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Slide 2 :
The number of people with diabetes mellitus from year to year continues to increase. In
Indonesia, based on 2018 Riskesdas data shows an increasing number of people diagnosed
with diabetes mellitus from 6.9% in 2013 to 8.5% in 2018

Slide 3 :
Of the four of diabetes mellitus management, according to Forouhi Nita et al (2018) diet
management is a major and important component in controlling blood sugar levels to prevent
cardiovascular complications

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The level of knowledge of people with diabetes mellitus especially about diet management still
varies and is significantly influenced by the level of education (Formosa & Muscat, 2016), age
(Karaouil et al, 2018), and education about the diabetes diet (Haryono et al., 2018). Patients
with diabetes mellitus need to be educated appropriately about the need to maintain regular
eating time, calorie counts, and types of food. The choice of food and the type of diet adopted
by people with diabetes mellitus is closely related to his knowledge of the recommended diet
(Sami et al, 2017)

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Based on WHO data (2016) of the world's adult population of around 1.9 billion, 39% are
overweight and 13% are obese. According to Bhupathiraju & Hu (2016) 85.2% of people with
type 2 diabetes mellitus are classified as overweight or obese

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Indicators that can be used in determining obesity are using BMI, RLPP and waist
circumference. BMI is considered less sensitive in determining obesity because it has a
weakness that BMI is unable to measure the distribution of fat tissue in the body (Tenta,
Martalena, & Yayuk, 2010). While the RLPP measurement results are considered more accurate
in determining the distribution of fat tissue in the body especially in the abdomen
(Shivaprakash et al., 2011; Tilaki & Heidari, 2015; Patil et al., 2015). Determination of obesity
based on RLPP uses a cut-off point in men ≥0.90 while in women ≥0.85, if it exceeds the cut-
off point then it is considered obese

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The unavailable of obesity measurements using the hip waist circumference indicator in the
“Unit Pelayanan Diabetes Terpadu (UPDT)” of the RSUP Persahabatan Jakarta in Jakarta and
research on the relationship between diabetes management knowledge management with
WHR, so researchers are interested in doing this research. This research will look for the
relationship between the level of knowledge of diet management with the WHR in patients with
type 2 diabetes mellitus.

Slide 8:
This research uses a cross-sectional approach in 141 people with type 2 diabetes mellitus
selected by non probability sampling sampling using consecutive sampling techniques. This
research uses univariate and bivariate data analysis. Bivariate analysis was performed with a
chi square test to see the relationship between the level of dietary knowledge management
with the ratio of hip circumference in patients with type 2 diabetes mellitus

Slide 9:
Data collection tools used are questionnaires from previous studies that have been tested for
validity and reliability and with a meter measuring instrument with a precision of 0.1 cm brand
Butterfly®. This research has been through the ethical review process and was declared to
have passed the ethical review by the Research Ethics Committee of the Faculty of Nursing,
University of Indonesia

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The results of this research regarding the characteristics of respondents found the average
length of suffering from diabetes 6 years, the majority aged 55-64 years, with female sex
(64.5%), originating from the Javanese tribe (34%), the last High School education was 56
patients (39, 7%), the majority had received education about the management of the diabetes
mellitus diet before as many as 132 respondents (93.6%), and people with type 2 diabetes
mellitus have a hip waist circumference ratio above the cut-off point (70.2%)

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This table shows the results of the analysis of the relationship between the level of dietary
management knowledge with the hip waist circumference ratio, the results show that diabetics
who have a high level of dietary management knowledge with WHR below the cut-off point are
25 (75.8%). There were 22 respondents (91.7%) who had WHR values above the cut-off point
with a lack of dietary management knowledge. Chi Square Test results concluded there is a
relationship between the level of dietary management knowledge with the hip waist
circumference ratio because p <0.05 (p = 0.000).

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Characteristics of respondents in this research include age, gender, ethnicity, last education,
long suffering from diabetes, diabetes education prior education. In this research found the
majority of respondents aged in the range 55-64 years (41.8%). The results of this research
also support the 2018 Riskesdas data which reports that the highest prevalence of diabetes
mellitus is in the age range of 55-64 years (6.3%), followed by 65-74 years (6%), and ages 45-
54 years (3, 9%). According to Suastika, Pande, Made, & Tuty (2012) the increasing number of
elderly populations worldwide and longer survival can have an impact on the number of
metabolic diseases including type 2 diabetes mellitus also increasing. Decreased function of
pancreatic cells in producing the hormone insulin occurs with increasing age so that it can be a
risk factor for type 2 diabetes mellitus

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Based on cross-tabulation between age and level of diabetes diet management knowledge, the
obtained data that respondents aged 25-34 years have high knowledge as much as 50% of a
total of 2 respondents and none are knowledgeable low. At the age of 75 years, the majority
(85.7%) of the 7 respondents are knowledgeable and none are highly knowledgeable. Research
conducted by Dwipayanti (2015) found that the majority of respondents aged over 35 years
who had low knowledge about diet were 88.3%. According to Dwipayanti (2015) this is due to
the thought process that is owned by elderly respondents has decreased in terms of
remembering and receiving something new so that it will affect the decline in the respondent's
own knowledge. Age can affect the development of a person's ability to catch, the more a
person ages, the process of mental development is also getting better, but at a certain age,
increasing the process of mental development is not as fast as when someone was a teenager.
This is consistent with the results of research conducted by Islam et al. (2014) said that
diabetics under the age of 35 have a higher level of knowledge compared to those aged ≥ 65
years

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The results of this research show that the majority are female (64.5%). These results support
the data from the 2018 Riskesdas which states that the prevalence of diabetes mellitus in
Indonesia by sex is greater in women (1.8%) compared to men (1.2%). However, based on IDF
data (2017) the prevalence of diabetes mellitus in the world in women aged 20-79 years is
8.4% which is lower when compared to the prevalence in men which is 9.1%. This is also in line
with the opinion of Leslie et al (2013) which states that men have a higher prevalence
compared to women. This difference can be caused because diabetics who are female sexes in
the community have a higher life expectancy when compared to men (Leslie et al, 2013). BPS
(2011) also shows data that the life expectancy of women in Indonesia is higher than that of
men, which is 72.6 years.

Based on the results of cross-tabulation between sex with the level of diabetes diet
management knowledge obtained data that male respondents who have a high level of
knowledge about diabetes diet management as much as 32% of 50 male respondents and
female respondents there are 18.7% who have high knowledge of 91 female respondents. The
level of knowledge about diet management is low in men as much as 12% of the total 50 male
respondents, while the knowledgeable female respondents are as low as 19.8% of the total of
91 female respondents. According to the results of research conducted by Islam et al. (2014)
found that men with diabetes mellitus had a higher level of knowledge compared to women.
Effect of sex on knowledge in Islam et al. (2014) due to past social trends that more women
were less educated than men and perhaps this will experience a shift in the years to come.

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The majority of respondents in this study are Javanese (34%). This can be caused by the
proportion of Javanese tribes which are the largest ethnic groups in Indonesia. Based on data
from the Central Statistics Agency of hundreds of ethnic groups in Indonesia, the proportion of
Javanese is the largest proportion, namely 40.05% of the total population of Indonesia
(www.bps.go.id). Holmes et al (2012); Begic et al (2016), and also ADA (2015) stated that
ethnicity is a risk factor for diabetes mellitus. Ethnicity or race was related to the selection of
certain types of food in accordance with their customs (Ettner et al, 2009).

Based on the results of cross-tabulation between ethnic groups with the level of knowledge of
diabetes diet management, the results show that there is no difference in the level of
knowledge between ethnic groups. The highest level of knowledge about the management of
the diabetic diet is the Sundanese 32% of the total 25 respondents, the Javanese in the second
sequence that is 27.1% of 48 respondents. Ali, Jarrar, El Sadig, & B. Yeatts (2013) in their
research stated that there was no difference in the level of dietary knowledge in diabetes
mellitus women from several ethnic groups at the United Arab Emirates

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The education level of respondents in this study mostly graduated from high school, namely 56
people (39.7%). According to the 2018 Riskesdas data the prevalence of diabetes mellitus
based on doctor's diagnosis varies at each level of education. The prevalence of diabetes
mellitus who graduated from high school ranks third at 1.6% below the prevalence of diabetics
who graduated from college (2.8%) and graduated from elementary school (1.8%). This can
happen because people with diabetes mellitus with high education tend to do more health
checks to health facilities (Huang, Zhao, Li, & Jiang, 2014). In line with that according to
Stanhope & Lancster (2014) said that someone who has a low level of knowledge tends to have
a low awareness also in improving health status and in the use of health services.

Based on the results of cross-tabulation between education with the level of knowledge of
diabetes diet management, the results showed that respondents who have never attended
school and have a low level of knowledge are 37.5% of 8 respondents and none are highly
knowledgeable. While respondents who graduated from D1-D3 or Higher Education who have a
low level of knowledge are only 5.3% of 38 respondents. A person's level of education is related
to his ability to understand the information obtained into knowledge (Boakye et al., 2018). The
higher level of education a person will have the skills to use the information obtained through
various media compared to someone who has low education (Abbasi et al., 2018).

Slide 19:
The results of this study indicate that the majority of people with diabetes mellitus have
received education about diet for diabetes mellitus in the amount of 93.6%. At this research
location, each newly diagnosed patient is always given education about diet management by
the nutrition department. In this study there were 6.4% of people with diabetes mellitus who
had not received nutritional education because patients had first come to an integrated
diabetes service unit or because of a referral from another hospital
Based on the hypothesis test conducted to determine the relationship of the level of dietary
management knowledge with the hip waist circumference ratio in patients with type 2 diabetes
mellitus using bivariate analysis of chi square test where it was found that the p value of the
analysis was 0,000. P value <0.05, it can be concluded that there is a significant relationship
between the level of dietary management knowledge with the hip waist circumference ratio in
patients with type 2 diabetes mellitus

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Conclusion