Tesis

Integrasi HbA1c, Lama sakit dan Status Pubertas ke dalam Michigan Neuropathy Screening Instrument untuk Prediksi Neuropathy Diabetik Perifer pada Diabetes Melitus Tipe 1 Anak = Integration of HbA1c, Duration of Illness, and Pubertal Status into The Michigan Neuropathy Screening Instrument for Predicting Diabetic Peripheral Neuropathy in Type 1 Diabetes Melitus in Children.

Latar belakang: Neuropati diabetik perifer (NDP) adalah komplikasi kronis serius dari diabetes melitus. Tingkat prevalensi NDP pada anak dilaporkan bervariasi dari 7% hingga 32%. Michigan Neuropathy Screening Instrument (MNSI) sebagai alat skrining NDP pada.penyandang DMT1 anak mempunyai performa kurang baik. Dilaporkan HbA1c, lama sakit dan status pubertas mempunyai korelasi positif dengan prevalensi NDP. Saat ini penelitian NDP pada penyandang DMT1 anak di Indonesia belum ada. Tujuan: Mengetahui nilai tambah integrasi HbA1c, lama sakit dan status pubertas ke dalam MNSI untuk nilai prediktif NDP. Metode: Dilakukan studi potong lintang terhadap penyandang DMT1 anak di RS Cipto Mangunkusumo pada bulan Oktober sampai dengan November 2024. Subjek penelitian adalah penyandang DMT1 anak 18 tahun dengan lama sakit minimal 2 tahun. Pemeriksaan laboratoris dengan rerata HbA1c pada satu tahun terakhir. Pemeriksaan status pubertas menggunakan referensi. Pemeriksaan skoring MNSI sebagai alat skrining dan KHS sebagai gold standart untuk diagnosis NDP yang dilakukan secara blind. Analisa sensitivitas dan spesifisitas integrasi dari HbA1c, lama sakit dan status pubertas ke dalam MNSI dibandingkan dengan KHS. Hasil: Pemeriksaan kuesioner MNSI pada 61 penyandang DMT1 anak mendapatkan 3 suspek NDP (4,9%), pada pemeriksaan KHS didapatkan 6 (9,8%) NDP. Pada grup NDP didapatkan median 14 tahun (13 – 16) tahun, lama sakit 3 tahun (2-6 tahun), HbA1c 8,92%, status pubertas dengan stadium Tanner 4 (3,75 – 5). Sensitivitas dan spesifisitas MNSI dalam mendeteksi NDP adalah 33,3 % dan 91,38 % dengan AUC 0,435. Simpulan: Integrasi HbA1c, lama sakit dan status pubertas kedalam MNSI tidak menambah nilai prediktif NDP
Kata kunci: Penyandang diabetes melitus tipe 1 anak, Neuropati diabetik perifer, MNSI, lama sakit, HbA1c, status pubertas.


Background: Diabetic Peripheral Neuropathy (DPN) is a serious chronic complication of diabetes melitus. The prevalence rate of DPN in children has been reported to vary from 7% to 32%, depending on the screening tool and the study population. The Michigan Neuropathy Screening Instrument (MNSI) has shown poor performance as a screening tool for DPN in children with type 1 diabetes (T1D). It has been reported that HbA1c, disease duration, and pubertal status are positively correlated with the prevalence of DPN. Currently, there has been no research on DPN in children with T1D in Indonesia. Objective: To determine the value of integrating HbA1c, disease duration, and pubertal status into the MNSI for predictive value of DPN Method: A cross-sectional study was conducted on children with type 1 diabetes melitus (T1D) at Cipto Mangunkusumo Hospital from October to November 2024. The study subjects were children with  18 years of age, with a disease duration of at least 2 years. Laboratory tests were performed with the average HbA1c levels from the past year. Pubertal status was assessed using reference. MNSI scoring was used as a screening tool, and nerve conduction velocity (NCV) was performed as the gold standard for diagnosing DPN, with all tests conducted blind. Sensitivity and specificity analyses were performed on the integration of HbA1c, disease duration, and pubertal status into MNSI, compared with NCV. Result: MNSI screening on 61 children with 3 DPN suspected (4.9%), while NCS revealed 6 cases (9.8%) of DPN. In the DPN group, the median age was 14 years (13 -16 ) years, the median disease duration was 3 years (2-6 years), the HbA1c level was 8.92% (8.51 -9.4%), and pubertal status was at Tanner stage 4 (range 3.75- 5). The sensitivity and specificity of MNSI in detecting DPN were 33.3% and 91.38% and AUC 0,435. Conclusion: The integration of HbA1c, illness duration, and pubertal status into the MNSI did not significantly improve its predictive value for NDP.
Keyword: Type 1 diabetes melitus, diabetic peripheral neuropathy, MNSI, disease duration, HbA1c, pubertal status, nerve conduction velocity.