MOTIVATION IMPLEMENTATION OF HBA1C DECREASE IN PATIENTS

DIABETES MELLITUS ( RIVIEW LITERATURE )

Christianto Nugroho
Nursing Division, Pamenang Pare-Kediri Nursing Academy

ABSTRACT
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by an
increase in blood glucose levels (hyperglycemia) due to abnormalities in insulin
secretion, insulin action or both. DM patients will be negative if there is rejection of the
patient during treatment. Negative attitudes towards disease and treatment will result
in failure of management of diabetes mellitus. This can affect the patient's quality of
life and social abilities. The purpose of this study is how to improve patient motivation
in controlling HbA1C Diabetes.
The methodology in this study used the Randomized Controll Trial approach,
with a population of between 44 - 344 samples, with the application of Motivational
Enhancement Therapy (MET), Cognitive Behavior Therapy (CBT), MET + CBT,
Motivational Interviewing (MI), Structural Diabetes education (SDE). ) and as a control
group the study used care as was usually obtained by the respondents. Analysis of data
from the 4 articles using SPSS for windows release 12.01 with regression, two- factor
ANOVA analysis , person correlation.
The results of the study of the 4 articles, by implementing MET, CBT, MI, SDE, gave
positive changes to diabetes control, this can be seen from the results of HbA1C which
decreased after the intervention above, although it was also mentioned in the article
that the changes were not too big.

PRELIMINARY 2030, according to data from WHO,

Diabetes Mellitus (DM) is a group of
metabolic diseases characterized by
increased blood glucose levels
(hyperglycemia) that occur due to
abnormalities in insulin secretion,
insulin action or both (Smeltzer S, 2008).
DM patients will have a negative
attitude if there is rejection of the
patient during treatment (Soegondo,
2006). Negative attitude towards disease
and medication will result in failure of
management of diabetes mellitus. This
can affect the patient's quality of life and
social abilities. Diabetes patients are
also found to experience psychological
problems that make the patient not
motivated to undergo treatment.
Diebetes patients are estimated to
have increased in the world to 366
million per year
Indonesia ranks 6th in the world as the
country with the highest number of
diabetes mellitus sufferers after India,
China, the Soviet Union, Japan and
Brazil. (WHO, 2014) It was recorded that
in the Kediri district at the end of 2012
there were 554 patients (Dinkes, 2013).
According to WHO (1994 in Suyono,
2006), prevention efforts can be carried
out in three stages, namely primary,
secondary and tertiary prevention.
Primary prevention is all activities
aimed at preventing the emergence of
hyperglycemia in the general
population, for example by means of a
healthy food campaign and counseling
on the dangers of diabetes. Motivation is
one form of education,
motivation is an impetus or move.
According to Winarto, 2011 is an effort
to improve the quality of life

J urnal AKP 62 Vol. 7 No.1; 1 January - 30 June 2016

patient namely by doing motivation,
motivation to provide support
positive for one's health. Conversely, DM
patients will be negative if there is
rejection of the disease, this can affect
the patient's quality of life.
Blood sugar in type 1 diabetes can
be controlled using a variety of ways,
namely insulin therapy and educational
programs, depression control and diet.
The effectiveness of psychological
factors on blood sugar control in adult
patients with type 1 diabetes has not
been proven. Counseling methods to
increase motivation can change health
behavior, motivation can reduce alcohol
abuse and smoking, and preliminary
evidence suggests that it may be
effective in diabetes (Miller W, 2002). In
this literature review, the search for a
model to improve patient motivation is
appropriate to control diabetes so that
the quality of life for diabetes patients
increases.
The results of this literature
review can be integrated in the form of
further research to be applicable to
diabetes patients and can be applied in
clinical practice where a critical review
is first conducted of the validity of the
study, how meaningful the results are,
and their relevance for application.
Based on the aforementioned
background, the researcher formulated
a research problem, namely How is the
right way of motivation for the quality
of life of diabetes patients?
MATERIAL / METHODS
PICOT F framework
From the literature that the author
searches and reads, the criteria for the
journal to be criticized, the author
makes a framework / PICO framework
as follows:
a. Population
The population defined in this
literature study was all DM patients
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without specifying gender and age.
b. Intervention
Based on the findings of the
intervention research determined
was an increase in the motivation of
DM patients
c. Comparison
The comparison group is the control
group without motivation, namely
doing daily habits.
d. Outcame
Providing motivation will improve
the quality of life for diabetes
patients .
Literature Search
Based on the formulation of the
problem above, the writer tries to find
scientific articles or journals in English
studies that are relevant to the topic
using the EBSCO HOST database,
PRO-QUES, limited from April 2004 to
April 2014. The keywords used are "
diabetes, motivation, quality of life, ".
From these keywords and criticized
again which is Full Text , then limited to
the last 10 years, it was obtained from
EBSCO, there were 23 journal titles and
PRO-QUES there were 17 articles, after
further analysis separated between
those that were related and those that
were not with the problem formulation,
only 4 were suitable with the
formulation of the problem you are
looking for. From this journal, the writer
tries to apply the steps and principles of
Evidence Based Nursing to answer the
problem formulation.
The author reads the entire article
and decides to find out whether the
evidence from the study is valid, if it is
valid, is it important and applicable to
patients?
RESULT / REVIEW
Methodology
a. Research design
The research design of these 4
articles used a randomized control
trial
Vol. 7 No.1; 1 January - 30 June 2016
b. Sample
The study sample of the 4 articles,
there were 2 with the same number
and criteria, namely the number of
samples of 344 patients (type 1
diabetes who suffered from more
than 2 years, ages 18 - 65) and
HbA1C levels> 8.2 - 15%,> 9 , 13 -
9.32%, 44 samples (type 1 diabetes
who suffer from more than 1 year,
age 12 - 18 years, HbA1C> 9%), there
is one article using type 2 diabetes in
overweight women.
c. Research sites
The research locations of these 4
articles are in hospitals and in the
community. The countries where the
samples were made in this study
were America, Africa, Europe
(Netherlands, UK).
d. Procedure
The research procedures of these 4
articles are using the application of
Motivational Enhancement Therapy
(MET), Cognitive Behavior Therapy
(CBT), MET + CBT, Motivational
Interviewing (MI), Structural
Diabetes education (SDE) and as a
research control group using such
treatments usually obtained by
respondents.
e. Data collection
Collecting data from these 4 articles
using a tiered system, namely by
being repeated 3 times, namely for 3,
6, 12 months after the intervention
(MET, CBT, MI, SDE) and some using
6,12,18 months (Motivational
Interviewing -Weight loss). The same
data collection in these 4 articles
looked at HbA1C levels.
f. Data analysis
Data analysis of the 4 articles used
SPSS for windows release 12.01 with
regression, two- factor ANOVA
analysis , pearson correlation, with
significant levels used at P <0.05.
g. Research result
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of data collection is done with a
tiered system, namely 3,6,12 or
6,12,18.
The results of the study of the 4
articles, by implementing MET, CBT,
MI, SDE, gave positive changes to
diabetes control, this can be seen
from the results of HbA1C which
decreased after the intervention
above, although it was also
mentioned in the article that the
changes were not too big. . In
Statistically there is a difference
between the treatment group and
the control group, where there is a
significant difference with p <0.05 on
the HbA1C size, so that it can affect
the patient's quality of life.
h. Clarity of research reports
The research reports of these 4
articles are quite clear, although in
the article it is also mentioned about
missing data and control of
interventions that are still weak, in
general these have been included in
the research report.
i. Research Limitations
The limitations of the research in
these 4 articles are that there is
missing data and weak control of the
intervention.
Review
a. Design summary
The research design used
a randomized control trial
b. Research criticisms in methodology.
The methodology in this article has
not been explained, namely how the
intervention process of MET, CBT, MI,
SDE there is only explained about
the implementation time and session
of each intervention, but the
application model has not been
explained. In addition, it has not yet
been explained who carried out the
implementation and how the
training was carried out for the
personnel who carried out the
implementation. In the methodology,
there is also no clear way of
controlling the intervention carried
out on the respondent, because you
see
Vol. 7 No.1; 1 January - 30 June 2016
The application of MI
(Motivational Interviewing) is
c. The main research issue
This study has an issue that is widely
raised in the article that patients
with diabetes mellitus have their
own characteristics, there are many
perceptions that patients have about
the application they are doing.
d. Research critique
Many of the research results in this
article have been reviewed, but
what is the same in this article is
that all HbA1C levels were checked,
this is a biased lab level.
determine how to control diabetes
mellitus. The results of the research
in this article prove that the
application of the above method can
reduce HbA1C levels.
e. Gaps in the research findings
reviewed
Research findings in these 4 articles
have different applications, the
existing gaps from implementation
are as follows:
1. MET application
MET (Motivational Enhanchement
Therapy) was given
to diabetes patients to increase
patient motivation, so that the
patient's quality of life improves,
it is proven that the lab results,
especially HbA1C, have decreased.
2. Application of CBT
The application of CBT (Cognitive
Behavior Therapy) is given to
patients
diabetes to increase patient
knowledge about the disease and
diabetes management, so that
with increased patient knowledge,
the patient's quality of life will
also increase, this is also proven
by the lab results
especially HbA1C has decreased.
3. Application of MI
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given to diabetic patients as a
form of increasing patient
motivation in handling and
control of their disease, this is
evidenced by the decrease in
HbA1C results.
4. Application of SDE
The application of SDE (Diabetes
Education Structure) is given to
diabetic patients as a form of a
structured explanation of the
concept of diabetes management,
this is also evident from the
decrease in HbA1C results.
Of the 4 applications in general and
looking at the results studied, there
was no significant difference, and
the decrease in HbA1C levels also
had insignificant differences, but
when the above applications were
combined with the examples of MET
and CBT application, this could
reduce more than therapy. other.
This shows that motivation to be
more acceptable to diabetes mellitus
patients needs a structure for
handling diabetes, including patient
knowledge and behavior that we
need to change.
f. The relevance of research
results to the development of
nursing science
The results of the research from the
intervention of MET, CBT, MI, SDE
were able to reduce HbA1C levels,
meaning that Diabetes Mellitus
patients had hope to control their
diabetes. Seeing this decrease in
HbA1C also has implications for
improving the patient's quality of
life. With these results, this research
has relevance value for the
development of science
nursing, especially in terms of
increasing the motivation of
Diabetes Mellitus patients, DM
patients have high motivation if
there is encouragement and control
from other parties. Nurse as one of
the health workers
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 has a role in the management of DM
patients, through motivation about
information and health education in
controlling DM and good prevention
macrovascular and microvascular
complications. Deep intervention
action
DM disease control is controlling
diet, exercise and therapeutic medic.
g. According to Winarto, 2011, one of
the efforts to improve the quality of
life of patients is by doing
motivation, motivation to provide
positive support for one's health.
Conversely, DM patients will be
negative if there is rejection of the
disease, this can affect the patient's
quality of life. This is evidenced by
the results of motivation
which were given by MET, CBT, MI,
SDE methods were able to affect the
quality of life of Diabetes Mellitus
patients.
h. Important findings that are not
reported in this study systematically
and
based on the standard rules have
submitted a complete result report.
Implications for Practice
Based on the results of the explanation
of this study, the application of MET,
CBT, MI, SDE, can help improve the
quality of life of patients with Diabetes
Mellitus. These results serve as the basis
for the development of nursing practice
in handling diabetes mellitus cases,
especially in terms of motivation. The
benefit of the results of this study is that
it can help nurses in the treatment of
Diabetes Mellitus, not only in
concentrating on medical interventions,
but through this research it is able to
change a person's perception, so that
there is an increase in motivation from
within the patient who is able to change
his lifestyle, so that this affects the
patient's quality of life and the ultimate
impact is to reduce the cost of care.
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Health Office, KK (2013). Data Recapitulation
Spread of Disease in the District.
Kediri: Health Office.
CONCLUSION
Based on the description above, in
general the authors can conclude that
this research with the topic "Motivation
for people with Diabetes Mellitus" needs
to be continued. The research objectives,
research methodology, data analysis,
and research results have been clearly
described. The results of this study have
also been able to answer the research
objectives accurately, accompanied by
complete secondary data so as to enrich
the discussion and explain the results of
the research very straightforwardly.
Although this research is classified
as good, the results of this study cannot
be fully generalized, especially in
Indonesia, because of differences
demographic characteristics of the place
of study, including differences in
seasonality, race, and possible
differences in procedures in Indonesian
society.
A more recent and more specific
literature search is needed regarding the
application of MET, CBT, MI, SDE in
diabetic patients. It is also necessary to
carry out further research on the MET,
CBT, MI, SDE modules especially
according to the culture in Indonesia.
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enhancement therapy with and
without cognitive behavior therapy
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Beck, A. (1976). Cognitive Therapy and The
Emotional Disorders. New York:
Meridian.
Delia Smith, ea (2007). Motivational
Interviewing Improves Weight Loss
in Women With Type 2 Diabetes.
Diabetes Care , 1081-1087.
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trial on implementing lifestyle
Khalida Ismail, ea (2008). Motivational
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Miller W, RS (2002). Motivational
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