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Vol. 34 No. 4 September 2017

PENGARUH PENGGUNAAN TUNGGAL MAUPUN KOMBINASI BIGUANID DAN PROTON PUMP INHIBITOR TERHADAP NEUROPATI DIABETIK (STUDI KADAR VITAMIN B12 SERUM PADA PENDERITA DIABETES MELITUS TIPE 2)
Marliani Afriastuti,* Aris Catur Bintoro,* Dwi Pudjonarko,* Tjokorda Gde Dalem Pemayun**

THE EFFECTS OF SINGLE OR COMBINATION USE OF BIGUANID AND PROTON PUMP INHIBITOR TO DIABETIC NEUROPATH (A STUDY OF SERUM VITAMIN B12 LEVEL ON TYPE 2 DIABETES MELLITUS PATIENTS)

ABSTRACT

Introduction: Diabetic neuropathy is a neurologic disorder that related to diabetes mellitus, it can be found in 25-50% type 1 and type 2 diabetes mellitus. Biguanid (metformin) and proton pump inhibitor (PPI)  frequently reported as a pharmacological cause of vitamin B12 deficiency. Vitamin B12 deficiency may worsen diabetic neuropathy that already occured, also may accelerate diabetic neuropathy events.

Aims: To prove that there is an effect of drugs use (biguanid and PPI) against diabetic neuropathy.

Method: This was a cross sectional study. Interview, data collection from medical record, physical examination and laboratorium examination were conducted. Statistical analysis used Chi-square and Pearson correlation test.

Result: Subjects contained as many as 40 subjekts, consisted of 92.5% with neuropathy and 7.5% without neuropa- thy. There was no significant difference of diabetic neuropathy state and serum vitamin B12 level between metformin group and metformin-PPI group. There was no correlation between dose and duration of metformin to diabetic neuropathy, as well as serum vitamin B12 level. There was also no correlation between serum vitamin B12 level, age, height, HbA1C and trigliserida to diabetic neuropathy.

Discusion: There was no significant difference of diabetic neuropathy state and serum vitamin B12 level between single and combination use of metformin and PPI, neither did serum vitamin B12 level with diabetic neuropathy.

Keywords: Diabetic neuropathy, metformin, proton pump inhibitor, vitamin B12

ABSTRAK

Pendahuluan: Neuropati diabetik merupakan kelainan pada saraf yang berhubungan dengan diabetes melitus (DM), yang terjadi pada hampir 25-50% pasien DM baik tipe 1 maupun tipe 2. Biguanid (metformin) dan proton pump inhibitor (PPI) kerap dilaporkan sebagai penyebab farmakologis dari defisiensi vitamin B12. Defisiensi vitamin B12 dapat memperberat neuropati diabetik yang sudah lebih dulu terjadi, maupun dapat mempercepat terjadinya neuropati diabetik.

Tujuan: Membuktikan adanya pengaruh biguanid dan PPI terhadap neuropati diabetik.

Metode: Penelitian potong lintang. Dilakukan wawancara, pengambilan data dari rekam medis, pemeriksaan fisik serta pemeriksaan laboratorium. Dilakukan analisis statistik menggunakan uji Chi-square dan uji korelasi Pearson.

Hasil: Didapatkan subjek sebanyak 40 orang, 92,5% neuropati dan 7,5% tidak neuropati. Status neuropati diabetik dan kadar vitamin B12 serum tidak berbeda bermakna antara kelompok subjek dengan terapi tunggal metformin maupun kelompok subjek dengan terapi kombinasi metformin dan PPI. Tidak ada perbedaan bermakna hubungan antara dosis dan durasi metformin dengan neuropati diabetik maupun dengan kadar vitamin B12 serum. Analisis korelasi antara kadar vita- min B12 serum, umur, tinggi badan, HbA1C dan trigliserida dengan neuropati diabetik juga tidak menunjukkan hubungan yang bermakna.

Diskusi: Tidak terdapat perbedaan bermakna status neuropati diabetik dan kadar vitamin B12 serum antara peng- gunaan tunggal dan kombinasi metformin dan PPI, serta tidak terdapat hubungan yang bermakna antara kadar vitamin B12 serum dan neuropati diabetik.

Kata kunci : Metformin, neuropati diabetik, proton pump inhibitor, vitamin B12

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*Bagian Neurologi FK Universitas Diponegoro/RSUP Dr. Kariadi, Semarang; **Bagian Penyakit Dalam FK Universitas Diponegoro/ RSUP Dr. Kariadi, Semarang

Korespondensi: asthy01118@yahoo.co.id

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