PENGARUH PEMBERIAN VITAMIN D3 TERHADAP KADAR OSTEOKALSIN, 25(OH)D DAN DURASI SAKIT PADA DIABETES MELLITUS TIPE 1 PADA ANAK
DOI:
https://doi.org/10.21776/ub.majalahkesehatan.006.02.3Keywords:
diabetes mellitus tipe 1, durasi penyakit, osteokalsin, vitamin D3Abstract
Diabetes mellitus tipe 1 (DM tipe 1) adalah salah satu penyakit kronik yang sampai saat ini belum dapat disembuhkan. Anak dan remaja dengan T1D (type 1 diabetes) mempunyai risiko osteoporosis dan komplikasi jangka panjang lainnya lebih tinggi daripada anak dan remaja nondiabetik. Kadar 25(OH)D ditemukan lebih rendah pada anak dengan DM tipe 1. Penelitian ini ingin membuktikan bahwa suplementasi vitamin D3 pada anak dengan DM tipe 1 dapat meningkatkan kadar 25(OH)D dan osteokalsin, serta ingin mengetahui hubungan antara durasi sakit terhadap kadar osteokalsin dan 25(OH)D serum. Desain penelitian ini adalah double-blinded randomized controlled trial suplementasi vitamin D3 pada anak dengan DM tipe 1. Sebanyak 26 pasien rawat jalan dengan DM tipe 1 berusia 1-18 tahun berpartisipasi dalam penelitian ini. Pasien kemudian dibagi menjadi 2 kelompok, kelompok kontrol dan kelompok perlakuan, sedangkan durasi sakit dibagi menjadi 2, yaitu kurang dan lebih dari lima tahun. Pasien diberikan vitamin D3 2000 IU tiap hari selama 6 bulan. Hasil penelitian mendapatkan bahwa kadar osteokalsin pada kelompok perlakuan lebih tiggi namun tidak berbeda bermakna dibandingkan dengan kelompok kontrol (p=0,663). Namun, kadar 25(OH)D pada kelompok perlakukan lebih tinggi secara signifikan dibanding dengan kelompok kontrol (p=0,000). Tidak ada korelasi antara durasi penyakit, baik dengan kadar osteokalsin maupun kadar 25(OH)D (p=0,955 dan p=0,203 secara berurutan). Pemberian vitamin D3 selama 6 bulan pada anak dengan DM tipe 1 dapat meningkatkan kadar osteokalsin dan 25(OH)D serum. Durasi penyakit tidak berhubungan dengan kadar osteokalsin dan 25(OH)D setelah suplementasi vitamin D3 selama 6 bulan.
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References
UKK Endokrinologi Anak dan Remaja IDAI. Konsensus Nasional Pengelolaan Diabetes Mellitus Tipe 1. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia.2009.
Batubara JRL, Tridjaya B, Pulungan AB. Diabetes Mellitus. Buku Ajar Endokrin Anak.Edisi ke-1. Jakarta. 2010. Hlm. 125-94.
Lamb WH. Pediatric Type 1 Diabetes Mellitus. (Online). 2015. Available from: http://www.emedicine.com.Diakses tanggal 8 Mei 2015.
Cahyono HA. Gambaran Klinis dan Laboratoris Diabetes Melitus Tipe-1 pada Anak.Jurnal Kedokteran Brawijaya. 2011; 26(4):195-198.
Batubara JR, Bambang T, Aman BP, Indra WH.Komplikasi Jangka Panjang dan Jangka Pendek Diabetes Melitus Tipe 1. Sari Pediatri. 2012; 10(6):367-372.
Steck AK, Barriga KJ, Emery LM, Fiallo-Scharer RV, Gottlieb PA, Rewers MJ. Secondary Attack Rate of Type 1 Diabetes in Colorado Families.Diabetes Care. 2005;28(2):296-300.
Mathieu C dan Bandenhoop K. Vitamin D and Type 1 Diabetes Mellitus: State of The Art.Trends Endocrinol Metab. 2005; 16(6):261-6.
Bock G, Prieti B, Mader JK, Holler E, Wolf M, et al. The Effect of Vitamin D Supplementation on Peripheral Regulatory T Cells and Beta Cell Function in Healthy Humans: A Randomized Controlled Trial. Diabetes Metab Res Rev.2011; 27:942–945.
Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, et al.Maternal Age at Birth and Childhood Type 1 Diabetes: A Pooled Analysis of 30 Observational Studies. Diabetes. 2010; 59(2):486-94.
Kanazawa I. Osteocalcin as A Hormone Regulating Glucose Metabolism. World J Diabetes. 2015. 25;6(18):1345-1354.
Neumann T, LodesS, KästnerB, FrankeS, KiehntopfM, et al. Osteocalcin, Adipokines,and Their Associations with Glucose Metabolism in Type 1 Diabetes. Bone.2016; 82:50–55.
Shimo N, Yasuda T, Kaneto H, Katakami N, Kuroda A, et al.Vitamin D Deï¬ciency is Signiï¬cantly Associated with Retinopathy in Young Japanese Type 1 Diabetic Patients.Diabetes Research and Clinical Practice. 2014;106:e41–e43.
Mattravadi M, Woerner SE, DiMeglio LA, Bhatia J, Schwarz JM, dan Klein GL. Pediatric Osteoporosis. (online).2016.Available from: www.medscape.com
Bechfold S, Dirlenbach I, Raile K, Noelle V, Bonï¬g W, Schwarz HP. Early Manifestation of Type 1 Diabetes in Children Is a Risk Factor for Changed Bone Geometry: Data Using Peripheral Quantitative Computed Tomography. PEDIATRICS. 2005; 118(3).
Hameed ERA, Badr HW, Abdallah AA, Hanna WM, dan Salah N. Osteoporosis in Diabetic Children. Journal of American Science. 2010;6(12).
Craig ME, Hattersley A, Donaghue KC. Definnition, Epidemiology and Classification of Diabetes in Children and Adolescents.Pediatric Diabetes.2009;7(10):3-12.
Endyarni B, Batubara JRL, dan Boediman I. Effects of A Structured Educational Intervention on Metabolic Control of Type-1 Diabetes Mellitus Patients.PaediatrIndones.2006; 46(11-12):260-265.
Pulungan AB. Pubertas dan Gangguannya.Dalam:Buku Ajar Endokrinologi Anak.Edisi ke-1. Jakarta: Badan Penerbit IDAI. 2010. Hlm. 85-120.
Diaz-Valencia PA, Bougnères P, dan Valleron AJ. Global Epidemiology of Type 1 Diabetes in Young Adults and Adults: A Systematic Review.BMC Public Health.2015; 15:255.
Tfayli H dan Arslanian S. The Challenge of Adolescence: Hormonal Changes and Sensitivity to Insulin.Diabetes Voice.2007; 52:28-30.
Wang L, Lovejoy NF, Faustman DL. Persistence of Prolonged C-peptide Production in Type 1 Diabetes as Measured with an Ultrasensitive C-Peptide Assay. Diabetes Care.2012; 35(3):465-70.
De Almeida, Hansen M, Dantas JR, Barone B, Serfaty FM, et al. Residual C-Peptide in Patients with Type 1 Diabetes and Multiethnic Backgrounds. CLINICS.2013;68(1):123-126.
Davis AK, DuBose SN, Haller MJ, Miller KM, DiMeglio LA, Bethlin KE, et al. Prevalence of Detectable C-Peptide According to Age at Diagnosis and Duration of Type 1 Diabetes. Diabetes Care. 2015; 38(3):476-81.
Khoshhal KI, Habeb AM. Does Type 1 Diabetes Mellitus Affect Bone Quality in Prepubertal Chlidren?.Journal of Thaibah University Medical Sciences.2015; 10(3):300-305.
Napoli N, Strollo R, Pitocco D, Bizzarri C, Maddaloni E, Maggi D, et al. Effect of Calcitriol on Bone Metabolism in Adolescents with Type 1 Diabetes.Endocrine Abstracts. 2012; 29:1308.
Hollick M. Vitamin D, Second Edition: Physiology, Molecular Biology, and Clinical Application. New York: Springer.2010.
Takiishi T, Van Belle T, Gysemans C, Mathieu C. Effects of Vitamin D on Antigen-specific and Non-Antigen Specific Immune Modulation: Relevance for Type 1 Diabetes. Pediatr Diabetes. 2013;14(2):81-9.
Mukhtar M, Batool A, Wajid A, Qayyum I. Vitamin D Receptor Gene Polymorphism Influence T1D Susceptibility Among Pakistanis. International Journal of Genomics. 2017. Article ID 4171254:6 pages.
Efe B, Akdere G, Yorulmaz G. Vitamin D levels in Newly Diagnosed Type I Diabetes Mellitus and Relationship with Organ Specific Autoimmune Disorders. Endocrine Abstracts. 2017;49:EP418.
SvorenBM, Volkening LK, Wood JR, Laffel LM. Significant Vitamin D Deficiency in Youth with Type 1 Diabetes Mellitus. J Pediatr.2009;154(1):132-4.
Soliman GT, Ali BAM, Mohamed AA, Mahmoud AM, and Abdellatif AA. Assessment of Vitamin D Status in Egyptian Children with Type-1 Diabetes Mellitus. J Diabetes Metab.2015; 6:573.
Roh YE, Kim BR, Choi WB, Cho MJ, Kim HY, Park KH, et al. Vitamin D Deficiency in Children Aged 6 to 12 Years: Single Center’s Experience in Busan. Ann Pediatr Endocrinol Metab. 2016; 21(3):149-154.
Misra M, Neumeyer A, Golas SB, O’Rourke J, dan Srinivasan S. Calcium and Vitamin D Supplement Prescribing Practices among Providers Caring for Children with Autism Spectrum Disorders: Are We Addressing Bone Health?.Autism Research and Treatment. 2016; Article ID 6763205:6 pages.
Elshakmak A, Shembes N, Ali N, Maziq N. Bone Markers in Children with Type 1 DM. Endocrine Abstracts. 2014; 36:25.
Abd El Dayem SM, El-Shehabby AM, Abd El Gafar A, Fawzy A, Salama H. Bone Density, Body Composition, and Markers of Bone Remodelling in Type 1 Diabetic Patients.Scand J Clin Lab Invest. 2011; 71:387-393.
Sharma S, Biswal N, Bethou A, Rajappa M, Kumar S, dan Vinayagam V. Does Vitamin D Supplementation Improve Glycaemic Control in Children with Type 1 Diabetes Mellitus? - A Randomized Controlled Trial. Journal of Clinical and Diagnostic Research. 2017;11(9):SC15-SC17.
