42

Chapter 3

RESULTS AND DISCUSSION

This chapter discussed the results of research on

self-care behaviors of patients diagnosed with diabetes

mellitus as a basis for a counseling program in Labuang

Baji and Pelamonia Hospital. Besides, it also discussed

about implication of results of research to nursing and

limitations of research.

Profile Diabetes Mellitus Patients. In this case, it

presented about the presentation and discussion of results

on the profile of diabetes mellitus patients. The profile

of diabetes mellitus patients includes age, gender, and

history of smoking which interpreted frequency and

percentage distribution (%). And then, weighted mean (M)

will be used to describe the blood sugar level, BMI and

self-management degree.

The first, in this below is interpretation frequency

and percentage distribution (%) age of diabetes mellitus

patients in Labuang Baji and Pelamonia Hospital as follow:

 43

Table 2. Interpretation Age of Diabetes Mellitus Patients

Age Frequency Percentage (%)
Less than equal 45 years old 28 38.9%
More than 45 years old 44 61.1%
Total 72 100%

The result of the research in table 2 shows that the

age of respondents in 2 hospitals is found excessively more

than 45 years old. Ages more than 45 years old are 44

respondents with a percentage 61.1%. Meanwhile, ages less

than equal 45 years old are 28 respondents with a

percentage 38.9%. Thus, this indicated that the concepts

and results of this study are aligned.

Conceptually, DM patients experienced the highest

number of cases occurred in the age range of the elderly by

age group based on the Ministry of Health Republic

Indonesia (2009) ranging from 46 years to 55 years as many

as 22 people respondent (50%)(Depkes RI, 2008). This data

is consistent with statements from the American Diabetes

Association (ADA), that age above 45 years is one of the

risk factors for type 2 diabetes (ADA, 2008).

In addition, according to Perkeni (2006) the risk of

developing type 2 diabetes mellitus increases with age. In

addition, a number of changes will occur with age,

including anatomy, physiology, psychology and sociology.

Califano suggests that age is one of the risk factors for

 44

health problems such as DM disease. Incidence of DM disease

increases with age.

The second, in this below is interpretation frequency

and percentage distribution (%) gender of diabetes mellitus

patients in Labuang Baji and Pelamonia Hospital as follow:

Table 3. Interpretation Gender of Diabetes Mellitus

Patients
Gender Frequency Percentage (%)
Male 25 34.7%
Female 47 65.3%
Total 72 100%

The result of the research in table 3 shows that the

gender of respondents in 2 hospitals is found excessively

female. Because, female is 47 respondents with a percentage

65.3%. Meanwhile, male is 25 respondents with a percentage

34.7%. Thus, this indicated that the concepts and results

of this study are aligned.

Conceptually, results of research conducted by Koja

Hospital stated that the prevalence of type 2 diabetes

mellitus that occurs in women is 62%, greater than the

prevalence in men (Santoso et al, 2004). According Joshlin

(1985) that women are more susceptible to type 2 diabetes

mellitus with a ratio of women and men were 1.8: 1. This is

in line with the research presented by Azrul Azwar which

 45

stated that there are variations in the prevalence of type

2 diabetes mellitus among men and women in some areas

(Azwar, 1985). Furthermore, Sucipto & Rosa (2014) stated

respondents consisted of 59.1% female sex and 40.9% male

sex.

The third, in this below is interpretation frequency

percentage distribution (%), and weight mean blood sugar

level of diabetes mellitus patients in Labuang Baji and

Pelamonia Hospital as follow:

Table 4. Interpretation Blood Sugar Level of Diabetes

Mellitus Patients
Percentage Weight
Blood Sugar Level Frequency
(%) Mean
Below 200 mg/dl 19 26.4%
200 mg/dl or more 53 73.6% 281.13
Total 72 100%

The result of the research in table 4 shows that the

blood sugar level respondents in 2 hospitals is found

excessively more than 200 mg/dl. Blood sugar level more

than 200 mg/dl are 53 respondents with a percentage 73.6%.

Meanwhile, blood sugar level less than equal 200 mg/dl are

19 respondents with a percentage 26.4%. In addition, the

weighted mean blood sugar level respondents in 2 hospitals

are 281.13 mg/dl. Thus, this indicated that the concepts

and results of this study are aligned.

 46

Conceptually, diabetes is a serious life-long health

condition that occurs when the amount of glucose (sugar) in

the blood is too high because the body can’t use it

properly. If left untreated, high blood glucose levels can

cause serious health complications (Diabetes UK, 2017).

In addition, diabetes mellitus is a descriptive term

for a family of disorders that are characterized by chronic

carbohydrate intolerance (fasting and/or post-prandinal

hyperglycemia) and the development of long-term medical

complications (Winter & Signorino, 2002).

The fourth, in this below is interpretation frequency

percentage distribution (%), and weight mean body mass

index of diabetes mellitus patients in Labuang Baji and

Pelamonia Hospital as follow:

Table 5. Interpretation Body Mass Index of Diabetes

Mellitus Patients
Percentage Weight
Body Mass Index Frequency
(%) Mean
Underweight 3 4.2%
Normal weight 29 40.3%
Overweight 19 26.4% 26.35
Obese 21 29.2%
Total 72 100%

The result of the research in table 5 shows that the

body mass index respondents in 2 hospitals is found

excessively normal weight. Body mass index underweight is 3

respondents with a percentage 4.2%. In addition, body mass

 47

index normal weight is 29 respondents with a percentage

40.3%. Moreover, body mass index overweight is 19

respondents with a percentage 26.4%. Meanwhile, body mass

index obese is 21 respondents with a percentage 29.2%.

Furthermore, the weighted mean body mass index respondents

in 2 hospitals are 26.35. Thus, this indicated that the

concepts and results of this study are not aligned.

Conceptually, BMI is often used as a screening tool to

decide if patient’s weight might be putting patient at risk

for health problems such as diabetes, heart disease, and

cancer (American Cancer Society, 2016).

According to Guyton's theory, obesity is a

predisposing factor for the rise in blood sugar levels,

this is because the Langerhans island beta cells become

less sensitive to stimuli or as a result of elevated levels

of sugar and obesity will also suppress the amount of

insulin receptors in cells whole body (Guyton & Hall,

2007).

Purwandari (2014) claimed obesity in employees at RS

Level IV Madiun showed that almost half (42%) is 17

respondents. In addition, blood sugar levels in employees

at Madiun Hospital showed that almost half (35%) had

between 111-140 mg / dL of 14 respondents. Furthermore,

there is an association of obesity with blood sugar levels

 48

in the employees of RS Level IV Madiun, in other words the

higher the value of body mass index (obesity), the higher

the level of blood sugar.

In addition, obesity is the etiology of diabetes

mellitus so that experienced by patients before diabetes

mellitus. However, after suffering from diabetes, diabetes

mellitus patients sustained lose weight. Whereas, the

patients in this study who already had diabetes mellitus.

As well, patients who suffer from obesity have been reduced

to normal weight and even underweight. This is in line with

Magee’s theory (2004) which stated diabetes type 2 is

metabolic interference cause by inability body to use

insulin appropriately. This interference occurred when body

resulted plentiful insulin, but insulin cannot perform its

duty. Because of pancreas made more insulin while blood

glucose increased which more available for diabetes

mellitus patients with obesity; in addition, activity of

pancreas more strive in the course of long period. Thus,

body cells became resistance insulin. It means, diabetes

mellitus patients who before obesity would encounter

metabolic interference so that caused diabetes mellitus

patients had normal weight or underweight.

The fifth, in this below is interpretation frequency

and percentage distribution (%) history of smoking diabetes

 49

mellitus patients in Labuang Baji and Pelamonia Hospital as

follow:

Table 6. Interpretation History of Smoking Diabetes

Mellitus Patients
History of Smoking Frequency Percentage (%)
Yes 19 26.4%
No 53 73.6%
Total 72 100%

Table 7. Interpretation History of Smoking Male Respondents

of Diabetes Mellitus Patients
History of Smoking Male
Frequency Percentage (%)
Respondents
Yes 19 76%
No 6 24%
Total 25 100%

The result of the research in table 6 shows that the

history of smoking respondents in 2 hospitals is found

excessively do not smoke. Because, respondents who had

history of smoking is 19 respondents with a percentage

26.4%. Meanwhile, respondents who had not history of

smoking is 53 respondents with a percentage 73.6%. Thus,

this indicated that this study found that 26.4% experienced

who had history of smoking. Furthermore, researcher

interpretation history of smoking male respondents caused

all of them are male respondents.

The result of the research in table 7 shows that the

history of smoking male respondents in 2 hospitals is found

 50

excessively smoke. Because, respondents who had history of

smoking is 19 respondents with a percentage 76%. Meanwhile,

respondents who had not history of smoking is 6 respondents

with a percentage 24%. Thus, this indicated that the

concepts and results of this study are aligned.

Conceptually, in accordance with Hillson (2015)

claimed people with diabetes who smoke have at least the

same risk of morbidity and mortality as non-diabetics who

smoke, probably greater. Give smokers support in stopping-

stop smoking groups/courses. Vigorously discourage young

people with diabetes from starting smoking. Nicotine may

alter the rate of insulin absorption, so monitor glucose

after stopping.

If patients have diabetes, patients have to work hard

enough already to keep patient’s blood sugar in check.

Smoking can make that task even more difficult. Smoking may

make patient’s body more resistant to insulin, which can

lead to higher blood sugar levels (Pletcher, 2016).

In addition, according to Patja et al (2005) examined

the association of cigarette smoking with the risk of type

2 diabetes and to find out whether the association is

modified by obesity and physical activity. Smoking had a

graded association with the risk type 2 diabetes, and it

remained significant after controlling for age and major

 51

risk factors. Smoking increased the risk of type 2 diabetes

at all levels of BMI and physical activity.

Smoking is a risk factor for type 2 diabetes

independently of BMI and physical activity. Prevention of

smoking should be encouraged as a part of efforts to reduce

the risk of type 2 diabetes, and it will result in other

health benefits, too (Patja et al, 2005).

The sixth, in this below is interpretation frequency

percentage distribution (%), and weight mean self-

management scores of diabetes mellitus patients in Labuang

Baji and Pelamonia Hospital as follow:

Table 8. Interpretation Self-Management Scores of Diabetes

Mellitus Patients
Percentage Weight
Self-Management Scores Frequency
(%) Mean
Very high degree 9 12.5%
High degree 9 12.5%
Moderate degree 15 20.8% 4.9781
Low degree 39 54.2%
Total 72 100%

The result of the research in table 8 shows that the

self-management scores respondents in 2 hospitals is found

excessively low degree. Self-management scores very high

degree is 9 respondents with a percentage 12.5%. In

addition, self-management scores high degree is 9

respondents with a percentage 12.5%. Moreover, self-

management scores moderate degree is 15 respondents with a

 52

percentage 20.8%. Meanwhile, self-management scores low

degree is 39 respondents with a percentage 54.2%.

Furthermore, the weighted mean body mass index respondents

in 2 hospitals are 4.9781. Thus, this indicated that the

concepts and results of this study are aligned.

Conceptually, according to Schmitt et al. (2013)

stated patients with good glycaemic control reported

significantly more glucose management, dietary control,

physical activity, and health-care use than those with poor

control. Furthermore, to assess self-care activities

associated with glycaemic control was developed, based on

theoretical considerations and a process of empirical

improvements that is four subscales, glucose management,

dietary control, physical activity, and health-care use.

The goal of blood glucose management is to keep

patient’s blood glucose levels in the target range that

prevents complications and helps patient feel the best.

Therefore, it is important to know how to identify blood

glucose problems, respond appropriately, and take action to

prevent in the future (May & Fletcher, 2012).

Self-Management Scores. In this case, it presented

about the presentation and discussion of results on the

degree of manifestation of the self-management behaviors of

the participants in terms of glucose management, dietary

 53

control, physical activity, and health-care use which

interpreted frequency, percentage distribution (%) and

weighted mean (M).

The first, in this below is interpretation frequency,

percentage distribution (%), and weighted mean glucose

management of diabetes mellitus patients in Labuang Baji

and Pelamonia Hospital as follow:

Table 9. Interpretation Glucose Management of Diabetes

Mellitus Patients
Percentage Weight
Glucose Management Frequency
(%) Mean
Very high degree 12 16.7%
High degree 9 12.5%
Moderate degree 12 16.7% 4.9072
Low degree 39 54.2%
Total 72 100%

The result of the research in table 9 shows that the

glucose management respondents in 2 hospitals are found

excessively low degree. Glucose management very high degree

is 12 respondents with a percentage 16.7%. In addition,

glucose management high degree is 9 respondents with a

percentage 12.5%. Moreover, glucose management moderate

degree is 12 respondents with a percentage 16.7%.

Meanwhile, glucose management low degree is 39 respondents

with a percentage 54.2%. Furthermore, the weighted mean

body mass index respondents in 2 hospitals are 4.9072.

 54

Thus, this indicated that the concepts and results of this

study are aligned.

Conceptually, the goal of blood glucose management is

to keep patient’s blood glucose levels in the target range

that prevents complications and helps patient feel the

best. Therefore, it is important to know how to identify

blood glucose problems, respond appropriately, and take

action to prevent in the future (May & Fletcher, 2012).

The second, in this below is interpretation frequency,

percentage distribution (%), and weighted mean dietary

control of diabetes mellitus patients in Labuang Baji and

Pelamonia Hospital as follow:

Table 10. Interpretation Dietary Control of Diabetes

Mellitus Patients
Percentage Weight
Dietary Control Frequency
(%) Mean
Very high degree 13 18.1%
High degree 4 5.6%
Moderate degree 19 26.4% 4.7342
Low degree 36 50.0%
Total 72 100%

The result of the research in table 10 shows that the

dietary control respondents in 2 hospitals are found

excessively low degree. Dietary control very high degree is

13 respondents with a percentage 18.1%. In addition,

dietary control high degree is 4 respondents with a

 55

percentage 5.6%. Moreover, dietary control moderate degree

is 19 respondents with a percentage 26.4%. Meanwhile,

dietary control low degree is 36 respondents with a

percentage 50.0%. Furthermore, the weighted mean body mass

index respondents in 2 hospitals are 4.7342. Thus, this

indicated that the concepts and results of this study are

aligned.

Furthermore, the beneficial effect of the dietary

pattern on diabetes mellitus and glucose metabolism in

general and traditional food pattern was associated with a

significant reduction in the risk of developing type-2

diabetes. The dietary pattern emphasizes a consumption of

fat primarily from foods high in unsaturated fatty acids,

and encourages daily consumption of fruits, vegetables, low

fat dairy products and whole grains, low consumption of

fish, poultry, tree nuts, legumes, very less consumption of

red meat (Bannard et al, 2005).

In accordance with Suhaema et al (2010) stated the

prevalence of diabetes mellitus (DM) is increasing

globally, including in Indonesia. Studies by Diabetes

Control and Complication Trial (DCCT) and U.K. Prospective

Diabetes Study Group (UKPDS) prove the benefit of medical

nutrition therapy (MNT) to glycemic control. Intake of

nutrient, nutrition status, blood glucose level and blood

 56

pressure of type 2 DM patients that got MNT was more

controllable than of those that got conventional nutrition

counseling.

The third, in this below is interpretation frequency,

percentage distribution (%), and weighted mean physical

activity of diabetes mellitus patients in Labuang Baji and

Pelamonia Hospital as follow:

Table 11. Interpretation Physical Activity of Diabetes

Mellitus Patients
Percentage Weight
Physical Activity Frequency
(%) Mean
Very high degree 6 8.3%
High degree 14 19.4%
Moderate degree 12 16.7% 4.8915
Low degree 40 55.6%
Total 72 100%

The result of the research in table 11 shows that the

physical activity respondents in 2 hospitals are found

excessively low degree. Physical activity very high degree

is 6 respondents with a percentage 8.3%. In addition,

physical activity high degree is 14 respondents with a

percentage 19.4%. Moreover, physical activity moderate

degree is 12 respondents with a percentage 16.7%.

Meanwhile, physical activity low degree is 40 respondents

with a percentage 55.6%. Furthermore, the weighted mean

body mass index respondents in 2 hospitals are 4.8915.

 57

Thus, this indicated that the concepts and results of this

study are aligned.

Conceptually, physical activity includes all movement

that increases energy use, whereas exercise is planned,

structured physical activity. Exercise improves blood

glucose control in type 2 diabetes, reduces cardiovascular

risk factors, contributes to weight loss, and improves

well-being (Lin et al, 2015).

In addition, increasing physical activity can reduce

the risk of type 2 diabetes. The protective effect of

physical activity was observed in subjects with an

excessive BMI and elevated glucose levels. Physical

activity and weight control are critical factors in

diabetes prevention in subjects with both normal and

impaired blood glucose regulation (Hu et al, 2004).

Furthermore, the researcher found alteration lifestyle

of activity pattern. In the past, people had strived at

work; nevertheless, nowadays people used machine to work.

And then, intake food pattern was nothing alteration such

as high calorie. In the other words, high calorie high

activity became high calorie low activity. It means lot of

calorie is not burning in the body caused diabetes mellitus

disease.
 58

The fourth, in this below is interpretation frequency,

percentage distribution (%), and weighted mean health-care

use of diabetes mellitus patients in Labuang Baji and

Pelamonia Hospital as follow:

Table 12. Interpretation Health-Care Use of Diabetes

Mellitus Patients
Percentage Weight
Health-Care Use Frequency
(%) Mean
Very high degree 5 6.9%
High degree 6 8.3%
Moderate degree 27 37.5% 5.2008
Low degree 34 47.2%
Total 72 100%

The result of the research in table 12 shows that the

health-care use respondents in 2 hospitals are found

excessively low degree. Health-care use very high degree is

5 respondents with a percentage 6.9%. In addition, health-

care use high degree is 6 respondents with a percentage

8.3%. Moreover, health-care use moderate degree is 27

respondents with a percentage 37.5%. Meanwhile, physical

activity low degree is 34 respondents with a percentage

47.2%. Furthermore, the weighted mean body mass index

respondents in 2 hospitals are 5.2008. Thus, this indicated

that the concepts and results of this study are aligned.

Conceptually, in accordance with Williams et al (1998)

applied the self-determination theory of human motivation

 59

to examine whether patient perceptions of autonomy

supportiveness (i.e., patient centeredness) from patient’s

diabetes care providers related to improved glucose control

over a 12-month period. Support the prediction of the self-

determination theory that patients with diabetes whose

health care providers are autonomy supportive will become

more motivated to regulate patient’s glucose levels, feel

more able to regulate patient’s glucose, and show

improvements in patient’s HbA1c values.

Cross Tabulation. In this time, the researcher assess

about significant difference in the self-management

behaviors of the participants when grouped according to

profile variables, such as age, gender, blood sugar levels,

body mass index, and history of smoking.

The first, the researcher appears cross tabulation of

age towards self-management behaviors of the participants

as follows below:
 60

Table 13. Cross Tabulation Age towards Self-Management

Behaviors of the Participants
Self-Management Behaviors
Very
Variable High Moderate Low N
high
Degree Degree Degree
degree
≤45
0 4 7 17 28
years
(0.0%) (14.3%) (25.0%) (60.7%) (100%)
old
Age
>45
9 5 8 22 44
years
(20.5%) (11.4%) (18.2%) (50.0%) (100%)
old
9 9 15 39 72
Total
(12.5%) (12.5%) (20.8%) (54.2%) (100%)
P-value = 0,035

In the table 13, it shows there is a significant

difference in the self-management behaviors of the

participants when grouped according to age with p-value

0.035 through Kruskal-Wallis Test. In addition, it shows

also less than equal 45 years old respondents with self-

management behaviors low degree are 60.7%; meanwhile, more

than 45 years old respondents with self-management

behaviors low degree are 50.0%. In other words, age within

less than equal 45 years old more excessively than above 45

years old. It indicates young people less than equal 45

years old have more self-management behaviors low degree

than above 45 years old. During observation and interview,

respondents who are less than equal 45 years old said busy

with their job, do not aware about their health, and never

consult their health to physicians. Furthermore,

 61

respondents who are above 45 years old said they diagnosed

diabetes mellitus since long time years ago, and then some

of them know about self-management behaviors. So that, as a

nurse gives counseling to society is important especially

young people to aware their health whereby self-management

behaviors with healthy life style.

The second, the researcher appears cross tabulation of

gender towards self-management behaviors of the

participants as follows below:

Table 14. Cross Tabulation Gender towards Self-Management

Behaviors of the Participants
Self-Management Behaviors
Variable Very N
High Moderate Low
high
Degree Degree Degree
degree
Male 5 2 5 13 25
(20.0%) (8.0%) (20.0%) (52.0%) (100%)
Gender
Female 4 7 10 26 47
(8.5%) (14.9%) (21.3%) (55.3%) (100%)
9 9 15 39 72
Total
(12.5%) (12.5%) (20.8%) (54.2%) (100%)
P-value = 0,982

In the table 14, it shows there is no significant

difference in the self-management behaviors of the

participants when grouped according to gender with p-value

0.982 through Kolmogorov Smirnov Test. In addition, it

shows also male respondents with self-management behaviors

low degree are 52.0%; meanwhile, female respondents with

 62

self-management behaviors low degree are 55.3%. In other

words, female respondents are more excessively than male

respondents. It indicates female respondents have more

self-management behaviors low degree than male respondents.

During observation and interview, female respondents who

are self-management behaviors low degree seemed have other

risk factor which is some of them sustain obesity, do not

aware their health, never consult their health to

physicians, and minimum activity. Furthermore, male

respondents who are self-management behaviors low degree

seemed have other risk factor which is some of them sustain

history of smoking long time years ago until now, do not

aware their health caused work, and never consult their

health to physicians. So that, as a nurse, gives counseling

to society is important especially females to aware their

health whereby self-management behaviors with healthy life

style, such as glucose management, dietary control,

physical activity, and health-care use.

The third, the researcher appears cross tabulation of

blood sugar levels towards self-management behaviors of the

participants as follows below:

 63

Table 15. Cross Tabulation Blood Sugar Levels towards Self-

Management Behaviors of the Participants
Self-Management Behaviors
Variable Very N
High Moderate Low
high
Degree Degree Degree
degree
Below
9 9 0 1 19
200
(47.4%) (47.4%) (0.0%) (5.3%) (100%)
Blood mg/dl
Sugar 200
Levels mg/dl 0 0 15 38 53
or (0.0%) (0.0%) (28.3%) (71.7%) (100%)
more
9 9 15 39 72
Total
(12.5%) (12.5%) (20.8%) (54.2%) (100%)
P-value = 0,000

In the table 15, it shows there is a significant

difference in the self-management behaviors of the

participants when grouped according to blood sugar levels

with p-value 0.000 through Kruskal Wallis Test. In

addition, it shows also blood sugar levels below 200 mg/dl

respondents with self-management behaviors low degree are

5.3%; meanwhile, blood sugar levels above 200 mg/dl

respondents with self-management behaviors low degree are

71.7%. In other words, blood sugar levels below 200 mg/dl

respondents are more excessively than blood sugar levels

above 200 mg/dl respondents. It indicates blood sugar

levels above 200 mg/dl respondents have more self-

management behaviors low degree than blood sugar levels

below 200 mg/dl respondents. During observation and

interview, blood sugar levels above 200 mg/dl respondents

 64

who are self-management behaviors low degree seemed busy

with their job, do not aware their health, and never

consult their health to physicians. Furthermore, blood

sugar levels below 200 mg/dl respondents who are self-

management behaviors low degree seemed have healthy life

style although never consult health to physicians. So that,

as a nurse, gives counseling to society is important

especially blood sugar levels above 200 mg/dl respondents

to aware their health whereby self-management behaviors

with healthy life style, importantly their glucose

management.

The fourth, the researcher appears cross tabulation of

body mass index towards self-management behaviors of the

participants as follows below:

Table 16. Cross Tabulation Body Mass Index towards Self-

Management Behaviors of the Participants
Self-Management Behaviors
Variable Very N
High Moderate Low
high
Degree Degree Degree
degree
Under- 0 0 1 2 3
weight (0.0%) (0.0%) (33.3%) (66.7%) (100%)
Normal 6 8 3 12 29
Body
Weight (20.7%) (27.6%) (10.3%) (41.4%) (100%)
Mass
Over- 2 1 6 10 19
Index
weight (10.5%) (5.3%) (31.6%) (52.6%) (100%)
1 0 5 15 21
Obese
(4.8%) (0.0%) (23.8%) (71.4%) (100%)
9 9 15 39 72
Total
(12.5%) (12.5%) (20.8%) (54.2%) (100%)
P-value = 0,015
 65

In the table 16, it shows there is a significant

difference in the self-management behaviors of the

participants when grouped according to body mass index with

p-value 0.015 through Kruskal Wallis Test. In addition, it

shows also body mass index underweight respondents with

self-management behaviors low degree are 66.7%; meanwhile,

body mass index normal weight respondents with self-

management behaviors low degree are 41.4%; while, body mass

index overweight respondents with self-management behaviors

low degree are 52.6%; whereas, body mass index obese

respondents with self-management behaviors low degree are

71.4%. In other words, body mass index obese respondents

are the most excessively than others. It indicates body

mass index obese respondents have more self-management

behaviors low degree than others. During observation and

interview, body mass index obese respondents who are self-

management behaviors low degree seemed do not aware their

health, minimum activity, and never consult their health to

physicians. Furthermore, body mass index normal weight

respondents who are self-management behaviors low degree

seemed have history obesity long time years ago and then

encounter decrease weight for many years ago until now have

normal weight. So that, as a nurse, gives counseling to

society is important especially body mass index obese

 66

respondents to aware their health whereby self-management

behaviors with healthy life style, importantly their

dietary control and physical activity.

The fifth, the researcher appears cross tabulation of

history of smoking towards self-management behaviors of the

participants as follows below:

Table 17. Cross Tabulation History of Smoking towards Self-

Management Behaviors of the Participants
Self-Management Behaviors
Very
Variable High Moderate Low N
high
Degree Degree Degree
degree
3 2 2 12 19
History Yes
(15.8%) (10.5%) (10.5%) (63.2%) (100%)
of
6 7 13 27 53
Smoking No
(11.3%) (13.2%) (24.5%) (50.9%) (100%)
9 9 15 39 72
Total
(12.5%) (12.5%) (20.8%) (54.2%) (100%)
P-value = 0,985

In the table 17, it shows there is no significant

difference in the self-management behaviors of the

participants when grouped according to history of smoking

with p-value 0.985 through Kolmogorov Smirnov Test. In

addition, it shows also respondents who have history of

smoking with self-management behaviors low degree are

63.2%; meanwhile, respondents who have not history of

smoking with self-management behaviors low degree are

50.9%. In other words, respondents who have history of

 67

smoking are more excessively than respondents who have not

history of smoking. It indicates respondents who have

history of smoking have more self-management behaviors low

degree than respondents who have not history of smoking.

During observation and interview, respondents who have

history of smoking with self-management behaviors low

degree seemed all of the smokers are male respondents, do

not aware their health, do not know cigarette danger which

concern diabetes mellitus, and never consult their health

to physicians. Furthermore, respondents who have not

history of smoking with self-management behaviors low

degree seemed all of them are female respondents caused in

Indonesia females is taboo for female to smoking. So that,

as a nurse, gives counseling to society is important

especially male respondents who have history of smoking to

aware their health whereby self-management behaviors with

healthy life style, importantly know cigarette danger which

concern diabetes mellitus.

Counseling Program. The researcher suggested to the

hospital for make counseling program towards diabetes

mellitus patients. The hospital concerns to having the

counselors who are registered counselors which must have

licensed from PEDI. Perhimpunan Edukator Diabetes Indonesia

(PEDI) is Educator Diabetes Association of Indonesia who is

 68

giving education through counseling or health promotion

concern diabetes.

In addition, the researcher prompted to the hospital

also to make bed side teaching from PEDI counselors which

expert in diabetes mellitus disease. Bed side teaching will

be more knowledgeable to the diabetes mellitus patients

because the patients will be more understand about diabetes

mellitus from the expertise.

Furthermore, diabetes mellitus patients are not only

stop counseling in the hospital. But, diabetes mellitus

patients will be still undergoing counseling to the

expertise counselors PEDI. So, the counseling is never stop

although the diabetes mellitus patients at home. The

diabetes mellitus patients can still call and message the

counselors through phone or directly go to the near public

health.

In addition, the researcher suggested to the public

health for willing infrastructure especially counseling

about diabetes mellitus. One of suggest from the researcher

is support counseling program through build counselors PEDI

from health workers. So, the counselor will be more

expertise in diabetes mellitus disease. And then, diabetes

mellitus disease will be protection from beginning. So, no

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more diabetes mellitus patients experienced complications

of the diabetes mellitus disease.

Furthermore, the researcher prompted also to the

hospital for make health promotion and health education

especially diabetes mellitus disease. The health promotion

and health education which concern young people, females,

high blood sugar levels, obese, and having history of

smoking. But, the old people, male, low blood sugar levels,

normal weight, and not having history of smoking are not

close possibility for having diabetes mellitus disease

also. Finally, all of the people must to know about

diabetes mellitus disease through health promotion and

health education.

The researcher added also health promotion and health

education must to having knowledge about self-management

behaviors. Because, self-management behaviors have

important roles to changes the lifestyle society. Moreover,

the self-management behaviors include glucose management,

dietary control, physical activity, and health-care use.

Those four components are having important roles to the

diabetes mellitus patients for have lifelong in the future.