REMINDER LIFE STYLE IMPACT ON HEALTHY LIFESTYLE AND BLOOD

SUGAR LEVEL OF PATIENTS WITH TYPE 2 DIABETES IN PADIMAS

COMMUNITY SURAKARTA

Manuscript

Submitted by :
MARTINI LISTRIKAWATI
15/388302/PKU/15524

MASTER OF NURSING PROGRAM

MEDICAL FACULTY OF UNIVERSITAS GADJAH MADA
YOGYAKARTA
2017
Reminder Life Style Impact on Healthy Lifestyle and Blood Sugar Level of Patients
with Type 2 Diabetes in Padimas Community Surakarta

Martini Listrikawati1, Heny Suseani Pangastuti2, Probo Suseno 3

Program Studi Magister Keperawatan Fakultas Kedokteran Universitas Gadjah
Mada Yogyakarta 1,2 , Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta 3

ABSTRACT
According to WHO, Diabetes Mellitus in Indonesia has pravelence with 6% of total
population. Diabetes mellitus type 2 modification factor is maintain healthy lifestyle. One of
the technologically based strategy to improve healthy lifestyle control is by sending short
reminder using short message service (SMS) to patients. To observe the effect of reminder
lifestyle system to healthy lifestyle and blood sugar level stability in patients with type 2
Diabetes Mellitus within Padimas Community Surakarta. Method used in the study was quasi
experimental with pretest and posttest. Study was done between March-April 2017 in
Padimas Community Surakarta. Subjects are chosen w using consecutive sampling. Total of
62 samples used in the study including 32 in intervention group and 30 in control group.
Instrument of the study was HPLP II questionnaire for healthy lifestyle and medical record of
blood sugar level monitoring. Data analysis done using multivariate test (MANOVA).
Univariate analysis shows mean score healthy lifestyle has increase and mean score blood
sugar level has decrease. Bivariate analysis shows p<0.05 for healthy lifestyle difference
significant between intervention and control group but has not for blood sugar. Multivariate
analysis which means that reminder lifestyle has an effect on improving healthy lifestyle has
p<0,05, while blood sugar level has p>0,05 meaning reminder lifestyle didn’t affect blood
sugar level. Conclusion reminder life style improve healthy lifestyle but didn’t significantly
effective in lowering blood sugar level.

ABSTRAK
Latar Belakang: Berdasarkan data WHO di Indonesia penyakit DM mencapai pravelensi
angka 6% dari total populasi. Faktor resiko diabetes mellitus tipe 2 yang dapat dimodifikasi
adalah pola hidup sehat. Salah satu strategi berbasis teknologi untuk meningkatkan kontrol
pola hidup sehat yaitu memberikan reminder dalam bentuk Short Message Service (SMS)
kepada pasien. Saat ini belum ada suatu sistem pengingat untuk kontrol pola hidup sehat
pasien Diabetes Mellitus.
Tujuan:Tujuan dalam penelitian ini mengetahui pengaruh sistem reminder life style terhadap
pola hidup sehat dan kadar gula darah pada pasien Diabetes Mellitus tipe 2 di Paguyuban
Padimas Surakarta.
Metode: Metode yang digunakan dalam penelitian ini adalah quasy experimental dengan pre
test and post test. Penelitian ini dilaksanakan pada bulan Maret-April 2017 di Paguyuban
Padimas Surakarta. Subjek penelitian dipilih dengan metode concecutive sampling. Jumlah
sampel sebanyak 62 terdiri dari 32 kelompok intervensi dan 30 kelompok kontrol. Instrumen
menggunakan kuesioner HPLP II untuk pola hidup sehat dan rekam medis cek gula darah.
Analisa data yang digunakan adalah univariat, bivariat dan multivariat (Manova).
Hasil: Hasil analisis univariat bahwa nilai rata-rata pola hidup sehat mengalami peningkatan
sedangkan nilai rata-rata kadar gula darah mengalami penurunan. Hasil analisis bivariat
menunjukkan nilai p<0,05, artinya terdapat perbedaan pola hidup sehat sedangkan nilai kadar
gula darah menunjukkan nilai p>0,05, artinya tidak terdapat perbedaan antara kedua
kelompok. Hasil analisis multivariat menunjukkan terdapat pengaruh pola hidup sehat
dengan nilai p<0,05 tetapi tidak menunjukkan nilai signifikan dengan nilai p>0,05 pada
kadar gula darah di kedua kelompok.
Kesimpulan: Reminder life style berpengaruh terhadap peningkatan pola hidup sehat tetapi
tidak signifikan dalam menurunkan kadar gula darah.

Kata Kunci: Diabetes Mellitus tipe 2, pola hidup sehat, reminder life style, kadar gula darah.
 modification can slow down complication in
INTRODUCTION
Diabetes Mellitus..
Diabetes Mellitus (DM) is one of
Media health promotion as an effort to
incommunicable diseases that have caused
provide health education today can be through
60% of death and 40% illness worldwide.
newspapers, radio, television, leaflets,
According to IDF 2013, Indonesia was ranked
newsletters, magazines, posters, brochures and
7th out of 10 countries with most DM number
so forth. However, this media is still limited
worldwide, while Diabetes Mellitus itself is
its use.7In the current era of globalization
ranked 3rd after cardiovascular disease and
health promotion reminder system can be
cancer with 6% of total population. In the era
done through SMS Gateway Server as a
of Sustainable Development Goals, among the
Promotional SMS message. Opportunities use
main targets are ensuring healthy lives and
of cellular mobile technology (mHealth) as a
promoting well-being for all at all ages.
health promotion strategy is expected to
Healthy lives are also a goal in health ministry
improve public health. This technology is able
regulations.
to facilitate the delivery of information more
Health ministry’s regulations that go in
closely, reaching healthy individuals but not
hands with SDGs target are composed into
regular contact of health care. According to
Strategic Plans of Health Ministry 2015-2019
WHO 2011 the use of mHealth technology
with one of its goal to increase disease
becomes a promising strategy in management
control. Health promotion and prevention was
of type 2 diabetes mellitus.
done to people with risk factors or already has
DM. This means done to people with risk
MATERIAL AND METHOD
factors are primary prevention, while the
Method used in the study was quasi
effort done to people with DM are secondary
experimental with pretest and post test
prevention to prevent complicating disease to
nonequivalent control group. Intervention is
patients that already has DM.
done by providing reminder messages via
Diabetes Mellitus (DM) are divided into
SMS (reminder life style). Data collection was
2 types, type 1 caused by hereditary factor and
conducted in March - April 2017 at Padimas
type 2 are caused by combination of genetics
Community Surakarta. Instrument in this
and lifestyle. According to American Diabetes
research is texs sms sent every day for 4
Association (ADA), in 2015 type 2 DM are
weeks, healthy lifestyle questionnaire adopted
the most common disease (90-95%). DM’s
from instrument of HPLP II (Pender) and
high prevalence as non-communicable disease
recording the result of blood glucose level
caused by a change of lifestyle and variation
through medical record.
of social and economic status in epidemiology
transition. DM type 2 can be controlled, up to
RESULT
90% related to modification and obedience in
There are 62 respondents with 32 grouped
healthy lifestyle. Effort in lifestyle
into intervention group and 30 into control
 group to show difference in proportion of
gender on both groups. Intervention group
consisted of mostly males (62.5%) while
control group are predominated by females
(53.3%). Education levels of both groups are
mostly bachelor with 65.6% in intervention
group and 53.3% in control. Occupations of
most respondents are civil worker (31.3%) in
intervention and other occupation in control
group (36.9%). P value of gender are 0.211,
0.097 for education, and 8.63 for occupation
with value of each variable p>0.05. This can
be seen in table 1.

Table 1. Distribution of Respondent Characteristics in GroupTreatment and Reminder Control

Group Life Style at Padimas community in March - April 2017 (n = 62)

No Variable Intervention Control Total p

Group Group
n=32 % n=30 % n=62 %
1 Jenis kelamin
a. Laki-laki 20 62,5 14 46,7 34 54,8 ,211
b. Perempuan 12 37,5 16 53,3 28 45,2

2 Pendidikan
a. Tidak 0 0 0 0 0 0
Sekolah 0 0 4 13,3 4 6,46 ,097
b. SD 0 0 0 0 0 0
c. SMP 11 34,4 10 33,3 21 33,87
d. SMA 21 65,6 16 53,3 37 59,67
e. PT/Diploma
3. Pekerjaan
a. Tidak Bekerja 6 18,8 6 20,0 12 19,36
b. Pensiun 6 18,8 4 13,3 10 16,13 ,863
c. Petani - 0 - 0 0 0
d. Pedagang - 0 - 0 0 0
e. PNS/TNI 10 31,3 7 23,3 17 27,42
Polri
f. Lain-Lain 10 31,2 13 36,9 23 37,09

4. Usia
a. 45 - 55 th 11 34,4 12 37,5 23 37,09
b. 56 - 65 th 19 59,4 17 53,1 36 58,06 0,72
c. >65 th 2 6,2 1 3,1 3 4,83

5. Lama DM
≤ 5 th 29 90,6 25 78,1 54 87,09 0,433
> 5 th 3 9,4 5 15,6 8 12,90

Table 2 explains that the average value vention group had decrease in the
of a variable pattern of healthy living in control group of different  blood sugar
the intervention group and the control post prandial. The pattern of healthy
group experienced an increase in the lifestyle shows the value of  p < 0.05
value of 2.1 delta on the higher possible means  thereare meaningful difference
intervention group compared with the in healthy life  pattern score 
control group values delta 0.68. The changes between the interven- tion
average value of fasting blood sugar group and the control
level levels or after meal in the inter- group while blood sugar levels
 indicate the value  p > 0.05 means that levels between the intervention
there is no difference in blood sugar group and control group.

Table 2. Comparison of mean pre test and post test Healthy Living Pattern and Blood
Sugar Levels Before and After Life Style Reminder Intervention at Padimas
Community from March to April 2017 (n = 62)

No Variabel Mean Mean Delta p

Pretest Posttest
1. Healty Life Style
Intervention 88,96 91,06 2,1
Group 0,001
Control Group 85,27 85,95 0,68

2. GDP
Intervention 143,41 138,28 -5,13
Group 0,545
Control Group 124,70 123,87 -0,83
GD2JPP
Intervention 260,50 235,22 -25,28
Group 0,237
Control Group 215,10 227,40 12,3

Table 3. Effect Analysis of Life Style Reminder on Healthy Living Pattern and Blood
Sugar Level at Padimas Community in March - April 2017 (n= 62)

Dependent variable   Mean Std. Deviation p R2

Delta GDP Intervention -5,13 79,30
,781 ,001
  Control -0,83 29,45
Delta GD2JPP Intervention -25,28 116,71
,105 ,043
  Control 12,30 46,43
Delta healthy
2,09 1,55
lifestyle Intervention ,000 ,216
  Control 0,70 1,09

Based on table 3 healthy life style shows value of blood sugar levels with a value
the value of p = 0.001 healthy patterns of p = 0,781 for a fasting blood Sugar
can be interpreted as a significant and (GDP) and the magnitude of the
influential of the magnitude of the influence of R2 = p value = 0.001 and
influence of R2 = 0,287 this indicates 0,105 blood sugar for 2 hour Post
that the coefficient of determination (R2) prandial (GD2JPP) with the magnitude of
intervention reminder life style influence the influence of R2 = 0.043. The results
on healthy living patterns of 28.7% while of blood sugar levels  showed
the rest is explained by other factors. The nostatistically meaningfull

DISCUSSION
 Diabetes Mellitus can be cause of telenursing to diabetic patient showd
acute or chronic complication. One of the effectiveness in increasing the level of
attempts in the secondary prevention of HbA1c, lowering the burdun of diet
people who have suffered with the therapy, monitor blood presure and blood
4
pattern of healthy lifestyle The cause sugar.12 The other study be influenced
factors can be modified through a change by other factors such as on study
13
in the pattern sf healthy lifestyle, while  that the sex of sufferers of  diabetes
8
most others unmodified. Results on table mellitus associated with control of blood
2 showed an increasing pattern of healthy glucose levels. Women known to have
lifestyle intervention groun and control had control of blood glucose levels that
group. The interventio group experieced are worse than the  men. This can be seen
an increase in score higher compared to on the characteristics of the respondents
the control group. in the control group respondents women-
The pattern of communication sex (53.3%).
between health care team with patient is Health promotion  of healthy
important in the proses of diagnosis, lifestyle in the community  is  an integral
therapy or prevention. Postive contac role  of health workers,
occurs giving to coopperations is especially nurses. The nurse has main
fundamentak to the emergence of the role in health promotion.14 
patients morivation and adherence According to the theory of Health
aspects in carring out the instructions of Promotion Model (HPM)7 States that the
the health team.9 Health promotion given process of health promotion that is given
to the intervention group in the form of to the patient can change the behavior of
consulting role where health nurse the specific cognitive and
educator give social support for patient 10. affective. Health promotion in the form
One of the factors that influence of a reminder media life style as an
15.
compliance was social support based on effective media. Short Message Service
theory HPM model that social support (SMS) is a form
impact of interpersonal factors7 of health communication in the form of 
The result of fasting blood sugar telecare  or  telenursing  variety of shape,
levels and blood glucosa postprandial did that is by letter, email, phone and sms.16
not significant. Control diabetes mellitus Study showed that the intervention
can affect a person’s blood sugar levels was delivered within a system of Short
of diabetic control.11. The decline in Message Service (SMS) has been
blood sugar levels in the intervention providing short term positive effect on
group due to the granting of health behaviour. 17 Clinical studies show
consultation and intervention reminder that text messages (SMS) can be
life style. This study regarding use of effective in promoting  positive changes
 in behavior and  disease management for Rencana Strategis Kementrian
patients with diabetes.18 The results Kesehatan Tahun 2015-2019, Jakarta.
4. Perkumpulan Endokrinologi Indonesia,
of other studies that support message
2015, Konsensus Pengendalian dan
reminder is designed as a medium of Pencegahan Diabetes Mellitus Tipe 2 di
communication  transfer for sending Indonesia, PB.PERKENI. Jakarta.
5. Emilia, 2008, Promosi Kesehatan dalam
messages and  reminder  messages
Lingkup Kesehatan Reproduksi. Pustaka
continuously  (returning) Cendekia Press, Yogyakarta
to systematically target groups can 6. Norris, S. et.al, 2002,.Self Management
EducationFor Adults With Type 2
improve  dherence to therapy.19 The use
Diabetes: A Meta-Analysis Of The Effect
of media promotion in the form of On Glycemic Control. Jounal Diabetes
reminder  life style  influence on Care, vol 25, pp 1159–1171, diakses 12
November 2016, http.www.diabetes-
increasing healthy life patterns for
care.com.
patients with diabetes. SMS based 7. Pender, Nola J, 2011, Heath Promotion
programs  can enhance self-awareness Model ManualUniversity of Michigan
and control of diabetes, other than it is a diakses 20 September
2016,http://hdl.handle.net/2027.42/85350
form of care and support for patients of
deepblue.lib.umich.edu.
Diabetes mellitus.20  Result form 8. Gibney, M.J. 2009. Gizi Kesehatan
multivariate not significant blood glucosa Masyarakat. EGC. Jakarta.
9. Sudarma, Momon. 2008. Sosiologi
the study educational  intervention via
Untuk Kesehatan. Salemba Medika,
SMS does not obtain significant Jakarta.
results for blood sugar  and laboratory 10. Niven, N. 2002. Psikolologi Kesehatan.
EGC. Jakarta
values HgA1c.21  These differences can
11. Rahmani, 2014, Monitoring GulaDarah
be caused by several factors, dan Kepatuhan Minum Obat Dapat
namely age22, gender23, Menstabilkan Kadar Gula Darah Pada
education24, durtion of  Diabetes Penderita Diabetes Melitus Tipe II Di
Wilayah Ambarketawang Gamping
Mellitus,25  stress, medication
Sleman Yogyakarta, Naskah Publikasi,
compliance and exposure against the Stikes Aisyiyah Yogyakarta, diakses 10
source of the information.26 Januari 2017,
http://opac.unisayogya.ac.id.
12. Higano et al., 2015,The Effects of
Telenursing with Goal Attainment
REFFERENCE
Scaling in Diabetic Patients: A Case
1. World Heath Organization, 2010, Global Report, Journal of Nursing & Clinical
Report on Diabetes, p.6, diakses 5 Mei Practices, pp 117, diakses 12 November
2016, 2016
http://apps.who.int/iris/bitsream/eng.pdf. 13. Xu, Jiaqiong, 2007,Macronutrient intake
2. UNDP, 2016, UNDP Policy and and glycemic control in a
Program Brief UNDP Support To the populationbased sample of American
Implementation of the 2030 Agenda for Indians with diabetes: the Strong Heart
Sustainable Development, USA. Study, The American Journal of Clinical
3. Kementrian Kesehatan RI, 2015, Nutrition, edisi 86, pp 480-487, diakses
30 April 2017, http//:www.ajcn.or
14. Kemppainen, V, Tossavainen, K & 23. Wilkstom, K et.al., 2015. National
Turunen, H 2012, 'Nurses' roles in health Diabetes Prevention Program (DEHKO)
promotion practice: an integrative Awareness and Self Reportes lifestyle
review', Health Promotion International, changes in Finnish middle-aged
vol. 27, pp. 1-12. population Journal Public Health,vol129
15. Soehoet, Hoeta. 2003. Media (3), pp. 210-217. diakses 5 Oktober
Komunikasi. Yayasan Kampus Tercinta 2016,http.www.jpublichealth.
II SIP. Jakarta 24. Menurut Chua dan Chan (2011)
16. Middleton. 2014. Effect Of Home 25. Soegondo. 2011. Penatalaksanaan
Telemonitoring On Glycemic And Diabetes Mellitus Terpadu. Balai
Blood Pressure Control InPrimary Care Penerbit FKUI. Jakarta.
Clinic Patients With Diabetes. Telemed 26. Monnier, L. 2003. Contributions of
J E Health20: 199-205. fasting and postprandial plasma glucose
https://www.telecare.com . diakses 23 incrementa to the overall diurnal
November 2016 hyperglycemia of type 2 diabetic
17. Fjeldsoe, B.S. Marshal. Al Miller YD. patients: variations with increasing
2009. Behavior Change Intervention levels of HbA(1c). Journal Diabetes
Delivered By Mobile Telephone Short Care.
Message Service. American Journal of https://www.care.diabetesjournals.org .
Preventive Medicine 36: 165-171. diakses 22 Juni 2017.
https://ajpmonline.org.diakses 17
September 2016.
18. Free, C.2013. Effectiveness of Mobile
Health Technology Based Health
Behaviour Change Or Disease
Management Interventions For Health
Care Consumers: A Systematic Review.
Journal PLoS Med.
https://www.plos.org.diakses 20
November 2016..
19. Lubis, 2015, Perancangan Reminder
System Untuk Meningkatkan Kepatuhan
Pengobatan Pasien Diabetes
Mellitus.Tesis. UGM. Yogyakarta
20. Nundy. 2013. Developing a behavioral
model for mobile phone-based diabetes
interventions. Patient Educ. Couns
90(1): 125-132.
https://www.ncbi.nlm.nih.gov.diakses
12 Juni 2017.
21. Peimani. 2015. Effectiveness of short
message service-based intervention
(SMS) on self-care in type 2 diabetes: A
feasibility study. Journal Primary Care
Diabetes. http://www.elsevier.com.
diakses 15 Juni 2017.
22. Holt, P2009,Diabetes in hospital: A
Practice Approach for Healthcare
Professionals, John Wiley & Sons, Ltd,
United Kingdom