JURNAL BERKALA EPIDEMIOLOGI

Volume 8 Issue 3 (2020) 256–264

DOI: 10.20473/jbe.v8i32020. 256–264
p-ISSN: 2301-7171 ; e-ISSN: 2541-092X
Website: http://journal.unair.ac.id/index.php/JBE/
Email: jbe@fkm.unair.ac.id / jbepid@gmail.com

ORIGINAL RESEARCH

RISK FACTORS OF TYPE 2 DIABETES MELLITUS DURATION AND NON-

COMPLIANCE WITH MEDICATION TO POOR GLYCEMIC STATUS
Faktor Risiko Durasi Diabetes Melitus Tipe 2 dan Ketidakpatuhan Minum Obat terhadap Status Glikemik
Buruk

Marisa Gita Putri1, K. Heri Nugroho HS2, Mateus Sakundarno Adi3, Suhartono Suhartono4, Bagoes
Widjanarko5
1
Master of Epidemiology, School of Postgraduate, Diponegoro University, marisagita90@gmail.com
2
Internal Medicine Dept., Faculty of Medicine, Diponegoro University, khris_heri@yahoo.com
3
Master of Epidemiology, School of Postgraduate, Diponegoro University, adisakundarno@yahoo.com
4
Environmental Health Dept., Public Health Faculty, Diponegoro University, suhartono_damas@yahoo.com
5
Health Promotion Dept., Public Health Faculty, Diponegoro University, bagoes62@gmail.com
Correspondence Author: Marisa Gita Putri, marisagita90@gmail.com, Master of Epidemiology, School of
Postgraduate, Diponegoro University, Imam Bardjo, SH Street, Semarang City, Central Java, Indonesia, 50241

ARTICLE INFO ABSTRACT

Article History: Background: Type 2 diabetes mellitus is a chronic disease that is
Received Novermber, 4th, 2019 still a global health problem. Uncontrolled diabetes mellitus (DM)
Revised form December, 16th, 2019 can result in poor glycemic status, with factors that affect patients
Accepted September, 13th, 2020 including long-term DM and medication compliance. Purpose: This
Published online September, 20th, 2020
study aimed to determine the risk factors of long-term DM and non-
compliance with medication on the poor glycemic control status of
Keywords:
type 2 diabetes mellitus;
patients with type 2 DM. Methods: This type of research used
poor glycemic status; observational analysis with a case–control design. Samples were
risk factors; taken from patients with type 2 DM, with 40 cases and 40 controls.
long suffered; The criteria for sample inclusion were that the patients had a
non-adherence with medication glycosylated hemoglobin level check, were willing to be research
respondents, and could communicate well. The exclusion criterion
Kata Kunci: was patients experiencing a drastic decline in health status during
diabetes melitus tipe 2; the study. The sampling technique used was consecutive sampling.
status glikemik buruk; This research was conducted at the Panti Wilasa Citarum Hospital
faktor risiko; in Semarang City from July to September 2019. The relationship
lama menderita diabetes melitus;
ketidakpatuhan minum obat
and the risk of long-term DM and adherence to taking medication
with glycemic status were tested using the chi-square test. Results:
This study showed that a duration of DM >5 years (p = 0.01; Odss
Ratio (OR) = 3.46; 95% confidence interval [CI] = 1.37 < OR <
8.69) and non-compliance with taking medication (p = 0.02; OR =
3.15; 95% CI = 1.25 < OR < 7.93) are risk factors for poor glycemic
status. Conclusion: Duration of DM >5 years and non-compliance
with taking medication are risk factors for poor glycemic status in
patients with type 2 DM.

©2020 Jurnal Berkala Epidemiologi. Published by Universitas Airlangga.

This is an open access article under CC-BY-SA license
(https://creativecommons.org/licenses/by-sa/4.0/)
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ABSTRAK
How to Cite: Putri, M. G., HS, KHN.,
Adi, M. S., Suhartono, S., & Latar Belakang: Diabetes melitus (DM) tipe 2 adalah penyakit
Widjanarko, B. (2020). Risk factors of kronik yang masih menjadi masalah kesehatan global. Diabetes
type 2 diabetes mellitus duration and melitus yang tidak terkontrol dapat berakibat status glikemik
non-compliance with medication to menjadi buruk, dengan faktor-faktor yang mempengaruhi
poor glycemic status. Jurnal Berkala diantaranya lama menderita DM dan kepatuhan minum obat.
Epidemiologi, 8(3), 256–264. Tujuan: Penelitian ini bertujuan untuk menentukan faktor risiko
https://dx.doi.org/10.20473/jbe.v8i320 lama menderita DM dan ketidakpatuhan minum obat terhadap
20. 256–264
status kontrol glikemik buruk pasien DM tipe 2. Metode: Jenis
penelitian menggunakan observasional analitik dengan desain case
control. Sampel diambil dari pasien DM tipe 2 dengan 40 kasus dan
40 kontrol. Kriteria inklusi sampel yakni pasien memiliki
pemeriksaan kadar HbA1c, bersedia menjadi responden penelitian,
dan dapat berkomunikasi dengan baik. Kriteria eksklusi yakni
pasien mengalami penurunan status kesehatan secara drastis saat
penelitian berlangsung. Teknik pengambilan sampel menggunakan
consecutive sampling. Penelitian ini dilakukan di RS Panti Wilasa
Citarum Kota Semarang pada bulan Juli-September 2019.
Hubungan dan besar risiko lama menderita DM dan kepatuhan
minum obat dengan status glikemik diuji menggunakan chi-square.
Hasil: Penelitian ini menunjukkan bahwa lama menderita DM > 5
tahun (p = 0,01; OR = 3,46; 95% CI = 1,37 < OR < 8,69) dan
ketidakpatuhan minum obat (p = 0,02; OR = 3,15; 95% CI = 1,25
< OR < 7,93) merupakan faktor risiko status glikemik buruk.
Kesimpulan: Lama menderita DM > 5 tahun dan ketidakpatuhan
minum obat merupakan faktor risiko status glikemik buruk pasien
diabetes melitus tipe 2.

©2020 Jurnal Berkala Epidemiologi. Penerbit Universitas Airlangga.

Jurnal ini dapat diakses secara terbuka dan memiliki lisensi CC-BY-SA
(https://creativecommons.org/licenses/by-sa/4.0/)

INTRODUCTION of physicians of the population aged ≥15 years

based on provinces in Indonesia by 2%, and
Cases of diabetes mellitus (DM) continue to Central Java has above the average prevalence in
increase globally. The World Health Organization Indonesia (Ministry of Health RI, 2018). One non-
estimated that there were 422 million adults communicable disease that needs to be controlled
suffering from diabetes worldwide in 2014. Type 2 in Central Java is DM. The proportion of DM
DM or type 2 diabetes has the largest percentage regarding all non-communicable diseases ranks
of between 90% and 95% of diabetes, with the second largest at 20.57% after hypertension
highest proportion in low- and middle-income (Central Java Provincial Health Office, 2019).
countries (WHO, 2019). Type 2 DM or Diabetes mellitus cannot be cured, but blood
hyperglycemia occurs due to insulin resistance, glycemic levels can be controlled. Glycemic
wherein insulin production is insufficient, so the control has always been the main therapeutic goal
body is unable to respond fully to sugar levels. for the prevention of target organ damage and
This is still a common and serious global health other complications arising from diabetes
problem, including in Indonesia. In 2015, (Kakade, Mohanty, & Rai, 2018). Poor glycemic
Indonesia was ranked seventh in the world with a control of patients with type 2 DM is a major
high diabetes prevalence of 10 million cases after public health problem and accelerates the
China, India, the United States, Brazil, Russia, and development of diabetes complications. Based on
Mexico (IDF, 2015). pathophysiology, DM complications are classified
The prevalence of DM in Indonesia regarding as microvascular (damage to small blood vessels)
the population aged ≥15 years is 10.90% and macrovascular (damage to arteries). Diabetes
(Soelistijo et al., 2015). According to the diagnosis is the leading cause of blindness, end-stage kidney
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disease, and stroke, which are common in diabetic can improve blood glucose control and prevent
patients (Fasil, Biadgo, & Abebe, 2019). long-term complications (Hashimoto et al., 2019).
Microvascular and macrovascular complications in Diabetes treatment adherence is associated with
people with DM who have glycemic control result lower HbA1c levels (Marinho et al., 2018).
in higher treatment costs (Waari, Mutai, & Methods of measuring compliance with
Gikunju, 2018). medication can be done directly and indirectly.
Glycemic control of DM can be seen from the The direct method looks at the concentration of
levels of glycosylated hemoglobin (HbA1c); drugs in the blood, while the indirect method uses
HbA1c is the main target of glycemic control and the Morisky Medication Adherence Scale
guides the strategy for initiating and intensifying (MMAS)-8 questionnaire given to respondents.
treatment for diabetics (Camara et al., 2015). Each This questionnaire is used to assess compliance
1% reduction in the mean HbA1c has been shown with taking medication and has been validated by
to be associated with a risk reduction of 21% for the World Health Organization. Studies conducted
diabetes-related deaths, 14% for myocardial by Nanda, Wiryanto, & Triyono (2018) provided
infarctions, and 37% for microvascular evidence of adherence to taking anti-diabetic drugs
complications (Kibirige, Akabwai, Kampiire, in female outpatients aged 45–59 years to have a
Kiggundu, & Lumu, 2017). According to the correlation with blood sugar regulation. Research
American Diabetes Association, the target for conducted by Purwitaningtyas, Putra, & Wirawan
long-term glycemic control in patients with (2015) also showed the relationship of medication
diabetes is an HbA1c value of less than 7%. adherence with controlling blood sugar levels;
Studies have shown that a significant reduction in uncontrolled blood sugar in patients with DM
mortality and morbidity occurs with an increase in occurred in patients who did not regularly take
glycemic control. This may be due to the reduction medication. This was in contrast to the results of
of microvascular complications such as low Lin, Sun, Heng, Kwang-Chew, & Chong (2017)’s
systemic inflammation by preventing immune research, which showed that there is no
dysfunction and protecting the endothelium and relationship between medication adherence and
mitochondrial ultrastructure and function glycemic control.
(Asmelash, Abdu, Tefera, Baynes, & Derbew, There has been an increase in patients with
2019). DM in Semarang City. In 2014, the DM cases
Uncontrolled DM can often damage organs amounted to 9,772 and, in 2018, increased rapidly
without being felt by patients. Some of the factors to 48,996 (Semarang City Health Office, 2018).
that can increase poor glycemic incidence at One hospital that has a lot of DM patient visits is
patients with DM were the duration of DM, Panti Wilasa Citarum Hospital in Semarang City,
adherence to taking DM medication, physical with 10,923 outpatient visits in 2018. A high
activity, and treatment control (Mamo, Bekele, number of complications due to poor glycemic
Nigussie, & Zewudie, 2019; Nanda, Wiryanto, & status were found in the data of outpatient DM
Triyono, 2018; Widodo, Tamtomo, & Prabandari, visits which are 1,253 patients in 2017 and
2016). increased become 1,531 DM patients with
Long-term DM can be related to insulin complications in August 2019.
secretion. The longer a person suffers from DM, The risk factors for poor glycemic status still
the more damaged their insulin secretion becomes. need to be investigated. These factors are the
Thus, it can cause difficulty in controlling blood duration of DM and medication adherence to
sugar levels. Li et al (2018)’s study proved that glycemic status of patients with type 2 DM. Based
there is a relationship between the duration of type on the description of the problem, this study aimed
2 DM and poor glycemic control of diabetes in to determine the risk factors of long-term DM and
patients in diabetes care centers in Ningbo, China medication adherence for poor glycemic status in
(p < 0.01). patients with type 2 DM at Panti Wilasa Citarum
Control of glycemic levels is the main Hospital in Semarang City.
objective in the treatment of DM. One of the
glycemic status controls performed by DM METHODS
patients is adhering to the treatment of diabetes.
Compliance is defined as an attempt to take action The type of research in this study was an
according to instructions given by doctors in the observational analysis with a case–control design.
form of exercise therapy, diet, medication, and Research with this design was carried out by
disease control. Adherence to diabetes treatment determining in advance which groups had a bad
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glycemic status as cases and which groups had a (30.00%), with the youngest age being 45 years
good glycemic status as controls. and the oldest 77 years. Most of the respondents
The population in this study was all patients had graduated from high school (43.80%).
with type 2 DM who visited Panti Wilasa Citarum Regarding occupation, the majority of respondents
Hospital in Semarang. The sample size in this did not work namely, because they were
study was 80 people, with 40 cases (bad glycemic housewives (41.30%).
status) and 40 controls (good glycemic status). The
inclusion criteria for the selected sample included Table1
examining HbA1c levels >7% for case samples Frequency Distribution of Respondents
and HbA1c levels ≤7% for control samples, Variable n %
willingness to become research respondents, and Age (years)
ability to communicate well. The exclusion 45–49 4 5.00
criterion of this study was patients experiencing a 50–54 15 18.80
drastic decline in health status during the study. 55–59 24 30.00
The sampling in this study used consecutive 60–64 21 26.30
sampling. 65–69 9 11.30
This research was conducted at Panti Wilasa 70–74 3 3.80
Citarum Hospital in Semarang City by 75–79 4 5.00
interviewing outpatients with type 2 DM. The time Gender
of the data collection was July–September 2019. Male 44 55.00
The primary data were obtained based on Female 36 45.00
interviews, namely independent variables Recent Education
consisting of age, sex, recent education, No School 1 1.30
occupation, duration of DM, and medication Elementary school 16 20.00
adherence. Adherence to medication was measured Middle School 7 8.80
from the Morisky Medication Adherence Scale High School 35 43.80
questionnaire with eight question items. The College 21 26.30
assessment of medication adherence was divided Occupation
into two categories, namely compliant (value ≥8) Unemployment 6 7.50
and non-compliant (value <8). The dependent Housewife 33 41.30
variable was the glycemic status obtained from Retired Government Employees 15 18.80
laboratory tests of the HbA1c levels of the patients Military/Police 3 3.80
with type 2 DM. The secondary data were the data General employees 13 16.30
on the number of patients with type 2 DM in Panti Entrepreneur 10 12.50
Wilasa Citarum Hospital in Semarang City.
Total 80 100.00
The data were analyzed univariately and
bivariately. The univariate analysis described the
Table 2 shows that the results of the
characteristics of the respondents, i.e., age, sex,
relationship test with the duration of DM obtained
recent education, and occupation in the frequency
a p-value of 0.01 with an Odds Ratio (OR) value
distribution table. The bivariate analysis was done
of 3.46 (95% confidence interval [CI] = 1.37–
by cross-tabulation between the dependent
8.69), which meant that there was a relationship
variable and the independent variable. Test the
between the duration of DM and the glycemic
relationship between duration of DM compliance
status of patients with type 2 DM. The odds ratio
with medication taking with glycemic status using
was 3.46 (95% CI = 1.37–8.69), which meant that
the chi square test. This study obtained ethical
patients who have type 2 DM for more than five
eligibility from the Health Research Ethics
years have a 3.46 times greater risk of
Commission of the Faculty of Medicine,
experiencing poor glycemic status than patients
University of Diponegoro, Number 412 / EC /
who have type 2 DM for less than five years. The
KEPK / FK UNDIP / IX / 2019.
proportion of patients suffering from DM for more
than five years in the case group (62.50%) was
RESULTS
greater than that in the control group (32.50%).
Table 1 illustrates that the majority of In Table 2, the proportion of respondents who
respondents were female (55.00%). The majority were not compliant with taking medication was
of respondents were aged between 55 and 59 years greater in the case group (57.50%) than in the
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control group (30.00%). A drug compliance test Table 3 shows the non-compliance of the
was obtained p = 0.02, OR = 3.15 (95% CI = 1.25 patients in the poor glycemic status group, most of
< OR < 7.93), which meant that there was a whom (75.00%) would forget to take the drug. The
relationship between medication adherence and statement of the reason for the non-compliance
glycemic status in patients with type 2 DM. The with medication that was proven to be related to
odds ratio was 3.15 (95% CI = 1.25–7.93), the glycemic status of the patients with type 2 DM
meaning that patients with type 2 DM who are not was that the patients felt worse when taking anti-
adherent to taking medication have a 3.15 times diabetic drugs, with a value of p = 0.03 (p < 0.05).
greater risk of experiencing a worse glycemic This meant there was a relationship between
status than patients with type 2 DM who are stopping or reducing the drug because the patients’
adherent to taking medication. condition became increasingly uncomfortable and
the glycemic status of the patients with type 2 DM.

Table 2
Relationship Between Long-Term Type 2 DM and Compliance with Medication for Glycemic Status
Glycemic Status
OR
Variable Poor Good p value
(95% CI)
n % n %
Long-Term Type 2 DM (years)
>5 25 62.50 13 32.50 3.46
0.01
≤5 15 37.50 27 67.50 (1.37–8.69)
Compliance with Medication
No 23 57.50 12 30.00 3.15
0.02
Yes 17 42.50 28 70.00 (1.25–7.93)
Total 40 100.00 40 100.00

Table 3
Reasons for Non-Compliance with Medication
Glycemic Status
p OR
Compliance with Medication Poor Good
value (95% CI)
n % n %
Forgot to take medicine
Yes 30 75.00 26 65.00 0.46 1.62
No 10 25.00 14 35.00 (0.61–4.25)
Deliberately did not take medicine
Yes 12 30.00 6 22.50 0.18 2.43
No 28 70.00 34 77.50 (0.81–7.30)
The condition felt uncomfortable
Yes 14 35.00 5 12.50 0.03 3.77
No 26 65.00 35 87.50 (1.21–11.79)
Forgot to bring medicine when traveling
Yes 19 47.50 19 47.50 1.00 1.00
No 21 52.50 21 52.50 (0.42–2.41)
Did not take medication yesterday
Yes 2 5.00 4 10.00 0.67 0.47
No 38 95.00 36 90.00 (0.08–2.75)
Felt healthy
Yes 12 30.00 7 17.50 0.29 2.02
No 28 70.00 33 82.50 (0.70–5.83)
Interrupted by having to take
medication 16 40.00 12 30.00 0.48 1.56
Yes 24 60.00 28 70.00 (0.62 – 3.93)
No
Total 40 100.00 40 100.00
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DISCUSSION not compliant with taking anti-diabetic drugs had a

3.46 times higher risk of experiencing poor
The Relationship of Long-Term DM with glycemic status compared to respondents who
Glycemic Status were compliant with taking anti-diabetic drugs.
This study showed that the proportion of The odds ratio showed that the more obedient a
long-term DM of more than five years in the case patient was in taking anti-diabetic medication, the
group (62.50%) was greater than that in the control more their glycemic status would be controlled.
group (32.50%). In theory, long-term DM is The results of this study were in line with those of
associated with glycemic status. In this study, the Alqarni, Alrahbeni, Al Qarni, & Al Qarni (2019),
results showed that there is a relationship between who showed that poor adherence to diabetes
the length of suffering from DM and glycemic medication provides poor glycemic control. A low
status (p = 0.01 ; OR = 3.46 ; 95% CI = 1.37– and optimal HbA1c value has also been found in
8.69), which means that patients with type 2 DM patients with high MMAS-8 scores (Waari, Mutai,
>5 years have a 3.46 times greater risk of & Gikunju, 2018). The same thing was also shown
experiencing poor glycemic status than patients in research by Nanda, Wiryanto, & Triyono
with type 2 DM ≤5 years. The results of this study (2018), which provided evidence of adherence to
support research from Li et al (2018) that proved taking oral anti-diabetic drugs in female
that the duration of type 2 DM is associated with outpatients aged 45–59 years in Surabaya related
poor glycemic control. Every one-year increase in to blood sugar regulation. In contrast, the research
the duration of DM is associated with a 5% results of Lin, Sun, Heng, Kwang-Chew, & Chong
reduction in the likelihood of achieving glycemic (2017) showed that there is no relationship
control targets. A longer diabetes duration between medication adherence and glycemic
negatively affects glycemic control. This happens control.
because of the progressive disruption of insulin Based on the test results of the current study
secretion over time as a result of beta cell failure. that the reasons for the non-compliance of patients
As the disease progresses, most patients require to taking drug consumption was because of the
increased pharmacotherapy to maintain glycemic condition of patients feeling uncomfortable when
control. taking anti-diabetic drugs (p-value of 0.03). The
A study conducted by Haghighatpanah, results of this study were consistent with those of
Nejad, Haghighatpanah, Thunga, & Mallayasamy studies conducted in India, wherein one of the
(2018) revealed the same results: A longer most common reasons for not complying with
duration of diabetes affects glycemic control, medication was feeling worse (Sajith, Pankaj,
perhaps due to a reduction in insulin secretion or Pawar, Modi, & Sumariya, 2014).
excessive insulin resistance in these patients. The The reason some patients felt their condition
same thing was also shown in research by Kayar et was getting worse was because they felt side
al (2017) that found a significant relationship (p = effects when taking anti-diabetic medication.
<0.01) between poor glycemic control and the Some patients experienced symptoms such as
duration of disease. Diabetes is a progressive dizziness, stomach discomfort, and diarrhea. The
disease, and because glucose levels increase, more patients were forced to stop taking medication
drugs are needed to achieve good glycemic until they returns to the doctor to complain of the
control. A longer duration of diabetes is known to side effects of the drug. Research by Rosyida,
be associated with poor glycemic control, and this Priyandani, Sulistyarini, & Nita (2015)“
can be explained by the progressive decrease of mentioned that patients who stop taking
insulin secretion over time due to beta cell failure medication or reduce medication due to side
(Badedi et al., 2016). This differs from the effects caused by drugs. The effects are disruptive
research conducted by Ishak, Mohd-Yusoff, but not consulted to the doctor so that when the
Rahman, & Kadir (2017) that found no patient drinks less than the recommended dose, the
relationship between the duration of diabetes and effect does not appear again.
glycemic status, with a value of p = 0.35. In this study, the majority of respondents
consumed oral anti-diabetes drugs, namely
The Relationship of Medication Compliance metformin and glimepiride. Metformin is an anti-
with Glycemic Status diabetes drug that increases insulin sensitivity but
There is a relationship between compliance has side effects in the form of digestive tract
with taking anti-diabetes drugs and poor glycemic disorders. Glimepiride is in the sulfonylurea class
status in patients with DM. Respondents who were of drugs to increase insulin secretion by pancreatic
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beta cells and has major side effects of The reasons for not taking medicine
hypoglycemia and weight gain(Soelistijo et al., yesterday (p = 0.67), i.e., feeling healthy (p = 0.29)
2015). and disturbed by the need to take medication (p =
Patients’ reasons for forgetting to take 0.48), were also not proven to be associated with
medication in this study proved to be unrelated to poor glycemic status of patients with type 2 DM.
poor glycemic status (p = 0.46). The majority of Patients felt bored with having to take mandatory
respondents with poor glycemic status by reason medication every day because they felt disturbed.
of forgetting to take medication (75.00%).
Research conducted by Jemal & Abdela (2017) Research Limitations
found that factors that cause non-compliance with Not all patients had HbA1c examination data
taking medication are forgetting to take from the last three months because it is rare for
medication, omitting the dose, lack of finances, patients to undergo HbA1c examination. This
and long duration of therapy in the case of some research would have been better if it were done
DM patients. In research conducted at the Addis homogeneously, taking HbA1c data from the last
Ababa Tikur Anbessa specialty hospital using the three months.
Morisky four-item instrument, most patients
missed their treatment due to negligence (Tsehay, CONCLUSION
Engidawork, & Ahmed, 2016).
Forgetfulness is the most common reason for Based on the results of the study, it can be
disobedience. In research conducted by Inbaraj, concluded that patients with a poor glycemic status
Georg, Kham, & Norman (2016), all respondents are more non-compliant with taking medication.
who were forgetful were over 40 years old, and Duration of DM >5 years and non-compliance
half (52.90%) of them were over 60 years old. with taking medication are risk factors for poor
Forgetting to take medicine can actually be glycemic status in patients with type 2 DM at Panti
overcome by telling family members to remind Wilasa Citarum Hospital in Semarang.
them or using a reminder alarm. In this study, the
reason for patients forgetting to take medicine was CONFLICT OF INTEREST
due to decreased memory of the patients due to
increasing age; however, the majority of The authors declare that no conflict of interest
respondents also tried not to forget to take the in this study.
medication because it had become a routine, so
they only forgot to take the medication once a AUTHOR CONTRIBUTION
week.
The reason of deliberately not taking All authors participate actively in this article
medication (p = 0.18) was shown to be unrelated and are responsible for the content of the article.
to poor glycemic status. The reason for not taking MGP: Writing- Original draft preparation,
drugs was because the patients did not want to Conceptualization Editing, HNHS: Reviewing,
become addicted to drugs. Some respondents were Research Supervisor, Conceptualization,
afraid that taking drugs could damage their Visualization, MSA: Reviewing, Research
kidneys. Some patients interspersed type 2 DM Supervisor, Methodology, SS: Reviewing, BW:
treatment with alternative or herbal treatments Reviewing.
such as cinnamon and garlic. In this study, the
reason of forgetting to bring the drug while ACKNOWLEDGMENTS
traveling (p = 1.00) was shown to be unrelated to
poor glycemic status. This differed from research “We thanks to Panti Wilasa Citarum Hospital
by Nanda, Wiryanto, & Triyono (2018) that Semarang City, for granting permission to conduct
proved that there is a relationship between patients this research.”
forgetting to take drugs while traveling and blood
sugar regulation with a value of p = 0.03. Patients REFERENCES
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