Tesis

Pengaruh Health Coaching terhadap Perubahan Kedisiplinan Diet, Latihan Fisik, dan Capaian Sasaran Kendali Diabetes Melitus pada Pasien Diabetes Melitus Tipe 2 = Impact of Health Coaching in Diet and Physical Excersice Compliance, and Achievement of Diabetes Mellitus Control in Type 2 Diabetes Mellitus Patients.

Latar Belakang: Edukasi merupakan salah satu komponen penting dalam tatalaksana pasien diabetes, meskipun demikian edukasi saja dirasakan tidak cukup untuk mempertahankan perubahan perilaku. Untuk mencapai perubahan perilaku tersebut, edukasi perlu dilengkapi dengan dukungan pengelolaan diri (self-management support). Health coaching merupakan sebuah pendekatan yang memiliki konsep yang sama dengan Diabetes Self Management Support (DSMS). Tujuan: Mengevaluasi pengaruh kombinasi edukasi dan health coaching dibandingkan dengan edukasi saja dalam perubahan kedisiplinan diet, latihan fisik, serta capaian sasaran kendali DM pada pasien DM tipe 2. Metode: Penelitian uji acak terkendali ini merekrut 60 subyek pasien DM tipe 2 yang belum terkontrol (HbA1c > 7.5%), 30 subyek pada kelompok intervensi (edukasi dan health coaching) dan 30 subyek pada kelompok kontrol (edukasi saja). Kelompok intervensi mendapatkan 12 sesi edukasi dan 12 sesi health coaching sedangkan kelompok kontrol mendapatkan 12 sesi edukasi saja. Seluruh perlakuan diberikan sebagai tambahan dari terapi farmakologis standar. Edukasi diberikan secara berkelompok di dalam kelas selama 30-60 menit dan coaching diberikan secara individu selama 45-60 menit. Evaluasi asupan diet, latihan fisik, indeks massa tubuh, tekanan darah, GDP, GD2PP, HbA1c, dan profil lipid dilakukan saat awal, 3 bulan, dan 6 bulan setelah perlakuan. Hasil: Tidak terdapat perbedaan yang bermakna pada kedisiplinan diet dan latihan fisik antara kelompok kontrol dan intervensi. Terdapat penurunan rerata GDP dan GD2PP pada kelompok edukasi dan coaching dari 197,69 mg/dL dan 247,88 mg/dL pada sebelum perlakuan menjadi 135,46 mg/dL dan 141,42 mg/dL pada 6 bulan setelah perlakuan sedangkan pada kelompok edukasi terdapat peningkatan rerata GDP dan GD2PP dari 170,30 mg/dL dan 237,74 mg/dL menjadi 176,59 mg/dL dan 242,11 mg/dL. Nilai p=0,006 untuk perbedaan rerata GDP dan nilai p=0,000 untuk perbedaan rerata GD2PP pada 6 bulan setelah perlakuan. Proporsi subyek yang mengalami penurunan HbA1c > 1% setelah 6 bulan perlakuan pada kelompok intervensi sebanyak 60% dan pada kelompok kontrol sebanyak 20% (nilai p=0,004), RR 2,250 dan NNT 2,5. Tidak terdapat perbedaan bermakna antara kedua kelompok pada parameter/variabel yang lain. Simpulan: Health coaching memberikan keuntungan tambahan sebagai pelengkap program edukasi dalam memperbaiki kendali glikemik dan kadar trigliserida pada pasien DM tipe 2 yang belum terkontrol. Pendekatan ini dapat digunakan oleh edukator dan tenaga profesional lain yang terlatih untuk memperbaiki kendali DM pada pasien DM tipe 2.
Kata kunci: edukasi, health coaching, DM tipe 2, profil lipid, IMT, tekanan darah, GDP, GD2PP, HbA1c, diet, latihan fisik.


Background: Education is one of the important component in managing patients with diabetes, however it is not sufficient to sustain behavioral changes. To achieve behavioural changes, education needs to be complemented by self-management support. Health coaching is an approach which has similar concept with diabetes self management support. Objective: We aim to evaluate the impact of education and health coaching combination compared to education alone on diet and physical excersice modification, and achievement of diabetes mellitus control in type 2 diabetes mellitus patients. Methods: We conducted a randomized controlled trial involving 60 poorly controlled type 2 diabetes mellitus patients (HbA1c > 7.5%). In the beginning of the study 30 subjects were allocated to the intervention group (education and health coaching) and 30 subjects were allocated to the control group (education alone). Subjects in the intervention group received 12 education and 12 health coaching sessions while subjects in the control group received 12 education sessions. Those interventions were given on top of standard diabetes care. Education was conducted in a class for 30-60 minute sessions and coaching was performed one on one and/or group for 45 to 60-minute sessions. Food record, physical excersice, BMI, blood pressure, FPG, PPG, HbA1c, and lipid profile were measured at baseline and 3-month after intervention. Results: There were no significant result in diet and physical excercise compliance between intervention and control group. Education and health coaching combination showed significant reduction in FPG and PPG in comparison to education alone at 6 months after intervention (197.69 mg/dL to 135.46 mg/dL vs 170.30 mg/dL to 176.59 mg/dL, p value 0.006; 247.88 mg/dL to 141,42 mg/dL vs 237.74 mg/dL to 242,11 mg/dL, p value=0.000, respectively). Participants who achieved reduction of HbA1c level 1% or more in the intervention group were 60% while in the control group were 20% (p value=0.004) with RR 2.250 and NNT 2.5. There were no significant result between two groups in other variables. Conclusions Health coaching may provide added benefit as complementary to education program to improve glycemic control and triglyseride level in patients with poorly controlled type 2 diabetes mellitus. This approach may be applied by trainneddiabetic educators and other professional to improve diabetic control.
Key words: eduction, type 2 DM, lipid profile, BMI, blood pressure, FPG, PPG, HbA1c, diet, physical excercise.