Kunyit sebagai Pencegah Neuropati Diabetika

Sumber foto : Chilibeli.com

Diabetes melitus merupakan penyakit penyebab kematian nomor satu di dunia. Menurut data Kementerian Kesehatan RI tahun 2018 penderita diabetes melitus mengalami kenaikan dari 6,9% pada tahun 2013 menjadi 8,5% pada tahun 2018. Neuropati diabetika merupakan salah satu komplikasi terbanyak yang dialami oleh penderita diabetes melitus baik tipe 1 maupun tipe 2. Kaki, tangan, jantung, gastrointestinal, dan kelamin adalah lokasi yang paling sering mengalami neuropati diabetika.

Neuropati diabetika dapat menghambat aktivitas fisik sehingga diperlukan pencegahan agar tidak terjadi komplikasi pada penderita diabetes melitus. Kunyit (Curcuma longa) merupakan tanaman herbal yang memiliki berbagai manfaat untuk kesehatan. Salah satu senyawa yang terkandung dalam kunyit adalah kurkumin. Kurkumin adalah suatu senyawa polifenol yang memiliki manfaat sebagai antioksidan, anti inflamasi, anti mutagenik, anti kanker, dan anti mikroba. Selain itu, kurkumin memiliki mekanisme kerja yang sama seperti thiazolidinedione sehingga bermanfaat sebagai anti diabetes. Kurkumin dapat mencegah komplikasi diebetes melalui berbagai macam mekanisme target molekuler di dalam tubuh.

Neuropati diabetika merupakan gangguan pada sistem saraf perifer yang sering mengenai akson sensoris, akson otonom, dan akson motoris. Keadaan tersebut terjadi karena hiperglikemia dan mikroangiopati. Hiperglikemia merupakan suatu keadaan di mana terdapat ketidakseimbangan produksi dan intake glukosa karena penurunan sekresi insulin maupun resistensi insulin. Hiperglikemia menyebabkan berbagai perubahan metabolik di dalam tubuh sehingga timbul gangguan pada saraf. Oleh karena itu, mengontrol kadar glukosa adalah terapi untuk mencegah terjadinya neuropati diabetika. Dystal Symetric Polyneuropathy (DSPN), Diabetic Autonomic Neuropathy (DAN), dan Cardiac Autonomic Neuropathy (CAN) adalah neuropati diabetika yang sering dialami oleh penderita diabetes melitus. Gejala yang dialami dapat berupa rasa tertusuk, terbakar, mati rasa seperti tersengat listrik, kelemahan otot, dan timbul ulkus.

Hiperglikemia mengakibatkan mirkrovaskular injuri akibat produksi Advanced Glycation End Product (AGEs) dari glukosa. Target utama hiperglikemia adalah sel-sel endotel pada pembuluh darah mikro karena pada sel endotel tidak terjadi proses downregulation transportasi glukosa saat kadar glukosa berlebih. AGE terbentuk secara irreversible di dalam pembuluh darah yang akan menstimulasi respon inflamasi dan agregasi platelet sehingga terjadi arteriosklerosis. Selain itu, AGE juga memicu produksi Vascular Endothelial Growth Factor (VEGF) yang dapat menyebabkan terjadinya angiogenesis patologi. Apabila terjadi trombosis arteri maka terjadi iskemia yang mengakibatkan kerusakan serabut saraf. Selain itu, hiperaktivitas jalur polyol terjadi pada keadaan hiperglikemia dan akan meningkatkan glukosa intraselular pada serabut saraf. Glukosa akan diubah menjadi sorbitol dengan bantuan enzim aldose reduktase dan sorbitol dehidrogenase sehingga memicu terjadi hiperosmolaritas pada sel saraf. Aktivitas aldose reduktase dapat menurunkan kadar  Nicotinamide Adenine Dinucleotid Phosphate (NADPH). Keadaan ini mengakibatkan terjadi stress oksidatif yang memicu disfungsi dan kematian sel saraf. Glikolisis pada keadaan hiperglikemia juga memicu produksi dyacylglycerol yang dapat mengaktivasi protein kinase C (PKC). Di mana aktivasi PKC ini juga dapat menyebabkan disfungsi dan kematian sel saraf.

Kurkumin yang terkandung dalam kunyit bersifat pleiotropik dengan memodulasi beberapa jalur persinyalan sel. Pada berbagai penelitian menunjukan kandungan kurkumin dapat mengeliminasi efek dari AGE dan dapat menurunkan VEGF secara signifikan sehingga secara tidak langsung kurkumin dapat mencegah terjadinya arteriosklerosis dan angiogenesis patologi pada penderita diabetes melitus. Selain itu, kurkumin dapat meminimalisir stres osmotik dengan meregulasi jalur polyol dan menghambat enzim aldose reduktase pada jalur polyol sehingga tidak terjadi stres oksidatif pada sel saraf. Kandungan kurkumin pada kunyit inilah yang dapat dijadikan terapi pencegahan neuropati diabetika bagi penderita diabetes melitus. Namun terdapat beberapa efek samping seperti diare, sakit kepala, ruam dan feses berwarna kuning jika konsumsi kurkumin mencapai 500-12000 mg per hari. Jadi, jangan mengonsumsi rimpang kunyit terlalu berlebihan untuk menghindari efek sampingnya.

Sumber : jurnal.globalhealthsciencegroup.com http://jurnal.globalhealthsciencegroup.com/index.php/JPPP/article/view/59/48

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