum makan pada pasien di rumah sakit dengan kadar glukosa yang tidak terkontrol.

   
Sita-Hospital ini merupakan suatu studi klinik acak, multisenter, non-inferior yang membandingkan antara pendekatan dari regimen basal-bolus konvensional (insulin glargine plus insulin rapid acting insulin lispro atau aspart) dibandingkan dengan kombinasi insulin glargine dengan sitagliptin sekali sehari pada 277 pasien diabetes yang dirawat di bangsal medis umum atau bangsal bedah di 5 RS di Amerika Serikat.

   
Hasilnya adalah dengan pemberian sitagliptin-insulin glargine terbukti sama efektifnya dengan regimen terapi konvensional dalam mengontrol glukosa darah  (9,5 vs 9,4 mmol/L; mean difference of 0.1 mmol/L). Dalam studi ini juga dicatat bahwa terjadi suatu perbaikan yang sifatnya cepat dalam kontrol glikemik pada kedua kelompok, tanpa adanya perbedaan dalam rerata glukosa darah harian, jumlah nilai glukosa darah yang masuk ke target, jumlah kejadian hipoglikemia, ataupun komplikasi RS. Regimen sitagliptin-insulin glargine juga menghasilkan suatu penurunan dosis insulin harian dan sedikitnya jumlah injeksi insulin, jika dibandingkan dengan pendekatan regimen terapi basal-bolus.

   
Pasien DM tipe 2 yang mendapatkan manfaat dari kombinasi ini adalah dengan kondisi hiperglikemia derajat sedang, pasien dengan kebutuhan insulin total harian kurang dari 0,6 unit/kgBB/hari, dan dewasa tua atau tua renta yang sangat berpotensi tinggi menderita hipoglikemia. Hasil studi ini dapat mewakili suatu landmark tatalaksana hiperglikemia di RS; namun uji klinik di masa yang akan datang diperlukan untuk dapat memberikan kejelasan alur bagi perawatan bagi masing-masing individu dalam situasi ini. (PMD)


Image : Ilustrasi
Referensi:
Brooks M. Sitagliptin plus basal insulin: A simplified in-hospital regimen? [Internet]. 2016 [cited Dec 28]. Available from: http://www.medscape.com/viewarticle/873286

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