Wismandari Wisnu
Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta

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Hubungan Status Tiroid dengan Intoleransi Glukosa pada Pasien Hipertiroid Wisnu, Wismandari; Soewondo, Pradana; Subekti, Imam
Jurnal Penyakit Dalam Indonesia Vol 5, No 1 (2018)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (449.378 KB) | DOI: 10.7454/jpdi.v5i1.175

Abstract

Pendahuluan. Diabetes melitus (DM) dan penyakit tiroid adalah dua kelainan endokrinopati yang paling sering ditemukan pada populasi dewasa. Hipertiroid akan memperburuk kontrol glukosa darah dan meningkatkan kebutuhan insulin. Penelitian ini dilakukan untuk mengetahui hubungan status tiroid dengan kejadian intoleransi glukosa pada pasien hipertiroid dan membandingkannya dengan pasien hipertiroid yang telah mencapai status klinis eutiroid dan populasi normal.Metode. Penelitian ini menggunakan desain potong lintang pada pasien hipertiroid rawat jalan dengan status hormonal hipertiroid, pasien hipertiroid dengan status hormonal eutiroid/hipertiroid subklinis dan subjek sehat dengan matching terhadap jenis kelamin dan  umur. Dilakukan pemeriksaan FT4 dan TSH serta TTGO dengan 75 gram glukosa pada jam ke 0 dan ke 2. Sedangkan resistensi insulin ditentukan berdasarkan perhitungan insulin puasa dan Homeostatis Model Assessment-Insulin Resistance. Analisis dilakukan dengan program SPSS 20.0 for windows.Hasil. Penelitian ini mengumpulkan 114 subjek yang terdiri dari 40 pasien hipertiroid, 40 pasien eutiroid/hipertiroid subklinis, dan 34 sukarelawan sehat. Angka kejadian intoleransi glukosa pada kelompok Hipertiroid adalah 52,5% (10% DM, 32,5% toleransi glukosa terganggu (TGT), dan 10% glukosa darah puasa terganggu (GDPT)). Sedangkan, pada kelompok Eutiroid/Hipertiroid Subklinis adalah 20% (5% DM, 15% TGT, dan 0% GDPT) dan pada kelompok sukarelawan sehat adalah 11,8% (0% DM, 8,8% TGT, dan 2,9% GDPT). Hasil analisis menunjukkan bahwa intoleransi glukosa pada kelompok hipertiroid berbeda bermakna dibandingkan kelompok Eutiroid/Hipertiroid Subklinis (p=0,002). Sementara itu, hubungan antara status klinis tiroid dengan intoleransi glukosa pada kelompok tanpa resistensi insulin juga bermakna secara klinis maupun statistik (p=0,004).Simpulan. Terdapat hubungan bermakna antara status tiroid dengan kejadian intoleransi glukosa pada pasien hipertiroid dan pasien hipertiroid yang status klinisnya sudah eutiroid/hipertiroid subklinis mempunyai risiko yang sama dengan orang sehat untuk terjadinya intoleransi glukosa. Kata Kunci: Hipertiroid, Intoleransi glukosa, Resistensi InsulinAssociation between Thyroid Status and Glucose Intolerance in Hyperthyroid PatientsIntroduction. The most common endocrinopathy in adults are diabetes mellitus (DM) and thyroid disease. Hyperthyroidism decreases blood glucose control and increased the need of insulin. However, the mechanism of abnormal glucose metabolism in hyperthyroidism is not fully understood. This study aims to determine the relationship of thyroid status with incidence of glucose intolerance in hyperthyroid patients compared to hyperthyroid patients who have achieved clinical status of eutyroid and normal population.Methods. This study was cross sectional design in outpatients with hyperthyroidism in hyperthyroid and euthyroid/subclinical hyperthyroid status, and healthy volunteers who had matching age and sex. An oral glucose test and Homeostatic Model Assesment Insulin Resistance was performed after the diagnosis of hyperthyroidism by FT4 and TSH measurement. Data analysis was performed using SPSS for Windows version 20.0.Results. There were 114 eligible patients (40 case hyperthyroid, 40 case euthyroidism/subclinical hyperthyroidism and 34 healthy subjects). Proportion of glucose intolerance in hyperthyroidism is 52,5% (10% DM,  32,5%  impaired glucose tolerance (IGT), and 10% impaired fasting glucose (IFG)), in  euthyroidism/subclinical hyperthyroidism was 20% (5% DM, 15% IGT, and 0% IFG), and in healthy subjects was 11,8% (0% DM, 8,8% IGT, and 2,9% IFG). Glucose intolerance in hyperthyroidism was significantly different than euthyroidism/subclinical hyperthyroidism (p=0.002). We also found that the association between thyroid status and glucose intolerance in the group without insulin resistance was significantly different (p=0.004). Conclusions. Our study conclude that there is association between hyperthyroidism and glucose intolerance. Hyperthyroid patients in euthyroidism/subclinical hyperthyroidism status have the same risk as the healthy subject to became glucose intolerance.
DiabCare Asia 2012: diabetes management, control, and complications in patients with type 2 diabetes in Indonesia Cholil, Achmad Rudijanto; Lindarto, Dharma; Pemayun, Tjokorda Gde Dalem; Wisnu, Wismandari; Kumala, Poppy; Puteri, Happy Helene Sulung
Medical Journal of Indonesia Vol 28, No 1 (2019): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (350.802 KB) | DOI: 10.13181/mji.v28i1.2931

Abstract

BACKGROUND Indonesia was a part of the most recent edition of DiabCare Asia held in 2008. DiabCare Asia 2012 is modeled after a similar project to provide the latest information to facilitate healthcare policymaking in this area.METHODS This was an observational, non-interventional, cross-sectional study of patients with type 2 diabetes mellitus from primary, secondary, and tertiary care centers in Indonesia. Patient data collected included demography, medical history complications, eye and foot examinations, diabetes management, and most recent laboratory investigations. Blood samples were collected from all patients for the analysis of glycated hemoglobin (HbA1c).RESULTS A total of 1,967 patients participated in the study, with a mean (SD) age of 58.4 (9.5) years and a median (range) duration of diabetes 6.0 (0.1−47.0) years. The percentage of patients with HbA1c <7.0% was 30.8% and the mean (SD) HbA1c level was 8.3 (2.2%). The proportion of patients using insulin was 34.7% with a mean (SD) total daily dose of 37.9 (24.1) IU. The most common diabetes-related complications were peripheral neuropathy (59.1%), erectile dysfunction (32.4%), and eye complications (29.1%).CONCLUSIONS Glycemic and metabolic control remain unsatisfactory in type 2 diabetes patients in Indonesia. Efforts are needed to optimize control and prevent complications in these patients.