THE EFFECT OF DRUG COMPLIANCE ON BLOOD SUGAR LEVELS IN

DIABETES MELLITUS PATIENTS AT GONDANG PUBLIC HEALTH

CENTER

A’yuni Qurrotu, Ratnasari Putu Diah, Maharani Ni Luh Putu Dea Ariska, Mashuri
Andy Satrio. 2022. The Effect of Drug Compliance on Blood Sugar
Levels in Diabetes Mellitus Patients at Gondang Public Health Center.
Final Assigment, Faculty of Medicine, Wijaya Kusuma Surabaya
University. Supervisor: Ayu Cahyani Noviana1

ABSTRACT

Various studies have reported low compliance with medication in patients with
diabetes mellitus (DM). Research conducted by Nafi'ah (2015) at the East
Surabaya Regional Health Center stated that compliance with drug use by DM
patients in the non-compliance category was 54.35%. Objective: The relationship
between medication compliance and DM blood sugar at Gondang Public Health
Center. Methods: This study used a cross-sectional design. The sample is 70
diabetes mellitus patients in the working area of Gondang Public Health Center
which were selected by simple random sampling. The instruments used in the
study were MMAS-8 to measure compliance with taking medication and the Easy
Touch GCU tool to measure blood sugar. Results: The results showed that most
of the patients had a low level of medication compliance (25,7%). have
uncontrolled blood sugar (70.0%). The results of the chi-square test showed a p-
value of 0.001, where the value is <0.05, which means that there is a relationship
between medication compliance and blood sugar of Diabetes Mellitus patients in
the Gondang Public Health Center work area. Conclusion: There is an effect of
medication compliance on diabetes mellitus blood sugar levels at Gondang
Public Health Center. It is hoped that further research will be carried out by
looking at other factors that can affect medication adherence in diabetes patients.
Keywords: compliance, diabetes mellitus, blood glucose

INTRODUCTION a global health threat. (Kemenkes

Globally, there has been a RI, 2017).
change in disease patterns, from Epidemiological research
infectious diseases to non- shows a tendency to increase the
communicable diseases. Non- incidence and prevalence of Type-2
communicable diseases are Diabetes Mellitus in various parts of
currently in the top ten causes of the world. The World Health
death nationally, one of which is Organization (WHO) predicts an
diabetes mellitus (DM). DM is now increase in people with Diabetes

1
Mellitus is one of the global health
threats. WHO predicts an increase
in the number of people with
diabetes mellitus in Indonesia from
8.4 million in 2000 to around 21.3
million in 2030. This report shows
an increase in the number of people
with diabetes by 2-3 times by 2035
(PERKENI, 2021). WHO states that
half of the adult diabetics in the
world are in 5 countries, namely
China, India, the United States,
Brazil, and Indonesia. (Tandra,
2017).
Indonesia is ranked 7th with
the highest number of people with
diabetes mellitus in the world. The
International Diabetes Federation
(IDF) stated that in 2016 Indonesia
had around 9.1 million people with
diabetes mellitus (IDF, 2015). It is
estimated that this number could
increase to 12.4 million people in
2025 and reach 14.1 million people
in 2035 (Tandra, 2017). One of the
areas with the highest number of
people with diabetes is East Java
Province with a prevalence of DM
sufferers, which is 2.1%, which is in
the top 10, named in fifth place in
the prevalence of people with
diabetes mellitus in Indonesia
(RIKESDAS, 2014). Data from
Riskesdas East Java 2018
prevalence of diabetes mellitus
based on the results of
measurements in the population
aged > 15 years, East Java province
in 2013 was 2.1% and increased in
2018 by 2.6%. From the prevalence
of diabetes mellitus, Mojokerto
Regency and Mojokerto City have a
fair high percentage of around 2.9%
of Mojokerto Regency data and
2
5.1% of Mojokerto City data.
Gondang Village consists of 52,839
residents in 2020.
Controlling blood sugar levels
is important in the treatment of DM.
Diabetic patients need to understand
the influencing factors to control
blood sugar levels, diet, physical
activity, medication adherence, and
knowledge. Successful management
of DM to prevent complications can
be achieved (Soegondo et al., 1995;
Nanda et al., 2018).
The success of DM
management to prevent
complications can be achieved of
them through adherence to
pharmacological therapy.
Compliance is one of the most
important factors in successful
therapies for a patient, including
type 2 DM patients. Compliance is
an issue that needs attention in type
2 DM patients. Various studies have
reported low compliance in these
patients. Research conducted at the
East Surabaya Regional Health
Center stated that compliance to
drug use by type 2 DM patients in
the non-adherent category was
54.35%. (Nafi’ah, 2015). Another
study found that only 39.6% of
patients were obedient in using
drugs and redeeming drugs and the
most reasons for non-compliance
were being late for taking drugs
(86.4%) and forgetting to take
medicine (77.3%) (Srikartika et al.,
2016).
Indirectly, the level of
medication compliance can be
measured by the Morisky
Medication Adherence Scale
(MMAS)-8 questionnaire. The
questionnaire is a method for
assessing medication compliance in
patients with chronic diseases,
including diabetes that has been
validated by WHO (Srikartika et al.,
2016).
From this description, the
author wants to find out more about
the effect of medication compliance
on blood sugar levels in patients
with diabetes mellitus at Gondang
Public Health Center.
METHODS
This study is a quantitative
study with a cross-sectional design.
This research was conducted in the
working area of the Gondang Public
Health Center, Mojokerto, East Java
in October 2022. The population of
this study was based on data
obtained from the Gondang Public
Health Center as many as 231
people. The sample in this study
were DM patients in the working
area of the Gondang Public Health
Center who met the inclusion
criteria, aged 56-76 years, were
able to communicate smoothly, and
were willing to participate in this
study. The sample amounted to 70
people and was selected using a
simple random sampling technique,
namely random sampling where
each population has an equal
chance of being selected as a
sample.
To measure the medication
adherence variable, the Morisky
Medication Adherence scale 8-Items
(MMAS-8) was measured and the
blood sugar variable was measured
using the Easy Touch GCU tool.
Blood sampling was performed on
3
patients who had previously been
asked to fast for 8 hours before the
examination. The analysis was used
in the form of univariate and
bivariate analyses. Bivariate
analysis was conducted to determine
the relationship between medication
compliance and blood sugar in DM
patients using the chi-square
statistical test. Data analysis results
are presented in the form of tables
and narratives.
RESULT
Respondents in this study
were DM patients in the working
area of Gondang Public Health
Center, Mojokerto, East Java.
Characteristics of respondents
based on blood sugar levels of
patients who visited the Gondang
Public Health Center in October
2022. Based on the results of data
collection from 70 respondents, it
was found that 21 respondents
(30.0%) had normal blood sugar
levels (GDA < 200 mg/dl), while 49
respondents (70.0%) had high blood
sugar levels (GDA 200 mg/dl). It
can be concluded that most
respondents are those with high
blood sugar levels as many as 49
respondents (70.0%). This can be
seen in table 1.
Table 1. Distribution of Respondents
Based on Blood Sugar Levels at
Gondang Public Health Center in 2022
Blood Sugar Frequency Percentage (%)
Level
Normal 21 30.0 %
High 49 70.0 %
Total 70 100.0 %
Source: Research, 2022
Table 2. shows the
distribution of respondent
characteristics based on compliance (14.3%) and 42 respondents (60.0%)
with medication in patients who with high blood sugar (Table 3).
visited the Gondang Public Health By using the chi-square
Center in October 2022. Based on statistical test, a p-value of 0.001
the results of data collection from 70 was obtained, where the value of
respondents, it was found that 18 <0.05, which means that there is a
respondents (25.7%) were obedient relationship between medication
to taking medicine, and 52 compliance and blood sugar levels
respondents (74,3%) who do not of Diabetes Mellitus patients at
comply with taking medication. Gondang Public Health Center.
Table 2. Distribution of Respondents Furthermore, the research data was
Based on Compliance with Taking analyzed by cross-tabulation, and
Medicines at Gondang Public Health the odds ratio (OR) was 6,600 % CI
Center in 2022 (2,044 – 21,308) (Table 3).
Compliance Frequency Percentage (%)
This shows that people who
Comply 18 25,7 %
Not comply 52 74,3 % do not adhere to medication are
Total 70 100,0 % estimated to have a 6.0 times risk
Source: Research, 2022 level of getting high blood sugar
Respondents who adhere to levels compared to people who
taking medication with normal blood comply with medication. Then the
sugar levels are 11 respondents Contingency Coefficient test was
(15.7%) and 18 respondents (10.0%) carried out which showed the results
who have high blood sugar levels, of the CC value = 0.371, which
while those who do not adhere to means that there is a relationship
taking medication with normal blood between the level of medication
sugar levels are 10 respondents. compliance and blood sugar levels
in low Diabetes Mellitus patients.
Table 3 Results of the Analysis of the Relationship Between Drug Compliance to Blood Sugar
Levels in Diabetes Mellitus Patients at Gondang Public Health Center, 2022.
Normal High Blood OR
Medication Total P CC
Blood Sugar Sugar 95% CI
Compliance
Ζ % Ζ % Ζ %
Comply 11 (15,7 7 (10 %) 18 (25,7%)
%) 0,001 0,371 6,600 (2,044 – 21,308)
Not Comply 10 (14,3%) 42 (60 %) 52 (74,3%)
Total 21 (30,0%) 49 (70 %) 75 (100%)
Source: Research, 2022

DISCUSSION hormone that regulates glucose.

Diabetes Mellitus (DM) is a
group of metabolic diseases
characterized by hyperglycemia that
occurs due to abnormalities in
insulin secretion, insulin action, or
both (PERKENI, 2021). Insulin is a
Insulin that does not work
adequately will make glucose levels
in the blood high. Uncontrolled
blood glucose levels can cause
various complications such as
kidney, eyes, nerves, heart, and an

4
increased risk of cardiovascular
disease (Ramadani, 2020). There are
4 pillars of DM control issued by
PERKENI, namely education, eating
arrangements, exercise, and
medication adherence. But the fact is
that there are still many people who
have low compliance because the
treatment period is so long that it
causes saturation (PERKENI, 2021).
The results of this study
indicate that most DM patients in the
Gondang Public Health Center have
a non-compliance rate (74.3%). This
situation can be influenced by
various factors such as age,
education, occupation, and length of
suffering from DM. This is in line
with research conducted at the
Tamalanrea Makassar Public Health
Center in 2022 which showed that
the majority of DM patients did not
comply with treatment at 61.2%.
(Husna et al., 2022). Most patients
who do not comply are in the range
of old age related to memory, so they
forget to take their medicine or
cause side effects that make the
patient uncomfortable. Other factors
such as education affect an
individual's intellectual power in
deciding something, including the
decision to take medicine (Alfian,
2015). A person with good
knowledge can weigh the long-term
benefits of sticking to medication. In
addition, work also has an effect,
where someone who works is busier
and tends to forget more easily
(Jasmine et al., 2020). Saturation or
boredom can also affect compliance,
especially for patients who have long
suffered from DM and are taking
medication (Bulu et al., 2019).
5
In this study, it was also
found that most of the patients had
high blood sugar (70.0%). Glucose
is the main fuel in body tissues which
also functions to produce energy.
However, if the levels exceed normal
(hyperglycemia) then the risk of
causing DM. For DM patients, blood
sugar levels must be continuously
controlled and kept in the normal
range (Soegondo, 2007; Husna et
al., 2022). Some of the factors that
can affect abnormal blood sugar
levels include obesity, hypertension,
family history of not exercising
regularly, alcohol, smoking,
unhealthy diet, and age. Especially
the age factor where as you get
older, natural changes occur in the
body that affect the heart, blood
vessels, and hormones, thereby
increasing blood sugar levels, and
causing diabetes mellitus. In line
with the results of this study where
most of the respondents belong to the
late elderly age group (56-75 years)
(PERKENI, 2021).
Based on the results of the
research above, it is known that most
of the respondents who do not
comply have uncontrolled blood
sugar, which is 60%. The results of
bivariate analysis obtained a p-value
of 0.001 (<0.05), which means that
there is a relationship between
medication compliance to blood
sugar levels in patients with diabetes
mellitus at Gondang Public Health
Center. This result is supported by a
previous study in 2021 which
showed a significant relationship
between medication compliance and
blood sugar levels in DM patients (p
< 0.05) (Husna et al, 2022). This
shows that people who do not adhere
to medication have an estimated risk
of 6.0 times that they will have high
blood sugar levels compared to
people who comply with medication.
These results are in line with
the theory that diabetes is a lifelong
disease that cannot be cured
permanently so many patients are
bored and do not comply with
treatment which causes uncontrolled
blood sugar levels (IDF, 2017). The
causes of low medication compliance
are often due to patients forgetting,
not complying with treatment
according to doctor's instructions,
and misreading etiquette (Fadinata
& Darmawan, 2020). Patients who
regularly take medication according
to the dose given by the doctor will
control their blood sugar. On the
other hand, if the patient does not
take medication according to the
dose given, either exceeding or
reducing the dose, it will increase
blood sugar to rise or fall.
CONCLUSION
The majority of respondents,
as many as 52 respondents (74.3%)
had non-compliance to taking
medication and as many as 18
respondents (25.7%) adhered to
taking medication, and 52
respondents (74.3%) did not comply
with taking medication. It can be
concluded that most respondents are
as many as. There is an effect of
medication adherence on blood
sugar levels in patients with diabetes
mellitus at the Gondang Public
Health Center. This is indicated by
25.7% of respondents who adhere to
taking medication, and 15.7% who
6
have normal blood sugar levels.
While 74.3% of respondents do not
comply with taking medication, 60%
have high blood sugar levels. It is
hoped that further research will be
carried out by looking at other
factors that can affect medication
compliance in diabetes patients.
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