Haemoglobin Glycosilate as a Glycemic Control at Type 2 Diabetes

Mellitus Patients

Rusdiana

1 *

, Maya Savira

, Sry Suryani Widjaja

Departement of Biochemistry, Medical Faculty of Universitas Sumatera Utara, Jl. dr. Mansur, Universitas Sumatera

Utara, Medan, 20155

Departement of Physiology, Medical Faculty of Universitas Sumatera Utara, Jl. dr. Mansur, Universitas Sumatera Utara,

Medan, 20155

Keywords: Diabetes Mellitus Type 2, Fasting Blood Sugar, Haemoglobin Glycosylate.

Abstract: Chronic disease that characterized by blood glucose levels that exceed normal values is Diabetes Mellitus.

The patient of type 2 diabetes mellitus must controlled their bood sugar level and the most accurate way to

determine blood sugar levels over the past to three months by Hba1c measurement.This study was to

determine the levels of blood sugar and Hba1c in patients with type 2 diabetes mellitus in Johor Primary

Health Care (PHC) in Medan of Sumatera Utara, Indonesia. This study used cross-sectional design conducted

in Johor PHC, Medan of Sumatera Utara, 40 patients with type 2 diabetes mellitus. All the samples of fasting

blood sugar and HbA1c were recorded for each patient who attend to the PHC . We collected the primary data

through interviews, physical examination and laboratory test. More than half of the samples of this study

have bad Hba1c levels (>8% ) cause of many patients of type 2 diabetes mellitus lack of knowledge about

the correct management of diabetes mellitus.

1 INTRODUCTION

One of the public health problem and a major clinical

is Diabetes mellitus, taht requires continuing medical

care and ingoing patient management education and

support to prevent acute complication and to reduce

the risk long-term complication. All over the world

the precalence of type 2 diabetes mellitus id rapidly

increasing. In 2011, the global prevalence of diabetes

was 366 million and caused 4.6 million deaths (IDF).

This figure is expected to rise to 522 million by 2030

and will be 7th leading cause of death in 2030 (IDF

2012, WHO 2011). Indonesia is the world’s fourth

most populated country, has the seventh largest

number of diabetic patients(7.6 million), despite

relatively low prevalence (4,8% including both

diabetes type 1 and 2 in individuals aged 20-79 years)

in 2012 (IDF, 2012). Because of its high morbidity

and mortality diabetes mellitus is an important health

problem (King H et al, 1998), Indonesia is the country

with the largest numbers of people with diabetes

(Shaw JE,2010, Wild et al, 2004). In urban Indonesia

of the prevalence of diabetes mellitus is 5.7%

(Mihardja L et al, 2009), and a younger age of the

incidence of diabetes mellitus is starting to rise (Chan

JC et al, 2009).

According American Diabetis Association(ADA)

glycemic control as one of the important strategies for

the management of DM and glycosylated

haemoglobin (Hbalc) is the best measure of glycemic

level over the previous 3 months. Hbalc is udes to

monitor diabetic treatment each 3 months once

because of the erythrocyte haemoglobinglycation

since erythrocytes have about 120 days life span, and

reflects overall blood glucose levels over a period 2-

3 months and further, in the achievement of the best

possible glycemic control it has been recognized that

hbalc as an essential adjunct to regular self-blood

glucose measurement assisting (Saudek CD et al,

2009). The health of individuals and communities

depended many factors which was influenced. The

low education level is one of these factors which is

linked poor health, more stress and lower self-

confidence. This aim of study to determine the levels

of Hbalc in patients with type 2 diabetes mellitus in

Johor PHC in Medan of North Sumatera, Indonesia.

2 MATERIAL AND METHODS

Patients were recruited from Medan Johor Primary

Health Care (PHC),North Sumatera, Indonesia.This

Rusdiana, ., Savira, M. and Widjaja, S.

Haemoglobin Glycosilate as a Glycemic Control at Type 2 Diabetes Mellitus Patients.

DOI: 10.5220/0010067604070409

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

407-409

ISBN: 978-989-758-449-7

407

was conducted from April to June 2018. We take 40

samples from this PHC. In appropriate with the

inclusion criteria which are both of sex (female,male),

aged > 40 years old, cooperative and gave the

signature for will join this research and exclusion

criteria which are, have the ability to read. All

participants gave written, informed concent to

participate in the study. This research was approved

by Health Research Ethical Committee, Medical

Faculty of University Sumatera Utara /H.Adam Malik

General Hospital by number 591/TGL/KEPK FK

USU-RSUP HAM /2017. Before starting education

activities, each sample we examine weight, height,

waist size, blood pressure, and laboratory tests such

as fasting blood sugar levels (FBS) and Hba1c.

Fasting blood sugar of samples we examined by using

portable measuring instrument (Gluco DR). Blood

samples were collected (using syringe) twice before

and after intervention by education and transferred to

Pramita clinic laboratory immediately to be

conducted glycosilated haemoglobin test by HPLC

method.

According to the American Diabetes

Association (ADA), a diagnosis of diabetes can be

estabilished in the presence of any of the following

(two tests are required) : 1) fasting plasma glucose

levels of ≥ 126 mg/dL ; 2) random plasma glucose ≥

200mg/dL in a patients with classic symptoms of

hyperglycemia ; 3) 2-h plasma glucose level ≥ 200

mg/dL during a 75 g oral glucose tolerance test; 4)

Hba1c level of ≥ 6.5% (Diabetes Care.2015).

The participants completed a general

information from included question on age, marital

status,family history of the disease,duration of the

disease, clinical characteristics, awareness of diabetic

complications, taking oral diabetic or insulin

injection, smoking, following any diet, daily activity,

education level and job.

3 RESULTS

The number of the samples from the Johor PHC were

comprised of female were people (30) and men were

people (10). Mean age of the samples were

62.53±7.809 years old. Hba1c value of the samples

>8% were 67.5% (27) people and Hba1c value 6-8%

were 32.5% (13) people of the samples.The

demographic data; gender, age-group, education

level, family history and type of treatment . See the

table 1 on the bellow.

Table 1: Charactheristic of the Participants.

Characteristic N %

Gender

Male 10 25%

Female 30 75%

Mean Age 62.53±7.809

Education Level

Junior High School 10 9%

Senior High School 23 20.7%

Academy/University 10 6.3%

Physical activity

insufficient 28 70%

sufficient 12 30%

Duration of disease

<3 years 18 45%

3-6 years 3 7.5%

>6 years 3 7.5%

Familial History

Mathernal 8 20%

Fathernal 3 7.5%

Mahernal and

Fathernal

4 10%

none 25 62.5%

Medications

OAD 34 85%

OAD+insulin 6 15%

Table 2: Hbalc Value.

Hbalc(%) Frequency Percentace(%)

6.5-8 17 42.5

>8 23 57.5

Table 3: BMI FBS and Hbalc result.

Min Max Mean SD

BMI(kg/m

) 18.57 32.46 25.54 3.39

FBS(mg/dL) 143 500 202.20 81.68

Hbalc(%) 6.1 14 8.65 1.75

Among study (n=40)

4 DISCUSSION

The result of this study from the 40 respondents

among the type 2 diabetes mellitus patients showed

that more than half of the samples Hbac1 value > 8%,

it means more than half of the samples were

cathegoryzed as uncontrolled diabetes mellitus

patients. Rusdiana et al published at Advanced

Science Letter 2017 showed that most of the type 2

DM patients in PHC in Binjai Hba1c value >8% at

type 2 diabetes mellitus. And research by Rusdiana et

al published at OAMJM showed that by education

management for three months can reduced Hba1c

value, it means for the type 2 diabetes mellitus needed

to increasing their knowledge for diabetes mellitus.

The other research by Rina Amelia about analysis of

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

408

factors affecting the self-care behaviors of diabetes

mellitus type 2 patients in Binjai, North Sumatera –

Indonesia showed that self-care behaviors of type 2

diabetes mellitus in Binjai are significantly

influenced by motivation, self – efficacy,

communication,knowledge, and attitude.

5 CONCLUSIONS

Because of more than half of this samples Hba1c

value >8% so this samples needed education about

the management of diabetes mellitus in order the type

2 diabetes mellitus get the a good understanding

about diabetes mellitus.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported by Ministry of Research and

Technology and Higher Education Republic of

Indonesia. The support is under the research grant

BP-PTN USU of Year 2018 Contract Number:

176/UN5.2.3.2.1/PPM 2018.

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