BAB V. KESIMPULAN DAN SARAN
5.2. Saran
1. Dari hasil penelitian ini diharapkan dapat berguna bagi usaha pencegahan yang lebih dini pada orang-orang yang mempunyai resiko tinggi untuk terjadinya penyakit diabetes mellitus dikemudian hari.
2. Perlu dilakukan penelitian yang menyesuaikan umur subjek pada setiap grup sehingga nilai hsCRP sesuai dengan yang diharapkan.
DAFTAR PUSTAKA
1. Gustaviani R, Diagnosis dan Klasifikasi Diabetes Melitus. Dalam: Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S (ed). Buku Ajar Ilmu Penyakit Dalam. Edisi IV. Jakarta. Balai Penerbit FKUI. 2006: 1879-1881. 2. The Expert Committee on the Diagnosis and Classification of Diabetes
Melitus. Report of the Expert Commitee on the Diagnosis and Classification of Diabetes Melitus. Diabetes Care. 1999(22) .
3. Vidal PM, Mazoyer E, Bongard V, Gourdy P, Ruidavets JB, Drouet L et al. Prevalence of Insulin Resistensi Syndrome in Southwestern France and Its Relationship with Inflammatory and Hemostatic Markers. Diabetes Care. 2002; 25: 1371-7.
4. Meigs JB, Cupples LA, Wilson PWF. Parental Transmission of Type 2 Diabetes. The Framingham Offsprings Study. Diabetes. 2000;(49): 2201-7. 5. Foster DW. Diabetes Mellitus. In: Fauci AS. Braunwald E, Issebacher KJ,
Wilson JD, Martin JB, Kasper DI, et al (editors). Harrison,s Principles of Internal Medicine 14th Edition Vol 2. New York. Mc Graw- Hill. 1998. p. 2060-81.
6. Barzilay JL,Abraham L, Heckbert SR,Cushman M, Kuller LH, Resnick HC et al. The Relation of Markers of Inflammation to the Development of Glucose Disorders in the Eiderly. The Cardiovascular Health Study. Diabetes. 2001;56: 2384-9.
7. Thorand B, Lowel H, Schneider A, Kolb H, Meisinger C, Frohlich M et al. C- Reactive Protein as a Predictor for Incident Diabetes Mellitus Among – Aged
Men. Results from the MONICA Augsburg Cohort Study 1984-1988. Arch Intern Med. 2003;163: 93-9.
8. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-Reaktive Protein, Interleukin 6, and Risk of Developing Type 2 Diabetes Mellitus. JAMA. 2001;286: 327-34.
9. Festa A, D’Agostino R Jr, Howard G, Mykkanen L, Tracy RP, Haffner SM. Chrinic Subclinical Inflammation as Part of the Insulin Resistance Syndrome. The Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000;102: 42-7.
10. Festa A, D’Agostino R Jr. Tracy RP, Haffner SM. Elevated levels of Acute- Phase Proteins and Plasminogen Activator Inhibitor-1 Predict the Development of Type 2 Diabetes. The Insulin Resistance Atherosclerosis Study. Diabetes. 2002;51: 1131-37.
11. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Peterson JK, Increased Insulin Consentrations in Non Diabetic Offspring of Diabetic Parents. N Engl J Med. 1988;(319): 1297-1301.
12. Han TS, Sattar N, William K, Villalpando CG, Lean MEJ, Haffner SM. Prospective Study of C-Reactive Protein in Relation to the Development of Diabetes and Metabolic Syndrome in the Mexico City Diabetes Study. Diabetes Care. 2002;25: 2016-21.
13. Yudkin JS, Stehouwer CDA, Coppack ESW. C-Reactive Protein in Healthy Subjects: Associations with Obesity, Insulin Resistance, and Endothelial Dysfunction. A Potentiol Role Cytokines Originating from Adipose Tissue? Arterioscler Thromb Vase Boil. 1999;(19): 972-8
14. Gunardi. Tesis: Hubungan Kadar C–Reaktif Protein dengan Resistensi Insulin pada Keturunan Penderita Diabetes Melitus. Bagian ilmu penyakit dalam FK USU. 2004.
15. Wayer C, Bogardus C, Mott DM, Pratley RE. The Natural History of Insulin Secretory Dysfunction and Insulin Resistance in Pathogenesis of Type 2 Diabetes. J Clin Invest. 1999;104:787-94.
16. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-Reaktive Protein, Interleukin 6, and Risk of Developing type 2 Diabetes Mellitus. JAMA. 2001;286: 327-34.
17. Konsensus Pengelolaan Diabetes Melitus Tipe 2 di Indonesia. PB. PERKENI. Jakarta. 2006.
18. Hansen T. Genetic of Type 2 Diabetes. Current Science. 2002;(83): 1477-82. 19.Radha V, Vimaleswaran KS, Deepa R, Mohan V. The Genetics of
Diabetes Mellitus. Indian J Med Res. 2003;(117):225-38.
20. Hendromartono. Resistensi Insulin pada Diabetes Tipe 2. Dalam : Prodjosudjadi W, Setiati S, Alwi I (editor). Pertemuan Ilmiah Nasional I. PB PABDI. 2003. Jakarta. Pusat Informasi dan Penerbitan. Bagian Penyakit
Dalam FK-UI. 2003. hal:83-90.
21. Frohlich M, Imhof A, Berg G, Hutchinson W, Pepye MB, Boeing H et al. Association between C-reactive protein and features of the metabolic syndrome. Diabetes care. 2000;23:1833-9.
22. Kresna RM. Imunologi: Diagnosis dan Prosedur Laboratorium. Edisi 4. Jakarta:FKUI. 2001. hal:63-80.
23. Gabay C, Kushner I. Acute-Phase Proteins and Other Systemic Response to Inflammation. N Engl J Med. 1999;340:448-54.
24. Nakanishi S, Yamane K, Kamei N, Okubo M, Kohno N. Elevated C-Reaktif Protein is a Risk Factor for the Development of Type 2 Diabetes in Japanese Americans.Diabetes Care. 2003;26:2754-57.
25. Darmono, Suhartono T, Pemayun T, Padmomartono F.S (ed). Naskah Lengkap Diabetes Melitus Ditinjau Dari Berbagai Aspek Penykit Dalam. Semarang. Balai Penerbit Universitas Diponegoro. 2007: 245 – 255.2.
26. Bloomgarden ZT. Definitions of The Insulin Resistance Syndrome. The 1st World Congress on the Insulin Resistance Syndrome. Diabetes Care. 2004;27: 824-30.
27. Hunter WA, Cundy T, Rabone D, Hofman PL, Harris M, Regan F et al. Insulin Sensitivity in the Offsprings of Women with Type 1 and Type 2 Diabetes. Diabetes Care. 2004;27: 1148-54.
28. Goran MI, Coronges K, Bergman RN, Cruz MI, Gower BA. Influence of Family History of Type 2 Diabetes on Insulin Sensitivity in Prepubertal Children. J Clin Endocrinol Metab. 2003;88:192-5.
29. Jensen CC, Cnop M, Hull RL, Fujimoto WY,Khan SE. -cell Function is a Major Contriibutor to Oral Glucose Tolerance in High-Risk Relatives of Four Ethnic Groups in the U.S.Diabetes. 2002;51: 2170-78.
30. Karam JH. Prancreatic Hormones and Diabetes Mellitus, In: Greespan FS. Strewler GJ. Editor. Basic and Clinical Endocrinology. Fifth Edition. San Francisco. Prentice Hall International Inc. 1997: 595-663.
31. Tjandrawinata RR. Mekanisme Resistensi Insulin: Tinjauan dari Sudut Seluler dan Melekuler. Dibawakan Pada Simposium Nasional 1 Sindroma Metabolik. Makasar Mai 2003.
32. Shepherd PR, Khan BB. Glucose Transporters and Insulin Action. Implication for Insulin Resistance and Diabetes Mellitus. N Engl J Med. 1999;341: 248-57.
33. Bloomgarden ZT. Definitions of the Insulin Resistance Syndrome. The 1st World Congress on the Insulin Resistance Syndrome. Diabetes Care. 2004;27: 602-9.
34. Cline GW, Petersen KF, Krssak M, Shen J,Hundal RS, Trajanoski Z et al. Impaired Glucose Transport as a Cause of Decreased Insulin Stimulated Muscle Glycogen Synthesis in Type 2 Diabetes. N Engl J Med. 1999;341: 240-6.
35. Reaven GM. Banting lecture 1988: Role of Insulin Resistance in Human Diases. Diabetes. 1988;37: 1595-1607.(abstract).
36. Grundy SM, Brewer HB, Cleeman JL, Smith SC, Lefant C. Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/Amirican Heart Assosiation Conference on Scientific Issues Related to Defenition. Circulation. 2004;109:433-8.
37. Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R. Diagnosing Insulin Resistance by Simple Quantitative Methods in Subjects with Normal Glucose Metabolism. Diabetes Care. 2003;26: 3320-25.
38. Ridker PM. Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention. 2003;107: 363-9.
39. Yeh ETH, Willerson JT. Coming of age of C-Reactive Protein. Using Inflammation Markers in Cardiology. Circulation. 2003;370-2.
40. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon III RO, Criqui M et al. Markers of Inflammation and Cardiovascular Disease Applikation to Clinical and Public Health Practice. Statement for Health Care Professionals from the Centers for Diasease and Prevention and the Amirican Hearth Association. Circulation. 2003;107:499-511.
41. Reeves G. C-Reactive Protein. 1988: Avalaible from :http:/www.haps.nsw.gov.au/edsrchh/edinfo/crp.gtml.
42. Freeman DJ, Norrie J, Caslake MJ, Gaw A, Ford I, Lowe GDO et al. C- Reactive Protein is an Independent Predictor of Risk for Development of Diabetes in the West of Scotland Coronary Prevention Study. Diabetes. 2002;51: 1596-1600.
43. Tan KCB, Wat NMS, Tam SCF, Janus ED, Lam TH, Lam KSL. C-Reactive Protein Predict the Deterioration of Glycemia in Chinese Subjects with Impaired Glucose Tolerance. Diabetes Care. 2003;26: 2323-28.
44. Wu t, Dorn JP, Donahue RP, Sempos CT, Trevisan M. Associations of Serum C-Reactive Protein with Fasting Insulin, Glucose, and Glycosylated Hemoglobin. Am J Epidemiol. 2002;155: 65-71.
MASTER TABEL. PENELITIAN Dr. MAHRIANI SYLVAWANI
Bapak DM Ibu DM Bapak dan Ibu BB TB IMT LP TD KGD HsCRP
NO. UMUR L/P Hb WBC DM (kg) (cm) kg/m2 (cm) mmHg Puasa 2 jam PP mg/L 1 23 P 12,6 7500 + 49 154 20,6 79 100/70 65 87 0,3 2 40 L 13,4 8000 + 50 159 19,8 74 110/80 78 91 0,1 3 23 L 13,1 8100 + 62 167 22,3 88 120/80 72 97 0,2 4 23 P 11,4 9000 + 58 160 22,6 85 120/80 67 101 0,1 5 33 P 11,6 8200 + 41 150 18,2 70 100/70 60 86 0,2 6 35 L 12,5 7600 + 57 153 24,3 79 100/70 62 93 0,4 7 26 L 11,9 7900 + 63 156 25,9 78 100/70 69 89 0,1 8 20 P 12,3 8000 + 50 152 21,6 76 100/70 68 94 0,2 9 23 P 13,2 9100 + 65 165 23,8 89 120/80 73 102 0,1 10 20 L 11,7 8200 + 50 155 20,8 80 120/70 85 100 0,2 11 21 L 12,2 7900 + 50 152 21,6 75 100/70 65 89 0,2 12 25 P 13,1 8300 + 60 160 23,4 88 120/80 70 93 0,3 13 35 P 11,9 7800 + 62 172 21 80 120/80 71 95 2,6 14 40 P 12,7 9100 + 68 174 22,5 86 120/80 82 102 0,9 15 35 P 12,2 8300 + 65 155 27 85 110/80 75 99 0,6 16 26 L 13,2 9200 + 72 178 24,6 84 120/80 69 94 0,2 17 40 P 12,6 8400 + 69 175 22,5 86 120/80 79 89 0,2 18 40 P 12,1 7100 + 90 180 27,7 92 120/80 71 108 0,6 19 26 P 11,7 8100 + 56 169 19,6 74 110/80 83 93 0,2 20 31 P 12,9 7500 + 64 160 25 88 120/80 79 110 1,1 21 22 L 13,2 8100 + 75 166 27,2 89 120/80 68 102 2,1 22 25 L 11,3 8200 + 62 160 24,2 80 110/80 70 93 0,4 23 40 L 11,6 7800 + 55 156 22,6 79 100/70 71 98 2,2 24 40 L 13,4 8600 + 68 165 25 88 120/80 69 94 0,3 25 27 L 11,9 7500 + 66 168 23 78 110/70 60 89 0,7
27 40 L 12,1 7400 + 60 153 25,6 80 120/80 69 103 1,5 28 40 P 11,3 7600 + 60 153 25,6 80 110/70 72 98 0,6 29 38 L 13,3 9200 + 80 168 28,3 90 120/80 65 99 1,8 30 39 L 12,7 7100 + 70 176 22,6 89 120/80 80 96 1,5 31 39 P 12,2 7300 + 78 170 26,9 85 120/80 63 98 1,4 32 38 P 11,8 7600 + 53 153 22,6 52 100/70 80 87 1,8 33 37 L 12,4 10000 + 76 175 24,8 89 120/80 72 103 1,2 34 40 P 12,3 8000 + 60 165 22 89 120/80 71 102 1,8 35 39 L 11,1 7800 + 65 165 23,8 78 110/80 69 102 1,9 36 33 P 12,3 7100 + 70 156 28,8 80 110/80 80 99 0,9 37 35 P 11,6 7000 + 60 150 26,6 80 120/80 71 97 1,4 38 40 L 11,4 8900 + 60 165 25,7 80 110/80 73 88 4,3 39 40 P 11,8 8800 + 56 150 24,8 79 100/70 69 89 1,5 40 22 P 12,8 7600 + 63 160 24,6 80 100/70 65 99 1,3 41 40 P 10,6 7000 + 58 155 24,1 68 100/70 67 90 1,7 42 34 L 12,8 8400 + 60 158 24 90 120/80 60 91 1,5 43 40 P 11,2 9000 + 47 152 20,3 75 100/70 63 85 2,1 44 36 P 11,5 8100 + 63 155 26,2 80 110/80 61 96 2,2 45 40 P 12,4 9100 + 65 162 24,8 79 110/70 61 94 1,4 Keterangan L/P : Laki-laki / Perempuan. LP : Lingkar Pinggang TD : Tekanan Darah Hb : Haemoglobin WBC : White Blood Count TB ; Tinggi Badan BB ; Berat Badan IMT : Indeks Massa Tubuh KGD : Kadar Gula Darah