STATUS MINERAL SENG(Zn) DAN MAGNESIUM (Mg) PENDERITA DIABETES MELITUS TIPE 2 DENGAN REGULASI GULA DARAH BAIK DAN JELEK S

Abstract

Background. Numerous studies have found alteration in micronutrient status of patients with diabetes mellitus. Zinc deficiency occurs in type 2 diabetics, may play a role in abnormal immune function which lead to increased infection and diabetic foot ulcers. Altered magnesium level is correlated with the metabolic homeostasis of glucose and may aggravate retinopathy and ischemic heart disease. The risk of developing DM type 2 increase progessively with rising BMI. Obese diabetic patients had lower Zn and Mg levels in their serum than nonobese diabetics. Objective. This study will identify Zn and Mg status in diabetes type 2 with good and poorly controlled. Patients and Methods. 72 subjects diagnosed type 2 diabetic attending outpatient clinic at general hospital in Semarang were recruited into the study. Grouping for good and poorly controlled diabetics were based on fasting and postprandial blood glucose every month for three consecutive months and confirmed with their HbAie. There were 30 subjects nondiabetics/normal enrolled in this study. Determination concentration of minerals was performed by Flame Atomic Absorption Spectrophotometry (FAAS). The t test dan Anova were used for differences in mean values between two groups, Chi square and Fisher's test used for association between two groups, Spearman's correlation were used to indentify the correlation between two condition variables. Results. Grouping based on blood glucose: 36 subjects were good controlled and 36 subjects were poorly controlled. Based on HbAic 12 subjects (33.33%) were good, 32 subjects were moderate and 28 subjects (85.7%) were poorly controlled. Zinc levels DM type 2 with poorly controlled had lower than good controlled (52.23 + 26.04, 68.03 + 31.03 kig/dL, p = 0.096). DM type 2 had lower Zn levels than NonDM (102.07 + 50.11 p.g/dL; p= 0.036). Mg Levels DM type 2 with poorly controlled had lower than good controlled (0.66 + 0.12, 0.73 + 0.11 mmol/L, p=0.063). DM type 2 had lower Mg levels than NonDM (0.86 + 0.33 mmol/L, p=0.001). BMI DM type 2 had upper than NonDM (24.54 + 2.5, 22.79 + 2.69.Kg/m2 vs 21.27 + 3.39 Kg/m2, p=0.002). There were correlation between Zn dan Mg (r: .2431, p=0.040). Mg and Blood glucose (r: -.2418, p=0.041). No correlations Zn and Mg with BMI and duration of diabetes with Zn and Mg. Conclusion. DM type 2 had lower serum Zinc and Magnesium compared to nondiabetics. The same trend was observed for poorly controlled than good controlled. Not correlated betwen lowered Zn and Mg with BMI and duration of diabetes. Key words : DM, Zinc and Magnesium Latar belakang: Penderita diabetes dapat mengalami perubahan mikronutrient. Defisiensi Zn akan menyebabkan terganggunya sistim imunitas yang dapat meningkatkan risiko infeksi dan ulkus diabetik. Sedangkan Mg sering dikaitkan dengan terjadinya retinopati, penyakit jantung iskemik dan gangguan toleransi glukosa. Risiko untuk terjadinya diabetes akan meningkat sejalan dengan kenaikan IlviT. Penderita DM yang obes akan mempunyai kadar Zn dan Mg yang lebih rendah dibandingkan DM nonobes. Tujuan penelitian: Untuk mengetahui status mineral Zn dan Mg serum penderita diabetes melitus tipe 2 dengan regulasi gula darah baik dan jelek. Pasien dan Metode: 72 penderita DM tipe 2 yang kontrol di poliklinik Endokrin RSUP Dr. Kariadi. Pengelompokan regulasi baik dan jelek dilakukan dengan menggunakan kadar Gula darah puasa dan 2 jam PP tiap bulan selama 3 bulan berturut-turut dan selanjutnya dikonfirmasi dengan HbAic. Dilakukan pula pengambilan darah pada pasien nonDM/normal/sehat. Penentuan kadar mineral dilakukan dengan metode Flame Atomic Absorption Spectrophotometry (FAAS). Analisa statistik untuk menilai rerata (mean) dan median dengan uji t, uji Anova, sedangkan untuk melihat asosiasi diantara kelompok dengan uji Chi Square dan Fisher, untuk melihat korelasi digunakan cara Spearman. Basil: Berdasarkan kadar gula darah dikelompokkan: 36 penderita regulasi baik dan 36 penderita regulasi jelek. Sedangkan berdasarkan HbAjc terdapat: 12 penderita(33.33%) regulasi baik, 32 penderita regulasi sedang dan 28 penderita(85.7%) regulasi jelek. Kadar Zn DM tipe 2 dengan Regulasi jelek lebih rendah dibanding regulasi baik (52.23 + 26.04, 68.03 + 31.03 itig/dL, p = 0.096). DM tipe 2 kadar Zn juga lebih rendah dibanding NonDM (102.07 + 50.11 mg/dL; p=.036). Kadar Mg DM tipe 2 Regulasi jelek lebih rendah dibanding regulasi baik (0.66 + 0.12, 0.73 + 0.11 mmol/L, p=0.063). DM tipe 2 kadar Mg juga lebih rendah dibanding NonDM (0.86 + 0.33 mmol/L, p=0.001). IMT penderita DM lebih tinggi dibandingkan NonDM (22.79 + 2.69, 24.54 + 2.53 vs 21.27 + 3.39 Kg/m2, p=0.002). Terdapat korelasi antara Zn dan Mg (r: .2431, p=0.040). Mg dan GDS (r: -.2418, p=0.041). Tidak ada korelasi antara Zn dan Mg dengan IMT dan lama sakit DM . Kesimpulan: Kadar Zn dan Mg serum penderita DM tipe 2 lebih rendah dibandingkan nonDM, Kecenderungan yang sama juga dijumpai pada DM regulasi jelek dibandingkan regulasi baik. Tidak ada kaftan antara rendahnya Zn dan Mg dengan IMT dan Lama sakit DM. Kata kunci : DM, Seng dan Magnesium