Korelasi kadar HbA1c dengan parameter elektrodiagnostik neuropati otonom diabetikum

Abstract

Diabetic autonomic neuropathy (DAN) is a frequent complication of diabetes mellitus (DM). Serious consequences of DAN are diabetic ulcer and silent myocardial infarction, both can be assessed by examining the sympathetic skin response (SSR) and the R-R interval. The progression of DAN increases the complications and this condition is influenced by glycemic control (HbA1c). The aim of this study was to find the correlation between HbA1c levels and SSR and R-R intervals. This was a cross-sectional study. The HbA1c levels, SSR latency and amplitude and R-R interval at lower extremities in DM patients were assessed. The correlation between HbA1c levels, demographic and laboratory variables with SSR latency, SSR amplitude, and R-R interval were tested with Pearson/Spearman correlation test followed by linear regression test.
There were 41 subjects, whose mean levels HbA1c, SSR latency, SSR amplitude, and R-R interval ratio were 8.7±3.02%, 2586.58±778.69 ms, 0.51±0.61 mV, 0.96±0.28, respectively. Significant bivariate correlations were found between HbA1c with SSR latency (r =0.312; p =0.047), HbA1c with R-R interval ratio (r =-0.392; p =0.011), duration of DM with SSR latency (r =0.524; p
=0.000), duration of DM with SSR amplitude (r =-0.444; p =0.003), and duration of DM with interval R-R ratio (r =-0.320; p =0.041). In the multivariate test, duration of DM correlated with SSR latency (β =0.417; p =0.008) and SSR amplitude (β =-0.351; p =0.021), HbA1c with SSR latency (β =0.175; p =0.248) and HbA1c with the R-R interval ratio (β =-0.298; p =0.063). In conclusion, both of HbA1c and duration of DM were positively correlated with SSR latency, and negatively correlated with the R-R interval.

ABSTRAK

Neuropati otonom diabetikum merupakan komplikasi diabetes melitus (DM) cukup sering. Komplikasi neuropati otonom diabetikum yang cukup serius adalah ulkus diabetikum dan silent myocard infarction. Risiko kedua komplikasi tersebut dapat dinilai dengan pemeriksaan sympathetic skin response (SSR) dan interval R-R. Progresivitas neuropati otonom diabetikum meningkatkan komplikasi dan hal itu dipengaruhi oleh kontrol glikemik (HbA1c). Penelitian ini bertujuan menentukan korelasi antara kadar HbA1c dengan SSR dan interval R-R.
Penelitian ini merupakan penelitian potong lintang. Subjek tersebut dilakukan pemeriksaan kadar HbA1c, pemeriksaan latensi dan amplitudo SSR ekstremitas bawah serta interval R-R. Korelasi antara kadar HbA1c, variabel demografi dan laboratorium dengan latensi SSR, amplitudo SSR dan interval R-R dengan uji korelasi Pearson/Spearman dilanjutkan uji regresi linier.
Didapatkan 41 subjek dengan rerata kadar HbA1c 8,7±3,02 %, latensi SSR 2586,58±778,69 ms, amplitudo SSR 0,51±0,61 mV, dan rasio interval R-R 0,96±0,28. Hasil uji korelasi bivariat yang signifikan adalah HbA1c dengan latensi SSR (r =0,312; p =0,047), HbA1c dengan rasio interval R-R (r =-0,392; p =0,011), durasi DM dengan latensi SSR (r =0,524; p =0,000), durasi DM dengan amplitudo SSR (r =-0,447; p =0,003) dan durasi DM dengan rasio interval R-R (r
=-0,320; p =0,041.) Pada uji multivariat, durasi DM berkorelasi signifikan dengan latensi SSR (β =0,417; p =0,008) dan amplitudo SSR (β =-0,351; p =0,021), untuk HbA1c dengan latensi SSR (β =0,175; p =0,248) dan untuk HbA1c dengan rasio interval R-R (β =-0,298; p =0,063). Kesimpulan penelitian ini, HbA1c dan durasi DM berkorelasi positif dengan latensi SSR dan berkorelasi negatif dengan interval R-R.