Analisis Faktor yang Berhubungan dengan Kejadian Ulkus Diabetik pada Pasien DM Tipe 2 di Poli Penyakit Dalam RSUD Umbu Rara Meha Waingapu

Retno Indarwati, Praba Dian Rahmawati, Yunita Veronika Sidhu

Abstract views = 310 times | downloads = 850 times


Introduction: The incidence of Diabetic Foot Ulcer (DFU) is currently still quite high resulting in a decrease in the quality of life and increase dependence on family and health services. But until now the factors that cause DFU are still not known with certainty. This study aimed to analyze the relationship of host factors with the incidence of foot ulcers in type 2 DM patients.

Method: The method used in this study was cross sectional, involving 115 patients with Type 2 diabetes who did not have other comorbidities and mental disorders. The variables studied were blood sugar levels, foot care and stress levels. Measuring instruments used were the Nottingham Assessment of Functional Footcare questionnaire and the Diabetes Distress Scale questionnaire. The collected data were analyzed using the Spearman Rho test with a significance level of 0.05.

Results: Most respondents had high levels of stress, poor foot care and blood sugar levels <200 md / dl. Bivariate test results showed that the host factors in this study were related to the incidence of DM ulcers including foot care (p = 0.003: r = 0.276), stress level (p = 0.049: r = 0.230), blood sugar control (p = 0.013: r = 0.184) which means that overall the variables are related to DFU events. Discussion: Overall the variables have a positive relationship. Good foot care will reduce the risk of DM ulcers. Stress levels and high blood sugar levels will increase the risk of DM ulcers.

Conclusion: Factors of blood sugar levels, stress levels, and foot care can influence the incidence of DM ulcers so that interventions are needed that can improve the behavior of foot care, blood sugar levels and stress management.

Full Text:



Ahmad, J. (2016). The diabetic foot. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 10(1), 48–60.

Alaei Karahroudi, F., Mohammadi Shahbolaghi, F., Hosseini, M. A., & M, R. (2016). Experiences of self-management of type I diabetes in adolescents: A phenomenological study. Iranian Journal of Endocrinology and Metabolism, 17(6), 1–11.

Alavi, A., Sibbald, R. G., Mayer, D., Goodman, L., Botros, M., Armstrong, D. G., … Kirsner, R. S. (2014). Diabetic foot ulcers: Part I. Pathophysiology and prevention. Journal of the American Academy of Dermatology, 70(1), 1.e1-1.e18.

Amoah, V. M. K., Anokye, R., Acheampong, E., Dadson, H. R., Osei, M., & Nadutey, A. (2018). The experiences of people with diabetes-related lower limb amputation at the Komfo Anokye Teaching Hospital (KATH) in Ghana. BMC Research Notes, 11(1), 1–5.

Articlesbase, (2009). Hypoglycemia in type 2 diabetes: Pathophysiology, frequency, and effects of different treatment modalities. Diabetes care, 28(12), 2948-2961.

Badan Penelitian dan Pengembangan Kesehatan. (2018). Riset Kesehatan Dasar (RISKESDAS) 2013. Laporan Nasional 2013, 1–384. Desember 2013

Badriah, S., & Sahar, J. (2018). Family support in caring for older people with diabetes mellitus: a phenomenology study. Enfermeria Clinica, 28, 245–249.

Brod, M., Pohlman, B., Blum, S. I., Ramasamy, A., & Carson, R. (2015). Burden of Illness of Diabetic Peripheral Neuropathic Pain: A Qualitative Study. Patient, 8(4), 339–348.

Bustan, M. N. (2016). Epidemiologi Penyakit Tidak Menular. Jakarta: Rineka Cipta.

Bai, J., Lovblom, L. E., Cardinez, M., Weisman, A., Farooqi, M. A., Halpern, E. M., … Perkins, B. A. (2017). Journal of Diabetes and Its Complications Neuropathy and presence of emotional distress and depression in longstanding diabetes : Results from the Canadian study of longevity in type 1 diabetes. Journal of Diabetes and Its Complications, 31(8), 1318–1324.

Bennett, J. (2016). Limb loss : The unspoken psychological aspect. Journal of Vascular Nursing, 34(4), 128–130.

Chithambo, T., & Forbes, A. (2015). Exploring factors that contribute to delay in seeking help with diabetes related foot problems: a preliminary qualitative study using Interpretative Phenomenological Analysis. International Diabetes Nursing, 12(1), 20–26.

De Almeida, S. A., Salomé, G. M., Dutra, R. A. A., & Ferreira, L. M. (2014). Feelings of powerlessness in individuals with either venous or diabetic foot ulcers. Journal of Tissue Viability, 23(3), 109–114.

Delea, S., Buckley, C., Hanrahan, A., McGreal, G., Desmond, D., & McHugh, S. (2015). Management of diabetic foot disease and amputation in the Irish health system: A qualitative study of patients’ attitudes and experiences with health services. BMC Health Services Research, 15(1), 1–10.

Dros, A. D., Cull, C. A., Macleod, K. M., & Holman, R. R. (2006). Hypoglycemia in Type 2 diabetic patients randomized to and maintained on monotherapy with diet, sulfonylurea, metformin, or insulin for 6 years from diagnosis: UKPDS73. Journal of diabetes and its complications, 20(6), 395-401.

Foster, D., & Lauver, L. S. (2014). When a diabetic foot ulcer results in amputation: A qualitative study of the lived experience of 15 patients. Ostomy Wound Management, 60(11), 16–22.

Elisabeth, K., Clench, J., & Kjærsti, R. (2016). Journal of Diabetes and Its Complications Sense of mastery as mediator buffering psychological distress among people with diabetes, 30, 839–844.

Eason , L., Cox, D., Kovatchev, B., Julian, D., & Clarke, W. (2005). The psychosocial impact of severe hypoglycemic episodes on spouses of patients with IDDM. Diabetes Care, 20(10), 1543-1546.

Fearns, N., Heller-murphy, S., Kelly, J., & Harbour, J. (2017). Placing the patient at the centre of chronic wound care : A qualitative evidence synthesis. Journal of Tissue Viability, 26(4), 254–259.

Frygberk, S., Gojka, R., Green, A., Sicree, R., & King, H. (2006). Global Prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes care, 27(5), 1047-1053.

Gorecki, C., Nixon, J., Lamping, D. L., Alavi, Y., & Brown, J. M. (2014). International Journal of Nursing Studies Patient-reported outcome measures for chronic wounds with particular reference to pressure ulcer research : A systematic review. International Journal of Nursing Studies, 51(1), 157–165.

Guell, C., & Unwin, N. (2015). Barriers to diabetic foot care in a developing country with a high incidence of diabetes related amputations: An exploratory qualitative interview study. BMC Health Services Research, 15(1), 1–7.

Guo, K., Zhang, L., Zhao, F., Lu, J., Pan, P., Yu, H., … Jia, W. (2016). Journal of Diabetes and Its Complications Prevalence of chronic kidney disease and associated factors in Chinese individuals with type 2 diabetes : Cross-sectional study. Journal of Diabetes and Its Complications, 30(5), 803–810.

Heitzman Kirkman, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., . . . Swift, C. S. (2010). Diabetes in older adults: A consensus report. journal of the american geriatrics society, 60(12), 2342-2356. doi: 10.1111/jgs.12035

Huang, C., Ph, D., Hsieh, H., Ph, D., Chiu, H., & Ph, D. (2017). Original Research Report Impact of Anxiety Disorders on Mortality for Persons With Diabetes : A National Population-Based Cohort Study. Psychosomatics, 58(3), 266–273.

Joensen, L. E., Willaing, I., Holt, R. I. G., Wens, J., Skovlund, S., & Peyrot, M. (2017). Journal of Diabetes and Its Complications Household composition and psychological health : Results of the Second Diabetes Attitudes , Wishes and Needs ( DAWN2 ) study. Journal of Diabetes and Its Complications, 31(2), 340–346.

Johansson, K., ÖSterberg, S. A., Leksell, J., & Berglund, M. (2016). Patients’ experiences of support for learning to live with diabetes to promote health and well-being: A lifeworld phenomenological study. International Journal of Qualitative Studies on Health and Well-Being, 11(June 2017).

Kemenkes RI. (2014). Situasi dan Analisis Diabetes. Pusat Data Dan Informasi Kementerian Kesehatan RI.

Kolltveit, B.-C. H., Gjengedal, E., Graue, M., Iversen, M. M., Thorne, S., & Kirkevold, M. (2016). Telemedicine in diabetes foot care delivery: health care professionals’ experience. BMC Health Services Research, 16(1), 134.

Kolltveit, B. C. H., Gjengedal, E., Graue, M., Iversen, M. M., Thorne, S., & Kirkevold, M. (2017). Conditions for success in introducing telemedicine in diabetes foot care: A qualitative inquiry. BMC Nursing, 16(1), 1–10.

Lee, P. A., Greenfield, G., & Pappas, Y. (2018). Patients’ perception of using telehealth for type 2 diabetes management: A phenomenological study. BMC Health Services Research, 18(1), 1–9.

LeMone, D. A., Havlin, C. E., Craft, S., & Cryer, P. (2011). Mechanism of awareness of hypoglycemia. Perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms. Diabetes, 42(12), 1791-1798.

Lim, J. Z. M., Ng, N. S. L., & Thomas, C. (2017). Prevention and treatment of diabetic foot ulcers. Journal of the Royal Society of Medicine, 110(3), 104–109.

Liu, J., Hu, K., Su, H., Xu, B., Xu, J., & Zhou, J. (2017). Classification Of Diabetic Feet In Terms Of Risk Of Ulceration Classification Of Diabetic Feet In Terms Of Risk Of Ulceration Classification Of Diabetic Feet In Terms Of Risk Of Ulceration Diabetic feet refers to the lower limb of diabetic patients and it, 17, 129–134.

Maidiana.,R.E.,Tety.,U.,& Paul.,T.(2012). Analisis faktor yang berhubungan dengan kejadian ulkus DM di wilayah kerja Puskesmas Semarang. Repository UGM. Tidak di publikasikan.

Manda, C. D., Phillips, L. S., Ziemer, D. C., Gallina, D. L., & et al. (2012). Hypoglycemia in patients with type 2 diabetes mellitus. Archives of internal medicine, 161(13), 1653-1659.

Margareth, M. C. R. (2012). Asuhan Keperawatan Medikal Bedah dan Penyakit Dalam. Yogyakarta: Nuha Medika.

Mckechnie, P. S., & John, A. (2014). Anxiety and depression following traumatic limb amputation : A systematic review. Injury, 45(12), 1859–1866.

Naicker, K., Øverland, S., Johnson, A., Manuel, D., & Skogen, J. C. (2017). Psychoneuroendocrinology Symptoms of anxiety and depression in type 2 diabetes : Associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study, 84(July), 116–123.

Ness, G. P., Wang, J., Broomhall, J., & Kelly, P. (2003). Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: A population-based study of health service resource use. Diabetes care, 26(4), 1176-1180.

Nikoloudi, M., Eleftheriadou, I., Tentolouris, A., Kosta, O. A., & Tentolouris, N. (2018). Diabetic Foot Infections: Update on Management. Current Infectious Disease Reports, 20(10).

Norman, D.G.Eikelboorn,R.T.,Hankey.,O.P (2004). The Experience of Hypoglycaemia and Strategies Used For Its Management by Community-Dwelling Adults with Diabetes Mellitus: A Systematic Review. International Journal of Evidence Based Healthcare, 10(3), 169-180.

Noor, S., Zubair, M., & Ahmad, J. (2015). Diabetic foot ulcer - A review on pathophysiology, classification and microbial etiology. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 9(3), 192–199.

Nurrahmani, H. K. (2015). Stop Diabetes, Hipertensi, Kolesterol Tinggi, Jantung Koroner. Yogyakarta: Istana Media.

Nyamu, S.-H., Lin, Y.-Y., Hsu, C.-W., Cheng, C.-S., & Chu, D.-M. (2003). Hypoglycemia revisited in the acute care setting. Yonsei medical journal, 52(6), 898-908. doi: 10.3349/ymj.2011.52.6.898

Ota, A., & Ulrih, N. P. (2017). An Overview of Herbal Products and Secondary Metabolites Used for Management of Type Two Diabetes. Frontiers in Pharmacology, 8(July), 1–14.

Pastor, A., O’Brien, C. L., Teng, J., Conn, J., Loh, M., Collins, L., … Bonomo, Y. (2018). Experiences of young adults with type 1 diabetes while using alcohol and recreational drugs: An interpretative phenomenological analysis (IPA) of semi-structured interviews. Diabetes Research and Clinical Practice, 141, 47–55.

Paton, J. S., Roberts, A., Bruce, G. K., & Marsden, J. (2014). Patients’ Experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: An interpretative phenomenological analysis (IPA). Journal of Foot and Ankle Research, 7(1), 1–9.

Pedras, S., Carvalho, R., & Pereira, M. G. (2016). Predictors of quality of life in patients with diabetic foot ulcer: The role of anxiety, depression, and functionality. Journal of Health Psychology, 135910531665676.

Perkeni. (2015). Pengelolaan dan pencegahan diabetes melitus tipe 2 di indonesia 2015. Pengurus Besar Perkumpulan Endokrinologi Indonesia (PB Perkeni).

Peters., S, Acharya LD, Rao PGM, (2007) Knowledge, attitude, and practice outcome: Evaluating the impact of counseling in hospitalized diabetic patient in india. P&T Around the World, Page; 31 (7), 383 -395.

Peyrot, M., Kovacs, K., Davies, M., Forbes, A., Hermanns, N., Holt, R., … Skovlund, S. E. (2012). Diabetes Attitudes Wishes and Needs 2 ( DAWN2 ): A multinational , multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes care. Diabetes Research and Clinical Practice, 99(2), 174–184.

Reiber, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., . . . Swift, C. S. (2000). Diabetes in older adults: A consensus report. journal of the american geriatrics society, 60(12), 2342-2356. doi: 10.1111/jgs.12035

Sieggreen, M., & Berger, W. (1999). Higher incidence of severe hypoglycaemia leading to hospital admission in type 2 diabetic patients treated with long-acting versus short-acting sulphonylureas. Diabetic medicine, 16(7), 586-590. doi: 10.1046/j.1464-5491.1999.00110.x

Stuckey, H. L., Mullan-jensen, C., Kalra, S., Reading, J., Wens, J., Vallis, M., … Peyrot, M. (2016). Living with an adult who has diabetes : Qualitative insights from the second Diabetes Attitudes , Wishes and Needs ( DAWN2 ) study. Diabetes Research and Clinical Practice, 116, 270–278.

Razjouyan, J., Grewal, G. S., Talal, T. K., Armstrong, D. G., Mills, J. L., & Najafi, B. (2017). Does Physiological Stress Slow Down Wound Healing in Patients with Diabetes? Journal of Diabetes Science and Technology, 11(4), 685–692.

Shanty, M. (2011). Silent Killer Disease. Yogyakarta: Javalitera.

Siersma, V., Thorsen, H., Holstein, P. E., Kars, M., Apelqvist, J., Jude, E. B., … Schaper, N. C. (2017). Diabetic complications do not hamper improvement of health-related quality of life over the course of treatment of diabetic foot ulcers – the Eurodiale study. Journal of Diabetes and Its Complications, 31(7), 1145–1151.

Syafril, S. (2018). Pathophysiology diabetic foot ulcer. IOP Conf. Ser.: Earth Environ. Sci, 125, 12161.

Udovichenko, O. V, N.V., M., M.V., A., O.A., Y., & E.G., B. E. A. and S. (2017). Prevalence and Prognostic Value of Depression and Anxiety in Patients with Diabetic Foot Ulcers and Possibilities of their Treatment. Current Diabetes Reviews.

Vileikyte, L., Crews, R. T., & Reeves, N. D. (2017). Psychological and Biomechanical Aspects of Patient Adaptation to Diabetic Neuropathy and Foot Ulceration. Current Diabetes Reports, 17(11).

Vlachakis, C., Dragoumani, K., Raftopoulou, S., Mantaiou, M., Papageorgiou, L., Tsaniras, S. C., … Vlachakis, D. (2018). Human emotions on the onset of cardiovascular and small vessel related diseases. In Vivo, 32(4), 859–870.

Washington, E. D., & Williams, A. E. (2016). An exploratory phenomenological study exploring the experiences of people with systemic disease who have undergone lower limb amputation and its impact on their psychological well-being. Prosthetics and Orthotics International, 40(1), 44–50.

WHO. (2014). Global status report on noncommunicable diseases 2014. World Health, 176. 9789241564854


  • There are currently no refbacks.

Copyright (c) 2020 Critical Medical and Surgical Nursing Journal

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This Journal is Indexed by:



This journal is Publish by the Faculty of Nursing Universitas Airlangga and in Collaboration with Indonesian Emergency and Disaster Nurses Association (IEDNA) East Java and Indonesian Critical Care Nurses Association (ICCNA) East Java



Creative Commons License

CMSNJ by Unair is licensed under a Creative Commons Attribution 4.0 International License.


View My Stats