MOTIVATION IMPLEMENTATION OF HBA1C DECREASE IN PATIENTS

DIABETES MELLITUS ( RIVIEW LITERATURE )

Christianto Nugroho
Nursing Division, Pamenang Pare-Kediri Nursing Academy

ABSTRACT
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by an
increase in blood glucose levels (hyperglycemia) due to abnormalities in insulin
secretion, insulin action or both. DM patients will be negative if there is rejection of the
patient during treatment. Negative attitudes towards disease and treatment will result
in failure of management of diabetes mellitus. This can affect the patient's quality of
life and social abilities. The purpose of this study is how to improve patient motivation
in controlling HbA1C Diabetes.
The methodology in this study used the Randomized Controll Trial approach,
with a population of between 44 - 344 samples, with the application of Motivational
Enhancement Therapy (MET), Cognitive Behavior Therapy (CBT), MET + CBT,
Motivational Interviewing (MI), Structural Diabetes education (SDE). ) and as a control
group the study used care as was usually obtained by the respondents. Analysis of data
from the 4 articles using SPSS for windows release 12.01 with regression, two- factor
ANOVA analysis , person correlation.
The results of the study of the 4 articles, by implementing MET, CBT, MI, SDE, gave
positive changes to diabetes control, this can be seen from the results of HbA1C which
decreased after the intervention above, although it was also mentioned in the article
that the changes were not too big.

PRELIMINARY 2030, according to data from WHO,

Diabetes Mellitus (DM) is a group of Indonesia ranks 6th in the world as the
metabolic diseases characterized by country with the highest number of
increased blood glucose levels diabetes mellitus sufferers after India,
China, the Soviet Union, Japan and
(hyperglycemia) that occur due to
Brazil. (WHO, 2014) It was recorded that
abnormalities in insulin secretion,
in the Kediri district at the end of 2012
insulin action or both (Smeltzer S, 2008).
there were 554 patients (Dinkes, 2013).
DM patients will have a negative
attitude if there is rejection of the According to WHO (1994 in Suyono,
patient during treatment (Soegondo, 2006), prevention efforts can be carried
2006). Negative attitude towards disease out in three stages, namely primary,
and medication will result in failure of secondary and tertiary prevention.
management of diabetes mellitus. This Primary prevention is all activities
can affect the patient's quality of life and aimed at preventing the emergence of
social abilities. Diabetes patients are hyperglycemia in the general
also found to experience psychological population, for example by means of a
problems that make the patient not healthy food campaign and counseling
motivated to undergo treatment. on the dangers of diabetes. Motivation is
one form of education,
Diebetes patients are estimated to
have increased in the world to 366 motivation is an impetus or move.
million per year According to Winarto, 2011 is an effort
to improve the quality of life

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patient namely by doing motivation, without specifying gender and age.
motivation to provide support
positive for one's health. Conversely, DM b. Intervention
patients will be negative if there is Based on the findings of the
rejection of the disease, this can affect intervention research determined
the patient's quality of life. was an increase in the motivation of
DM patients
Blood sugar in type 1 diabetes can c. Comparison
be controlled using a variety of ways, The comparison group is the control
namely insulin therapy and educational group without motivation, namely
programs, depression control and diet. doing daily habits.
The effectiveness of psychological d. Outcame
factors on blood sugar control in adult Providing motivation will improve
patients with type 1 diabetes has not the quality of life for diabetes
been proven. Counseling methods to patients .
increase motivation can change health
behavior, motivation can reduce alcohol Literature Search
abuse and smoking, and preliminary Based on the formulation of the
evidence suggests that it may be problem above, the writer tries to find
effective in diabetes (Miller W, 2002). In scientific articles or journals in English
this literature review, the search for a studies that are relevant to the topic
model to improve patient motivation is using the EBSCO HOST database,
appropriate to control diabetes so that PRO-QUES, limited from April 2004 to
the quality of life for diabetes patients April 2014. The keywords used are "
increases. diabetes, motivation, quality of life, ".
From these keywords and criticized
The results of this literature again which is Full Text , then limited to
review can be integrated in the form of the last 10 years, it was obtained from
further research to be applicable to EBSCO, there were 23 journal titles and
diabetes patients and can be applied in PRO-QUES there were 17 articles, after
clinical practice where a critical review further analysis separated between
is first conducted of the validity of the those that were related and those that
study, how meaningful the results are, were not with the problem formulation,
and their relevance for application. only 4 were suitable with the
formulation of the problem you are
Based on the aforementioned
looking for. From this journal, the writer
background, the researcher formulated
tries to apply the steps and principles of
a research problem, namely How is the
Evidence Based Nursing to answer the
right way of motivation for the quality
problem formulation.
of life of diabetes patients?

MATERIAL / METHODS The author reads the entire article

PICOT F framework and decides to find out whether the
From the literature that the author evidence from the study is valid, if it is
searches and reads, the criteria for the valid, is it important and applicable to
journal to be criticized, the author patients?
makes a framework / PICO framework
as follows:
RESULT / REVIEW
a. Population Methodology
The population defined in this a. Research design
literature study was all DM patients The research design of these 4
articles used a randomized control
trial

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b. Sample The results of the study of the 4
The study sample of the 4 articles, articles, by implementing MET, CBT,
there were 2 with the same number MI, SDE, gave positive changes to
and criteria, namely the number of diabetes control, this can be seen
samples of 344 patients (type 1 from the results of HbA1C which
diabetes who suffered from more decreased after the intervention
than 2 years, ages 18 - 65) and above, although it was also
HbA1C levels> 8.2 - 15%,> 9 , 13 - mentioned in the article that the
9.32%, 44 samples (type 1 diabetes changes were not too big. . In
who suffer from more than 1 year, Statistically there is a difference
age 12 - 18 years, HbA1C> 9%), there between the treatment group and
is one article using type 2 diabetes in the control group, where there is a
overweight women. significant difference with p <0.05 on
c. Research sites the HbA1C size, so that it can affect
The research locations of these 4 the patient's quality of life.
articles are in hospitals and in the
community. The countries where the h. Clarity of research reports
samples were made in this study The research reports of these 4
were America, Africa, Europe articles are quite clear, although in
(Netherlands, UK). the article it is also mentioned about
d. Procedure missing data and control of
The research procedures of these 4 interventions that are still weak, in
articles are using the application of general these have been included in
Motivational Enhancement Therapy the research report.
(MET), Cognitive Behavior Therapy i. Research Limitations
(CBT), MET + CBT, Motivational The limitations of the research in
Interviewing (MI), Structural these 4 articles are that there is
Diabetes education (SDE) and as a missing data and weak control of the
research control group using such intervention.
treatments usually obtained by
respondents. Review
e. Data collection a. Design summary
Collecting data from these 4 articles The research design used
using a tiered system, namely by a randomized control trial
being repeated 3 times, namely for 3, b. Research criticisms in methodology.
6, 12 months after the intervention The methodology in this article has
(MET, CBT, MI, SDE) and some using not been explained, namely how the
6,12,18 months (Motivational intervention process of MET, CBT, MI,
Interviewing -Weight loss). The same SDE there is only explained about
data collection in these 4 articles the implementation time and session
looked at HbA1C levels. of each intervention, but the
application model has not been
f. Data analysis explained. In addition, it has not yet
Data analysis of the 4 articles used been explained who carried out the
SPSS for windows release 12.01 with implementation and how the
regression, two- factor ANOVA training was carried out for the
analysis , pearson correlation, with personnel who carried out the
significant levels used at P <0.05. implementation. In the methodology,
there is also no clear way of
g. Research result controlling the intervention carried
out on the respondent, because you
see

J urnal AKP 64 Vol. 7 No.1; 1 January - 30 June 2016

of data collection is done with a The application of MI

tiered system, namely 3,6,12 or (Motivational Interviewing) is
6,12,18.
c. The main research issue given to diabetic patients as a
This study has an issue that is widely form of increasing patient
raised in the article that patients motivation in handling and
with diabetes mellitus have their control of their disease, this is
own characteristics, there are many evidenced by the decrease in
perceptions that patients have about HbA1C results.
the application they are doing.
d. Research critique 4. Application of SDE
Many of the research results in this The application of SDE (Diabetes
article have been reviewed, but Education Structure) is given to
what is the same in this article is diabetic patients as a form of a
that all HbA1C levels were checked, structured explanation of the
this is a biased lab level. concept of diabetes management,
determine how to control diabetes this is also evident from the
mellitus. The results of the research decrease in HbA1C results.
in this article prove that the
application of the above method can Of the 4 applications in general and
reduce HbA1C levels. looking at the results studied, there
e. Gaps in the research findings was no significant difference, and
reviewed the decrease in HbA1C levels also
Research findings in these 4 articles had insignificant differences, but
have different applications, the when the above applications were
existing gaps from implementation combined with the examples of MET
are as follows: and CBT application, this could
1. MET application reduce more than therapy. other.
MET (Motivational Enhanchement This shows that motivation to be
Therapy) was given more acceptable to diabetes mellitus
to diabetes patients to increase patients needs a structure for
patient motivation, so that the handling diabetes, including patient
patient's quality of life improves,
knowledge and behavior that we
it is proven that the lab results,
need to change.
especially HbA1C, have decreased.
2. Application of CBT f. The relevance of research
The application of CBT (Cognitive results to the development of
Behavior Therapy) is given to nursing science
patients The results of the research from the
diabetes to increase patient intervention of MET, CBT, MI, SDE
knowledge about the disease and were able to reduce HbA1C levels,
diabetes management, so that meaning that Diabetes Mellitus
with increased patient knowledge, patients had hope to control their
the patient's quality of life will diabetes. Seeing this decrease in
also increase, this is also proven HbA1C also has implications for
by the lab results improving the patient's quality of
especially HbA1C has decreased. life. With these results, this research
has relevance value for the
3. Application of MI development of science
nursing, especially in terms of
increasing the motivation of
Diabetes Mellitus patients, DM
patients have high motivation if
there is encouragement and control
from other parties. Nurse as one of
the health workers

J urnal AKP 65 Vol. 7 No.1; 1 January - 30 June 2016

 has a role in the management of DM CONCLUSION
patients, through motivation about Based on the description above, in
information and health education in general the authors can conclude that
controlling DM and good prevention this research with the topic "Motivation
macrovascular and microvascular for people with Diabetes Mellitus" needs
complications. Deep intervention to be continued. The research objectives,
action research methodology, data analysis,
DM disease control is controlling and research results have been clearly
diet, exercise and therapeutic medic. described. The results of this study have
g. According to Winarto, 2011, one of also been able to answer the research
the efforts to improve the quality of objectives accurately, accompanied by
life of patients is by doing complete secondary data so as to enrich
motivation, motivation to provide the discussion and explain the results of
positive support for one's health.
the research very straightforwardly.
Conversely, DM patients will be
negative if there is rejection of the
disease, this can affect the patient's Although this research is classified
quality of life. This is evidenced by as good, the results of this study cannot
the results of motivation be fully generalized, especially in
which were given by MET, CBT, MI, Indonesia, because of differences
SDE methods were able to affect the demographic characteristics of the place
quality of life of Diabetes Mellitus of study, including differences in
patients. seasonality, race, and possible
h. Important findings that are not differences in procedures in Indonesian
reported in this study systematically society.
and A more recent and more specific
based on the standard rules have literature search is needed regarding the
submitted a complete result report. application of MET, CBT, MI, SDE in
diabetic patients. It is also necessary to
carry out further research on the MET,
Implications for Practice CBT, MI, SDE modules especially
Based on the results of the explanation according to the culture in Indonesia.
of this study, the application of MET,
CBT, MI, SDE, can help improve the
quality of life of patients with Diabetes REFERENCES
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