Diabetes Self-Management Education (DSME) Methods using Web-Based and Application

Abstract


INTRODUCTION
Diabetes mellitus (DM) is a chronic condition when there is an increase in blood sugar levels because the body cannot produce or use insulin effectively [1].Diabetes Mellitus can also be called the mother of Disease because DM is the parent of various diseases such as hypertension, stroke, kidney failure, blindness, and leg amputation. 1 in 2 people with diabetes are still unaware that they have diabetes.Diabetes Mellitus will be very dangerous if the sufferer is unable to regulate blood sugar and will cause complications that can endanger the health of the body [2].
People with diabetes (diabetes) require systematic, routine, and organized care by health care providers.Management of DM treatment must be carried out for life.In 2015, as many as 415 million adults suffered from DM, up to 4 times the 108 million people in the 1980s.By 2040 it is estimated that the number of people with diabetes will increase to 642 million people [1].Nearly 80% of people with diabetes are in low-and middleincome countries [2].In 2015, Indonesia was ranked seventh in the prevalence of people with diabetes in the world after China, India, United States, Brazil, Russia, and Mexico with approximately 10 million people with diabetes [3].The prevalence of people with diabetes in Indonesia aged ≥15 years tends to increase from 5.7% (2007) to 6.9% (2013) with the number of people with diabetes reaching 12,191,564 million people.As many as 2/3 of people with diabetes in Indonesia do not know they have diabetes and tend to have complications so it is too late to access health services [4].This situation will have an impact on people with diabetes experiencing readmission.Readmission according to the National Quality Forum America is defined as the occurrence of patient visits with conditions that interfere with their health during a period of ≤ 30 days from previous hospitalization.The readmission limit referred to above is for a patient who has received treatment at the same or a different hospital for ≤ 30 days in a certain period [5].
It is likely that people with diabetes are at higher risk of being re-admitted than people who do not have diabetes.In a study of 4769 medical patients, diabetes was associated with a statistically significant 40% increased risk of re-admission within 30 days [6].
Diabetes Self-Management Education (DSME) is a process of providing knowledge to people with diabetes about self-care strategies to optimize metabolic control, prevent complications, and improve the quality of life for people with diabetes.The purpose of DSME is to support decisionmaking, self-care behavior, problem-solving, and active collaboration with the health team to improve clinical outcomes, health status, and quality of life [7].Healthy living education is a promotion of healthy living that needs to be done.

METHODS
The research was conducted using the literature review method.The selection process for these study articles is illustrated in the Flow Diagram (Fig.

1).
The articles were selected after going through a selection process that referred to the article inclusion criteria as determined and carried out by the two researchers.To avoid bias in the article selection process, the researcher uses the Critical Appraisal Tool (CASP) [14], and determines articles that have a score above 50% of "YES" answers to be selected or determined.

RESULTS
Based on the ten articles that met the inclusion criteria (Fig. 1), there are three diabetes self-management education methods used, namely using an application (7) and the web (3).Most of the research designs used are quasi-experimental and randomized experimental studies.There is one study that uses a qualitative study.The average number of participants is more than hundreds.Overall, all studies discuss the effect of diabetes self-management education using applications or the web.Studies consistent with the average systematic review were carried out in Indonesia with 5 studies [15]; [16]; [17], and the others were two studies in America [18]; [19] and one study each in Canada, Iran, and Australia [20]; [21]; [22].The ten studies describe the use of applications and the web as a method to educate people with diabetes that it is important to monitor health according to the four pillars of diabetes self-management education.

Table 1
Literature Search Results

DSME Methods
The use of the web or application in daily life is one of the right choices which provides effectiveness in continuous learning.Mobile technology and the internet are available for 24-hour access and can be used for health promotion and changing behavior [25].
Several studies have shown that the use of the web or application can affect not only blood sugar levels in the body but also self- Community needs in terms of information, science, and working world mechanisms, web application developers are needed so they can continue to be active and innovate [22].In this fast-paced world of technology, a network is needed that can simplify and speed up the delivery of information widely and can be (before eating, after eating, and before going to bed).SMBG can help patients and doctors to understand the profile and dynamics of the patient's blood glucose towards changes in diet, and physical activity, along with the use of anti-hyperglycemic drugs with insulin and certain clinical conditions [24].This also has an effect on dietary patterns and influences on blood glucose levels where there is an influence on the use of the application as a DSME method [27].The use of virtual media (LIVE) where people with diabetes will create their own character (Avatar).The web supports the DSME program.From the results of the study, it was found that the use of LIVE and the diabetes self-management education and support control website had no significant effect, but the results showed that LIVE users lost more weight [19].This literature review focusing on the effect of web-based DSME methods and applications on people with diabetes mellitus, on average research reveals that DSME has a positive effect on People with diabetes to improve their quality of life, knowledge, selfmanagement behavior, self-efficacy, and condition patient's clinical condition such as HbA1c, lipid profile.In addition, it also affects the weight of the application or web user.
However, in one study, the use of the Bluestar app for diabetes self-management showed no difference between the intervention and control groups for primary clinical with glycemic control results as measured by HbA1c.In addition, there was no effect of secondary intervention on the results of measuring diabetes self-efficacy, quality of life, and health service utilization behavior [20].There was low usage of the app overall, with nearly half of the users in the intervention group having minimal engagement with the app.Many of the app's underused features, including diet and exercise tracking, were previously shown to play a critical role in T2DM self-management [28].
There were several study design factors that likely contributed to the low app usage and lack of a detected intervention effect.
Instead of downloading the app, participants were given the intervention on a second phone they used for the duration of the study in an attempt to standardize implementation by the funder.However, the use of a second phone to deliver eHealth interventions has been a noted barrier to usage in previous studies, and future mobile app evaluations would likely benefit from allowing participants to use their own smartphones when possible [27].Given previous evidence on the benefits of strong primary care participation in diabetes self-management apps, the use of the primary site of recruitment likely had a negative impact on enrollment, usage, and clinical impact.

Nursing implication
The studies suggest several nursing that more and more applications and websites will be developed so that they can make it easier and reach everyone with diabetes mellitus in order to reduce the number of complications due to diabetes mellitus.

Fig. 1 .
Fig. 1.Literature Review Flow Chart Based on PRISMA 2009 management behavior, dietary behavior, knowledge about the disease, and the quality of life of people with diabetes.Kustanto's research (2019) stated that the application of the DM calendar increases self-efficacy and improves good self-management, which can be seen from changes in HbA1c levels controlled by lipid profiles and insulin.This application contains three of the four pillars of DM, namely blood sugar control, educational programs, nutritional therapy, and physical activity [15].At this time, technology is developing very fast.Caused by many factors, including the rapid development of the human mindset.
easily and quickly used by anyone who has access to the internet(Bekti H, 2015).The use of the web as a DSME method also has an influence where sufferers can access where and when to prevent complications and maintain dietary patterns by increasing their knowledge and skills[18].The various applications include various health interventions, especially education with the aim of improving health and having positive benefits for improving quality of life[26].The variety of types of applications is evidenced by Hanifah's research (2019) in Bengkulu using the healthy greeting application which has a chat room feature available in the application and can see videos about how the DM process can occur in the body.Not only that, the application developed by Kshanti et al. also has features that can be filled manually or automatically.Patients can record data on blood glucose levels (BG) guide patients in their effective use.They should also consider contextual factors that influence app utility and adjust recommendations accordingly.Nurses can support health education through these apps, facilitate peer support networks, promote weblogs to enhance patient quality of life and teach patients to integrate smartphone apps for self-monitoring.Encouraging patient participation in Diabetes Self-Management Education programs is crucial, and nurses should stay updated on the latest app features.Patient feedback on app usability is valuable for customization.Nurses should empower patients to engage with digital resources and provide continuous monitoring and support.Overall, nurses play a vital role in promoting and supporting technology in diabetes self-management, emphasizing individual patient needs and contextual factors.CONCLUSION Most of the use of the web and applications as a DSME method greatly affects the quality of life, self-efficacy, self-management, knowledge, body weight, and clinical conditions of patients such as blood glucose levels, HbA1c, and lipid profiles.However, one study showed no difference between the intervention and control groups for primary clinical with glycemic control results as measured by HbA1c.In addition, there was no effect of secondary intervention on the results of measuring diabetes self-efficacy, quality of life, and health service utilization behavior.There was low usage of the app overall, with nearly half of the users in the intervention group having minimal engagement with the app.Many of the app's underused features, including diet and exercise tracking, have previously been shown to have an important role in T2DM self-management.With the very rapid development of technology, it is hoped