Oleh admin kalbemed pada June 07, 2018 06:00

Intensifikasi Terapi Diabetes, Apakah Menguntungkan?

Seberapa sering kita menjumpai terlalu lambannya intensifikasi terapi diabetes padahal semestinya hal tersebut sudah harus dilakukan? Rasanya sangat sering terjadi di Indonesia. Hal yang sama ternyata juga terjadi di AS, berdasarkan penelitian yang baru ini dipublikasikan. Ditemukan hanya 1/3 pasien yang tidak terkontrol baik hanya dengan obat oral anti diabetes mengalami peningkatan dosis, diganti ke obat yang lain atau dengan insulin dalam 6 bulan.

Dalam penelitian yang dilakukan, semua pasien mengkonsumsi 2 jenis obat anti diabetes sekurang-kurangnya selama 6 bulan pada awal dimulainya studi, namun HbA1c yang dicapai masih tetap yaitu sekurang-kurangnya 7%. Seharusnya jika berpedoman pada panduan tatalaksana maka semua pasien tersebut harus segera diganti ke terapi yang lebih intensif. Namun yang terjadi adalah 6 bulan setelah studi dimulai, dokter hanya meresepkan terapi yang lebih intensif pada 37% pasien saja.

Peneliti utama, Dr. Kevin Pantalone dari Cleveland Clinic di Ohio mengatakan, jika HbA1c pasien masih tidak mencapai target, maka HbA1c antara akan tetap di level itu atau bisa jadi lebih parah (lebih tinggi). Jarang sekali malah jadi membaik. Sedihnya bahwa seringkali dokter dan pasien mencari alasan untuk tidak perlu melakukan intensifikasi terapi sehingga komplikasi akan sering terjadi nantinya.

Peneliti memeriksa catatan kesehatan elektronik terhadap 7.389 pasien yang diabetesnya tidak terkontrol baik, dirawat di the Cleveland Clinic antara tahun 2005-2006. Studi yang dilakukan tidak didesain untuk membuktikan apakah atau bagaimana intensifikasi terapi dapat secara langsung memperbaiki kontrol gula darah.  Di antara pasien dengan rentang A1c dari 7 – 7,9%, hanya 28% yang terapi diintensifkan selama studi dilakukan. Untuk A1c dengan rentang 8-8,9%, hanya 47% yang terapinya diintensifkan, dan hanya 60% pada A1c rentang 9% ke atas. Dari sini juga diambil suatu temuan bahwa pasien dengan kontrol gula darah yang lebih jelek cenderung mendapatkan terapi yang lebih intensif.

Pasien harusnya memberdayakan dirinya dengan melakukan pemeriksaan gula darah secara teratur, harus tahu seberapa besar target gula darah yang seharusnya mereka capai dan memeriksakan diri secara teratur ke dokter. Salah satu sinyal peringatan yang membuat pasien merasa “tertohok” adalah ketika mereka tahu target gula darah tidak tercapai sesuai harapan, maka itulah saatnya mereka kontrol ke dokter untuk mendapatkan pendekatan lain dalam pengobatan diabetesnya.[PMP]



Image: Ilustrasi
Referensi: Rapaport L. Doctors slow to switch diabetes treatment when oral meds don't work [Internet]. 2018 [cited 2018 May 29]. Available from: https://www.medscape.com/viewarticle/896679.

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chenlixiang chenlixiang
## chenlixiang chenlixiang
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chenlina chenlina
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