Tesis

Perbedaan Variabilitas Glukosa Sebelum dan Selama Puasa Ramadan pada Pasien Diabetes Melitus dengan Sirosis Hepatis = Glucose Variability in Patients with Diabetes Mellitus and Hepatic Cirrhosis before and during Ramadan Fasting.

Latar Belakang. Pasien dengan diabetes melitus tipe 2 (DMT2) dan sirosis hepatis menghadapi tantangan metabolik yang kompleks selama puasa Ramadan, termasuk fluktuasi kadar glukosa yang dapat meningkatkan risiko hipoglikemia maupun hiperglikemia. Meskipun puasa Ramadan banyak dijalankan oleh pasien dengan kondisi ini, data mengenai variabilitas glukosa pada pasien populasi ini masih terbatas. Tujuan. Menilai perbedaan variabilitas glukosa, yang diukur dengan coefficient of variation (CV), time in range (TIR), time above range (TAR), dan time below range (TBR), sebelum dan selama puasa Ramadan pada pasien diabetes melitus dengan sirosis hepatis. Metode. Desain kohort prospektif, sebanyak 32 subjek diambil dengan metode consecutive sampling. Variabilitas glukosa dievaluasi dengan alat Continuous Glucose Monitoring (CGM) Sinocare selama 14 hari sebelum Ramadan dan 14 hari selama Ramadan. Data dianalisis menggunakan uji Wilcoxon sign rank test. Hasil. Tidak ditemukan perbedaan yang bermakna secara statistik pada seluruh parameter variabilitas glukosa, termasuk CV, TIR, TAR, dan TBR (p > 0,05). Meskipun terjadi penurunan median TBR dari 0,45% menjadi 0,35% selama Ramadan, perbedaan ini tidak signifikan (p=0,749). Mayoritas subjek merupakan pasien dengan skor risiko rendah hingga sedang berdasarkan klasifikasi IDF-DAR risk dan berada pada fase sirosis kompensata (Child-Pugh A). Kesimpulan. Puasa Ramadan tidak menyebabkan peningkatan variabilitas glukosa yang signifikan pada pasien dengan DMT2 dengan sirosis hepatis. Hasil ini menunjukkan bahwa puasa relatif aman bagi populasi ini, terutama pada pasien dengan sirosis kompensata dan risiko rendah hingga sedang menurut skor IDFDAR.
Kata Kunci. Sirosis, Ramadan, variabilitas glukosa, TIR, TAR, TBR


Background. Patients with type 2 diabetes mellitus (T2DM) and hepatic cirrhosis face complex metabolic challenges during Ramadan fasting, including fluctuations in glucose levels that can increase the risk of hypoglycemia or hyperglycemia. Although Ramadan fasting is widely practiced by patients with this condition, data on glucose variability in this patient population is still limited. Objective. Assessing the differences in glucose variability, measured by the coefficient of variation (CV), time in range (TIR), time above range (TAR), and time below range (TBR), before and during Ramadan fasting in patients with diabetes mellitus and liver cirrhosis. Methods. Prospective cohort design, with 32 subjects selected using the consecutive sampling method. Glucose variability was evaluated using the Sinocare Continuous Glucose Monitoring (CGM) device for 14 days before Ramadan and 14 days during Ramadan. Data were analyzed using the Wilcoxon sign rank test. Results. All glucose variability metrics, including CV, TIR, TAR, and TBR, showed no statistically significant variations (p > 0.05). The median TBR decreased during Ramadan from 0.45% to 0.35%, although this difference was not statistically significant (p=0.749). Most people were in the compensated cirrhosis phase (ChildPugh A) and had low to moderate risk scores according to the IDF-DAR. Conclusion. In patients with type 2 diabetes who also have liver cirrhosis, fasting throughout Ramadan does not significantly increase glucose variability. These findings suggest that fasting is generally safe for this population, particularly for patients with compensated cirrhosis who have an IDF-DAR score of low to moderate risk.
Keywords: Cirrhosis, Ramadan, glucose variability, TIR, TAR, TBR