Path Analysis on the Effects of Bio-psychosocial Factors and Calorie Intake in Blood Glucose Control in Patients with Type 2 Diabetes Mellitus
Abstract
Background: Diabetes mellitus (DM) is a serious chronic disease with its tendency to deteriorate. The DM cases worldwide in 2015 was 415 million people and it is estimated to increase as many as 642 million cases in 2040. Indonesia ranked 7 in the world with 10 million cases of DM in 2015, about 90% of which were Type 2 Diabetes Mellitus. This study aimed to determine the effect of biopsychosocial factors and calorie intake on the blood glucose control in patients with Type 2 DM.
Subjects and Method: This was an analytic and observational study with case control design. This study was carried out at Internal Medicine Polyclinic, Department of Endocrinology, Dr. Moewardi Hospital, Surakarta, Central Java, from October to November 2016. A total sample of 135 cases of Type 2 DM were selected for this study by fixed disease sampling. As many as 106 of these study subjects at HbA1c ≥6.5% and 29 cases of Type 2 DM had HbA1c <6.5%. The dependent variable was HbA1c level. The independent variables were educational level, family income, psychological stress, calorie intake, and Body Mass Index (BMI). The data were collected by a set of questionnaire. HbA1c was measured by High Performance Liquid Chromatography (HPLC), which was recorded in the medical record. Calorie intake was measured by 24 hour food recall. Psychological stress was measured by International Physical Activity Questionnaire (IPAQ). The data was analyzed by path analysis on STATA 13.
Results: Psychological stress (b=0.99, 95%CI=0.07 to 1.92, p=0.034), calorie intake (b= 1.84, 95%CI= -0.24 to 3.92, p=0.083), and BMI (b= 1.15, 95%CI= 0.22 to 2.08, p=0.016), had positive and statistically significant effect on HbA1c. Calorie intake increased BMI (b= 2.35, 95%CI=0.31 to 4.39, p=0.024), education decreased calorie intake (b=-2.26, 95%CI= -3.38 to -1.14, p<0.001), and family income increased calorie intake (b= 1.23, 95%CI= 0.26 to 2.21, p= 0.013).
Conclusion: Calorie intake, BMI, psychologi stress, and family income are associated with increase in HbA1c level. Education decreases HbA1c level via decreased calorie intake. Type 2 DM patients need to pay attention to these biopsychosocial factors and calorie intake in order to control blood sugar.
Keywords: biopsychosocial factors, calorie intake, HbA1c
Correspondence: Isfaizah. Ngudi WaluyoUniversity, Ungaran, Central Java. Email: is.faizah84@yahoo.com. Mobile: +6281228570003.
Indonesian Journal of Medicine (2016), 1(2): 90-99
https://doi.org/10.26911/theijmed.2016.01.02.02
References
ADA (2012). Statistic About Diabetes: Overall Numbers, Diabetes and Prediabetes. http://www.diabetes. org/diabetesbasics/statistics/?r eferrerhttps://www.google.co.id/
Aliasgharzadeh A, Mobasseri M, Adib M, (2006). Adherence to Management Plant For Diabetes in Type 2 Diabetic Patients, Abstract Book 13th Asia Oceania Congress of Endocrinology. 162
Almatsier S (2011). Prinsip Dasar Ilmu Gizi. Jakarta: Gramedia Pustaka Utama.
Anagnostis P, Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP (2009). Clinikal Review: The Pathogenetic Role of Cortisol in The Metabolic Syndrome: a Hyputhesis. J Clin Endocrinol Metab. 94(8):2692-2701
Billous R, Donelly R (2014). Buku Pegangan Diabetes Edisi Ke 4. Jakarta: Bumi Medika.
CDC (2014). National Diabetes Statistics Report 2014. https:// www.cdc.gov/ diabetes/pubs/statsreport14/nationaldiabetes reportweb.pdf
Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Taber LC, Albright AL, Braun B (2010). Exercise and Type 2 Dia-betes: The American College of Sports Medicine and The American Diabetes Association: Joint Position Statement. Diabetes Care 33: e147-e167. doi:10. 2337/dc10-9990.
Farmer (2009). Self monitoring of Blood glucose for people with type 2 diabetes: the need for better understanding. Diabetes Voice.54.
Gray N, Picone G, Sloan F, Yashkin A (2015). The Relationship between BMI and Onset of Diabtes Mellitus and its Complications. South Med J 108(1): 29-36. doi: 10.14423/SMJ. 00000000000214.
Harahap R (2006). Disfungsi Seksual pada Penderita Diabetes Melitus Pria. Majalah Kedokteran, 39 (3).
Izzati W, Nirmala (2015). Hubungan Tingkat Stres dengan Peningkatan Kadar Gula Darah pada Pasien Diabetes Melitus di Wilayah Kerja Puskesmas Perkotaan Rasimah Ahmad Bukittinggi Tahun 2015.Karya Tulis Ilmiah.Prodi DIII Keperawatan STIKES YARSI SUMBAR Bukittinggi.
IDF (2015). Diabetes Atlas. www.idf.org/e-atlas.diakses pada tanggal 12 Juli 2016 pukul 11.05
Jawad M, Lee JT, Millet C (2014). The Relationship Between Waterpipe and Cigarette Smoking in Low and Middle Income Countries : Cross-Sectional Analysis of the Global Adult Tobacco Survey. PLos ONE 9(3): e93097.
Kann PH, Muntel M, Hadji P, Daniel H, Flache S, Nyarango P, Wilhelm A (2014). Alterations of Cortisol Homeo-stasis May Link Changes of the Sociocultural Environment to an Increased Diabetes and Metabolic Risk in Developing Countries: A Prospective Diagnostic Study Perfor-med in Cooperation With the Ovahimba People of the Kunene Region/Nortwestern Namibia. J Clin Endocrinol Metab 100(3): E482-E486; doi:10.1210/jc.2014-2625.ISSN Print 0021-972X ISSN Online 1945-7197.
Kemenkes RI (2013). Diabates Melitus Penyebab Kematian Nomor 6 di Dunia: Kemenkes Tawarkan Solusi Cerdik Melalui Posbind. http://www. depkes.go.id/article/view/2383/diabetes melitus penyebab kematian nomor 6 didunia kemenkes tawarkan solusi cerdik melalui posbindu.html
Lawn S, Battersby M, Harvey P, Pols R, Ackland A (2009). A Behavioural Therapy Approach to Self Management: The Flinders Program.
Logue L, Walker JJ, Colhoun H, Leese GP, Lindsay RS, Mcknight JA, Morris AD, Pearson D, Petrie JR, Philip S, Wild S, Sattar N (2011). Do men Develop type 2 Diabetes at Lower Body Mass Indices than Women?. Diabetologia 54(12): 3003-3006.
Majgi SM, Soudarssanane B, Roy G, Das AK (2012). Risk Factors of Diabetes Mellitus in Rural Puducherry.Online Journal of Health and Allied Sciences 11(1):4.ISSN 0972-5997.
Miharja L (2009). Faktors Associated with Blood Glucose Control in Patient with Diabetes Mellitus in Urban Indonesia. Majalah Kedokteran Indonesia 59:9.
Mitra A (2008). Diabetes and Stress. A Review. Ethmomed. 2(2):131-135
Nugroho SA, Purwati (2010). Hubungan antara tingkat stres terhadap kadar gula darah penderita diabetes melitus di Wilayah Kerja Puskesmas Sukoharjo I Kabupaten Sukoharjo. Skripsi. Fakultas Ilmu Kesehatan Masyarakat Universitas Muhammadiyah Surakarta.
Paruntu OL (2012). Asupan Gizi dengan Pengendalian Diabetes pada Diabetesi Tipe II Rawat Jalan di BLU Prof.Dr. R.D.Kandou Manado.Gizido 4:1.
Perkeni (2011). Konsesnsus Pengelolaan dan pencegahan Diabetes Melitus Tipe 2 di Indonesia. https://drive. google.com /file/d/ 0BzXy8chsYGc1d0hOVUJUN0UtbVU/view
