Oleh Admin Kalbe Medical pada March 07, 2017 07:30

Manfaat L-carnitine pada Terapi Obesitas pada Diabetes Melitus

Pencegahan dan tatalaksana kelebihan berat badan ataupun obesitas merupakan hal yang krusial, karena faktor ini berhubungan dengan peningkatan prevalensi faktor risiko kardiovaskular, resistensi insulin, toleransi glukosa terganggu, type 2 diabetes mellitus (T2DM), dislipidemia, dan hipertensi. Terapi inisial ynag direkomendasikan untuk kelebihan berat badan dan obesitas meliputi peningkatan aktivitas fisik dan mengurangi asupan kalori. Namun, ketika pendekatan kebiasaan ini tidak adekuat mencapai sasaran berat badan dan kontrol metabolik yang optimal, terapi farmakologis direkomendasikan pemberiannya.

Terapi farmakologis yang diindikasikan untuk obesitas, yaitu sibutiramine dan orlistat. Sibutiramine adalah sebuah penyekat reuptake norepinefrin dan serotonin yang biasa digunakan untuk terapi jangka panjang obesitas pada pasien yang tidak berhasil menurunkan berat badan dengan diet dan perubahan pola hidup semata. Sedangkan orlistat bekerja menghambat aktivitas lipase di traktus gastrointestinalis. Penghambatan lipase dapat mengurangi kuantitas asam lemak bebas dan monogliserida pada usus yang akan mengurangi solubilitas dan absorpsi kolesterol yang berperan menaikkan berat badan.


Carnitine (L-ẞ-hydroxy-γ-N-trimethylaminobutyric acid), senyawa yang disintesis di hepar dan ginjal, berperan penting dalam metabolisme lipid. Carnitine merupakan kofaktor penting untuk oksidasi-ẞ asam lemak dengan memfasilitasi perpindahan asam lemak rantai panjang melewati membran dalam mitikondria sebagai acylcarnitine esters. Gangguan pada fungsi ini, penggunaan lemak sebagai sumber energi, dapar berakibat pada terjadinya dekompensasi metabolik akut, seperti ensefalopati hepatikum dan hipoglikemia hipoketotik

   
Derosa G, et al, melakukan sebuah studi acak tersamar ganda, multisenter, terkontrol pada 254 pasien T2DM tidak terkontrol untuk mengetahui efek pemberian sibutiramine dan L-carnitine dibandingkan dengan monoterapi sibutiramine selama 12 bulan. Dosis yang digunakan untuk sibutiramine sebesar 10 mg sedangkan dosis L-carnitine 2 gram. Hasil studi ini mengemukakan bahwa penambahan L-carnitine pada terapi sibutiramine memberikan perbaikan yang lebih cepat pada gula darah puasa, gula darah post prandial, profil lipid, tumor necrosis factor-α (TNF-α), dan high-sensitivity C-reactive protein (HS-CRP) dibandingkan dengan monoterpai sibutiramine.


Studi lain yang dilakukan Derosa G, et al, mengevaluasi efek terapi 1 tahun orlistat ditambah L-carnitine banding orlistat saja pada pasien T2DM tidak terkontrol. Ditemukan adanya penurunan signifikan pada berat badan, profil glikemik, homeostasis model assessment insulin resistance index (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), serta perbaikan lebih cepat dari fasting plasma insulin (FPI), total cholesterol, trigliserida, leptin, TNF-α, HS-CRP, dan vaspin. Dibutuhkan studi lebih lanjut untuk mempelajari manfaat suplementasi L-carnitine dalam optimalisasi tatalaksana pasien T2DM, khususnya yang tidak terkontrol. (JCH)


Image : Ilustrasi
Referensi:
1.Derosa G, Maffioli P, Salvadeo SAT, Ferrari I, Gravina A, Mereu R, et al. Effects of combination of sibutiramine and L-carnitine compared with sibutiramine monotherapy on inflammatory parameters in diabetic patients. Metabolism. 2011;60:421-9. doi: 10.1016/j.metabol.2010.03.010.
2.Derosa G, Maffioli P, Ferrari I,  D'Angelo A, Fogari E, Palumbo I,  et al. Comparison between orlistat plus L-carnitine and orlistat alone on inflammation parameters in obese diabetic patients. Fundam Clin Pharmacol. 2011;25(5):642-51. doi: 10.1111/j.1472-8206.2010.00888.x.

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