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 Epidemiology and Society Health Review| ESHR 
Vol. 4, No. 2, 2022, pp. 76-86 ISSN 2656-6052 (online) | 2656-1107 (print) 
 
 

 

      10.26555/eshr.v4i2.5341  

 
76 

 
 

  

Research Article  
 
Quality of Life Among Diabetes Mellitus Patients in 
Indonesian Chronic Disease Management Program 
(Prolanis) 
 
Tri Ani Marwati1*, Nur Aini Kusmayanti 2, Rosyidah Rosyidah1 

1 Faculty of Public Health, University of Ahmad Dahlan, Yogyakarta, Indonesia 
2 Department of Nutrition, Faculty of Public Health, University of Ahmad Dahlan, Yogyakarta, 

Indonesia 
 
*Correspondence: triyani.marwati@ikm.uad.ac.id.  Phone: +628122942538 
 
Received 13 December 2021; Accepted 07 August 2022; Published 7 August 2022 
 

ABSTRACT 

Background: International Diabetes Federation (IDF) data shows that the increasing 
prevalence of diabetes mellitus worldwide is still happening and is a significant global health 
challenge. Patients with diabetes mellitus tend to have a poorer quality of life than those without 
a chronic disease. This study aims to obtain an overview of the quality of life of patients with 
diabetes mellitus. 
Method: This research was a quantitative descriptive study with a cross-sectional approach, 
conducted in July–October 2021 at one of the Chronic Disease Management Program 
Communities (Prolanis) in Bantul District, Yogyakarta. The total participants of this study were 
63 patients with diabetes mellitus who were registered in the Prolanis community; they did not 
show mental disorders and were willing to participate in the study. We used purposive sampling 
to recruit the participants. Researchers used the WHOQOL-BRIEF questionnaire that has been 
standardized and created by WHO. Other variables recorded in this study include eating patterns 
and socio-demographic characteristics. A descriptive analysis was conducted to present the 
results in tables and graphs. 
Results: Most participants were elderly (over 50 years old), had a high level of education, had 
good religious spirituality, were in marital status, and had no comorbidity. Patients with diabetes 
mellitus in the Prolanis group had a good quality of life and level of life satisfaction. The 
description of the participants' eating patterns was also good, where none of them consumed 
instant food anymore, and all consumed a variety of fruits and vegetables regularly. 
Conclusion: This study showed the quality and satisfaction of life and a good diet in patients 
with diabetes mellitus in the Prolanis Community. Therefore, it is necessary to advance the 
Prolanis community to maintain the quality of life, life satisfaction, and lifestyle of patients with 
diabetes mellitus. 

Keywords: Quality of life; Diabetes mellitus; Prolanis community 



 
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INTRODUCTION 

The International Diabetes Federation (IDF) reports an escalating prevalence of diabetes 
mellitus globally. This number will continue to increase and become a significant global health 
challenge for individuals, families, and communities. In 2021, the IDF reported a total of 537 
million or similar, with 1 in 10 adults living with diabetes. Cases will increase to 643 million in 
2030 and 784 million in 2045. The IDF also states that because of diabetes, one person in the 
world dies every five seconds, and it causes a total loss of USD 966 billion (1). In Indonesia, 
WHO and IDF predict diabetes cases will increase by 2-3 times in 2030 (1-2).  

Quality of life has an essential role in human health outcomes. It is the ultimate goal of all 
health interventions (3,4) WHO states that the definition of "health" is not only the absence of 
disease in a person but a state of complete physical, mental and social well-being (5). A 
person's quality of life can be measured by looking at physical and social functioning aspects 
and feelings towards their physical and mental condition (6). Recently, interest in quality-of-
life issues has increased significantly, especially in health-related issues.  

Compared to persons who do not have a chronic disease, people with diabetes mellitus have 
a lower quality of life (7-9). People with diabetes mellitus have challenges accepting and 
adapting to the disease throughout their lives. Therefore, improving or maintaining a good 
quality of life is part of the main goal in treating diabetes mellitus. Studies identified factors 
related to the quality of life of people with diabetes mellitus, including blood sugar levels, 
complications with other diseases, and psychological, social, and demographic characteristics 
(3).  

The Chronic Disease Management Program (Prolanis) is a health care system with a proactive 
approach implemented in an integrated manner involving participants, health facilities, and 
BPJS Kesehatan. This program provided effective and efficient health care services, including 
medical education and consultations, home visits, reminders, club activities, and health status 
monitoring. Prolanis aims to support participants who suffer from chronic diseases to achieve 
their optimal quality of life. Prolanis' targets are all BPJS Kesehatan participants with chronic 
conditions (Diabetes Mellitus Type 2 and Hypertension) (10).  

Previous studies have reported positive public acceptance of Prolanis, as evidenced by an 
increase in the number of participants, which has tripled since 2014 (11). However, some 
barriers related to support from policymakers were still found – i.e., limited funding, 
infrastructure, and human resources, as well as unclear standard operation procedure (SOP) 
(12). This poor support, possibly caused by limited evidence, directly reported the advantages 
of Prolanis for their participants. Previous evaluation programs mainly focused on their impact 
on health costs and the health services system (11,12). Thus, this study is intended to provide 
the descriptive impact of Prolanis on its participants, particularly on their quality of life, to 
encourage policymakers to give maximum support to this program.   

 

 

 



 
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METHOD 

The Research Design and Setting 

This research was a quantitative descriptive study with a cross-sectional method conducted 
from July-October 2021 in one of the Prolanis Communities in Bantul Regency, DI Yogyakarta. 
The reason for choosing this location was based on data showing 610 diabetes mellitus 
patients joined the Prolanis community in Bantul Regency.  

Research Participants 

This study involved 61 patients with diabetes mellitus registered in the Prolanis community, 
who did not show mental disorders, could communicate well and were willing to participate. 
The sample was selected by using purposive sampling. The sample calculation was based on 
a 90% confidence level and a 10% margin error.  

Research Variables and Instruments  

The primary variable in this study was the quality of life of patients with diabetes mellitus. 
Researchers used the standardized WHOQOL-BRIEF questionnaire (6) and created by WHO. 
This questionnaire has good reliability, as indicated by an alpha coefficient of 0.76 and external 
validity of 93%. In this study, researchers included four aspects (physical, psychological, 
social, and environmental) in the WHOQOL-BRIEF questionnaire. Social factors: personal 
relationships, social relationships, and sexual activities. Ecological aspects: have financial 
resources, freedom, security, physical safety, health and social care, home environment, 
sharing of information and skills, and engaging in fun activities. All questions were assessed 
using a Likert scale of 1-5, including intensity, capacity, frequency, and evaluation. 

Other variables recorded in this study: eating patterns and socio-demographic characteristics. 
Dietary data were taken using a questionnaire containing the grouping of foodstuffs based on 
macro and micro nutrition sources and the frequency of eating weekly. 

Data Analysis 

Data analysis was done descriptively through cleaning, editing, and coding before further 
analysis. The analysis was presented in graphical form to make it more informative.  

Ethical Consideration 

Researchers respect participant confidentiality and only use research data for scientific 
purposes. Researchers had explained the entire research process to the participants before 
the study was conducted. The research started when the participants had signed the informed 
consent. 

 

  



 
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RESULTS 

General characteristics  

The total participants of this study were 61 patients with diabetes mellitus. Most of the research 
participants were male, aged over 50 years (elderly), Moslem, not working formally 
(housewife, retired, not working), highly educated (at least a bachelor's degree), and were in 
marital status. The comorbidities found in this study: are cholesterol, high blood pressure, 
gout, stomach acid, heart disease, and tuberculosis. However, for the most part, the study 
participants had no comorbidities. Most of the participants in this study had a good quality of 
life and were satisfied with their current living conditions (Table 1). 

Table 1. Characteristics of Diabetes Mellitus Patients in the Prolanis Group 

Variables Frequency Percentage (%) 
Gender 

Female 
Male 

 
33 
28 

 
54 
46 

Age 
<50 
>50 

 
17 
44 

 
28 
72 

Religion 
Moslem 
Not Moslem  

 
57 
4 

 
93 
7 

Employment status  
Employed  
Unemployed  

 
36 
25 

 
59 
41 

Education 
Senior high school or less 
University 

 
23 
38 

 
37 
63 

Marital Status 
Married  
Not married 

 
57 
4 

 
93 
7 

Comorbidities  
No comorbidities 
Hypertension 
Lung disease 
Gout 
Cholesterol 
Heart Disease 

 
37 
14 
4 
3 
3 
1 

 
61 
23 
7 
5 
5 
2 

Quality of life  
Very Good 
Good 
Fair 
Worse  

 
9 
32 
13 
7 

 
15 
53 
21 
12 

Self-condition satisfaction  
Very satisfied 
Satisfied 
Moderately satisfied  
Not satisfied 

 
8 
33 
19 
1 

 
13 
54 
31 
12 

 

The quality of life physically, psychologically, socially, and environmentally. 

Based on physical categories, most study participants did not need medical therapy, had an 
adequate sleep, and did not feel pain or discomfort. For the most part, participants thought 
they could work and carry out mobility daily, although they felt pretty tired and entirely 
dependent on drugs (Figure 1). 



 
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Figure 1. The Quality of Life of Diabetes Mellitus Patients by Physical Category 

Psychologically, some of the research participants felt they could keep thinking, had good 
spirituality or belief in religion, were confident, had positive feelings, and were able to provide 
a self-image (Figure 2). 

 

Figure 2. The Quality of Life of Diabetes Mellitus Patients by Psychological Category 

The results of this study indicated that most participants have a level of satisfaction that is not 
high enough for social quality, including satisfaction with support from friends and other social 
support, satisfaction with relationships and personal relationships, satisfaction with living 

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

need
medical
therapy

need rest feel unwell
and

discomfort

perform
mobility in
daily life

being able
to work

feeling
tired very

often

drug
addiction

performing
daily

activities

very high high moderate low very low

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

try to keep
thinking and

studying

has religious
believe

self-confidence has positive
thinking

has negative
thinking

self-recognition

very high high moderate low very low



 
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conditions, satisfaction with sexual life, and satisfaction to access information. However, most 
participants were satisfied with their health services (Figure 3).  

 

Figure 3. The Quality of Life of Diabetes Mellitus Patients by Social Category 

The study's results related to the description of the quality of life based on environmental 
factors showed that most participants were in a relatively healthy and safe environment and 
quite able to enjoy their lives. Most of them can do recreation and fun activities with moderate 
frequency. However, most also experience mild frequency disturbances from pollution, noise, 
climate, and traffic (Figure 4). 

 

Figure 4. Experience of disturbances from pollution, noise, climate, and traffic 

The diet of patients with diabetes mellitus 

The results showed that the most consumed carbohydrate source by the participants was 
white rice. Meanwhile, many participants have never again consumed instant noodles. 
Participants in this study consumed a variety of sources of protein and vegetables. The type 
of fruit most consumed by participants in this study was banana. Meanwhile, dragon fruit and 
melon were the most never consumed fruits by participants in this study. Participants in the 
study were a group that rarely consumed milk and yoghurt, and many never consumed both 
(Figures 5-9). 

0%

20%

40%

60%

80%

100%

sexual
satisfaction

support from
friends

satisfaction
towards place

of live

satisfaction
towards

health facility

sociability information
access for
daily life

very satisfied satisfied moderate dissatisfied very dissatisfied

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%

100%

polutio
n, n

oise
, cl

im
ate

tra
nsp

orta
tio

n sa
tis

fac
tio

n

hea
lth

y e
nvir

onment

saf
ety 

en
vir

onment

su
pport 

to co
nce

ntra
te

life
 is 

mea
ningfu

l

enjoy l
ife

nee
d m

edica
l su

pport

lei
su

re opportu
nitie

s

too many many moderate low never



 
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Figure 5. Diet of Diabetes Mellitus Patients based on Carbohydrate Sources 

 

Figure 6. Diet of Diabetes Mellitus Patients based on Protein Source 

 

Figure 7. Diet of Diabetes Mellitus Patients by Vegetable Group 

0%

20%

40%

60%

80%

100%

white rice yellow rice bread instant noodle casava

never 1-3 times a month 1-3 times a week 1-3 times a day

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%

100%

ch
ick

en
meat

duck

ch
ick

en egg
s

duck 
eg

gs

tah
u/to

fu

tem
peh

ca
t fi

sh

ban
deng f

ish

mujai
r fi

sh

tongk
ol fi

sh

sh
rim

p
sq

uid

ch
ick

en gi
zza

rd

ch
ick

en liv
er

never 1-3 times a month 1-3 times a week 1-3 times a day

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%

100%

sp
inac

h

wate
r s

pinac
h

so
up

so
ur s

oup

ca
p ca

y

long b
ean

s

mush
room

urap pec
el

never 1-3 times a month 1-3 times a week 1-3 times a day



 
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Figure 8. Diet of Diabetes Mellitus Patients by Fruits Group 

 

Figure 9. Diet of Diabetes Mellitus Patients by Milk and Yoghurt Group 

DISCUSSION  

This study showed that diabetes mellitus patients in the Prolanis group had a good quality of 
life and level of life satisfaction. However, most of them were elderly (over 50 years of age). 
Prolanis is a health care system and a proactive approach implemented in an integrated 
manner involving participants, health facilities, and BPJS Kesehatan. In this context of health 
care for BPJS Kesehatan participants who suffer from chronic diseases achieve optimal 
quality of life with effective and efficient health care costs (10). The results of this study are 
similar to previous studies in the age group over 65 years, which showed that community-
based programs such as Prolanis, which encourage activity and involvement of patients in 
maintaining health, can improve the quality of life of patients with diabetes mellitus (13-14). 
This study's results differ from a study conducted in Mexico, which reported a low quality of 
life for people with diabetes mellitus (15). This result is probably because the participants in 
Mexico were patients in the hospital, while the participants in this study were Prolanis 
participants in the community. 

The assessment results in the physical, psychological, social, and environmental categories 
indicate good quality and life satisfaction. Participants gave "fair" to "high" scores on all 
aspects of the assessment. The level of good quality and life satisfaction in this study was 
influenced by socio-demographic characteristics and clinical status of diabetes mellitus 

0%

20%

40%

60%

80%

100%

ban
an

a
melon

wate
rm

elon

man
go

ap
ple

oran
ge

drag
on fru

it

sn
ak

e fru
it

never 1-3 times a month 1-3 times a week 1-3 times a day

0%

20%

40%

60%

80%

100%

never 1-3 times a month 1-3 times a week 1-3 times a day

yoghurt fresh milk



 
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patients who participated in this study. Including higher education level, good religious 
spirituality, marital status, and not having comorbidities. The participants in this study also had 
a picture of a good diet, where none consumed instant food, and all consumed various fruits 
and vegetables regularly. 

The resulting study is also in line with the previous research. Although many are retired or no 
longer actively working formally, higher education levels symbolize good economic conditions 
that can improve their mood so that their perceptions of quality and life satisfaction are high 
(16). At the same time, research also proves that low levels of education are associated with 
low quality of life in patients with diabetes mellitus (17). The results of previous studies also 
showed that belief in religion significantly increased the patient's strength in dealing with 
difficult situations due to the diagnosis of his illness (18). Marital status, which shows family 
support, is also a factor that significantly affects the quality of life of people with chronic 
diseases, even more than support from friends or other social environments (19). Another 
thing that is very important in influencing the quality of life of patients with diabetes mellitus is 
a comorbid disease (20,21) because its presence can increase psychological stress and or 
reduce the patient's activity and mobility. 

This research is one of the studies on the quality of life and life satisfaction that is rarely carried 
out in the Prolanis community in Yogyakarta. Therefore, this research is expected to become 
scientific evidence regarding the importance of conducting similar studies in more numbers so 
that health workers have good sources to pay more attention to patients' quality and life 
satisfaction with diabetes mellitus. The researcher admits that this research is limited by an 
explanatory study approach where all research results are analyzed and presented 
descriptively without analyzing the relationship on each variable. 

CONCLUSION 

This study showed the quality and satisfaction of life and a good diet in patients with diabetes 
mellitus in the Prolanis Community. Although most study participants did not have 
comorbidities, many still had hypertension and cholesterol. Therefore, the researchers 
recommend that the Prolanis member be more active in the Prolanis community to maintain 
the quality of life, life satisfaction, and lifestyle of patients with diabetes mellitus, including by 
providing a pocketbook, "Healthy Living Guide for Diabetes Mellitus Patients." 

Acknowledgement 

We are grateful to the University of Ahmad Dahlan for funding this research.  We thank the 
Prolanis Community in Bantul District for participating in this study. 

Authors' contribution 

TAM did the chapters Introduction, method and result, NAK did the data analysis, and R did 
language editing and generated the abstract 

Funding Statement 

This research has not received external funding. 



 
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Conflict of interest 

There is no conflict of interest in this research.  

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