Self Management Pasien Diabetes Melitus dengan Komplikasi Kardiovaskular dan Implikasinya terhadap Indikator Klinik

Titis Kurniawan, Citra Windani Mambang Sari, Iis Aisyah

Abstract


 

ABSTRAK

Penyakit kardiovaskular merupakan salah satu komplikasi utama diabetes melitus (DM) dan berisiko memperburuk prognosis, kualitas hidup serta meningkatkan risiko kematian. Self-management merupakan kunci utama dalam pengelolaan penyakit maupun pencegahan komplikasi dan dampak negatif yang diakibatkanya. Penelitian deskriptif ini bertujuan untuk mengidentifikasi self-management pada pasien DM dengan komplikasi kardiovaskular beserta dampaknya terhadap indikator klinik. Seluruh pasien (123 orang) diabetes mellitus yang didiagnosa menderita penyakit kardiovaskular (hipertensi, dislipidemia, dan/atau coronary artery diseases) dilibatkan dari unit rawat jalan salah satu rumah sakit swasta di Kota Bandung, Jawa Barat secara total sampling. Data self-management dikumpulkan menggunakan kuesioner yang dikembangkan oleh peneliti yang mencakup 6 domain (pemantauan, aktivitas fisik, pencegahan komplikasi, diet, pengobatan, dan merokok) dan mencakup 28 item pernyataan dengan skor Alpha Chronbach 0,738 dan validitas (r 0,377-0,760). Adapun data tentang indikator klinik dikumpulkan berdasarkan data sekunder dari rekam medik yang mencakup tekanan darah, kadar gula darah sewaktu, dan kadar kolesterol. Data yang terkumpul dianalisis menggunakan analisis deskriptif dan uji beda. Hasil penelitian menunjukkan lebih dari setengah responden (54,5%) berada pada kategori self-management rendah dimana domain pemantauan merupakan domain dengan persentase kategori rendah paling besar (62,6%). Rerata skor self-management yang lebih tinggi ditemukan pada pasien yang mencapai target indikator klinik; tekanan darah sistolik < 140mmHg, kolesterol darah < 200mg%, dan gula darah sewaktu < 200mg%. Namun, perbedaan skor self-management yang signifikan hanya ditemukan pada indikator gula darah (p = 0,05). Hasil penelitian ini menunjukkan bahwa pasien DM dengan komplikasi kardiovaskular di tempat penelitian ini perlu meningkatkan perilaku self-management terutama dalam aspek pemantauan. Penting juga bagi pihak rumah sakit untuk mengintensifkan upaya yang sudah dijalankan guna memfasilitasi kebutuhan tersebut.

 

ABSTRACT


Cardiovascular problem is one of the main diabetes mellitus complications that potentially worsen patients’ prognosis, quality of life as well as increase the patient mortality rate. Self-management in the other hand is a key success of diseases management and complication prevention. This descriptive study aimed to identify self-management of diabetic patients who diagnosed with cardiovascular diseases and its impact on clinical indicators. All 123 diabetic patients with cardiovascular diseases (hypertension, dyslipidaemia, dan coronary artery diseases) were involved in this study (total sampling) and recruited from an outpatient clinic of a private hospital in Bandung Municipality, West-Java. Data self-management were collected using questionnaire developed by the researcher covering 6 domains (monitoring, Physical exercise, complication management and prevention, diet, medication and smoking) consisted of 28 items with Alpha Chronbach 0,738 and inter-item correlation r 0.377 - 0.760. Data regarding clinical indicators were secondarily collected from patients’ medical record including current blood pressure, blood sugar level and cholesterol level. Collected data were analysed descriptively and comparatively with significance at p < 0.05. The results suggested that more than half patients (54.5%) report low level of self-management where monitoring domain found as the domain with the biggest percentage of low self-management category (62.6%). In addition, respondents with higher mean score of self-management was found in patient who achieved the clinical outcomes; blood pressure < 140mmHg, cholesterol < 200mg%, and blood glucose < 200mg%. However, statistically significant finding only identified in blood glucose indicator (p = 0.05). These results indicated that diabetic patients with cardiovascular problem in this setting need program or strategy to improve their capability in performing self-management particularly in the monitoring aspect. It also is significance for hospital to address those issues. 

 


Keywords


cardiovascular; complication; diabetes mellitus; self-management.

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References


Adriaanse, M. C., Drewes, H. W., van der Heide, I., Struijs, J. N., & Baan, C. A. (2016). The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Quality of Life Research, 25(1), 175–182. https://doi.org/10.1007/s11136-015-1061-0

Alrahbi, H. (2014). Diabetes self-management (DSM) in Omani with type-2 diabetes. International Journal of Nursing Sciences, 1(4), 352–359.

Ang, Y. G., Heng, B. H., Saxena, N., Liew, S. T. A., & Chong, P. N. (2016). Annual all-cause mortality rate for patients with diabetic kidney disease in Singapore. Journal of Clinical and Translational Endocrinology, 4, 1–6. https://doi.org/10.1016/j.jcte.2016.01.002

American Diabetes Association (ADA). (2015). Standards Of Medical Care in Diabetes. The Journal of CLinical and Applied Research and Education, 38(January), 99. https://doi.org/10.2337/dc15-S005

Antari, G. A. A., Widyanthari, D. M., & Raya, N. A. J. (2016). Hubungan Diabetes Self Management dan Persepsi Penyakit Terhadap Kualitas Hidup Pasien Diabetes Melitus Tipe 2 Di Pagyuban Diabetes Puskesmas II Denpasar Barat.

Beverly, E. A., Miller, C. K., & Wray, L. A. (2008). Spousal support and food-related behavior change in middle-aged and older adults living with type 2 diabetes. Health Education & Behavior, 35(5), 707–720.

Burner, E., Menchine, M., Taylor, E., & Arora, S. (2013). Gender Differences in Diabetes Self-Management: A Mixed-Methods Analysis of a Mobile Health Intervention for Inner-City Latino Patients. Journal of Diabetes Science and Technology, 7(1), 111–118.

Crowley, M. J., Bosworth, H. B., Coffman, C. J., Lindquist, J. H., Neary, A. M., Harris, A. C., … Edelman, D. (2013). Tailored case management for diabetes and hypertension (TEACH-DM) in a community population: Study design and baseline sample characteristics. Contemporary Clinical Trials, 36(1), 10.1016/j.cct.2013.07.010. https://doi.org/10.1016/j.cct.2013.07.010

Damayanti, S., Nursiswati, & Kurniawan, T. (2014). Dukungan Keluarga pada Pasien Diabetes Melitus Tipe 2 dalam Menjalankan Self-Management Diabetes. Jurnal Keperawatan Padjadjaran, 2(1), 26–35.

Dewi, G. K., & Triseptinora, R. (2014). Gambaran diabetes militus dan pola makan pada lansia yang osteoporosis di panti sosial tresna werdha budi luhur kota jambi tahun 2014. Scientia Journal STIKes Prima Jambi, 3(2), 115–122.

Donsu, J. D. (2014). Peran Faktor-faktor Psikologis terhadap Depresi pada Pasien Diabetes Mellitus Tipe 2. Jurnal Psikologi, 41(1), 241–249. Retrieved from http://download.portalgaruda.org/article.php?article=353160&val=5021&title=Peran Faktor-faktor Psikologis terhadap Depresi pada Pasien Diabetes Mellitus Tipe 2

Edwina, D. A., & Manaf, A. (2015). Artikel Penelitian Pola Komplikasi Kronis Penderita Diabetes Melitus Tipe 2 Rawat Inap di Bagian Penyakit Dalam RS . Dr . M . Djamil. Jurnal Kesehatan Andalas, 4(1), 102–106.

Elpriska. (2016). Pengaruh Stres, Dukungan Keluarga dan Manajemen Diri Terhadap Komplikasi Ulkus Kaki Diabetik Pada Penderita DM Tipe 2 Influences Of Stress, Family Support, And Self Management Toward Complication Of Diabetic Foot Ulcer Of Diabetes Mellitus Type 2 Patiens. Idea Nursing Journal, VII(1), 20–25.

Eirnarson, T., Acs, A., Ludwig, C., & Panton, U.J. (2018). Prevalence of cardiovascular diseases in type 2 diabtes: a systematic literature review of scientific evidence from across the world in 2007 - 2017. Cardiovascular Diabetologi, 17(83), 1-19.

Ernawati, Setiawati, E. P., & Kurniawan, T. (2015). Pengaruh Motivasi Internal dan Eksternal terhadap Diabetes Self Management di Wilayah Kecamatan Gombong Kabupaten Kebumen Gombong Subdistrict Kebumen Regency. JSK, 1, 55–62.

Gao, J., Wang, J., Zheng, P., Haardörfer, R., Kegler, M. C., Zhu, Y., & Fu, H. (2013). Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes. BMC Family Practice, 14(1), 66.

Gonzalez-Zacarias, A. A., Mavarez-Martinez, A., Arias-Morales, C. E., Stoicea, N., & Rogers, B. (2016). Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus. Frontiers in Public Health, 4, 195. https://doi.org/10.3389/fpubh.2016.00195

Hariyono, Suwandi, T., & Yusuf, A. (2016). Effectiveness of Diabetes Self Management Education Against Type 2DM patients Independence in Managing Diet Disease In General Hospital Jombang. Journal of Applied Science And Research, 4(5), 83–90.

Hastono, S.P. (2017). Analisis Data pada Bidang Kesehatan. Depok : Rajawali Pers.

Kemenkes RI. (2014a). Infodatin-diabetes. Pusat Data Dan Informasi.

Kemenkes.RI. (2014b). Pusdatin Hipertensi. Infodatin, (Hipertensi), 1–7. https://doi.org/10.1177/109019817400200403

King, D. K., Glasgow, R. E., Toobert, D. J., Strycker, L. A., Estabrooks, P. A., Osuna, D., & Faber, A. J. (2010). Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care, 33(4), 751–753.

Kishore, P., Kim, S. H., & Crandall, J. P. (2012). Glycemic Control and Cardiovascular Disease: What’s a Doctor to Do? Current Diabetes Reports, 12(3), 255–264. https://doi.org/10.1007/s11892-012-0268-5

Kurniawan, T., & Yudianto, K. (2016). Diabetes Self-Management and Its related Factors Manajemen Diabetes dan Faktor-Faktor yang Memengaruhi, 4, 267–273.

Kusnanto. (2013). Meningkatkan Respons Psikososial-Spiritual Pada Pasien Diabetes Melitus TIPE 2 Melalui Aplikasi Model Self Care Management. Jurnal Ners, 8(1), 47–55.

Kusuma, H., & Hidayati, W. (2013). Hubungan Antara Motivasi Dengan Efikasi Diri Pada Pasien Diabetes Mellitus Tipe 2 Di Persadia Salatiga. Jurnal Keperawatan Medikal Bedah, 1(2), 132–141.

Lin, P.J., Kent, D. M., Winn, A., Cohen, J. T., & Neumann, P. J. (2015). Multiple Chronic Conditions in Type 2 Diabetes Mellitus: Prevalence and Consequences. American Journal of Managed Care, 21(January 2015 1). Retrieved from http://www.ajmc.com/journals/issue/2015/2015-vol21-n1/multiple-chronic-conditions-in-type-2-diabetes-mellitus-prevalence-and-consequences

Magnan, E. M., Palta, M., Mahoney, J. E., Pandhi, N., Bolt, D. M., Fink, J., … Smith, M. A. (2015). The relationship of individual comorbid chronic conditions to diabetes care quality. BMJ Open Diabetes Research and Care, 3(1). https://doi.org/10.1136/bmjdrc-2015-000080

Mathew, R., Gucciardi, E., De Melo, M., & Barata, P. (2012). Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis. BMC Family Practice, 13, 122. https://doi.org/10.1186/1471-2296-13-122

McCleary-Jones, V. (2011). Health literacy and its association with diabetes knowledge, self-efficacy and disease self-management among African Americans with diabetes mellitus. ABNF Journal, 22(2).

Mohd-Yusoff, N.H., Rahman, R.A., & Kadir, A.A. (2017). Diabates self-care and its associated factors among elderly diabates in primary care. Journal Taibah University Medical Sciences. 12(6), 504-511.

Muhadi (2016). ANALISIS JNC 8 : Evidence-based Guideline Penanganan Pasien Hipertensi Dewasa, 43(1), 54–59.

Namageyo-Funa, A., Muilenburg, J., & Wilson, M. (2013). The Role of Religion and Spirituality in Coping with Type 2 Diabetes: A Qualitative Study among Black Men. Journal of Religion and Health, 54(1), 242–252. https://doi.org/10.1007/s10943-013-9812-0

Nejaddadgar, N., Solhi, M., Jegarghosheh, S., Abolfathi, M., & Ashtarian, H. (2017). Self-Care and Related Factors in Patients with Type 2 Diabetes. Asian J Biomed Pharmaceut Sci, 7(61), 6–10.

Panjaitan, S. H., Hasibuan, P. J., & Handini, M. (2013). Hubungan Antara Aktivitas Fisik dan Kualitas Hidup Pasien Diabetes Melitus Tipe 2 Di PUSKESMAS Purnama Kecamatan Pontianak Selatan Kota Pontianak.

Palsson, R., & Patel, U. D. (2014). Cardiovascular Complications of Diabetic Kidney Disease. Advance Chronic Kidney Disease, 21(3), 273–280. https://doi.org/10.1053/j.ackd.2014.03.003.

Patel, M. R., Kruger, D. J., Cupal, S., & Zimmerman, M. A. (2016). Effect of Financial Stress and Positive Financial Behaviors on Cost-Related Nonadherence to Health Regimens Among Adults in a Community-Based Setting. Preventing Chronic Disease, 13(3), E46. https://doi.org/10.5888/pcd13.160005

PERKENI. (2015a). Konsensus Pengendalian dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Perkeni. https://doi.org/10.1017/CBO9781107415324.004

PERKENI. (2015b). Panduan Pengelolaan Dislipidemia di Indonesia. PB Perkeni, 4.

Weinger, K., Beverly, E.A., & Smaldone, A., (2014). Diabetes self-care and the Older Adult. Western Journal of Nursing research, 36(9):1272-1298

Primahuda, A., & Sujianto, U. (2016). Hubungan Antara Kepatuhan Mengikuti Program Pengelolaan Penyakit Kronis (PROLANIS) BPJS Dengan Stabilitas Gula Darah Pada Penderita Diabetes Melitus di Puskesmas Babat Kabupaten Lamongan. Jurnal Jurusan Keperawatan.

Putri, D. S. R., Yudianto, K., & Kurniawan, T. (2013). Perilaku Self-Management Pasien Diabetes Melitus (DM) Self-Management Behaviour of Patient with Diabetes Mellitus (DM), 1 (April 2013), 30–38. Retrieved from http://jkp.fkep.unpad.ac.id/index.php/jkp/article/viewFile/49/46

Rahman, H. F., & Sukmarini, L. (2017). Efikasi Diri , Kepatuhan , dan Kualitas Hidup Pasien Diabetes Melitus Tipe 2 ( Self Efficacy , Adherence , and Quality of Life of Patients with Type 2 Diabetes ), 2, 108–113.

Reyes, J., Tripp-Reimer, T., Parker, E., Muller, B., & Laroche, H. (2017). Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes. Global Qualitative Nursing Research, 4, 2333393617713097. https://doi.org/10.1177/2333393617713097

Schmitt, A., Gahr, A., Hermanns, N., Kulzer, B., Huber, J., & Haak, T. (2013). The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health and Quality of Life Outcomes, 11(1), 138. https://doi.org/10.1186/1477-7525-11-138

Sedlar, N., Lainscak, M., Mårtensson, J., Strömberg, A., Jaarsma, T., & Farkas, J. (2017). Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies. European Journal of Cardiovascular Nursing, 16(4), 272–282. https://doi.org/10.1177/1474515117691644

Swami, J., & Korytkowski, M. (2017). The futile cycle of hospital readmission in patients with diabetes. Journal of Diabetes and Its Complications, 31(8), 1252–1253. https://doi.org/10.1016/j.jdiacomp.2017.06.006

Sugiyarti, Meikawati, W., & Salawati, T. (2011). Hubungan Ketaatan Diet Dan Kebiasaan Pasien Diabetes Mellitus Yang Berobat Di Puskesmas Ngembal Kulon Kabupaten Kudus. Jurnal Kesehatan Masyarakat Indonesia, 7(1), 51–58.

Taha, N. M., Zaton, H., & Elaziz, N. A. A. (2016). Impact of a health educational guidelines on the knowledge, self-management practice and self-efficacy of patients with type-2 diabetes. Journal of Nursing Education and Practice, 6(9), 46.

Tanash, M. I., Fitzsimons, D., Coates, V., & Deaton, C. (2016). An evaluation of the effectiveness of self-management interventions for people with type 2 diabetes after an acute coronary syndrome: a systematic review. Journal of Clinical Nursing, 26(11–12), 1458–1472. https://doi.org/10.1111/jocn.13487

Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The Summary of Diabetes Self-Care. Diabetes Care Journal, 23(7), 943–950. https://doi.org/10.2337/diacare.23.7.943

Vellone, E., Paturzo, M., D’Agostino, F., Petruzzo, A., Masci, S., Ausili, D., … Riegel, B. (2017). MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF): Study protocol of a three-arm multicenter randomized controlled trial. Contemporary Clinical Trials, 55, 34–38. https://doi.org/10.1016/j.cct.2017.02.003

Verma, S. K., Luo, N., Subramaniam, M., Sum, C. F., Stahl, D., Liow, P. H., & Chong, S. A. (2010). Impact of depression on health related quality of life in patients with diabetes. Annals of the Academy of Medicine Singapore, 39(12), 913–919.

Vincze, G, Barner, J.C., & Lopez, D. (2004). Factors associated with adherence to self-monitoring blood glucose. The Diabetes Educator, 30(1); 112-125.

Weinger, K., Baverly, E.A., & Smaldone, A. (2014). Diabates self-care and the older adult. Western Journal Nursing Research; 36(9):1272-1298

Xu, Y., Pan, W., & Liu, H. (2010). Self‐management practices of Chinese Americans with type 2 diabetes. Nursing & Health Sciences, 12(2), 228–234.

Zimmet, P., Alberti, K. G., Magliano, D. J., & Bennett, P. H. (2016). Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nature Reviews Endocrinology, 12(10), 616–622. https://doi.org/10.1038/nrendo.2016.105




DOI: https://doi.org/10.17509/jpki.v6i1.18256

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