Pengaruh Kepatuhan Minum Obat terhadap Pengendalian HbA1c pada Pasien Diabetes Melitus Tipe 2: Tinjauan Sistematis Berdasarkan Metode Pengukuran Kepatuhan
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Diabetes melitus tipe 2 (DMT2) merupakan masalah kesehatan masyarakat utama di Asia, seiring dengan pesatnya urbanisasi dan perubahan gaya hidup yang menyebabkan peningkatan prevalensi penyakit. Kepatuhan minum obat yang rendah masih menjadi hambatan utama dalam mencapai kontrol glikemik yang optimal, sehingga meningkatkan risiko komplikasi dan beban pelayanan kesehatan.Tinjauan sistematis ini bertujuan untuk mengkaji hubungan antara kepatuhan minum obat dan kadar hemoglobin terglikasi (HbA1c) pada pasien DMT2, membandingkan kekuatan hubungan tersebut berdasarkan metode pengukuran kepatuhan, serta mengidentifikasi faktor-faktor utama yang memengaruhi kepatuhan dan kontrol glikemik di Asia. Pencarian literatur dilakukan pada basis data PubMed, Europe PMC, Scopus, dan ScienceDirect untuk studi potong lintang yang dipublikasikan antara Januari 2015 hingga April 2025. Studi yang memenuhi kriteria melibatkan pasien DMT2 dewasa dengan pelaporan kepatuhan minum obat (misalnya MMAS-8, penghitungan pil) serta luaran HbA1c. Data disintesis secara naratif, dan kualitas studi dinilai menggunakan instrumen penilaian terstandar. Dari 584 artikel yang disaring, sebanyak 14 studi memenuhi kriteria inklusi. Sebagian besar studi menunjukkan hubungan terbalik yang signifikan antara kepatuhan minum obat dan kadar HbA1c, dengan hubungan yang lebih kuat pada penggunaan metode pengukuran kepatuhan yang objektif atau multidimensional. Tingkat kepatuhan berkisar antara 12% hingga 42%, sedangkan rerata HbA1c berkisar antara 6,4% hingga 9,2%. Tingkat pendidikan yang lebih tinggi, efikasi diri yang baik, serta lingkungan pelayanan kesehatan yang suportif berhubungan dengan kepatuhan yang lebih baik. Sebaliknya, distres psikologis, kompleksitas regimen, dan komorbiditas berhubungan dengan kepatuhan yang rendah dan kontrol glikemik yang buruk. Kepatuhan minum obat merupakan determinan penting dalam pengendalian glikemik pada pasien DMT2 di Asia. Pemilihan metode pengukuran kepatuhan memengaruhi kekuatan hubungan dengan HbA1c. Intervensi perlu menargetkan hambatan psikososial dan klinis serta menggunakan pendekatan penilaian kepatuhan yang multidimensional dan sesuai budaya.
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