Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.73-79 73 Diet Compliance Analysis Towards Blood Sugar Levels For Diabetes Mellitus Patients Septi Dwi Rahmawati, Atik Setiawan Wahyuningsih, Eva Agustina Yalestyarini 1 1 STIKes Surya Mitra Husada, Kediri, East Java, Indonesia Corresponding author : atiksetiawan9@gmail.com ABSTRACT Background: People with diabetes mellitus are increasing in number. Controlling blood sugar levels is an action that must be taken to get normal and stable blood sugar levels. Self-control takes precedence over treatment. Compliance with diet is one of the important things in controlling blood sugar levels. Raflesia Room as one of the internal medicine inpatients in dr. SoedomoTrenggalek, received inpatient care for the majority of diabetes mellitus patients. Purpose : The purpose of this study was to analyze the relationship between diet adherence and blood sugar levels in people with diabetes mellitus. Methods : The research design used descriptive analytic with cross sectional approach. The population in this study were patients with diabetes mellitus in the Raflesia room of Dr. SoedomoTrenggalek Hospital in January 2017 with 30 patients. With a simple random sampling technique so that 29 samples were obtained. Result : The results showed that almost all respondents, namely 25 (86%) respondents, had abnormal blood sugar levels. Almost all respondents, 23 (79%) did not comply with the diet. Chi square test results obtained 0.004 which means there is a relationship between dietary compliance with blood sugar levels of diabetes mellitus patients in Raflesia room Dr. Soedomo Hospital Trenggalek in 2017. Conclusion : Old age is an age that is susceptible to a decrease in body function, especially hormonal causes of decreased pancreatic function resulting in a decrease in insulin sensitivity which causes high blood sugar levels. The level of education has an important role in diet compliance where patients are required to understand 3J "Types, Amounts and Schedules" so that the lower level of education causes lower diet compliance. Disobedience to diets causes sufferers to consume irregular foods which cause a pile of glucose and blood so that hyperglycemia occurs. Keywords : Diabetes Mellitus, Blood Sugar Levels, Dietary Compliance Received July, 25, 2018; Revised August 24, 2018; Accepted September 14, 2018 How to Cite: Rahmawati, S., Wahyuningsih, A., Yalestyarini, E. (2018). Diet Compliance Analysis Towards Blood Sugar Levels For Diabetes Mellitus Patients. Journal Of Nursing Practice, 2(1), 73-79. https://doi.org/10.30994/jnp.v2i1.46 The Journal of Nursing Practice, its website, and the articles published there in are licensed under a Creative Commons Attribution- NonCommercial-ShareAlike 4.0 International License. https://doi.org/10.30994/jnp.v2i1.46 Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.73-79 74 BACKGROUND Diabetes mellitus (DM) is a cause of high mortality due to the resulting cardiovascular disease. Patients with diabetes mellitus have 2-3 times higher risk than non- DM populations (Siregar, 2010). Diabetes mellitus (DM) is a chronic syndrome of metabolic disorders of carbohydrates, proteins, and fats due to insufficient insulin secretion or insulin resistance in tissues (Dorland, 2002). According to Riyadi&Sukarmin (2008) there are several factors that cause an increase in blood sugar levels, namely genetic factors, age, stress, wrong diet and obesity. Raflesia Room is an internal medicine inpatient room at RSUD dr. SoedomoTrenggalek. Patients who were hospitalized in the raphlesia room were mostly diabetic mellitus. Patients with diabetes mellitus who are hospitalized due to problems with an increase in uncontrolled blood sugar. The latest data from the (International Diabetes Federation, 2018) at the Diabetes Comolications Congress shows that currently the complications of DM lead to 425 million adults and will increase to 629 million in 2045. World Pratiwi, 2007 included data from the Health Organization (WHO) predicts the increase in the number of people with diabetes mellitus in Indonesia from 8.4 million in 2000 to around 21.3 million in 2030, even Indonesia ranks fourth in the world as the largest number of people with diabetes mellitus after India, China and America (as cited in Aini et al., 2012). (KOMINFO, 2015) Based on data from Basic Health Research (Riskesdas) in Indonesia there are 10 million people with diabetes, and 17.9 million people at risk of developing this disease. While East Java Province entered the top 10 prevalence of diabetics throughout Indonesia or ranked ninth with a prevalence of 6.8. Monthly report in the Raflesia room of RSUD dr. Soedomo Trenggalek, the number of patients with diabetes mellitus who were treated in October to December 2016 was 72 patients. Based on the results of the diet obedience interview on 10 patients, 6 people were obedient and 3 people were not compliant. Plasma glucose levels are determined at a time by the balance between the amount of glucose entering the bloodstream and the amount that leaves it. Therefore, the main determinant of input is from diet, the rate of entry into muscle cells, adipose tissue, and other organs, and liver glucostatic activity. Five percent of glucose consumed is converted directly into glycogen in the liver, and 30-40% is converted to fat. The rest is metabolized in muscles and other tissues. During fasting, liver glycogen is broken down from the liver to increase blood glucose levels. If there is a longer fasting, the liver glycogen is depleted and glycogenogenesis occurs from amino acids and glycerol in the liver (Ganong, 2010). So that to keep controlling the sugar levels diet compliance becomes one of the important elements to control sugar levels. But in reality not all people with diabetes mellitus are able to obey their diet. Disobedience of patients in managing diabetes mellitus will have a very large negative impact including increased health costs and diabetes complications (Aini et al., 2012). From the description above the author will conduct research on the relationship of blood sugar levels with diet adherence in patients with diabetes mellitus in the Raflesia room of RSUD dr. SoedomoTrenggalek. OBJECTIVE The purpose of this study was to analyze the relationship between diet adherence and blood sugar levels in people with diabetes mellitus. Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.73-79 75 METHODS The research design used in this study is descriptive analytical method and cross sectional research type. The population in this study were all DM patients in the raphlesia room in RSUD Dr. Trenggalek in January 2017, totaling 30 patients with simple random sampling obtained 29 respondents. The statistical test used was Chi Square. The measuring instrument used to measure blood sugar levels using a glumometer to determine normal levels and abnormal blood sugar levels. Diet compliance measuring tool uses a questionnaire to identify compliance and non-compliance. RESULTS a. Characteristics of respondents age Table 1. Age characteristics of DM patients in the Raflesia Room of RSUD dr. Soedomo Trenggalek dated April 5 to April 18 2017 Characteristics Amount Percentage ≤20 years old 0 0 21-25 years old 0 0 26-35 years old 2 6 >35 years old 27 93 Totals 29 100 Primary source : 2017 From Table 1 shows that the majority of respondents aged> 35 years were 27 respondents (93%). b. Characteristics of respondents based on gender Table 2. Sex characteristics of DM patients in the Raflesia Room of RSUD dr. Soedomo Trenggalek dated April 5 to April 18 2017 Characteristics Amount Percentage Laki-laki 17 58 Perempuan 12 42 Totals 29 100 Primary Source : 2017 Based on Table.2 shows that more than some respondents were male as many as 17 respondents (58%). c. Characteristics of respondents based on education level Table 3. Characteristics of education level of DM patients in the Raflesia Room of RSUD dr. Soedomo Trenggalek dated April 5 to April 18 2017 Characteristics Amount Percentage SD 3 10 SMP 9 32 SMU 17 58 PT 0 0 Totals 29 100 Primary source : 2017 From Table 3 shows that more than half of respondents with high school education were 17 respondents (58%).. d. Characteristics of respondents based on job Table 4. Job characteristics of DM patients in the Raflesia Room of RSUD dr. SoedomoTrenggalek dated April 5 to April 18 2017 Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.73-79 76 Characteristics Amount Percentage Unemploy 5 17 Farmer 7 25 Entrepreneur 17 58 Civils/self employ 0 0 Jumlah 29 100 Primary source : 2017 Based on Table 4, showed that more than some respondents were entrepreneur as many as 17 respondents (58 %) e. Blood sugar levels Based on diagram 1 shows that almost all respondents have abnormal sugar levels, namely there are 25 (86%) of the total 29 respondents f. Compliance With Diet Based on diagram 2 shows that almost all respondents did not comply with the diit, namely 23 respondents (79%) of the total respondents 29 respondents g. Tabulation tabulation of diet compliance with blood sugar levels Table 5 cross tabulation of sugar content with diit adherence to diabetes mellitus patients in the Raflesia room of RSUD dr. SoedomoTrenggalek dated April 5 to April 18 2017 Comply Diet Uncomplyed diet Total ValueP Normal Blood sugar 4 14.8% 23 79.3% 27 93.1% Abnormal Blood Sugar 2 6.9% 0 0% 2 6.9% 0.004 TOTAL 6 20.6% 23 79.3% 29 100 Based on Table 5 shows almost all respondents had sugar levels in the abnormal category and did not comply with diit as many as 23 respondents (79.3%). DISCUSSION a Blood sugar levels Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.73-79 77 Based on diagram 1, it is known that almost all respondents had abnormal sugar levels, namely 25 (86%) of the total 29 respondents and almost all respondents aged> 35 years, as many as 27 respondents (93%) of a total of 29 respondents. Based on research conducted by Wahyuningsih& Nusantara (2017) in the title of patients with DM with insomnia in terms of characteristics shows that diabetes mellitus is the most common in the elderly. Diabetes mellitus (DM) is a group of heterogeneous disorders characterized by increased levels of glucose in the blood or hyperglycemia. Glucose normally circulates in a certain amount in the blood. Glucose is formed in the liver from the food consumed. Insulin is a hormone produced by the pancreas, controlling glucose levels in the blood by regulating its production and storage (Smeltzer& Bare, 2002). Increased sugar levels can be influenced by age and stress, where humans generally experience a physiological decline that dramatically decreases rapidly after age 40. This decrease will be at risk for decreasing the endocrine function of the pancreas to produce insulin. Elderly age is the age at which respondents experience a decline in all tissue functions, disrupted hormone production including decreased insulin production and decreased long-term memory that causes uncontrolled respondents in medication adherence. Besides diabetes mellitus is a type of disease that can only be controlled, but can not be cured, so suffering from long-term disease can cause the boredom of respondents so often do not pay attention to the condition of blood sugar conditions, respondents began to not care about the disease so that abnormal blood sugar increases not give any influence to the respondent. b Compliance with diet Based on diagram 2, it is known that most of them do not comply with the diet, which is 79% of the total respondents of 29 respondents. Compliance is a behavior in keeping a recommendation on daily habits and can be scored with the research score. A compliance is influenced by the level of education, where education is a major basis in the success of prevention or treatment (Tjokroprawiro, 2002). Based on Table 3 it is known that more than half of respondents with high school education were 17 respondents (58%). This shows that 42% of other respondents still lack education, namely elementary and junior high school. This is consistent with the research conducted by Senuk et al., 2013 that education has a role to play in increasing compliance with the information provided. In regulating the diet for people with diabetes mellitus, the principle is 3J, namely: a) Amount The amount of food consumed is adjusted to height, weight, type of activity, and age. You can calculate your calorie needs based on guidelines on daily calorie requirements. b) Type Food preparation for people with diabetes mellitus includes carbohydrates, proteins, fats, and fruits and vegetables. Nutritional needs must be fulfilled with the right menu so as not to raise blood sugar. c) Schedule That is a fixed meal time including breakfast, lunch, dinner, and a snack. Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.73-79 78 Compliance is an order in carrying out actions that are in line with the objectives to be achieved. Understanding the purpose of treatment in patients with diabetes mellitus is influenced by maturity in thinking. Compliance with the DM treatment diet requires adequate education so that the patient is able to control the desire to consume the desired food but must be avoided. Education is one of the milestones of knowledge to take real action. With education that is insufficient for patients with DM, they will find it difficult to determine 3J, namely the exact number, the right type and the right schedule. DM sufferers are required to know how many calories must be consumed every meal and what time or time the patient is allowed to consume food. This condition requires DM sufferers to process their knowledge and be shown clearly in the form of compliance with DM treatment die. So that if education is insufficient it will tend to look less obedient in treatment and have an impact on deviant behavior with goals. c Blood sugar levels and dietary compliance Based on the results of the statistical test in table 1, the results of the statistical value (p-value) chi square obtained Sig (2-tailed) is equal to = 0.004 means