Abstract
Abstrak
Krisis hiperglikemia merupakan komplikasi akut diabetes melitus yang dapat mengancam jiwa dan memerlukan terapi insulin intensif. Terapi standar dengan insulin kerja cepat intravena efektif menurunkan kadar glukosa darah, tetapi sering diikuti oleh rebound hiperglikemia dan fluktuasi kadar glukosa setelah penghentian infus. Penambahan insulin basal kerja panjang terbukti membantu mempertahankan kestabilan glukosa selama masa transisi terapi. Penelitian ini bertujuan untuk menilai efikasi penambahan insulin basal kerja panjang terhadap insulin kerja cepat intravena dalam memperbaiki resolusi glikemik dan menurunkan komplikasi metabolik pada pasien dengan krisis hiperglikemia. Penelitian eksperimental dengan rancangan quasi-experimental ini melibatkan 80 pasien krisis hiperglikemia yang dirawat di RSUD dr. Zainoel Abidin, Aceh, Indonesia. Subjek dibagi menjadi dua kelompok: kelompok kombinasi yang menerima insulin basal kerja panjang bersama insulin kerja cepat intravena, dan kelompok kontrol yang hanya menerima insulin kerja cepat intravena. Parameter yang dievaluasi meliputi durasi hiperglikemia, kebutuhan total insulin, kejadian rebound hiperglikemia, episode hipoglikemia, lama rawatan, dan mortalitas. Kelompok kombinasi menunjukkan waktu resolusi hiperglikemia yang lebih singkat dibanding kelompok kontrol (47,0 ± 26,0 jam vs 79,35 ± 30,64 jam; p < 0,001) serta insiden rebound hiperglikemia yang lebih rendah (7,5% vs 22,5%; p = 0,04). Tidak terdapat perbedaan bermakna pada kebutuhan total insulin (p = 0,19), episode hipoglikemia (p = 0,40), lama rawatan (p = 0,28), maupun mortalitas (p = 0,65). Penambahan insulin basal kerja panjang pada terapi insulin kerja cepat intravena secara signifikan mempercepat pencapaian kontrol glikemik dan menurunkan kejadian rebound hiperglikemia tanpa meningkatkan risiko hipoglikemia atau mortalitas. Hasil penelitian ini menunjukkan bahwa tujuan penelitian, yaitu meningkatkan kestabilan glikemik pada krisis hiperglikemia, telah tercapai dengan baik.
Kata Kunci: Krisis hiperglikemia, insulin basal kerja panjang, insulin kerja cepat intravena, kontrol glikemik, rebound hiperglikemia.
Abstract
A hyperglycemic crisis is an acute, life-threatening complication of diabetes mellitus requiring intensive insulin therapy. Standard treatment with intravenous rapid-acting insulin effectively lowers glucose levels, but is often followed by rebound hyperglycemia and glucose fluctuations after infusion cessation. The addition of long-acting basal insulin may help maintain glycemic stability during the transition period. This study aims to evaluate the efficacy of adding long-acting basal insulin to intravenous rapid-acting insulin in improving glycemic resolution and reducing metabolic complications in patients with hyperglycemic crisis. This quasi-experimental study enrolled 80 patients with hyperglycemic crisis at Dr. Zainoel Abidin General Hospital, Aceh, Indonesia. Subjects were allocated into two groups: one group received a combined regimen of long-acting basal insulin and intravenous rapid-acting insulin. In contrast, the other group received intravenous rapid-acting insulin alone. Measured outcomes included duration of hyperglycemia, total insulin requirement, incidence of rebound hyperglycemia, hypoglycemic episodes, length of hospital stay, and mortality. The combination group achieved a significantly shorter duration of hyperglycemia compared to the control group (47.0 ± 26.0 h vs. 79.35 ± 30.64 h; p < 0.001) and a lower incidence of rebound hyperglycemia (7.5% vs. 22.5%; p = 0.04). There were no significant differences in total insulin requirement (p = 0.19), hypoglycemic episodes (p = 0.40), length of stay (p = 0.28), or mortality (p = 0.65). Adding long-acting basal insulin to intravenous rapid-acting insulin significantly accelerates glycemic resolution and reduces rebound hyperglycemia without elevating the risk of hypoglycemia or mortality. The study demonstrates that achieving the research objective improving glycemic stability in hyperglycemic crisis was successful.
Keywords: Hyperglycemic crisis, basal insulin, intravenous rapid-acting insulin, glycemic control, rebound hyperglycemia.
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