Prevalensi dan Hubungan Glukokortikoid dengan Kejadian Efek Samping Hiperglikemia pada Pasien Systemic Lupus Erythematosus

Ulfa Filliana; Cindy Aurelia Vernanda; Achmad Quraisy Aljufri

doi:10.33006/ji-kes.v9i1.888

Authors

Ulfa Filliana Universitas Wahid Hasyim, Semarang, Indonesia
Cindy Aurelia Vernanda Universitas Wahid Hasyim, Semarang, Indonesia
Achmad Quraisy Aljufri Universitas Wahid Hasyim, Semarang, Indonesia

DOI:

https://doi.org/10.33006/ji-kes.v9i1.888

Abstract

Abstrak

Systemic lupus erythematosus (SLE) adalah penyakit autoimun yang memerlukan pengelolaan terapi jangka panjang dan berkelanjutan terutama keamanan terapi. Glukokortikoid merupakan terapi lini pertama dan memiliki potensi efek samping hiperglikemia paling tinggi. Dampak perburukan penyakit dan rendahnya kesadaran tenaga medis untuk monitoring efek samping obat merupakan tantangan paling besar. Tujuan penelitian ini untuk mengetahui prevalensi efek samping hiperglikemia akibat penggunaan glukokortikoid dan faktor-faktor yang mempengaruhinya. Metode menggunakan penelitian observasional yang dilakukan dengan rancangan retrospektif cross sectional study pada periode 2024 di RSUP Dr. Kariadi Semarang. Hasil penelitian ini yaitu prevalensi kejadian efek samping hiperglikemia akibat penggunaan glukokortikoid sebesar 12.7% pada periode tahun 2024. Data subjek penelitian yaitu 72 pasien, sebanyak 32 pasien mengalami ESO hiperglikemia dan 40 pasien tidak mengalami ESO hiperglikemia. Faktor-faktor yang signifikan mempengaruhi kejadian ESO hiperglikemia yaitu jenis kortikosteroid metilprednisolon (p-value=0,000) dan rute pemberian intravena (p-value=0,000). Kesimpulan penelitian ini yaitu jenis kortikosteroid metilprednisolon menunjukkan faktor yang paling berhubungan dengan kejadian efek samping hiperglikemia akibat glukokortikoid (OR 6.500; 95% CI 2.185-19.333).

Kata kunci: glukokortikoid; efek samping obat; hiperglikemia; SLE

Abstract

Systemic Lupus Erythematosus (SLE) is an autoimmune disorder requiring prolonged and ongoing therapeutic management, particularly for the safety of the treatment. Glucocorticoids are the first-line therapy and have shown the highest potential for adverse effects on hyperglycemia. The impact of worsening disease and low awareness among medical personnel to monitor adverse drug reactions is the biggest challenges. This study aimed to determine the prevalence of adverse effects associated with hyperglycaemia resulting from glucocorticoid treatment and the factors that influence this condition. Method used was observational research conducted with a retrospective cross-sectional study design in 2024 at Dr. Kariadi Central Public Hospital Semarang. This study found that the prevalence of hyperglycaemia adverse effects due to glucocorticoid used was 12.7% in 2024. The total subjects of this study were 72 patients; 32 patients experienced hyperglycaemia while 40 others did not. Significant factors influencing the incidence of hyperglycaemia, adverse effect, were the type of corticosteroid methylprednisolone (p-value=0.000) and the intravenous route of administration (p-value=0.000). In conclusion, the type of corticosteroid methylprednisolone is the factor most associated with adverse effects of hyperglycaemia due to glucocorticoids (OR 6.500; 95% CI 2.185-19.333).

Keywords: glucocorticoids; adverse drug reaction; hyperglycemia; SLE

Downloads

Download data is not yet available.

References

Affinati, A. H., Wallia, A., & Gianchandani, R. Y. (2021). Severe hyperglycemia and insulin resistance in patients with SARS-CoV-2 infection: a report of two cases. Clinical Diabetes and Endocrinology, 7(1), 1–5. https://doi.org/10.1186/s40842-021-00121-y

Amin, M., & Puspitasari, F. (2013). Hubungan Antara Kadar Glukosa Darah Dengan Tekanan Darah Pada Lansia Di UPT PSTW Bondowoso. Jurnal Kesehatan Dr. Soebandi, 4(2), 241–249.

Barber, M. R. W., Drenkard, C., Falasinnu, T., Hoi, A., Mak, A., Kow, N. Y., Svenungsson, E., Peterson, J., Clarke, A. E., & Ramsey-Goldman, R. (2021). Global epidemiology of systemic lupus erythematosus. Nature Reviews. Rheumatology, 17(9), 515. https://doi.org/10.1038/S41584-021-00668-1

Cho, J. H., & Suh, S. (2024). Glucocorticoid-Induced Hyperglycemia: A Neglected Problem. In Endocrinology and Metabolism (Vol. 39, Issue 2, pp. 222–238). Korean Endocrine Society. https://doi.org/10.3803/EnM.2024.1951

Diamant, Z., Samuelsson Palmgren, G., Westrin, B., & Bjermer, L. (2017). Phase I study evaluating the safety, tolerability and pharmacokinetics of a novel oral dissolvable film containing dexamethasone versus Fortecortin dexamethasone tablets. European Clinical Respiratory Journal, 4(1). https://doi.org/10.1080/20018525.2017.1353395/ASSET/747CED94-F37C-405E-A117-8188FECC71A6/ASSETS/IMAGES/ZECR_A_1353395_F0002_OC.JPG

Healy, S. J., Nagaraja, H. N., Alwan, D., & Dungan, K. M. (2017). Prevalence, predictors, and outcomes of steroid-induced hyperglycemia in hospitalized patients with hematologic malignancies. Endocrine, 56(1), 90–97. https://doi.org/10.1007/s12020-016-1220-2

Kasturi, S., & Sammaritano, L. R. (2016). Corticosteroids in Lupus. Rheumatic Disease Clinics of North America, 42(1), 47–62. https://doi.org/10.1016/J.RDC.2015.08.007

Limbachia, V., Nunney, I., Page, D. J., Barton, H. A., Patel, L. K., Thomason, G. N., Green, S. L., Lewis, K. F. J., & Dhatariya, K. (2024a). The effect of different types of oral or intravenous corticosteroids on capillary blood glucose levels in hospitalized inpatients with and without diabetes. Clinical Therapeutics, 46(2), e59–e63. https://doi.org/10.1016/j.clinthera.2023.11.013

Limbachia, V., Nunney, I., Page, D. J., Barton, H. A., Patel, L. K., Thomason, G. N., Green, S. L., Lewis, K. F. J., & Dhatariya, K. (2024b). The effect of different types of oral or intravenous corticosteroids on capillary blood glucose levels in hospitalized inpatients with and without diabetes. Clinical Therapeutics, 46(2), e59–e63. https://doi.org/10.1016/J.CLINTHERA.2023.11.013

Lin, Y. J., Chien, C. C., Ho, C. H., Chen, H. A., & Chen, C. Y. (2022). Increased risk of type 2 diabetes in patients with systemic lupus erythematosus: A nationwide cohort study in Taiwan. Medicine, 101(51), e32520. https://doi.org/10.1097/MD.0000000000032520

Möhlmann, J. E., Ezzafzafi, S., Lindemans, C. A., Jansen, M. H. A., Nierkens, S., Huitema, A. D. R., & van Luin, M. (2024). Pharmacokinetics and Pharmacodynamics of Systemic Corticosteroids in Autoimmune and Inflammatory Diseases: A Review of Current Evidence. Clinical Pharmacokinetics, 63(9), 1251. https://doi.org/10.1007/S40262-024-01419-7

Nakamura, H., Fujieda, Y., Nakamura, A., & Atsumi, T. (2021). How should rheumatologists manage glucocorticoid-induced hyperglycemia? Modern Rheumatology, 31(3), 519–528. https://doi.org/10.1080/14397595.2020.1823060

Noetzlin, S., Breville, G., Seebach, J. D., & Gastaldi, G. (2022). Short-term glucocorticoid-related side effects and adverse reactions: a narrative review and practical approach. Swiss Medical Weekly, 152(1–2). https://doi.org/10.4414/SMW.2022.W30088

Perhimpunan Reumatologi Indonesia. (2019). Diagnosis dan Pengelolaan Lupus Eritematosus Sistemik.

Pratiwi, P. S., Arimbawa, I. M., & Yuda, I. M. D. (2024). Ketoasidosis diabetes diinduksi-steroid : Sebuah laporan kasus. 55(2), 130–134. https://doi.org/10.15562/medicina.v55i2.1326

Rahmawati, R. P., Besan, E. J., & Saputri, A. M. (2023). Hubungan Rasionalitas Penggunaan Kortikosteroid Oral Terhadap Efek Samping Peningkatan Kadar Glukosa Darah di Apotek Kanigoro Kabupaten Malang. Indonesia Jurnal Farmasi, 8(1), 32–38.

Sari, D. A., Samodra, G., & Kusuma, I. Y. (2021). Molecular mechanism of glucocorticoid-induced hyperglycemia. Pharmacy Reports, 1(1), 1–1. https://doi.org/10.51511/PR.1

Tian, Z., McLaughlin, J., Verma, A., Chinoy, H., & Heald, A. H. (2021). The relationship between rheumatoid arthritis and diabetes mellitus: a systematic review and meta-analysis. Cardiovascular Endocrinology & Metabolism, 10(2), 125. https://doi.org/10.1097/XCE.0000000000000244

Timur, W. W., Letta, D., & Novitasari, Y. (2023). Hubungan Rasionalitas Penggunaan Kortikosteroid Pada Penyakit Asma Terhadap Lama Rawat Inap Di RSUD Dr. R Soedjati Soemodiardjo Kabupaten Grobogan Tahun 2021-2022. Media Farmasi Indonesia, 17(2). https://doi.org/10.53359/mfi

Widyanrika, F. A., Mudjanarko, S. W., Rochmanti, M., Ardiany, D., & Permana, P. B. D. (2024). Association between the Duration of Steroid Therapy and Hyperglycemia in Patients with Systemic Lupus Erythematosus (SLE). Current Internal Medicine Research and Practice Surabaya Journal, 5(1), 17–22. https://doi.org/10.20473/cimrj.v5i1.53043

Williams, D. M. (2018). Clinical pharmacology of corticosteroids. Respiratory Care, 63(6), 655–670. https://doi.org/10.4187/respcare.06314

Yadav, J. P., Lodhi, L., Fatma, T., Dey, K. K., & Ghosh, M. (2022). Investigation of the Influence of Various Functional Groups on the Dynamics of Glucocorticoids. ACS Omega, 7(47), 43190–43209. https://doi.org/10.1021/acsomega.2c05892