INTEREST: Jurnal Ilmu Kesehatan

Vol. 10, No. 2, November 2021

https://doi.org/10.37341/interest.v0i0.365

Original Research

Caring-Based Supportive Educative Enhance Prevention Ability Of

Diabetic Ulcers In Patients With Type II Diabetes

Elyk Dwi Mumpuningtias1*, Emdat Suprayitno2, Qory Nelia Damayanti3

1,2,3
Faculty of Health University of Wiraraja, Indonesia

ABSTRACT
Background: Patients with diabetes mellitus are at risk for ARTICLE HISTORY
complications of diabetic foot ulcers. This complication can Received : October 23th, 2021
avoid if people with diabetes mellitus have the proper Accepted : January 4th, 2022
knowledge of self-care management. This study aimed to
determine the effect of self-care management education on KEYWORDS
preventing foot ulcers in patients with type II diabetes mellitus. caring, diabetes, diabetic ulcer,
supportive educative;
Methods: The design of this study is quasi-experiment. The
number of samples was 86 with a simple randomized sample CONTACT
divided into two groups, 43 in the treatment group caring base Elyk Dwi Mumpuningtias
supportive educative activities, and 43 in the control group
distributing leaflets on diabetes. Results from studies were [email protected]
analyzed using the paired t-test and the independent t- test. Faculty of Health University of
Wiraraja. Jl. Raya Pamekasan -
Results: These study results are based on independent t-test Sumenep No.KM, RW.05, Panitian
scores of self-care management in the treatment and control Utara, Patean, Batuan, Sumenep
groups after the intervention, namely p = 0.002. The difference Regency, East Java 69451
in the delta score of self-care management scores in the
treatment and control groups after the intervention was
p=0.000.

Conclusion: The results showed that self-care management

education interventions effectively increased the ability of self-
care patients with type II diabetes mellitus to prevent
complications of diabetic ulcers. This intervention can be a
promotive effort to increase self-care independence in patients
with type II diabetes mellitus to avoid complications of diabetic
wounds.

Cite this as: Mumpuningtias, E., Suprayitno, E., & Damayanti, C. (2022). Caring-Based Supportive
Educative Enhance Prevention Ability Of Diabetic Ulcers In Patients With Type II
Diabetes. Interest : Jurnal Ilmu Kesehatan, 198-206.
https://doi.org/10.37341/interest.v0i0.365

INTRODUCTION
One of the health problems is a non-communicable disease, namely the incidence
of diabetes mellitus in Indonesia. According to the Indonesian Endocrinology
Association, non-communicable diseases are the highest cause of death in Indonesia
(Rahman et al., 2020). Diabetes mellitus is a serious and complex metabolic disease that
attacks almost all vital organs in the body and is usually has hyperglycemia symptom

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due to decreased insulin secretion and impaired insulin activity or even both (Yusnaeni
& Fajriansih, 2021).
Currently, the prevalence of diabetes mellitus is increasing; especially type II
diabetes mellitus, which amounts to more than 90% to 95% of all diabetes
populations. In patients with DM type II, it is more difficult to monitor blood glucose
levels because they are not dependent on insulin and are more often caused by
unhealthy lifestyle management (Fatmawati et al., 2020). If the person or patient does
not control or maintain blood glucose levels properly, it can cause various
complications or other diseases such as chronic kidney failure, stroke, heart attack, leg
ulcers to amputation of part of the body, blindness, and impotence (Dewi & Hinchliffe,
2020).
There are 425 million people with diabetes mellitus and 82 million people in the
world and Southeast Asia (Septiani et al., 2020). Indonesia is the highest number of
people with diabetes mellitus in the world and is in the top 10 in 2019 according to the
International Diabetes Federation, which is 10.7 million people, of which Indonesia is
ranked seventh based on these data (Dewi & Hinchliffe, 2020). Doctor's diagnosis in the
population aged 15 in the East Java province is 2.6%. doctor's diagnosis in residents of
all ages and the prevalence of routinely checking blood sugar levels (KGD) in the West
Java province is 2.0% (Rumaiza & Khairani, 2019).
Based on data obtained from the Health Service, Sumenep Regency, in 2019 there
were 15,497 people diagnosed with diabetes mellitus and an increase in 2020 as many
as 43,567 people were recorded, and based on data from the Kalianget Health Center in
2020 as many as 10,486 people were diagnosed with diabetes mellitus. Most of the
respondents have also experienced diabetic wounds and do not know for sure how to
prevent complications.
Diabetes Mellitus is a disease that cannot be cured but what can be done is to
control blood sugar levels which require lifelong management to improve the life’s
quality of sufferers. Lack awareness of self-control and an unhealthy lifestyle or wrong
self-management in people with diabetes mellitus can ultimately lead to an increase in
health problems that cause patients to suffer complications and lead to an increased
mortality rate every year (Khansa, 2020).
The lack of public knowledge about diabetes mellitus in preventing and how to
treat this disease is still poor, marked by an increase in the number of its
complications. Where people only know the causes and signs of the symptoms, but do
not practice a good lifestyle to prevent the occurrence of Type II diabetes mellitus, so
that until now the number of people with diabetes mellitus has not decreased. Diabetes
mellitus does not directly cause death, but poor lifestyle management can lead to
complications and cause a decrease in the life’s quality of patients (Rahman et al.,
2020).
The environment is one of the factors that greatly affect a person's
diabetes mellitus, as caused by poor eating patterns or diets and lifestyles. Eating
patterns or diets that are accustomed to foods that contain lots of fat, high
carbohydrates, and high calories are very influential in increasing a person's risk of
developing diabetes mellitus, while poor lifestyles such as irregular lifestyles, prolonged
stress, feelings of worry, excessive fear, and far from spiritual values which are believed
to be factors that greatly influence a person's susceptibility to diseases such as diabetes
or other diseases (Dolongseda et al., 2017).

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 Lack of physical activity or exercise can also cause a person to be susceptible to
diabetes mellitus. Diabetes mellitus is a disease that has complications and is easy to
cause most other diseases which are caused by blood sugar levels that continue to
increase, resulting in damage to blood vessels, nerves and internal structures in the
body (Priyono et al., 2021)
People with diabetes mellitus are susceptible to various kinds of chronic
complications if blood glucose levels are not controlled properly. Diabetes mellitus
complications that is easily experienced by people with diabetes mellitus is diabetic foot
ulcers that are one of the main complications of diabetes mellitus with a fairly high
prevalence in several countries. Health promotion is in accordance with the 2006 DM
Management Consensus, namely the promotion of healthy behavior is an important
factor in health service activities. Patients need to be given health education to be able
to perform regular self-examinations of the feet, with particular attention to callus
growths, loss of sensation in the skin, infections and blisters on the feet (Wijaya, 2021).
The prevalence in Indonesia is around 15% of the occurrence of diabetic foot
ulcers during their lifetime and the risk of recurrence in 5 years is 70%, the risk of
amputation is 30%, the mortality rate is 32%, and in Indonesia complications of diabetic
foot ulcers are the biggest cause, namely 80% for hospital treatment (Verdoia et al.,
2019). Complications of diabetes mellitus are more easily experienced by people with
diabetes mellitus who cannot control their blood glucose. Complications of diabetes
mellitus are divided into two, namely acute and chronic complications. Acute
complications include hypoglycemia and hyperglycemia, while chronic complications
include heart attack, chronic kidney failure, stroke, and retinopathy of the eye and
diabetic foot ulcers (Pranata et al., 2020).
Health education to change the behavior of a person or individual, group or
community in a planned manner so that they can be more independent to achieve their
health goals And prevention is the main thing in diabetic foot ulcers that are
indispensable (Sumarlan, 2020). One of the prevention strategies is health education
provided by nurses to patients who are deemed necessary and can increase patient
knowledge about diabetes-related problems and complications (Valk et al., 2002). Self-
care management is one of the efforts that can be applied to to prevent complications in
people with diabetes mellitus.
The aim of self-care management is to maintain blood glucose levels within
normal limits. The components of self-care management are diet, blood glucose control,
physical activity or exercise, routine examinations and pharmacological therapy. People
with diabetes mellitus in implementing self-care management are influenced by several
factors, namely, health education, support, communication and personal
factors (Septiani et al., 2020). This aim of this study was to determine the effect
of caring-based supportive education on the ability to prevent diabetic ulcers.

MATERIALS AND METHOD

This research is quantitative with a quasi-experimental design. The populations in
this study were all patients with type II diabetes mellitus in the Kertasada Kalianget
village with simple random sampling. The population of this study was some type 2
diabetes mellitus patients as many as 109 patients with the criteria of suffering from
diabetes mellitus for more than a year, there are no complications, can read, write and
are willing to be respondents.

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 The number of samples was 86 people divided into two groups. Many as 43
people were given a supportive educative intervention once a week for one month, and
the control group as many as 43 people were only assigned leaflets about diabetes ulcer
prevention. The instrument used in this study was a diabetic ulcer prevention
questionnaire with significance criterion r in the range r = 0.2000.742, table r = 0.362
and confidence value Cronbach's alpha = 0.813. Data analysis used the paired t-test and
the independent t- test.

RESULTS
The following is general data

Tabel 1. Respondents Characteristic Based on Age, Gender, Last Education and Occupation
Characteristic Frequency Percentage
Age
32-38 Years 18 20.9
39-45 Years 10 11.6
46-52 Years 18 20.9
53-59 Years 20 23.3
60-66 Years 14 16.3
67-76 Years 6 7.0
Gender
Man 14 16.3
Woman 72 83.7
Last Education
Uneducated 20 23.3
Elementary School 50 58.1
Senior High School 14 16.3
College 2 2.3
Occupation
Civil Servant 0 0
Teacher 0 0
Entrepreneur 12 14.0
Farmer 2 2.3
Unemployed 72 83.7
Total 86 100.0

Based on table 1 of the frequency distribution by age, it is known that most of the
respondents who suffer from type II diabetes mellitus are aged 53-59 years, as many as
20 respondents (23.3%). The frequency distribution by gender, it is known that the
majority of respondents who suffer from type II diabetes mellitus are women as many as
36 respondents (83.7%).
The frequency distribution based on the last education, it is known that most of
the respondents who suffer from type II diabetes mellitus, most of them are elementary
school as many as 50 respondents (58.1%). The frequency distribution based on

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occupation, it is known that the majority of respondents who suffer from type II
diabetes mellitus are unemployed as many as 72 respondents (83.7%).
The following is special data

Table 2. Differences In The Mean Self-Care Scores Before and After –Caring-Based Supportive
Educative Interventions Group and In The Control Group.
Selfcare Score Mean SD P-value
Pre 28.02 4.77
Control group 0.160
Post 28.25 4.74
Variable Score mean SD P-value
Pre 27.90 5.02
Intervention group 0.000
Post 31.74 5.21

Based on table 1, the average self-care score of the control group before
the caring-based supportive educative intervention was 28.02 ± 4.77 and the average
self-care score after the caring-based supportive educative intervention was 28.25 ±
4.74. The results of the paired t-test self-care score, p=0.160, means that there is no
significant difference in self-care scores in the control group before and after caring-
based supportive educative intervention in the control group.
Based on table 2, the average self-care score in the intervention group before
the caring -based supportive educative intervention was 27.90 ± 5.02 and the average
self-care score after the caring-based supportive educative intervention was 31.74 ±
5.21. The results of the paired test-test self-care score that is p = 0.000 means that there
is a significant difference in self-care scores in the intervention group before and
after caring-based supportive educative intervention in the intervention group.

Table 3. The Difference In Mean Self-Care Scores Before Caring-Based Supportive

Educative Intervention In The Control Group and The Intervention Group
Variable Group Mean SD P-value
Intervention 27.90 5.02
Self-care 0.896
Control 28.02 4.77

Based on table 3 the average value of the self-care score for the treatment group
before the caring-based supportive educative intervention was 27.90 ± 5.02 and the
control group was 28.02 ± 4.77. The independent t-test attitude score results, p=0.896,
meant there is no a significant difference in self-care scores in the treatment group and
the control group with caring-based supportive educative intervention.

Table 4. Differences In Mean Self-Care Scores After Caring-Based Supportive Educative Intervention
In The Intervention Group and The Control Group
Variable Group mean SD P-value
Intervention 31.74 5.21
Self-care 0.002
Control 28.25 4.74

Based on table 4, the average self-care score in the treatment group after caring-
based supportive educative intervention was 31.74 ± 5.21 and the control group was

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28.25 ± 4.74. The independent t-test attitude score results that is p = 0.002 means that
there is a significant difference in self-care scores in the treatment group and the control
group with caring-based supportive educative intervention.

Table 5. The Difference In The Delta Mean Difference In Self-Care Scores Before and After Caring-
Based Supportive Educative Intervention In The Control Group and The Intervention Group
Variable Group Mean SD P-value
Treatment 3.83 3.42
Attitude 0.000
Control 0.23 1.06

Based on table 5 the difference between the delta values of the self-care score in
the intervention group before and after the –caring-based supportive
educative intervention was 3.83±3.42 and the control group was 0.23±1.06. The
independent t-test attitude score results that is p = 0.000 means that there is a significant
difference in the delta difference in attitude scores in the treatment group and the control
group after caring-based supportive educative intervention.

DISCUSSION
Based on the statistical test analysis results using the paired sample t-test, it
is known that the significant value or sig (2-tailed) is 0.000 <0.05, meaning that there is
a significant effect of giving before and after self care management education treatment
to ulcer prevention foot in patients with type II diabetes mellitus. According to research
by kalsum, 2020 stated that diabetic foot ulcers are largely preventable by the patients
themselves. One of the prevention strategies is health education provided by nurses to
patients who are deemed necessary and can increase patient knowledge about foot
problems related to diabetes, foot care behavior and reduce foot problems such as
neuropathy, foot disability, lesions, ulcers, tinea pedis, and callus (Kalsum et al., 2020).
One way that can be done in prevention is with self-care management. Self-
care management is an independent behavior in self-care that is carried out to prevent
complications in people with diabetes mellitus. Self care management aimed in
controlling glucose levels in the blood so that they are in a normal state. The
components of self care management itself consist of physical activity (exercise),
monitoring blood glucose levels, nutritional therapy (diet), pharmacological therapy,
and routine check-ups with health workers (Septiani et al., 2020).
Supportive educative is the way of education support provided by groups that are
expected to improve self-care through the use of a variety of
ways includes teaching (hurtful were able to increase understanding of
the disease), guiding (guidance and counseling to include solutions and how to solve a
problem on the patient to have good confidence and self-efficacy in efforts to overcome
disease), providing an environment (an environment that can support and provide
sufferers' skills to improve self-care abilities (Darmansyah et al., 2013).
Dorothea Orem argued that self-care is an individual's self-care activity to
maintain his/her own health independently. Orem's self-care theoretical
framework focuses on increasing the patient's ability to improve behaviors that affect
their health (Sari, 2017). A research conducted by Nurul & Ayudiah stated that the
prevention of amputation is actually very simple, but is often neglected. Diabetes self-
care management education significantly improves the ability of diabetes mellitus

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patients to perform independent foot care and can reduce the incidence of non-diabetic
foot ulcers.
Foot care is part of health management in reducing the incidence of diabetic foot
ulcers (Jannah & Uprianingsih, 2020). According to Mainak, Soumen, and Rimesh
(2020), Diabetes self-care management education refers to an ongoing process to
facilitate the knowledge, skills, and abilities needed to manage their disease
successfully. It is an essential element of care for all people with diabetes and improves
patient outcomes.
The American Association of Diabetes Educators (AADE) has described seven
patient self-care behaviors as reliable outcomes of diabetes self-care education, namely,
being active, eating healthy, taking medication, monitoring, problem-solving, risk
reduction, and healthy coping (Banerjee et al., 2020). Masomeh et al's research (2017) It
was found that nursing theory as a standard nursing language has an influential role in
promoting self-care in patients with type II diabetes mellitus. Thus, dedicated self-care
behaviors to prevent diabetes-related morbidity and mortality are urgently needed.
This study results influence the application of the Orem self-care model, which
has proven to help patients with diabetes mellitus in preventing complications of
diabetic foot ulcers and reducing the risk of amputation and treatment costs (Seyed et
al., 2017). The research of Helen Jebakumari (2021), stated that there is a significant
difference between pre and post knowledge scores proving that education and regular
attendance in diabetes mellitus patients can prevent disability and reduce future medical
care expenses (Yesurathinam & Jebakumar, 2021).
In addition, special training programs can bring a bright future for diabetes
mellitus patients to reduce foot complications. The study found that there was an effect
of foot care education and regular foot examinations as a strategy to prevent foot
ulcers. Patients without foot ulcers will never experience foot complications through
preventive practices with their knowledge of foot care. This study emphasizes that
knowledge of foot care is a must for all diabetes mellitus patients to avoid
complications (Yesurathinam & Jebakumar, 2021).

CONCLUSION
Caring-based supportive educative is effective in increasing the ability of type 2
diabetics in preventing diabetic ulcers, this intervention can be used as a
recommendation in carrying out treatment for type 2 diabetes mellitus patients so that
ulcer complications do not occur.

ACKNOWLEDGEMENT
The authors would like to thank the LPPM Universitas Wiraraja and the
participants of this study

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