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RESUME JURNAL

Judul artikel : The Impacts of Diabetes Education on Self Care Agency, Self-Care
Activities and HbA1c Levels of Patients with Type 2 Diabetes: A
Randomized Controlled Study

Pengaruh dari Edukasi Diabetes terhadap Self Care Agenccy, Self-


care Aktivities dan tingkat HbA1c pada Pasien dengan Diabetess
Tipe 2.

Penulis : Hamdiye Arda Surucu, MSc, PHD, Sevgi Kizilci, PHD dan
Gul Ergor, MD

Publikasi : International Journal of Caring Sciences January– April 2017


Volume 10 | Issue 1| Page 479

Penelaah : Yayang Savita

Tanggal telaah : Rabu, 5 September 2018

Metode pencarian literatur :


a. Database yang digunakan : ebsco
b. Kata kunci pencarian di google scholar/google/database journal :
Type 2 Diabetes, Self Care Deficit Nursing Theory, Self-Management Education,
HbA1c, self care activities, self-care agency
c. Jumlah literatur yang didapatkan relevan dengan yang dicari : 6
I. Deskripsi singkat artikel
a. Tujuan penelitian :
The study aims to investigate the effects of diabetes education
based on the self-care deficit nursing theory (SCDNT) on the self-care
agency, self-care activities, and HbA1c levels of patients with type 2
diabetes
Menentukan perbedaan pengaruh pemberian nasihat secara
umum tentang perubahan gaya hidup, program modifikasi gayahidup
secara intensif dan pemberian nasihat secara umum+metformin dalam
mengurangi prevalensi sindrom metabolik (MetS) pada subjek dengan
pradiabetes

b. Hasil penelitian :
After the SCDNT-based diabetes self-management education, a
statistically significant difference was observed in the self-care agency
between the two groups (p< .05) but there was no significant
difference in HbA1c and self-care activites between the two groups.
When the pretest and posttest scores were analyzed, the intervention
group scores after interventions for self-care agency and self-care
activity were significantly higher, and HbA1c was significantly lower
than the scores at pre-intervention (p<0.05). Control group scores
showed no difference at the initial and 6th month of the study
(p>0.05).
Kriteria MetS sudah disaring dari awal, 6 dan 12 bulan. MetS
dalam kelompok ILMP menurun 26% (p <0,001); dalam grup GA +
Met sebesar 22,4% (p = 0,01) dan dalam grup GA sebesar 8,2% (p =
0,28). Jumlah komponen MetS menurun secara signifikan dalam ILMP
dan Grup GA + Met (rata-rata berubah 0,81, p <0,001 dan 0,35, p =
0,05,). Perbandingan antar kelompok menunjukkan penurunan
signifikan dalam komponen MetS yang mendukung kelompok ILMP
(−0.58 (−0.88-0.28), p <0,001).

c. Kesimpulan penelitian :
Following the self-management education based on SCDNT,
self care agency and self-care activity and the glisemic control of the
individuals with diabetes in intervention group were improved.
SCDNT was a good guide in planning the study and for the self-
management education.
Penelitian ini menyoroti potensi klinis ILMP dibandingkan
lainnya pilihan pencegahan diabetes dalam mengurangi MetS pada
orang dewasa Saudi dengan glukosa puasa tinggi
II. Telaah artikel
a. Fokus utama penelitian :
Diabetes Education on Self Care Agency, Self-Care Activities and
HbA1c Levels of Patients with Type 2 Diabetes

Perbedaan pemberian modifikasi terapi diet dan gaya hidup dalam


pasien prediabetik yang mengalami sindrom metabolik

b. Elemen yang mempengaruhi tingkat keabsahan penelitian


Gaya penulisan
1) Sistematika penulisan :
- Tittle
- Abstract
- Introduction
- Methodology
- Interventions
- Results
- Discussion
- Conclusions
- References
2) Tata bahasa : English

Penulis
Kualifikasi penulis :
1) Prince Mutaib Chair for Biomarkers of Osteoporosis
Biochemistry Department, College of Science, King Saud
University, Riyadh 11451, Saudi Arabia; halfawaz@ksu.edu.sa
(H.A.A.); wani.kaiser@gmail.com (K.W.);
aalnaami@yahoo.com (A.M.A.); omrattas@ksu.edu.sa
(O.S.A.-A.); msa85@yahoo.co.uk (M.S.A.)
2) Department of Food Science and Nutrition, College of Food
Science & Agriculture, King Saud University, Riyadh 11451,
Saudi Arabia
3) Biomarkers Research Program, Biochemistry Department,
College of Science, King Saud University,Riyadh 11451, Saudi
Arabia
4) College of Medicine, King Saud bin Abdulaziz University for
Health Sciences, Riyadh 11461, Saudi Arabia
alaslawi@hotmail.com
5) Specialized Diabetes and Endocrine Center, King Fahad
Medical City, Faculty of Medicine, King Saud bin Abdulaziz
University for Health Sciences, Riyadh 11525, Saudi Arabia;
najijohani@gmail.com
6) Division of Metabolic and Vascular Health, Clinical Sciences
Research Institute, University Hospitals Coventry and
Warwickshire Trust, Walsgrave, Coventry CV2 2DX, UK;
Sudhesh.Kumar@warwick.ac.uk
* Correspondence: aldaghri2011@gmail.com; Tel.: +966-11-
467-5939

Judul
1) Kelebihan : dapat menjelaskan inti dari artikel yang akan
dibahas
2) Kekurangan : judulnya terlalu panjang

Abstrak
1) Kelebihan : mampu menjelaskan secara ringkas isi artikel
2) Kekurangan : kurang diberikan outlinenya supaya lebih
memudahkan pemahaman saat membaca
abstrak

c. Elemen yang mempengaruhi kekuatan suatu penelitian


1. Tujuan/masalah penelitian :
This study aimed to investigate the differences in the
effectiveness of lifestyle modifications (diet and physical
activity) and drug therapy (metformin), in an adult Saudi
population with impaired glucose regulation, in preventing or
reversing full MetS and its individual components.

Penelitian ini bertujuan untuk menyelidiki perbedaan


dalam efektivitas modifikasi gaya hidup (diet dan aktivitas
fisik) dan terapi obat (metformin), dengan populasi berasal
dari orang dewasa di Saudi dengan gangguan regulasi
glukosa, dalam mencegah atau mengatasi MetS .

2. Hipotesis :
We hypothesize that lifestyle modifications in diet and
physical activity have a role in preventing or reversal of Mets
in subjects with impaired glucose regulation

Kami berhipotesis bahwa modifikasi gaya hidup dengan


diet dan aktivitas fisik memiliki peran dalam mencegah dan
mengatasi Mets pada subjek dengan gangguan regulasi
glukosa.

3. Sasaran :
A total of 294 Saudi males and females (age range 25–
60) attending King Khalid University Hospital and King
Salman Hospital in Riyadh, Saudi Arabia, agreed to take part in
this lifestyle intervention Programme.

Sebanyak 294 pria dan wanita Saudi (rentang usia 25-


60 tahun) datang ke Rumah Sakit King Khalid University dan
Rumah Sakit King Salman di Riyadh, Arab Saudi, setuju untuk
ambilbagian dalam intervensi program perubahan gaya hidup.
4. Pertimbangan etik :
This lifestyle intervention programme was approved by
the Ethics Committee of the College of Science, King Saud
University; Riyadh, Saudi Arabia (Reference# 8/25/220355)
and funded by the National Plan for Science and Technology;
Riyadh, Saudi Arabia (Grant# 12-MED2881-02

Program intervensi gaya hidup ini telah disetujui oleh


Komite Etik dari College of Science, King Saud University;
Riyadh, Arab Saudi (Referensi # 8/25/220355) dan didanai
oleh Rencana Nasional Sains dan Teknologi; Riyadh, Arab
Saudi (Hibah # 12-MED2881-02

5. Definisi operasional
- Umur : rentang usai 25–60 tahun.
- Lingkar pinggang obesitas untuk laki-laki > 101,6 cm
dan untuk perempuan >88,9 cm
- Hiperglikemia- gula darah puasa > 5,6 mmol / L.
- Low HDL-Kolesterol untuk laki-laki <1,03 mmol / L
dan untuk wanita <1,30 mmol /
- Hipertrigliserida- Trigliserida puasa > 1,7 mmol / L.
- Hipertensi- Tekanan darah-sistolik > 130 mmHg dan /
atau tekanan darah diastolik> 85 mmHg.

6. Metode
a. Desain penelitian :
This is a 12 months, 2-center, 3-arm randomized
controlled (1:1:1), lifestyle intervention study conducted
from April 2013 until March of 2017.
Dilakukan selama 12 bulan, di 2 rumah sakit sentral,
dengan 3 kelompok terkontrol acak (1: 1: 1), lifestyle
intervation study yang dilakukan dari April 2013
hingga Maret 2017.
b. Populasi dan sampel :
 Populasi : A total of 294 Saudi males and
females (age range 25–60) attending King
Khalid University Hospital and King Salman
Hospital in Riyadh, Saudi Arabia, agreed to take
part in this lifestyle intervention Programme.

Sebanyak 294 pria dan wanita Saudi (rentang


usia 25-60 tahun) datang ke Rumah Sakit King
Khalid University dan Rumah Sakit King
Salman di Riyadh, Arab Saudi, setuju untuk
ambilbagian dalam intervensi program
perubahan gaya hidup.

 Sampel :
Out of the 294 initially recruited, the data for
217 was used in this study

Dari 294 orang yang awalnya direkrut, data


yang dipakai hanya 217 orang dalam penelitian
ini

 Teknik :
The criteria for selection was a fasting
glucose level of 5.6 to 6.9 mmol/L, identified as
one of the five components of MetS (NCEP
ATP III criteria. Subjects who were already on
anti-hyperglycemic treatment; pregnant or
lactating women; with known renal, hepatic,
pulmonary, cardiac, etc., complications were
excluded
A computer-generated serial number,
randomly assigned to one of the three
intervention groups (GA, ILMP, and GA +
Met), was given blindly to each participant. All
participants were allocated (1:1:1) to receive one
of the three interventions. True allocation
concealment was done since the research
personnel involved cannot adjust randomization

Kriteria untuk seleksi adalah kadar


glukosa puasa 5,6-6,9 mmol / L, diidentifikasi
sebagai salah satu dari lima komponen MetS
(kriteria NCEP ATP III). Subyek yang sudah
menjalani pengobatan anti-hiperglikemik;
wanita hamil atau menyusui; dengan ginjal
yang dikenal, hati, paru, jantung, dll.,
komplikasi dikeluarkan
Nomor seri yang dihasilkan komputer,
yang secara acak ditetapkan ke salah satu dari
tiga kelompok intervensi (GA, ILMP, dan GA +
Met), diberikan secara langsung tanpa ada nya
pertimbangan kepada setiap peserta. Semua
peserta dialokasikan (1: 1: 1) untuk menerima
salah satu dari tiga intervensi. Alokasi
tersembunyi yang sebenarnya dilakukan karena
personil penelitian yang terlibat tidak dapat
menyesuaikan pengacakan.

 Penentuan besar sampel


The total duration of this lifestyle
intervention programme was 12 months. Fasting
blood samples and anthropometric data was
collected at recruitment, at 6-month and at the
end of the programme. Out of the 294 initially
recruited, the data for 217 was used in this
study. A flow chart summarizing the programme
is provided in Figure 1.

Total durasi dari intervensi program


dilakukan selama 12 bulan. Sampel darah puasa
dan data antropometrik dikumpulkan saat
rekruitmen, pada 6 bulan dan di akhir program.
Dari 294 yang awalnya direkrut, didapatkan
data 217 orang yang digunakan dalam
penelitian ini. Diagram alur yang meringkas
penjelasan seperti gambar dibawah ini:
c. Variabel penelitian
Independen:
Anthropometrics included height (cm), weight
(kg), waist and hip circumferences (cm), systolic and
diastolic blood pressure by standard methods. Fasting
blood samples, taken at each time point, were sent
immediately to Prince Mutaib Chair for biomarkers in
Osteoporosis (PMCO), King Saud University (KSU),
Riyadh where they were processed, aliquoted and stored
at recommended temperature for further
analysis.Fasting blood glucose and lipid profile was
quantified using routine biochemical tests in an
automated biochemistry analyzer (Konelab 20, Thermo-
Fischer scientific, Helsinki, Finland). The reagents were
supplied ready to use by Thermo Fischer (catalog#
981379 for glucose; 981812 for total cholesterol;
981823 for HDL-cholesterol and 981301 for
triglyceride). The imprecision, calculated as the total
CV, was ≤5%, ≤3.5%, ≤4% and ≤4% for these tests
respectively.25(OH)vitamin D was quantified using
COBAS e-411 autoanalyzer (Roche Diagnostics,
Indianapolis, IN, USA). Glycated haemoglobin
(HbA1c) was quantified in DCA vantage analyzer
(Siemens, Munich, Germany). The imprecision of the
HbA1c assay was ≤3.6% in the important clinical
ranges. The standards and controls used for these
biochemical assays were routinely tested by Quality
assurance department of KSU, for highly reproducible
research data.

Antropometri termasuk tinggi (cm), berat badan


(kg), lingkar pinggang dan pinggul (cm), tekanan darah
sistolik dan diastolik dengan metode standar.Glukosa
darah puasa dan profil lipid (kolesterol total, HDL-
kolesterol, trigliserida), (OH) vitamin D dan Glycated
hemoglobin (HbA1c).

Dependen :
The status of MetS and its five components were
evaluated at follow up (6-month and 12-month) versus
baseline. MetS was defined by the criteria set in “The
National Cholesterol Education Programme Adult
Treatment Panel III” (NCEP ATP III) as having atleast
three of the five components
a) Central obesity-waist circumference of >101.6
cm in males and >88.9 cm in females.
b) Hyperglycemia-fasting glucose > 5.6 mmol/L.
c) Low HDL-Cholesterol < 1.03 mmol/L in males
and <1.30 mmol/L in females.
d) Hypertriglyceridemia-fasting triglycerides > 1.7
mmol/L.
e) Hypertension-systolic blood pressure > 130
mmHg and/or diastolic blood pressure > 85
mmHg
Lima kriteria dalam evaluasi sindrom metabolik
yang dievalauasi tiap 6 dan 12 bulan. MetS
didefinisikan oleh kriteria yang ditetapkan dalam
"Program Pendidikan Nasional Kolesterol Dewasa
Pengobatan Panel III" (NCEP ATP III) minimal
harus memiliki tiga dari lima komponen tanda dari
sindrom metabolik :
a) Lingkar pinggang obesitas untuk laki-laki >
101,6 cm dan untuk perempuan >88,9 cm
b) Hiperglikemia- gula darah puasa > 5,6
mmol / L.
c) Low HDL-Kolesterol untuk laki-laki <1,03
mmol / L dan untuk wanita <1,30 mmol /
d) Hipertrigliserida- Trigliserida puasa > 1,7
mmol / L.
e) Hipertensi- Tekanan darah-sistolik > 130
mmHg dan / atau tekanan darah diastolik>
85 mmHg

Instrumen yang digunakan : informed concert, MetS risk-score


formula, The Receiver Operating Characteristic (ROC) analysis
was employed to test this score for predicting MetS, Fasting
blood glucose and lipid profile was quantified using routine
biochemical tests in an automated biochemistry analyzer
(Konelab 20, Thermo-Fischer scientific, Helsinki, Finland).
The reagents were supplied ready to use by Thermo Fischer
(OH)vitamin D was quantified using COBAS e-411
autoanalyzer (Roche Diagnostics, Indianapolis, IN, USA).
Glycated haemoglobin (HbA1c) was quantified in DCA
vantage analyzer (Siemens, Munich, Germany). TThe standards
and controls used for these biochemical assays were routinely
tested by Quality assurance department of KSU, for highly
reproducible research data.

7. Analisis data
a. Analisis statistik yang digunakan
Simple One-way ANOVA and Kruskal-Wallis one-way
ANOVA were used to test the differences between the
three treatment groups at baseline. The status of MetS
and its five components were evaluated as
present/absent at all three time-points, which were
presented as frequency (% of the present in the
respective group) and chi-square test (McNemar 2 × 2
contingency table) was used to calculate the p-value of
the difference in percentages. The intervention effect
within each group was shown as Odds ratio (95%
confidence interval) and respective p-value representing
odds of having MetS and its components independently
at follow-up compared to baseline and this data was
generated by Generalized Estimating Equation
(GEE) in SPSS for repeated measures of nominal data.
Finally, the intervention effect between the
groups was shown as mean Change (95% confidence
interval), p-value for the total number of MetS
components (taking MetS components as scalar
quantity) and MetS risk-score by mixed repeated
measures ANCOVA. p-Values were considered
significant at <0.05.

Simple One-way ANOVA dan Kruskal-Wallis one-way


ANOVA digunakan untuk menguji perbedaan antara
ketiga kelompok perlakuan pada permulaan. Status
MetS dan lima komponennya dievaluasi dan disajikan
sebagai frekuensi (% dari saat ini di grup masing-
masing) dan uji chi-square (McNemar 2×2 contingency
table) digunakan untuk menghitung p-value dari
perbedaan dalam persentase. Efek intervensi dalam
setiap kelompok ditampilkan sebagai rasio Odds
(interval kepercayaan 95%) dan p-value yang mewakili
peluang memiliki MetS dan komponennya secara
independen di tindak lanjut dibandingkan dengan
baseline dan data ini dihasilkan oleh General Estimasi
Equation (GEE) di SPSS untuk pengukuran berulang
data nominal. Akhirnya, efek intervensi antara
kelompok ditunjukkan sebagai perubahan rata-rata
(95% interval keyakinan), p-value untuk jumlah total
komponen MetS (mengambil komponen MetS sebagai
kuantitas skalar) dan skor risiko-MetS dengan
campuran ulang mengukur ANCOVA. p-Nilai dianggap
signifikan pada <0,05
b. Hasil penelitian
Anthropometric and Biochemical Characteristics at
Baseline and over Time
Table 1 shows the anthropometric, glycemic, and lipid
characteristics of the study participants at baseline, 6-
month, and 12-month, according to treatment groups.
The mean change in fasting glucose from baseline to
end of study for ILMP and GA + Met groups decreased
significantly (-0.39 mmol/L, p = 0.003 and -0.81
mmol/L, p < 0.001 respectively). This was not observed
in the GA group (-0.005 mmol/L, p = 0.65). Weight was
significantly reduced in the GA + Met group from
baseline to 12 months (mean change of -4.15 kg, p <
0.001). ILMP group also showed a significant reduction
in weight (mean change = -1.86 kg, p = 0.015) while the
average weight for GA group increased from baseline to
the end of the study by 0.49 kg. Waist, systolic blood
pressure and triglycerides significantly reduced from
baseline to 12 months in the ILMP group (-1.61 cm, p =
0.004; -2.59 mmHg, p = 0.049 and -0.23 mmol/L, p =
0.03 respectively). At baseline, the three treatment
groups were significantly different in waist (p < 0.01),
systolic blood pressure (p = 0.01), diastolic blood
pressure (p = 0.02), fasting glucose (p < 0.01), HbA1c
(p < 0.01) and vitamin D levels (p = 0.03)
Karakteristik Antropometri dan Biokimia Seiring
Perkembangan Waktu
Tabel 1 menunjukkan karakteristik antropometri,
glikemik, dan lipid peserta penelitian pada awal
penelitian, 6 bulan, dan 12 bulan, menurut kelompok
perlakuan. Perubahan rata-rata dalam glukosa puasa
dari awal sampai akhir penelitian untuk ILMP dan GA
+ Grup Met menurun secara signifikan (-0,39 mmol / L,
p = 0,003 dan -0,81 mmol / L, p <0,001). Ini tidak
diamati pada kelompok GA (-0,005 mmol / L, p = 0,65).
Berat badan berkurang secara signifikan pada
kelompok GA + Met dari awal sampai 12 bulan (rata-
rata perubahan -4,15 kg, p <0,001). Kelompok ILMP
juga menunjukkan penurunan berat badan yang
signifikan (perubahan rata-rata = -1,86 kg, p = 0,015)
sedangkan berat rata-rata untuk kelompok GA
meningkat dari awal sampai akhir penelitian sebesar
0,49 kg. Pinggang, tekanan darah sistolik dan
trigliserida berkurang secara signifikan dari awal
menjadi 12 bulan pada kelompok ILMP (-1,61 cm, p =
0,004; -2,59 mmHg, p = 0,049 dan -0,23 mmol / L, p =
0,03 masing-masing). Pada awal penelitian, ketiga
kelompok perlakuan berbeda secara signifikan di
pinggang (p <0,01), tekanan darah sistolik (p = 0,01),
tekanan darah diastolik (p = 0,02), glukosa puasa (p
<0,01), HbA1c (p <0,01) dan tingkat vitamin D (p =
0,03).

Prevalence of MetS and Its Components at Baseline and


Overtime
Table 2 shows the percentage of subjects having
different components of MetS and full MetS in
the three treatment groups at baseline, follow-up and
percentage of subjects in which there was
a change in status over time. MetS and its components
were evaluated as binomial variables.
Component 1 (central obesity) and component 4
(hypertriglyceridemia) showed the lowest changes
at follow-up in all the three groups (-1.2%, -1.4% and -
1.7% in central obesity; and +3.5%, -4.1%
and 0% in hypertriglyceridemia for groups GA, ILMP
and GA + Met respectively). Component 3
(Low HDL-Cholesterol) increased by 7.1% (n = 6) in
GA group at end of the study compared to
baseline while it decreased by 6.8% (n = 5) and 3.4% (n
= 2), respectively, in ILMP and GA + Met
groups. Component 5 (Hypertension) increased by 2.4%
(n = 2) and by 8.5% (n = 5, p = 0.035)

Odds of Having MetS and Its Components at Follow-Up


Compared to Baseline
Table 3 shows the odds of having MetS and its
individual components at follow-up compared to
baseline in each group. Supplementary Table S3 shows
the odds of having MetS for these covariates,
independent of each other The odds of central obesity
and hypertriglyceridemia showed marginal changes in
all groups, with odds ratio (95% confidence interval
(C.I.)) of 0.84 (0.4, 1.8) and 0.86 (0.5, 1.3),
respectively, in GA group; 0.80 (0.3, 2.2) and 0.80 (0.5,
1.4) in ILMP group and 0.74 (0.2, 3.5) and 1.0 (0.6, 1.8)
in GA + Met group. The odds of low HDL-cholesterol
increased (1.66 (0.8, 3.5)) in GA group, but was
reduced both in ILMP (0.79 (0.4, 1.4)) and GA + Met
(0.86 (0.4, 1.7)) groups. The odds of hypertension
increased in GA + Met group (2.36 (1.2, 4.6), p-value =
0.012) and GA group (1.28 (0.5, 3.1)) but was modestly
decreased in ILMP group (0.88 (0.4, 2.1)). The odds of
full MetS was significantly reduced both in
ILMP (0.25 (0.1, 0.4), p-value < 0.001) and GA + Met
(0.32 (0.1, 0.7), p-value = 0.005) groups only.
Figure 2 shows the odds ratio of MetS and its
components at the end of the study compared to
baseline for different treatment groups. The odds for
MetS were significantly reduced in ILMP group
followed by GA + Met group.
Prevalensi MetS dan Komponennya Seiring
Perkembangan Waktu
Tabel 2 menunjukkan persentase subyek yang memiliki
komponen MetS yang berbeda dan MetS yang
memenuhi 5 kriteria ditiga kelompok perlakuan pada
awal, tindak lanjut dan persentase subjek di mana ada
perubahan status seiring waktu. MetS dan
komponennya dievaluasi sebagai variabel binomial
.Komponen 1 (obesitas sentral) dan komponen 4
(hipertrigliseridemia) menunjukkan perubahan
terendah di keseluruhan tiga kelompok tersebut (-1,2%,
-1,4% dan -1,7% pada obesitas sentral; dan + 3,5%, -
4,1%dan 0%, di hypertriglyceridemia untuk kelompok
GA, ILMP dan GA + Met masing-masing). Komponen
3(Low HDL-Kolesterol) meningkat sebesar 7,1% (n =
6) pada kelompok GA pada akhir penelitian
dibandingkan pada awal penelitian sementara itu
menurun 6,8% (n = 5) dan 3,4% (n = 2), masing-
masing, di kelompok ILMP dan GA + Met. Komponen 5
(Hipertensi) meningkat 2,4% (n = 2) dan 8,5% (n = 5, p
= 0,035).

Odds of Having MetS and Its Components at Follow-Up


Compared to Baseline
Table 3 shows the odds of having MetS and its
individual components at follow-up compared to
baseline in each group. Supplementary Table S3 shows
the odds of having MetS for these covariates,
independent of each other. The odds of central obesity
and hypertriglyceridemia showed marginal changes in
all groups, with odds ratio (95% confidence interval
(C.I.)) of 0.84 (0.4, 1.8) and 0.86 (0.5, 1.3),
respectively, in GA group; 0.80 (0.3, 2.2) and 0.80 (0.5,
1.4) in ILMP group and 0.74 (0.2, 3.5) and 1.0 (0.6, 1.8)
in GA + Met group. The odds of low HDL cholesterol
increased (1.66 (0.8, 3.5)) in GA group, but was
reduced both in ILMP (0.79 (0.4, 1.4)) and GA + Met
(0.86 (0.4, 1.7)) groups. The odds of hypertension
increased in GA + Met group (2.36 (1.2, 4.6), p-value =
0.012) and GA group (1.28 (0.5, 3.1)) but was modestly
decreased in ILMP group (0.88 (0.4, 2.1)). The odds of
full MetS was significantly reduced both in ILMP (0.25
(0.1, 0.4), p-value < 0.001) and GA + Met (0.32 (0.1,
0.7), p-value = 0.005) groups only. Figure 2 shows the
odds ratio of MetS and its components at the end of the
study compared to baseline for different treatment
groups. The odds for MetS were significantly reduced
in ILMP group followed by GA + Met group.

Kemungkinan Memiliki MetS dan Komponennya di


Tindak Lanjut Dibandingkan dengan Baseline
Tabel 3 menunjukkan kemungkinan memiliki MetS dan
komponen individu pada tindak lanjut dibandingkan
dengan baseline pada masing-masing kelompok.
Tambahan Tabel S3 menunjukkan kemungkinan
memiliki MetS untuk kovariat ini, independen satu sama
lain. Kemungkinan obesitas sentral dan
hipertrigliseridemia menunjukkan perubahan marginal
pada semua kelompok, dengan odds ratio (95%
confidence interval (C.I.)) sebesar 0,84 (0,4, 1,8) dan
0,86 (0,5, 1,3), masing-masing, pada kelompok GA;
0,80 (0,3, 2,2) dan 0,80 (0,5, 1,4) dalam kelompok
ILMP dan 0,74 (0,2, 3,5) dan 1,0 (0,6, 1,8) dalam
kelompok GA + Met. Kemungkinan low HDL kolestrol
meningkat (1,66 (0,8, 3,5)) dalam grup GA, tetapi
berkurang pada 2 kelompok yaitu di ILMP (0,79 (0,4,
1,4)) dan GA + Met (0,86 (0,4, 1,7)) . Kemungkinan
hipertensi meningkat dalam grup GA + Met (2,36 (1,2,
4,6), p-value = 0,012) dan grup GA (1,28 (0,5, 3,1))
tetapi menurun pada kelompok ILMP (0,88 (0,4, 2,1)).
Peluang MetS yang memenuhi 5 kriteria berkurang
secara signifikan baik di ILMP (0,25 (0,1, 0,4), p-value
<0,001) dan GA + Met (0,32 (0,1, 0,7), p-value =
0,005) hanya kelompok. Gambar 2 menunjukkan rasio
peluang MetS dan komponennya pada akhir penelitian
dibandingkan dengan awal penelitian untuk kelompok
perlakuan yang berbeda. Peluang untuk MetS
berkurang secara signifikan dalam grup ILMP diikuti
oleh grup GA + Met.

Intervention Effects in Total Number of MetS


Components and MetS Risk Factor
Table 4 shows the intervention effects in the total
number of MetS components and the MetS
risk-score. The number of MetS components
significantly decreased from baseline to the end of the
study in the ILMP group (mean change (standard error))
of 0.81 (0.13), p-value < 0.001. Similarly, it decreased
in GA + Met group by 0.35 (0.18), p-value = 0.05.
Between-group comparison revealed that the decrease
in the number of MetS components in ILMP was
statistically more significant than GA (p < 0.001).
Between (GA + Met) and GA groups, this decrease was
not significant. Intervention effects between groups for
MetS risk score showed the same trend between ILMP
vs. GA group (0.31(-0.53, -0.09); p = 0.003).

Efek Intervensi dalam Jumlah Total Komponen MetS


dan MetS Faktor Risiko
Tabel 4 menunjukkan efek intervensi dalam jumlah
komponen MetS dan risiko terjadinya Mets. Jumlah
komponen MetS menurun secara signifikan dari awal ke
akhir di grup ILMP (perubahan rata-rata (standard
error)) 0,81 (0,13), p-value <0,001. Demikian pula,
penurunan dalam kelompok GA + Met sebesar 0,35
(0,18), p-value = 0,05. Antara-kelompok perbandingan
mengungkapkan bahwa penurunan jumlah komponen
MetS di ILMP secara statistik lebih signifikan daripada
GA (p <0,001). Antara (GA + Met) dan grup GA,
penurunan ini tidak signifikan. Efek intervensi antara
kelompok untuk skor risiko MetS menunjukkan tren
yang sama antara ILMP dengan grup GA (0,31 (-0,53, -
0,09); p = 0,003).

8. Literatur review / referensi


Buku : 1
Jurnal : 36

9. Kesimpulan dan saran


Intensive lifestyle modifications or low dose metformin
for a period of 12 months significantly reduces MetS
manifestation in individuals with prediabetes, with lifestyle
modifications being superior to metformin, as the latter’s
potency is limited to weight loss and reduction of
hyperglycemia, while the former improves all the components
of MetS together as well as independently.

Modifikasi gaya hidup yang intensif atau pemberian


metformin dosis rendah untuk jangka waktu 12 bulan secara
signifikan mengurangi manifestasi MetS pada individu dengan
pradiabetes, dengan intervensi pemberian modifikasi gaya
hidup yang lebih unggul daripada metformin, karena potensi
yang terakhir ini terbatas pada penurunan berat badan dan
pengurangan hiperglikemia, sementara yang pertama
meningkatkan semua komponen MetS bersama serta mandiri.