Tesis

Perbandingan Kadar Vitamin D pada Pasien Diabetes Melitus dengan dan tanpa Ulkus Kaki Diabetik = Comparison of Vitamin D Levels in Diabetes Mellitus Patients with and without Diabetic Foot Ulcers: An Analytical Observational Study in Jakarta, Indonesia.

Latar Belakang: Ulkus kaki diabetik (UKD) merupakan salah satu bentuk dari luka kronik yang merupakan komplikasi serius pada pasien diabetes melitus (DM) dengan kondisi hiperglikemia kronik dan kurang terkontrol. Pasien dengan UKD dilaporkan memiliki risiko mortalitas 2 kali lebih tinggi dibandingkan pasien DM tanpa UKD. Beberapa penelitian terbaru menyebutkan bahwa vitamin D memiliki peran penting pada diferensiasi, proliferasi, dan pertumbuhan sel, serta modulasi sistem imunitas melalui pengaturan sitokin proinflamasi. Oleh karenanya, kadar vitamin D yang optimal diyakini sangat dibutuhkan untuk proses penyembuhan luka. Selain itu, defisiensi vitamin D diduga mengganggu produksi dan sekresi insulin sehingga berkontribusi pada kronisitas UKD. Hingga saat ini belum ada penelitian yang membandingkan kadar vitamin D pada pasien DM dengan dan tanpa UKD pada populasi di Indonesia. Tujuan: Penelitian ini dilakukan untuk membandingkan kadar vitamin D pada pasien DM dengan dan tanpa UKD; mengetahui korelasi antara durasi UKD dan kadar vitamin D; serta mengetahui korelasi keparahan UKD berdasarkan skor PEDIS (perfusion, extension, depth, infection, and sensation) dengan kadar vitamin D. Metode: Karakteristik umum subyek penelitian dicatat pada status penelitian. Durasi UKD dicatat dan derajat keparahannya diukur dengan sistem klasifikasi PEDIS. Penanda biokimia serum 25-hidroksivitamin D (25(OH)D) dianalisis menggunakan invitro chemiluminescent immunoassay (CLIA). Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian. Nilai p < 0,05 dianggap signifikan secara statistik. Hasil: Perbandingan nilai median (Q1-Q3) kadar vitamin D pada pasien DM dengan dan tanpa UKD secara berurutan adalah 8,90 ng/mL (6,52-10,90) dan 16,25 ng/mL (1319,59), serta bermakna secara statistik (p < 0,001). Tidak ada korelasi antara durasi UKD dan keparahan UKD berdasarkan skor PEDIS terhadap kadar vitamin D, serta tidak bermakna secara statistik. Kesimpulan: Kadar vitamin D pada pasien DM dengan UKD lebih rendah dibandingkan pasien tanpa UKD. Namun belum ada bukti yang cukup untuk menyimpulkan bahwa tidak ada korelasi antara durasi UKD dan keparahan UKD dengan skor PEDIS terhadap kadar vitamin D.
Kata kunci: durasi, skor PEDIS, ulkus kaki diabetik, vitamin D


Background: Diabetic foot ulcer (DFU) is a form of chronic wound which becomes a serious complication in diabetes mellitus (DM) patients with chronic and uncontrolled hyperglycemia. It is reported that DFU patients have mortality risk twice higher than DM patients without DFU. Recently, vitamin D has been identified to play an essential role in cellular differentiation, proliferation, growth, and modulation of the immune system via regulating the proinflammatory cytokines. Therefore, optimal level of vitamin D is believed to be necessary for healing process. In addition, vitamin D deficiency has been shown to interfere with insulin production and secretion which subsequently contribute to DFU chronicity. To date, there has been no study analyzing vitamin D level in DM patients with and without DFU in Indonesia. Objective: This study aims to compare the vitamin D level of DM patients with chronic active DFU to that of DM patients without DFU; to assess the duration of DFU and its correlation with vitamin D level; as well as to assess DFU severity by PEDIS (perfusion, extension, depth, infection, sensation) score and their correlation with the vitamin D. Methods: The sociodemographic characteristics of patients were documented. Duration of DFU was documented. The severity was examined in accordance with PEDIS classification system. Serum biochemical marker, namely 25-hydroxyvitamin D (25(OH)D) was analyzed using in-vitro chemiluminescent immunoassay (CLIA). Statistical analysis was performed to prove study hypothesis. The p-value < 0.05 was considered as statistically significant. Results: The median (Q1-Q3) vitamin D levels in DM patients with and without DFU were 8.90 ng/mL (6.52-10.90) and 16.25 ng/mL (13-19.59), respectively. Significant difference was identified (p < 0.001). There was no correlation between the duration of DFU and DFU severity by PEDIS score with vitamin D level. Conclusion: Vitamin D levels in DM patients with DFU are lower than those in patients without DFU. However, there was insufficient evidence to conclude that there is no correlation between the DFU duration and DFU severity by PEDIS score with vitamin D levels.
Keyword: duration, diabetic foot ulcer, PEDIS score, vitamin D