Corresponding Author: Chandra
Buana
E-mail: [email protected] �
INTRODUCTION
Diabetes Mellitus (DM) is a group of
metabolic diseases characterized by hyperglycemia
resulting from impaired insulin secretion, insulin performance, or both (Giraudet et
al., 2022). Hyperglycemia occurs due to insulin deficiency (type I DM) or decreased cell responsiveness
(type II DM) to insulin (von Deneen & Garstka,
2022). Effect
multisystem, Which is caused
by enhancement glucose
that begins with polyuria,
polydipsia, And polyphagia; then progressive
complications like disturbance cardiovascular, musculoskeletal, And integument
(Rompolski, 2022).
People living with Diabetes in Bengkulu
province are still very high, reaching 4,184 cases spread across 9 districts or 1 city. Diabetes is now entering
the level or rank of two types of
non-communicable diseases that can cause death, so it is necessary to
have a healthy and regular lifestyle to prevent the disease. Kabid disease control and environmental health
(P2PL) Bengkulu provincial health office that
cases of people with diabetes in Bengkulu province based on the data it
receives every year, highest in region city Bengkulu Which reaches 3,087
cases. Sufferer diabetes is Still
very dominant in the regional city of Bengkulu; even his
death reached 32 people in the past
2019. As for the district area, people
living with diabetes are evenly distributed, and the highest cases occur
in the Rejang Lebong district, reaching
382 cases. Those who died from this disease reached 5 people in 2019 (Bengkulu Province Health Profile,
2020).
Diabetes Mellitus can cause complications in various body systems,
namely hypoglycemia, hyperglycemia,
macrovascular disease of the great vessels, coronary heart disease, a microvascular disease affecting small
vessels retinopathy and nephropathy, neuropathies of nerves sensory or affect the extremities (L. Anggraeni et al., 2018). Diabetes complications include ketoacidosis, retinopathy, stroke, attack, heart
And neuropathy (Dunggio, 2021). Neuropathy peripheral and disease peripheral vascular cause decline
perfusion, peripheral Which will start happening hypoxia
network. Such conditions reduce the oxygen in the tissues, affecting the activity of vascular and cellular
networks. Impact more carry
on caused happening damage network
and diabetic foot ulcers or gangrene develop in patients with diabetes
mellitus. The number of complications
that can occur in the end will be able to reduce the quality of life of
patients with DM (Djrolo et al., 2015).
One of the causes of the decreased quality of life of DM patients
is that the patient cannot carry out self-care (Ekayasa, 2017). Self-care is a purposeful action to control diabetes which includes a series of treatment and
prevention actions for complications.
DM sufferers are expected to have good knowledge and skills to can do management independently in a comprehensive manner.
Strategies that can be done to prevent complications or the four
pillars of management DM cover education, therapy,
nutrition, medical, exercise,
physical, And pharmacological intervention (AFN
Anggraeni et al., 2018). Diabetic Self Management Education (DSME) is a program designed
to provide understanding and skills
in caring for DM sufferers at home in day-to-day care, stability of blood sugar, and prevention of complications,
which includes educational activities, medical
nutrition therapy, physical exercise,
and pharmacological interventions to improve the quality of life of sufferers DM. The objective of this study was to
analyze the effect of giving DSME on quality
of life in patients with type 2 diabetes mellitus in the PKM Perumnas area,
Rejang district Lebong.
METHODS
This type of
research is quasi-experimental with a pretest and posttest approach with a
control group design. The sampling technique used consecutive sampling
involving 30 respondents, divided into 15 respondents in the treatment group
and 15 in the control group. The treatment group was given DSME in the form of
discharge planning in 4 sessions; namely, sessions 1-3 were held at PKM with a
duration of 50 minutes, and session 4 was carried out at the patient's home
with a duration of 100 minutes. The control group received discharge planning
as usual for 4 sessions carried out at the PKM simultaneously with a duration
of 150 minutes. The research time is from May to October 2021.
The instrument used
in this study was the DQOL (Diabetes Quality of Life) questionnaire adopted
from Yusra's research and the DSME SOP by modifying it based on the results of
previous studies. Data analysis used univariate and bivariate analysis, bivariate
analysis in the form
of parametric tests, namely the dependent t-test and independent t-test with
α = 0.05. Researchers use computer programs for data processing and
statistical analysis. The research design is shown in the following figure.
Figure 1. Research design
Information
X.1����� : Pretest in the treatment
group
X.2����� : Posttest in the treatment
group
Y.1����� : Pretest in the control
group
Y.2����� : Posttest in the control
group
O.1���� : Intervention in the form of
DMSE modules and assistance
O.2���� : Intervention in the form of leaflets
without assistance
RESULTS AND DISCUSSION
Characteristics of
Respondents
Table
1. Characteristics of Respondents
|
Characteristics
|
Treatment
|
Control
|
|
Total
(N=30)
|
%
|
Total
(N=30)
|
%
|
|
Age
|
|
|
|
|
|
<50 yrs
|
7
|
23.3
|
8
|
26.6
|
|
50-60 yrs
|
10
|
33.3
|
12
|
40
|
|
>60 yrs
|
13
|
43.3
|
9
|
30
|
|
Total
|
30
|
100
|
30
|
100
|
|
Gender
|
|
|
|
|
|
Man
|
10
|
33.3
|
12
|
40.0
|
|
Woman
|
20
|
66.6
|
18
|
60.0
|
|
Total
|
30
|
100
|
30
|
100
|
|
Level of
education
|
|
|
|
|
|
SD
|
12
|
40.0
|
4
|
13.3
|
|
junior high
school
|
4
|
13.3
|
3
|
10
|
|
high school
|
9
|
30
|
14
|
46.6
|
|
Bachelor
|
5
|
16.6
|
8
|
26.6
|
|
Total
|
30
|
100
|
30
|
100
|
|
Work
|
|
|
|
|
|
civil
servant
|
4
|
13.3
|
4
|
13.3
|
|
Private
|
13
|
43.3
|
9
|
30
|
|
Does not
work
|
13
|
43.3
|
16
|
53.3
|
|
Total
|
30
|
100
|
30
|
100
|
Characteristics of
Respondents The results showed that of the 30 respondents, most respondents in
the treatment group were 13 people (43.3%) aged > 60 years and in the control,
group were 12 respondents (40%) aged 50 to 60 years. Based on gender, in the
treatment group, the majority were female, with 20 respondents (66.6%) and
female respondents in the treatment group 18 respondents (60.0%). The education
level of the respondents in the treatment group was mainly elementary school,
namely 12 respondents (40.0%), with 10 respondents (66.7%) in the treatment
group and 6 respondents (40%) in the control group. The work of respondents in
the treatment group was dominated by entrepreneurs, namely 14 respondents
(46.7%), with 6 respondents (40%) in the treatment group and 8 respondents
(53.3%) in the control group.
Characteristics of respondents the results of the study showed
that of the 30 respondents, the majority of
respondents in the treatment group were 13 people (43.3%) aged > 60 years
and in the control, group were 12 respondents (40%) aged 50 to 60 years. As age
increases, the risk of experiencing glucose intolerance increases (Ekayasa, 2017). This ageing process causes a reduced ability of pancreatic
β cells to produce insulin (Rompolski, 2022). Age affects a person's ability to carry out self-care for DM (Qurniawati et al., 2020). DM patients who cannot carry out care independently can reduce
their quality of life.
Based on gender, in the treatment group, the majority were female,
with 20 respondents (66.6%) and female respondents in the treatment group 18
respondents (60.0%). Women quickly experience an increase in body mass index, a
decrease in the hormone estrogen and low physical activity, which
increases the risk of developing DM (Qurniawati et al., 2020). Women are prone to experiencing stress which can interfere with
their mental condition. Hence, their quality of life is lower than that of men.
The education level of the respondents in the treatment group was
mainly elementary school, namely 12 respondents (40.0%) with 10 respondents
(66.7%) in the treatment group and 6 respondents (40%) in the control group.
The level of education also determines a person's ability to understand the
knowledge obtained; that is, the higher a person's education level, the easier
it is for a person to accept the information obtained (Ahdiah & Arofiati, 2020). Knowledge of a person in preventing both short-term and
long-term complications can improve the quality of life.
The work of respondents in the treatment group was dominated by
entrepreneurs, namely 14 respondents (46.7%), with 6 respondents (40%) in the
treatment group and 8 respondents (53.3%) in the control group. The type of
work the respondent indirectly describes his physical activity. Physical
activity can control blood sugar. In people with light physical activity, it
causes food substances that enter the body not to be burned but stored in the
body as fat and sugar, which can cause type 2 DM (Ahdiah & Arofiati, 2020). Respondents who do a light physical activity can increase
insulin sensitivity and can reduce DM complications that can affect their
quality of life
Average Quality of Life (QOL) of DM Patients in the
Intervention Group (N=30)
Table 2. Average Quality of Life
(QOL) of DM Patients in the Intervention Group (N=30)
|
Variable
|
Means
|
std. Dev
|
Min
|
Max
|
|
Quality of
life of DM patients in the intervention group (pretest)
|
27.3
|
3.19
|
20
|
33
|
|
Quality of
life of DM patients in the intervention group (posttest)
|
49.2
|
4.84
|
39
|
57
|
Table 2 shows that in the intervention group,
before the action, respondents' average quality of life was 27.3, with a standard
deviation of 3.19, a minimum value of 20 and a maximum of 33. After the action,
respondents' average quality of life was 49.2, with a standard deviation of
4.84. with a minimum value of 39 and a maximum of 57.
Improving the quality of life in
the treatment group is influenced by the provision of structured education and
is given in stages to patients. One education that can be given to patients
with type 2 diabetes mellitus is Diabetes Self Management Education and Support
(DSME/S). DSME/S is a program designed to provide health for patients,
knowledge, family support, financial status, medical history, and other factors
that affect patient activities in carrying out self-care (Rahayu, 2014).
DSME/S is given in the form of
discharge planning. Discharge planning is anticipating and planning needed by
patients and their families after returning home to carry out comprehensive
health care. It is carried out in every patient care plan (Fitriani et al., 2019). DSME/S supports patient decision-making and self-care so that
patients experience increased knowledge, attitudes, and behaviour. This
increase will encourage patients to manage and manage DM independently.
Patient self-care will affect the
quality of life of DM patients. Self-care is an action that aims to control
diabetes, including treatment and prevention of complications (Nolasco-rodr�guez et al., 2022). Complications due to the patient's inability to carry out
self-care impact decreasing the quality of life. Factors from family support
also influence the improved quality of life because the DSME/S involves the
family.
Average Quality of Life (QOL) of DM patients in the
control group (N=30)
Table 3. Average Quality of Life
(QOL) of DM Patients in the Control Group (N=30)
|
Variable
|
Means
|
std. Dev
|
Min
|
Max
|
|
Quality of
life of DM patients in the control group (pretest)
|
36.6
|
3.95
|
26
|
44
|
|
Quality of
life of DM patients in the control group (posttest)
|
24.2
|
1.84
|
24
|
38
|
In table 3, it is found that in the control group, before the action, the
average quality of life of the respondents was 36.6 with a standard deviation
of 3.95 with a minimum value of 26 and a maximum of 44. After the action, the
average quality of life of the respondents was 24.2, with a standard deviation
of 1.84; the minimum value is 24, and the maximum is 38.
Respondents
in the control group were not given DSME/S education, and respondents carried
out activities according to treatment procedures at Curup PK by being given
leaflets routinely given to respondents who went to PKM Curup for treatment.
Respondents in this study experienced an increase in quality of life due to
receiving information about diet and examination methods from health workers,
although not in detail, only in the form of information on taboos and
recommendations for eating (Ahdiah & Arofiati,
2020).
This freedom
of information can also be obtained from other type 2 DM sufferers in the same
treatment room to exchange information. The difference in the quality of life
between hospitalized and non-hospitalized patients is influenced by medical and
psychological factors. In hospitalized patients, the quality of life will be
affected by medical factors, including stress due to the burden of self-care
and the threat of complications that can reduce the quality of life of type 2
DM patients (Hulya Parildar, Ozlem
Cigerli, 2015).
Disease-related
stress caused by continuous self-care burdens can lead to low self-care for
patients, impacting their quality of life (Waleed M Sweileh, Hanadi M
Abu-Hadeed, Samah W Al-Jabi, 2014). For patients who are not hospitalized, their quality of life
will be influenced by psychological factors. Psychological factors such as
daily stressors, anger, hostility, and social support are closely related to
the patient's blood sugar levels. Daily stress, originating from daily events
and stress related to diabetes, affects the quality of life of type 2 DM
patients (Ekayasa, 2017).
Differences in Average Quality of Life (QOL) of DM Patients Before and
After Intervention in Kab. Rejang Lebong Year 2022 (n=30)
Table 4. Differences in
Average Quality of Life (QOL) of DM Patients
Before and After Treatment in
Kab. Rejang Lebong Year 2022 (n=30)
|
Variable
|
Means
|
Men
difference
|
|
Pretest
|
Posttest
|
|
Quality of
life of DM patients in the intervention group
|
27.46
|
44.93
|
17,47
|
|
Quality of
life of DM patients in the control group
|
36.46
|
43.86
|
7,41
|
Table 4 shows that
DM patients' average quality of life in the intervention group before DSME
assistance was 27.46, with a posttest value of 44.93 and a mean difference of
17.47. Meanwhile, in the control group, the mean pretest quality of life was
36.46, with a posttest value of 43.86 and a mean difference of 7.41.
Effect of Diabetes Self Management Education (DSME) on
Quality of Life (QOL) of Diabetes Mellitus (DM) Patients in Kab. Rejang Lebong.
Table
5. Effect of Diabetes Self Management Education (DSME)
�on Quality of Life (QOL) of DM Patients in
Kab. Rejang Lebong (n=30)
|
Variable
|
Means
|
Std. Dev
|
t
|
sign
|
|
DM
patient's quality of life
|
36.20
|
10.79
|
1.39
|
0.00
|
Based on Table 5. the
mean value of quality of life for DM patients is 36.20 with a standard
deviation of 10.79, and the Sig value is 0.000 <0.05. This shows that after
the intervention, there is an increase in the quality of life of DM patients by
36.20; it can be concluded that there is an effect of Diabetes Self-Management
Education (DSME) on the Quality of Life of Diabetes Mellitus (DM) Patients in
Kab. Rejang Lebong Year 2022.
These results indicate that the
value of quality of life in the treatment group is higher than in the control
group. Education is essential for patients to change their behaviour and manage
DM independently. The role of nurses as educators for patients helping patients
to increase their knowledge by providing self-care knowledge that can be
carried out by patients and their families (Utama et al., 2021).
Respondents in this study
experienced an increase in quality of life after being given DSME/S. DSME/S is
given in the form of discharge planning to patients to increase knowledge about
DM and increase patient skills in self-care independently. Patients and their
families at home can carry out this independent management of diabetes. The
advantage given by DSME/S is that it involves the family in it. This form of
ongoing support or ongoing support for DSME/S requires the community to support
the self-management behaviour of diabetes clients in daily life (Andriyanto et al., 2021).
DSME/S implementation is given in
stages, with 4 sessions at PKM and 2 sessions at the patient's home. There was
an increase in the quality of life in the control group because patients
received health education. At the same time, they were hospitalized at the
hospital. This is
due to obtaining information about diet and methods of examination from health
workers in the form of information on taboos and recommendations for eating (Nkomani et al., 2021).
CONCLUSION
Based on the results of this study, it was
found that there was an effect of Diabetes Self-Management Education (DSME) on
the Quality of Life of Diabetes Mellitus (DM) Patients in Kab. Rejang Lebong
Year 2022. The quality of life in the treatment group is higher than in the
control group. Education is essential for patients to change their behaviour
and self-management independently to improve the quality of life of DM
patients.
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