Pemilihan Obat Antidiabetik Oral pada Pasien Diabetes Melitus Tipe 2 dengan Risiko Tinggi untuk Kejadian Kardiovaskular

Derlin J. Leander, Dicky L Tahapary

Abstract

Pasien diabetes melitus tipe 2 (DMT2) dikaitkan dengan peningkatan risiko kejadian kardiovaskular. Sebelum era cardio-vascular trial outcome (CVOT) bukti efikasi obat oral diabetes (OAD) golongan lama seperti metformin, sulfonilurea, tiazolidindion, glinid, dan inhibitor alfa glukosidase dalam menurunkan risiko kejadian kardiovaskular sangatlah terbatas. Sejak 2008, semua OAD wajib memiliki data CVOT. Penghambat DPP-4 bersifat netral terhadap risiko kejadian kardiovaskular sedangkan penghambat SGLT-2 dilaporkan dapat menurunkan risiko kejadian kardiovaskular secara bermakna. Temuan ini bahkan turut mengubah panduan pengelolaan DMT2 yang dikeluarkan oleh American Diabetes Association European Association for the Study of Diabetes (ADA-EASD) di akhir tahun 2018. Namun demikian, penggunaan penghambat SGLT-2 di Indonesia sepertinya akan terkendala dalam hal biaya. Bila dibandingkan dengan pendekatan multifaktorial secara intensif yang berusaha menurunkan glukosa darah, lipid, tekanan darah, berat badan, dan pemberian aspirin; ternyata pendekatan multifaktorial ini dikaitkan dengan penurunan risiko kejadian kardiovaskular yang lebih tinggi dan biaya yang lebih rendah. Dalam era JKN, diperlukan kendali mutu dan kendali biaya, nampaknya upaya pendekatan multifaktorial akan masih menjadi pilihan utama dalam rangka meurunkan kejadian kardiovaskular pada penyandang DMT2 di Indonesia.

Kata kunci: Diabetes melitus tipe 2, kejadian kardiovaskular, obat antidiabetik oral, pendekatan multifaktorial

 

The Selection of Oral Antidiabetic Drugs in Type 2 Diabetes Mellitus Patients with High Risk for Cardiovascular Events

Type 2 diabetes mellitus (DMT2) patients are associated with an increased risk of cardiovascular events. Prior to the era of cardio-vascular trial outcome (CVOT) evidence on the efficacy of old oral diabetes (OAD) drugs such as metformin, sulfonylurea, thiazolidindion, glinid, and alpha glucosidase inhibitors in reducing the risk of cardiovascular events was very limited. Since 2008, all OADs must have CVOT data. DPP-4 inhibitors are neutral against the risk of cardiovascular events while SGLT-2 inhibitors are reported to significantly reduce the risk of cardiovascular events. This finding even helped to change the DMT2 management guidelines issued by American Diabetes Association (ADA-EASD) in late 2018. However, SGLT-2 inhibitor applications in Indonesia are likely to be constrained in terms of costs. When compared with an intensive multifactorial approach that seeks to reduce blood glucose, lipids, blood pressure, weight, and aspirin; it turns out that this multifactorial approach is associated with a lower risk of higher cardiovascular events and lower costs. In the JKN era, where quality control and cost control are needed, it seems that the multifactorial approach will still be the main choice in reducing cardiovascular events in people with T2DM in Indonesia.

 

Keywords

Cardiovascular events, diabetes mellitus type 2, multifactorial approach, oral antidiabetic drugs

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