The Journal of Palembang Nursing Studies

Quantitative Studies

The Correlation Between Self Management Level and Blood Glucose In Type 2

Diabetes Mellitus At Klatak Community Health Center In 2022

Abstract

Background: Diabetes mellitus (DM) is a condition of high blood sugar levels

caused by unstable blood sugar levels in diabetics. DM can not only be treated with

pharmacological therapy, but must be followed by non-pharmacological therapy, one

of which is self-management.

Purpose: The purpose of this study was to determine the relationship between the

level of self management and blood glucose in type 2 diabetes mellitus at the Klatak

Health Center in 2022.

Methods: This research method used a cross sectional design with 35 respondents

were selected by accidental sampling technique. Data collection used Questionnaire

Summary Diabetes Self Care Activities (SDSCA) and Glucometer which was held on

May 11 th – May 23 rd, 2022.

Results: The results of data analysis were (62,9%) patients with Type 2 DM

experienced self-management in the medium category and (88,6%) experienced

blood sugar levels in the high category. After testing by using the Spearman rank

test with SPSS version 25 with a significance of 0,05 (5%), obtained P value of 0,180

which means (P>0,05), the alternative hypothesis is rejected and H 0 is accepted,

meaning that there is no relationship between self-management and glucose blood

in patients with type 2 diabetes mellitus. With a close correlation of 0,232, the

correlation strength was low. The correlation coefficient is negative so that the

relationship between the two variables is not in the same direction.

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Conclusions: It is very important for respondents to improve self-management in

order to have stable or normal blood sugar levels, this can prevent complications in

people with diabetes Mellitus. It is very important for respondents to improve self-

management in order to have stable or normal blood sugar levels, this can prevent

complications in people with Diabetes Mellitus. The higher the level of self-

management, the lower the blood sugar.

Keywords: Self Management, Blood Sugar Levels, Type 2 Diabetes Mellitus

Introduction : Diabetes mellitus (DM) is one of the non-communicable diseases that

is still a problem in Indonesia. DM is a condition of high blood sugar levels caused by

unstable blood sugar levels in people with diabetes (International Diabetes

Federation, 2017). DM not only be overcome with pharmacological therapy, but must

be followed by non-pharmacological therapy, one of which is self-management

(Hidayah, 2019). Self management is an integral part of DM control. Self

management can describe individual behaviour that is carried out consciously,

universally, and limited to oneself (Handriana & Hijriani, 2020). So that self-

management can help blood glucose levels become stable (normal).

Based on the world prevalence related to DM International Diabetes Federation

(IDF) in 2017, the number of people with Diabetes Mellitus aged 20-79 years was

425 million people, and it is estimated that there will be an increase in 2045 at the

age of 20-79 years as many as 629 million people. The prevalence of people with

diabetes mellitus in Indonesia increased by 1.6% from 6.9% in 2013 to 8.5% in 2018.

In East Java people with diabetes mellitus also increased in 2018, from 2.1% in

2018. 2013 to 2.6% in 2018 (Riskesdas, 2018). In Banyuwangi, there were 41,965

people with diabetes mellitus in 2019, and at the Klatak Health Center it took the first

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position with 1,737 people with diabetes mellitus (Dinkes, 2019). According to data

from the Klatak Health Center in 2021, there were 346 DM patients who routinely

took treatment at the Klatak Health Center with blood sugar levels of more than 200

mg/dL.

Risk factors for type 2 diabetes mellitus include age, physical activity, body mass

index (BMI), blood pressure, stress, lifestyle, family history, cholesterol, gestational

diabetes, history of glucose disorders and other disorders (De Graaf et al, 2016).

Uncontrolled and untreated diabetes mellitus can lead to complications. The main

complications that can arise are usually heart attack, kidney failure, stroke, and

gangrene. This complication can affect any individual who suffers from type 1 or type

2 diabetes mellitus. Self-management includes five aspects including diet, exercise,

blood sugar monitoring, medication adherence, and foot care. Self management, if

done properly, can stabilize the blood sugar levels of people with diabetes.

DM management basically begins with eating arrangements with adequate physical

exercise for some time (2-4 weeks). If after that the blood glucose level still cannot

meet the desired metabolic target level, then pharmacological intervention is carried

out with oral antidiabetic drugs or insulin injections as indicated. In conditions of

severe metabolic decompensation, example ketoacidosis, DM with severe stress,

rapid weight loss, insulin can be given immediately. In certain circumstances, anti-

diabetic drugs can also be used according to indications and doses according to the

doctor's instructions. Monitoring blood glucose levels if posible can be done alone at

home, after receiving special training for it. Management of diabetes patients is in the

form of a comprehensive approach that includes medical care, psychosocial care,

lifestyle changes, education, continuous monitoring, and self-management.

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Self-management is an individual's ability to manage daily life, control and reduce

the impact of the illness he or she suffers from. In relation to diabetes, self-

management is the basis of diabetes treatment and is very important in preventing

complications. Self Management that can be given to patients according to the

Consensus on the Management and Prevention of Type 2 Diabetes Mellitus with a

focus on glucose control, namely diet, physical exercise, and medication/insulin

(Galuh & Prabawati, 2021). Efforts to control risk factors for type 2 Diabetes mellitus

are called CERDIK actions, namely by carrying out: 1) Regular health checks to

control weight, check blood pressure, blood sugar, and cholesterol regularly, 2) Stay

away from cigarette smoke and do not smoke. smoking, 3) Diligently doing physical

activity for at least 30 minutes a day, 4) A balanced diet by consuming healthy food

and balanced nutrition, 5) Adequate rest and, 6) Manage stress properly and

correctly (Kemenkes, 2017).

Self-management of Diabetes Mellitus in the literature review, Self-management of

Type II DM patients at the Tarogong Health Center, DM self-management is an

action taken by DM patients to manage and control DM which includes activities, diet

(diet), exercise, blood sugar monitoring, drug control and foot care. The goal of self-

management is optimizing the control of metabolism in the body, preventing acute

and chronic complications, optimizing quality patient's life and reduce the cost of

treatment / treatment of DM. In this study, almost all respondents with type II DM

97.1% did moderate self-management. These results are not in accordance with

research (Putri et al and Hung et al 2016) where the self-management behavior of

type 2 DM patients is in the good category. Based on the background of the problem

above, the researcher is interested in conducting research on The Correlation

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Between Self Management Level and Blood Glucose in Type 2 Diabetes Mellitus at

Klatak Community Health Center In 2022.

Materials and Methods

Design

Research design is a strategy used in research that is used to design and identify

problems in data collection and is used to define the structure of the research to be

carried out (Nursalam, 2016). In this study, researchers used a cross-sectional

research design to determine whether or not there was The Correlation Between Self

Management Level and Blood Glucose in Type 2 Diabetes Mellitus at Klatak

Community Health Center in 2022.

Sample and setting

Sampling with a population exceeding 100 people can be taken 10-15% or 20-25%

of the sample (Arikunto, 2016). Based on the total population as many as 346 people

with DM. So the study used 10% of the population calculation, namely as many as

35 DM patients. Sample Criteria are divided into inclusion criteria and exclusion

criteria.

Variable

An independent variable is a variable that affects or its value determines another

variable (Nursalam, 2016). The independent variable in this study is self

management. The dependent variable is a variable whose value is determined by

another variable (Nursalam, 2016). The dependent variable in this study is the blood

sugar levels in type 2 DM patients.

Instruments

Research instruments are tools used by researchers to obtain or collect data in

solving a research problem (Alfianika, N 2016). The instrument in this study used

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self-management is Summary of Diabetes Self-Care Activity Questionnaire (SDSCA)

and glucometer to assess blood sugar levels in type 2 DM patients.

Data Collection

The research was conducted at the Klatak health center Banyuwangi East Java

Indonesia from on May 11 th – May 23 rd, 2022. Geographically, the Klatak Health

Center is located at the eastern tip of Java Island which is bordered by the Bali

Strait. Puskesmas Klatak is one of the three Puskesmas in Banyuwangi. The

working area of the Puskesmas is divided into 4 areas consisting of Klatak, Bulusan,

Ketapang, and Kalipuro. The condition of the research area is strategically located,

the Klatak Health Center is close to the main road and the road is paved so that it

has no obstacles in conducting research and is easily accessible. Data collection

was carried out by giving direct questionnaires to respondents who were selected

according to the inclusion criteria.

Data analysis

The results of data analysis in this study used the Spearman Rank statistical test

using SPSS 25 for windows.

Ethical consideration

Before collecting data, the researcher first went through an ethical process by

submitting a pass the ethical test to the Klatak Health Center. Research ethics in this

study involved health workers as research subjects. Therefore, the process must

meet research ethical standards. In this study, the researcher asked the

respondent's consent to participate as a respondent after an explanation of the

research process was explained. Respondents signed the informed consent while

the researcher guaranteed the confidentiality of the data.

Results

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The results of data analysis were (62,9%) patients with Type 2 DM experienced self-

management in the medium category and (88,6%) experienced blood sugar levels in

the high category. After testing by using the Spearman rank test with SPSS version

25 with a significance of 0,05 (5%), obtained P value of 0,180 which means

(P>0,05), the alternative hypothesis is rejected and H0 is accepted, meaning that

there is no relationship between self-management and glucose blood in patients with

type 2 diabetes mellitus. With a close correlation of 0,232, the correlation strength

was low. The correlation coefficient is negative so that the relationship between the

two variables is not in the same direction.

Discussion

Table 1. The Correlation between Self Management level and Blood glucose

(n = 35)

Correlations

RANDOM BLOOD SELF

GLUCOSE MANAGEMENT
Spearman's rho RANDOM BLOOD GLUCOSE Correlation Coefficient 1.000 -.232
Sig. (2-tailed) . .180
N 35 35
SELF MANAGEMENT Correlation Coefficient -.232 1.000
Sig. (2-tailed) .180 .
N 35 35

Self Management in Patients with Type 2 Diabetes Mellitus at the Klatak

Community Health Center in 2022

Based on the results of the study in table 5.7 that self-management at the Klatak

Health Center in patients with type 2 DM in 2022, most of them are in the medium

category as many as 22 respondents (62.9%). This study is in line with research

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(Srywahyuni et al., 2021) which results in self-management in the moderate

category.

Self management is an action taken by a patient in controlling and managing their

disease independently which includes treatment and preventing complications

(Medical Dictionary, 2017). There are 5 pillars of self-management of type 2 diabetes

mellitus, namely education, nutritional therapy (diet), physical activity (exercise),

blood sugar monitoring, pharmacological interventions and wound care (PERKENI,

2015). Good or bad self-management is influenced by several factors that can

influence patients in self-management of diabetes, namely age, gender, level of

education, and occupation (Ningrum et al., 2019).

Factors that can affect self-management is age. Based on the results of the study,

22 respondents (62.9%) had self-management in the medium category and almost

half of them were 14 respondents (40.0%) aged 46-55 years. From the results of

interviews and filling out self-management questionnaires because respondents

have experienced an aging process that results in changes to their physique and

anatomy. So that respondents with increasing age are able to monitor their own self-

management. This is in line with research (Kusniawati 2011 in Yuanita 2018) which

states that the aging process that takes place after the age of 30 years results in

anatomical, physiological and biochemical changes.

Another factor that can affect self-management is gender. Based on the results of

the study, 22 respondents (62.9%) had self-management in the medium category

and most of the 19 respondents (54.3%) were female. From the results of interviews

and filling out the self-management questionnaire, the researcher stated that there

were more female respondents than male because female respondents were better

able to manage and also pay more attention to self-management health compared to

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men. This is in line with research (Sousa 2011) in Fatimah, 2016) which says that

the female gender shows better self-management compared to male clients.

Another factor that can affect self-management is education. Based on the results of

the study, 22 respondents (62.9%) had self-management in the medium category

and almost half of them were 14 respondents (40.0%) in the elementary school

education category. From the results of interviews and filling out the self-

management questionnaire, the researcher stated that respondents who had an

elementary school education had less knowledge related to health sciences. Higher

education will gain more knowledge and knowledge, specifically about self-

management information so as to produce positive behaviour. This is in line with

research (Noto admodjo, 2011) which says that good education will produce positive

behaviour so that it is more open and objective in receiving information.

Another factor that can affect self-management is occupation. Based on the results

of the study, 22 respondents (62.9%) had self-management in the medium category

and almost half of them were 16 respondents (45.7%) in the house wife category.

From the results of interviews and filling out the self-management questionnaire, the

researcher stated that respondents who occupation as housewives spent more time

at home, because as housewives in the house, many jobs were completed, which

interfered with activities to manage self-management which could cause diabetes to

increase. This is in line with Kosegeran's research (2017) which says the majority of

respondents who suffer from diabetes mellitus occupation as housewives because

they have high occupation hours with irregular schedules.

Another factor that can affect self management is the length of people with DM.

Based on the results of the study, it was found that self-management of 22

respondents (62.9%) had self-management in the medium category and most of the

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long-time DM sufferers were 24 respondents (68.6%) in the category of less than 5

years. From the results of self-management interviews, researchers stated that

respondents who experienced DM were less than 5 years because DM sufferers had

a long duration of treatment became frustrated from continuous treatment so that this

negligence could result in complications. Complications cause a worsening of

physical and psychic conditions, in addition to lack of knowledge of self-

management, there can also be difficulties to improve self-management and the risk

of failure in achieving therapeutic targets. This is in line with the research of Hung et

al (2014) which said patients diagnosed with DM < 5 years where the shorter

duration of the disease has better medical behavior because patients who have a

long duration of treatment will make the patient frustrated.

Blood glucose in Type 2 Diabetes Mellitus Patients at Klatak Community

Health Center in 2022

Based on the results of the study in table 5.8 that blood sugar levels at Klatak Health

Center in patients with type 2 DM in 2022, most of them were in the high category or

more than 144 mg/dL as many as 31 respondents (88.6%). This study is in line with

research (Winta et al., 2018) which results in a high category of sugar content.

Blood sugar levels are an increase after eating and a decrease in the morning after

waking up. Blood sugar in the body increases above normal when a person

experiences hyperglycaemia, while hypoglycaemia is when there is a decrease in

blood sugar values below normal (Perkeni, 2015). Patients with type 2 diabetes do

not realize that their blood glucose levels are already high. This is due to several

factors, including the factors that can be changed are the level of education that can

affect the patient's knowledge (Berkat et al. 2018), while the factors that cannot be

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changed are age, gender (Akhsyari 2016). Other characteristic factors can be

caused by occupation (Yanuar, et al. 2017).

Factors that can affect blood sugar levels are age. Based on the results of the study,

31 respondents (88.6%) had blood sugar levels in the high category or more than

144 mg/dL and almost half of them were 17 respondents (48.6%) aged 46-55 years.

The aging process results in reduced function of pancreatic cells to produce insulin.

In addition, there can be a decrease in mitochondrial activity in muscle cells by as

much as 35%. This is an increase in fat levels in muscles as much as 30% which

can lead to insulin resistance. So, the increase in diabetes risk of diabetes is

influenced by age, specifically at the age of more than 45- 60 years, because at that

age began to increase intolerance to blood sugar levels. This is in line with research

(Wulandari and Kurnianingsih, 2018) which states that the older a person is, the risk

of increased blood glucose levels and impaired glucose tolerance will be higher due

to the weakening of all body organ functions including pancreatic cells in charge of

producing insulin.

Another factor that can affect blood sugar levels is gender. Based on the results of

the study, 31 respondents (88.6%) had blood sugar levels in the high category or

more than 144 mg/dL and most of the 22 respondents (62.9%) were female. The

number of women with high blood sugar levels is more than the number of men. This

is because there is an increase in sensitivity to insulin action in the liver and

muscles. Women have the hormone oestrogen. Increased and decreased blood

sugar levels are influenced by the hormone oestrogen. If the hormone oestrogen

increases, there will be resistance to insulin. This is in line with research (Brunner &

Suddarth, 2014; Pelt & Beck, 2012) which states that the number of women suffering

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from DM is higher than the number of men due to increased and decreased levels of

the hormone oestrogen which can affect blood glucose levels.

Education level factors can also affect blood sugar levels. Based on the results of the

study, 31 respondents (88.6%) had blood sugar levels in the high category or more

than 144 mg/dL and almost half of them were 16 respondents (45.7%) in the

elementary school education category. Education is the most effective thing in

increasing knowledge. If someone has low education, it will be difficult to receive

information because they have limited knowledge. This results in inappropriate food

choices and uncontrolled eating patterns, thereby increasing blood sugar levels. This

is in line with research (Rosyid et al. 2018) which states that individuals with low

education are able to have a risk of paying less attention to lifestyle and diet and

what to do to prevent DM.

Another factor that can affect blood sugar levels is occupation. Based on the results

of the study, 31 respondents (88.6%) had blood sugar levels in the high category or

more than 144 mg/dL and most of them were 18 respondents (51.4%) in the

housewife occupation category. People with Diabetes mellitus mostly occupation as

housewives who have more time to take care of the house such as cooking,

washing, cleaning the house, during rest time most housewives spend their time

sleeping, watching TV or telling stories with other people. This causes a lack of

physical exercise and fat easily accumulates in the body, causing increased blood

sugar levels and being overweight. Increased physical exercise promotes increased

sensitivity of insulin receptors in muscles. Muscle contractions that occur when a

person does physical activity will make it easier for glucose to enter cells, thereby

reducing insulin resistance which in turn will lower blood glucose. This is in line with

research (Mongisidi, 2014) which states that lack of physical exercise causes fat to

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easily accumulate in the body causing overweight and causing overweight and

triggering diabetes.

Another factor that can affect blood sugar levels is the length of time people with DM.

Based on the results of the study, it was found that the blood sugar levels of 31

respondents (88.6%) had blood sugar levels in the high category or more than 144

mg / dL and most of the long time dm sufferers as many as 24 respondents (68.6%)

in the category of less than 5 years. Long periods of DM sufferers can cause blood

sugar levels to accumulate continuously so that complications can occur. Blood

sugar control can be controlled properly if the patient does therapy properly. This is

in line with research (HerreraRangel, et.al., 2014) said that the length of time a

person experiences diabetes mellitus along with the complications that will appear,

meaning that if a person has diabetes mellitus for a long time, the higher the

incidence of complications experienced by patients.

The Relationship of Self Management with Blood glucose in Type 2 Diabetes

Mellitus Patients at the Klatak Community Health Center in 2022

Based on the results of the spearman rank test analysis using SPSS version 25 with

a significance of 0.05 (5%), a P value of 0.180 was obtained which means (P>0.05),

an alternative hypothesis was rejected and H0 was accepted, meaning that there

was no relationship between self-management and blood glucose in patients with

type 2 diabetes mellitus at Klatak Health Center in 2022. With a close correlation of

0.232 indicates a low correlation strength. The correlation coefficient number is

negative, namely the relationship between the two variables is not in the same

direction, it can be interpreted that the higher the level of self-management, not

necessarily the lower the blood sugar level.

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Based on the results of research from table 5.9 that self-management with blood

sugar levels in people with type 2 diabetes mellitus at Klatak health center in 2022

from 35 respondents, shows that most of the self-management is moderate with high

blood glucose or more than 144 mg / dL as many as 18 respondents (51.4%). This

research is in line with research according to (Ansafa Salsabillah, 2022).

Self management is an integral part of diabetes control. For example, in most cases

patients are advised to maintain a healthy diet and exercise to keep glucose levels

under control. Self-management can describe individual behaviour that is carried out

consciously, universally, and limited to oneself. Diabetes self-management is an

individual's actions to control diabetes including treatment and prevention of

complications. Several aspects that are included in diabetes self-management are

dietary regulation (diet), physical activity/exercise, blood sugar monitoring, drug

consumption compliance, and self/foot care (Handriana & Hijriani, 2020).

Blood sugar levels are an increase after eating and a decrease in the morning after

waking up. Blood sugar in the body increases above normal when a person

experiences hyperglycaemia, while hypoglycaemia is when there is a decrease in

blood sugar values below normal (Perkeni, 2015). The highest level achieved one

hour after eating normally does not exceed 180 mg per 100 cc of blood (180 mg/dl),

if more than this number the kidneys cannot hold sugar and the excess will be

excreted in the urine. It can be toxic and can also cause weakness and lead to

complications and other metabolic disorders. If you don't get enough energy from

sugar, your body will process other substances, namely fat and protein (Desita,

2019).

Self-management consists of five aspects, namely the management of eating a diet,

physical activity, checking blood sugar levels, regularly taking medications and foot

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care. The self-management questionnaire consisted of 14 questions. From the

results of the self-management questionnaire question items, most of the 20

respondents (57%) had dietary food management in the bad category, most of the

24 respondents (69%) had physical activity in the bad category and almost all as

many as 33 respondents (94%) had foot care in the bad category.

According to the researchers' assumptions, from the results of interviews and filling

out self-management questionnaires, most respondents in the bad category in

carrying out aspects of diet food management were 20 respondents (57%). This is

because respondents did not meet several aspects of improper dietary

arrangements, where people with type 2 diabetes mellitus could not avoid sweet

foods and foods that contain high carbohydrates. Therefore, sufferers must be

disciplined in their diet settings. This dietary regulation has the aim of controlling

metabolic so that blood sugar levels can be maintained within the normal range. This

is in line with research by Susanti & Bistara, (2018) stated that the increase in blood

sugar levels is due to a person often consuming sweet food.

From the results of the interview and filling out the self-management questionnaire,

most of the respondents were in the bad category of doing physical activity aspects

as many as 24 respondents (69%). This is because respondents lack physical

activity, because most of the patients who suffer from diabetes are female and as

large as housewives so that there is a lack of physical activity to be done regularly.

This physical activity aims to increase the sensitivity of insulin receptors so that

patients can move well to have stable blood sugar levels. This is in line with

research (Li et al., 2016) which shows that moderate intensity physical activity is

effective for lowering, optimizing blood sugar and insulin levels in people with type 2

diabetes mellitus.

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From the results of the interview and filling out the self-management questionnaire,

almost all respondents in the bad category in carrying out aspects of foot care were

33 respondents (94%). This was due to the fact that respondents were uninformed

and lacked knowledge of dehooks of foot care. This foot treatment has the aim of

preventing the occurrence of diabetic legs or diabetic ulcers. Foot care is an

important activity that must be done in people with DM which aims to reduce the risk

of foot ulcers. Things that must be considered when doing foot care are to check the

condition of the feet every day, wash the feet cleanly and dry them with a rag,

choose comfortable footwear, and check the parts of the shoes used. This is in line

with research (Sonsona, 2014) which says people with DM foot care are very

important because disorders in the legs are the most common problem resulting in

sufferers having to be treated, amputations or lifelong disabilities.

From the above aspects, it can be concluded that self-management which is still in

this moderate category which results in blood sugar levels in people with diabetes

mellitus continues to increase even though they have done part of the self-

management aspect. So, sufferers can improve self-management which is still poor,

by being given education and following the recommendations that have been given

regarding aspects of diet food management, exercise and foot care. This research is

in line with research according to (Ansafa Salsabillah, 2022).

Conclusions

1. Self Management Klatak Community Health Center is in the medium category as

many as 22 respondents (62.9%).

2. Sugar levels at Klatak Community Health Center were in the high category or

more than 144 mg/dL as many as 31 respondents (88.6%).

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3. There is not relationship between self management and blood sugar levels in

patients with Type 2 Diabetes Mellitus at Klatak Community Health Center. With

a close correlation of 0,232 it shows a low correlation strength. The number of

negative correlation coefficient so that the relationship between the two variables

is not the same direction, it can be interpreted that the higher the level of self-

management, the better the blood sugar level.

Declaration of Interest

No conflict of interest

Acknowledgment

The researcher would like to thank the head of the Puskesmas who has given

permission for the study, the head of the room and the room nurse regarding data

collection and the research process. In addition, the researcher would like to thank

all those who have supported.

Funding

None

Data Availability

The datasets generated during and/or analyzed during the current study are

available from the corresponding author on reasonable request.

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