Latar belakang: Diabetes melitus tipe 2 adalah sindrom metabolik dengan ciri hiperglikemi. Manajemen terdiri dari perubahan gaya hidup dan farmakoterapi seumur hidup untuk mencapai target kadar normal glukosa darah sehingga mencegah terjadi penyakit komplikasi. Prevalensi di dunia adalah 2,8% sedangkan di Indonesia adalah 5,7% di daerah urban. Farmakoterapi dari diabetes melitus adalah terapi tunggal metformin, apabila tidak tercapai target optimal dalam 3 bulan akan berganti ke lini terapi ganda metformin dengan penambahan satu obat antidiabetes dari golongan sulfonilurea, inhibitorDPP-4, antagonis reseptor GLP-1, atau insulin basal. Obat antidiabetes sulfonylurea merupakan pilihan terbaik dalam menurunkan kadar glukosa dalam darah, namun karena memiliki jenis lebih daru satu dan memiliki efikasi yang berbeda dibutuhkan penelitian evidence-based medicine untuk menentukan terapi kombinasi terbaik dalam menurunkan glukosa darah dengan harga paling efisien. Tujuan: Membandingkan efektivitas 3 macam terapi kombinasi metformin dengan penambahan sulfonylurea terhadap penurunan glukosa darah puasa pada pasien diabetes mellitus tipe dua dan membandingkan rerata harga obat tiap macam golongan terapi. Metode penelitian:Penelitian pada 15.200 catatan kunjungan dan preskripsi rekam medis dari 8 klinik perusahaan minyak di Kalimantan selama 5 tahun dari tahun 2005 – 2009. Kriteria subjek penelitian adalah penderita diabetes melitus tipe 2 yang mendapatkan terapi kombinasi metformin dengan penambahan satu obat antidiabetes dan memiliki hasil laboratorium glukosa darah puasa. Data diolah menggunakan uji hipotesis oneway ANOVA golongan terapi terhadap kadar glukosa darah puasa. Selain menggunakan analisis uji hipotesis, analisis deskriptif juga dilakukan untuk menganalisis karakteristik persebaran preskripsi pada ketiga golongan mengenai durasi pengobatan, jenis kelamin, penyakit komorbid, dan biaya pengobatan. Hasil:Terdapat 79 sampel preskripsi dengan kriteria inklusi serta eksklusi yang sesuai. Data dianalisis menggunakan oneway ANOVA terhadap rerata glukosa darah puasa yaitu metformin + glibenclamide (204 mg/dl ± 58), metformin + glicazide (172 mg/dl ± 67), dan metformin + glimepiride (164 mg/dl ± 49). Setelah dianalisis menggunakan posthoc oneway ANOVA didapatkan bahwa hanya metformin + glimepiride saja yang memiliki nilai bermakna terhadap metformin + glibenclamide baik dari kadar glukosa darah puasa (-40 mg/dl ± 19, P<0,05). Rerata harga obat dianalisis secara deskriptif yaitu metformin + glibenclamide Rp 3814 ± 131,73; metformin + glicazide Rp 3845 ± 256,13; metformin + glimepiride 4664 ± 803,91. Kesimpulan:Kelompok metformin dengan glimepiride memiliki penurunan glukosa darah puasa lebih baik dibandingkan metformin dengan glibenclamide (-40 mg/dl ± 19, P< 0,05) dengan rerata harga paling mahal (Rp 4664 ± 803,91) . kelompok metformin dengan glibenclamide memiliki rerata harga paling rendah (Rp Rp 3814 ± 131,73).

Background: Diabetes mellitus type 2 is a metabolic syndrome characterized by hyperglycemia. Management of this disease is consists of lifestyle modification and administration of pharmacologic agent for lifetime to reach normal blood glucose levels, thus preventing disease complications occur. The prevalence in the world is 2.8%, while in Indonesia was 5.7% in urban areas. The first line pharmacotherapy of diabetes mellitus is metformin monotherapy, if monotherapy cannot reach normal blood glucose levels, it will switch to metformin dual therapy which is added by whether sulfonylureas, DPP-4 inhibitors, GLP-1 receptor antagonists, or basal insulin. Sulfonylurea is the best option of antidiabetic drug added to dual therapy in lowering blood glucose levels, but because of difference in efficacy among sulfonylurea types, it is needed evidence-based medicine research to determine which one is the best option with the most efficient price. Objective: To compare the effectiveness of three type of metformin dual therapy with the addition of sulfonylurea in declining fasting blood glucose levels in type 2 diabetes mellitus patients and compare the average price of each type of drug therapy group. Research Methods:The study on 15,200 patients visits by medical record of 8 health clinic owned by oil companies in borneo during 5 years from 2005 - 2009. Subject criteria were type 2 diabetes mellitus patients who received metformin dual therapy with sulfonylurea and have suitable fasting blood glucose laboratory results. Data were processed using oneway ANOVA between therapy group and fasting blood glucose laboratory results. Besides hypothesis analysis data were processed to determine descriptive analysis about the distribution of prescription in three treatment groups, duration of treatment, sex, comorbid diseases, and treatment costs. Results:There were 79 prescriptions which have suitable inclusion and exclusion criterias. Data were analyzed using oneway ANOVA in mean fasting blood glucose among three treatment groups, metformin + glibenclamide (204 mg/dl ± 58), metformin + glicazide (172 mg/dl ± 67), and metformin + glimepiride (164 mg/dl ± 49). After a posthoc oneway ANOVA analysis in fasting blood glucose only metformin + glimepiride have significant value in declining fasting blood glucose level better than metformin + glibenclamide (-40 mg/dl ± 19, P<0,05). Average price among treatment groups were processed by descriptive analysis, and the results are metformin + glibenclamide Rp 3814 ± 131.73; metformin + glicazide Rp 3845 ± 256.13; metformin + glimepiride 4664 ± 803.91. Conclusion:Dual therapy of metformin and glimepiride group have a better effect in declining fasting blood glucose than metformin and glibenclamide (-40 mg/dl ± 19, P< 0.05). Metformin and glimepiride have the highest average price (Rp 4664 ± 803.91), then metformin and glibenclamide have the lowest average price (Rp Rp 3814 ± 131.73).

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