PENGARUH EDUKASI GIZI DAN AKTIVITAS FISIK TERHADAP PERBAIKAN BIOMARKER METABOLIK PADA WANITA PENDERITA PREDIABETES

Abstract

Prevalensi diabetes melitus terus meningkat dan berdampak pada morbiditas serta mortalitas akibat komplikasi. Deteksi dini prediabetes penting dilakukan untuk mencegah diabetes. Prediabetes merupakan keadaan patologis sebelum terjadi diabetes ditandai dengan toleransi glukosa terganggu (TGT) atau glukosa darah puasa terganggu (GDPT). Di Indonesia, prevalensi GDPT pada usia =15 tahun mencapai 36,6% dan TGT 30,8%. Di Kabupaten Gorontalo, 15,4% kelompok dewasa mengalami hiperglikemia. Wanita dewasa berisiko prediabetes berkaitan dengan obesitas, pola makan tidak sehat, rendah konsumsi sayur-buah, dan kurang aktivitas fisik. Kebiasaan mengonsumsi makan berisiko dan kurang aktivitas fisik dapat dipengaruhi oleh pengetahuan kurang dan sikap negatif terkait pola makan dan aktivitas fisik. Pengetahuan, sikap, dan praktik merupakan komponen perubahan perilaku yang saling terkait, sehingga edukasi gizi diperlukan untuk mendorong perbaikan perilaku gizi. Teori perubahan perilaku health belief model (HBM) menekankan bahwa perubahan perilaku dipengaruhi oleh persepsi keparahan, persepsi kerentanan, persepsi manfaat, persepsi hambatan, efikasi diri dan kesiapan untuk bertindak. Edukasi gizi dirancang dalam bentuk kunjungan rumah dengan pelaksanaan secara edukasi personal dan kelompok. Penelitian ini bertujuan untuk menganalisis pengaruh intervensi edukasi gizi dan aktivitas fisik terhadap perubahan biomarker metabolik pada penderita prediabetes. Penelitian dilakukan melalui dua tahap yakni studi pendahuluan dan intervensi. Penelitian dilaksanakan di Kabupaten Gorontalo pada bulan Juli 2023 hingga Desember 2024. Pada studi pendahuluan terdiri dari penelitian survei faktor risiko prediabetes, pengembangan instrumen dan media edukasi gizi. Desain penelitian survei menggunakan cross sectional study dengan pengambilan subjek secara consequtive sampling pada dua wilayah kerja Puskesmas. Total subjek sebanyak 223 orang dengan usia 26-51 tahun. Tahap penelitian intervensi menggunakan desain kuasi eksperimen pre post dengan pembanding eksternal. Terdapat 24 orang pada kelompok intervensi dan 25 orang pada kelompok kontrol yang berpartisipasi hingga akhir penelitian intervensi. Kriteria subjek pada penelitian intervensi adalah mengalami prediabetes dan belum menopause. Kelompok intervensi menerima edukasi gizi dan aktivitas fisik berjalan kaki. Edukasi gizi dilakukan selama 12 minggu menggunakan media edukasi berupa modul dan video edukasi gizi yang disampaikan oleh fasilitator terlatih berupa penyampaian materi edukasi, wawancara motivasi, praktik dan penugasan pada setiap sesi edukasi gizi. Sementara kontrol menerima leaflet manajemen prediates setiap minggu. Variabel penelitian diukur sebelum, setelah dan follow up yakni tiga bulan setelah intervensi edukasi gizi. Data dikumpulkan melalui kuesioner pengetahuan dan sikap manajemen prediabetes, HBM pola makan dan aktivitas fisik, frekuensi konsumsi pangan, recall 2 x 24 jam, international physical activity questionnaire (IPAQ) dan physical activity level (PAL). Pengumpulan data dilakukan secara langsung dengan mengukur status gizi, komposisi tubuh, tekanan darah, glukosa darah puasa (GDP), tes toleransi glukosa oral (TTGO), dan HbA1c. Analisis data menggunakan analisis univariat, kappa statistik, Cronbach coefficient alpha, regresi multinomial, korelasi Spearman’s, paired t tets/Wilcoxon test, dan independent t test/Mann whitney test. Hasil penelitian menunjukkan bahwa kuesioner pengetahuan, sikap HBM pola makan, dan aktivitas fisik tergolong valid dan reliabel. Kuesioner frekuensi konsumsi mencakup 118 item dari 18 kelompok pangan. Prediabetes ditemukan pada 30,5% subjek berdasarkan GDP dan TTGO. Sebagian besar subjek jarang mengonsumsi sayur (70,8%) dan buah (91,5%), sering mengonsumsi gula, sirup, dan konfeksionari (50,2%), serta melakukan aktivitas fisik ringan (65,5%). Konsumsi makanan minuman manis, aktivitas fisik kurang, dan obesitas sentral meningkatkan risiko prediabetes (p<0,05). Sebanyak 61,8% subjek memiliki pengetahuan kurang, terutama terkait gejala diabetes, pengaturan makan, dan aktivitas fisik. Sikap manajemen prediabetes sebagian besar netral (60,5%), dengan sikap negatif pada aspek faktor risiko keturunan dan konsumsi makanan berisiko. Terdapat korelasi positif antara pengetahuan dan sikap, serta korelasi negatif antara aktivitas fisik dan sikap manajemen prediabetes. Intervensi edukasi gizi dan aktivitas fisik berpengaruh terhadap perbaikan komponen sikap HBM yakni peningkatan persepsi keparahan, kerentanan, manfaat, efikasi diri, kesiapan untuk bertindak dan penurunan skor persepsi hambatan. Intervensi edukasi gizi meningkatkan skor pengetahuan, konsumsi sayur dan buah, aktivitas fisik, serta menurunkan konsumsi makanan/minuman manis. GDP menurun pada kelompok intervensi, TTGO menurun pada kedua kelompok, namun tidak berbeda signifikan antara kedua kelompok. HbA1c meningkat signifikan pada kelompok kontrol, sedangkan status gizi indeks massa tubuh (IMT) tidak berubah signifikan. Tingkat kepatuhan aktivitas fisik 92,3% yang menunjukkan efektivitas intervensi. Penelitian ini menyimpulkan edukasi gizi dan aktivitas fisik mendorong perbaikan sikap HBM, konsumsi sayur dan buah, penurunan konsumsi makanan berisiko dan peningkatan aktivitas fisik yang berdampak pada perbaikan biomarker metabolik. Penelitian ini menunjukkan bahwa pendekatan edukasi terstruktur berbasis teori perubahan perilaku dan aktivitas fisik menjadi strategi yang dapat diterapkan untuk mencegah progresivitas prediabetes menjadi diabetes.

Diabetes mellitus is a non-communicable disease (NCD) with a steadily increasing prevalence, contributing to higher risks of morbidity and mortality due to various complications. Therefore, early detection of prediabetes is crucial. Prediabetes is a pathological condition that precedes diabetes, characterized by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). In Indonesia, the prevalence of IFG among individuals aged =15 years is 36.6%, while IGT is 30.8%. In Gorontalo Regency, 15.4% of adults were found to have hyperglycemia. Adult women are at higher risk of developing prediabetes, which is associated with obesity, unhealthy dietary patterns, low intake of fruits and vegetables, and insufficient physical activity Unhealthy eating habits and physical inactivity can be influenced by low level of knowledge and negative attitudes toward diet and physical activity. Knowledge, attitudes, and practices are interrelated components of behavior change, highlighting the need for nutrition education to promote healthier behaviors. The Health Belief Model (HBM) suggests that behavioral change is influenced by perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy, and cues to action. Nutrition education in the study was delivered through home visits, both personal and groups education. The study aims to analyze the effect of nutrition education and physical activity interventions on changes in metabolic biomarkers among individuals with prediabetes. The study was conducted in two stage, including a preliminary study and an intervention study. The study was carried out in Gorontalo Regency from July 2023 to December 2024. The preliminary study included an assessment of prediabetes risk factors, development of a questionnaire, and creation of nutrition education media. In preliminary study, a cross-sectional design with consecutive sampling was used in two health centers, involving a total of 223 participants aged 26–51 years. The intervention study used quasi experimental pre post design with an external comparison group. A total of 24 participants in the intervention group and 25 in the control group completed the study. Inclusion criteria for the intervention phase were individuals diagnosed with prediabetes who had not reached menopause. The intervention group received nutrition education and walking sessions. The nutrition education was conducted 12 weeks using educational materials, including modules and videos, delivered by trained facilitators. Each session included the delivery of educational content, motivational interviewing, practical activities, and assignments. Meanwhile, the control group received weekly leaflets on prediabetes management. Study variables were measured at baseline, endline after the intervention, and at a three-month follow-up. Data were collected using instruments measuring knowledge and attitudes toward prediabetes management, the Health Belief Model (HBM) related to diet and physical activity, food frequency questionnaires, two 24-hour dietary recalls, the International Physical Activity Questionnaire (IPAQ), and Physical Activity Level (PAL). The collective data using direct measurement with measuring nutritional status, body composition, blood pressure, fasting blood glucose (FBG), oral glucose tolerance test (OGTT), and HbA1c levels. Data analysis involved univariate analysis, kappa statistics, Cronbach’s alpha coefficient, multinomial regression, Spearman’s correlation, paired t-test/Wilcoxon test, and independent t-test/Mann–Whitney test. The results showed that the development of the knowledge and attitude questionnaires, as well as the HBM dietary habits and physical activity were valid and reliable. The food frequency questionnaire included 118 items across 18 food groups. Prediabetes was identified in 30.5% of the subjek t based on FBG and OGTT measurements. A majority of subjek ts reported infrequent vegetable (70.8%) and fruit consumption (91.5%), frequent intake of sugar, syrups, and confectionaries (50.2%), and low levels of physical activity (65.5%). Consumption of sugary beverages, low physical activity, and central obesity were associated with an increased risk of prediabetes (p<0.05). A total of 61.8% of subjek ts demonstrated low levels of knowledge, particularly regarding diabetes symptoms, dietary patterns, and physical activity. Many subjek ts (60.5%) had neutral attitudes toward prediabetes management, with negative attitudes observed in relation to hereditary risk factors and high-risk food consumption. There was a positive correlation between knowledge and attitudes, and a negative correlation between physical activity and attitudes toward prediabetes management. Nutrition education and physical activity interventions positively influenced components of the Health Belief Model (HBM), including increased perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and cues to action, as well as reduced perceived barriers. The intervention also improved knowledge scores, increased vegetable and fruit intake, reduced consumption of sugary foods, and enhanced physical activity levels. A decrease in fasting blood glucose (FBG) was observed in the intervention group, while oral glucose tolerance test (OGTT) values decreased in both groups after intervention, although the differences in FBG and OGTT between groups were not statistically significant. HbA1c levels significantly increased in the control group, while body mass index (BMI) showed no significant change. The physical activity compliance rate was 92.3%, indicating the effectiveness of the intervention. The study concludes that nutrition education and physical activity contribute to improvements in Health Belief Model (HBM) constructs, increased consumption of vegetables and fruits, reduced intake of high-risk foods, and increased physical activity, which has an impact on the improvement of metabolic biomarkers. These findings suggest that a structured, theory-based educational approach combined with physical activity is an effective and actionable strategy to prevent the progression from prediabetes to diabetes