How to cite:

Devi Ratnasari, Eva Daniati, Eti Suliyawati, Zahara Farhan (2021).

The Effect of Wound Care with Palm Sugar on Diabetic Ulcer

Repairing in Type 2 Diabetes Patients. Journal Eduvest. 1(12):

1473-1477

E-ISSN:

2775-3727

Published by:

https://greenpublisher.id/

Eduvest – Journal of Universal Studies

Volume 1 Number 12, December 2021

p- ISSN 2775-3735 e-ISSN 2775-3727

THE EFFECT OF WOUND CARE WITH PALM SUGAR ON DIABETIC

ULCER REPAIRING IN TYPE 2 DIABETES PATIENTS

Devi Ratnasari, Eva Daniati, Eti Suliyawati, Zahara Farhan

STIKes Karsa Husada, Garut, Indonesia

E-mail: [email protected], [email protected],

[email protected], [email protected]

ARTICLE INFO ABSTRACT

Received:

November, 26

2021

Revised:

December, 17

2021

Approved:

December, 19

2021

Diabetic ulcers are one of the most common complications

of type 2 diabetes mellitus. Diabetic ulcers are infected

sores that develop in the lower extremities. Proper

diabetic foot wound care methods will improve wound

healing. One of the efforts to treat the complement to

prevent infection is wound care with palm sugar. Palm

sugar contains antibiotic-like substances such as vitamin

C, riboflavin, vitamin A, and ascorbic acid. Dr. Slamet

Garut's study aims to determine the effectiveness of

wound care with palm sugar media against the repair of

diabetic ulcers in patients with type 2 diabetes mellitus

after hospitalization in 2021. The study used a quasi

experimental research design with one group pretest and

posttest design (Pre-action) and one group of subjects

receiving palm sugar therapy on diabetic ulcer wounds

(Post-action). The researcher used consecutive sampling

techniques, samples that met the inclusion criteria could

have 8 people. The wounds were treated with palm sugar

for two weeks. The findings revealed that wound care

with palm sugar had an effect on the repair of diabetic

ulcers in patients with type 2 diabetes mellitus, with a

Devi Ratnasari, Eva Daniati, Eti Suliyawati, Zahara Farhan

The Effect of Wound Care with Palm Sugar on Diabetic Ulcer Repairing in Type 2

Diabetes Patients 1974

Pvalue = 0.000. Then it is possible to conclude that

treating wounds with palm sugar affects the improvement

of diabetic ulcers.

KEYWORDS

Wound Care, Palm Sugar, Diabetic Ulcer, Diabates Mellitus

Type 2

This work is licensed under a Creative Commons

Attribution-ShareAlike 4.0 International

INTRODUCTION

Diabetic ulcers, which occur in the lower extremity and are caused by three

factors: peripheral innervation disorders (neuropathy), infections, and impaired blood

flow, are one of the most common complications of neuropathy (Christia et al., 2015).

The presence of this condition causes wounds to heal more slowly, making them more

susceptible to infection, which can lead to tissue death (Gangrene) and amputation

(Maryunani, 2013).

Efforts to prevent the spread of diabetic ulcer infection include wound care

measures with the appropriate treatment method, which improves the wound healing

process. One of the wound treatment methods that can be used, according to Aragón-

Sánchez et al. (2012) and Permana et al. (2012), is to keep moisture at the wound's base

to prevent bacterial colonization. According to the findings of a study conducted by

Permana et al. (2012), wound care media containing honey can improve the healing

process of infection-related wounds. Natural honey is one of the replacement therapy

media used to treat diabetic foot infection wounds caused by diabetes.

Currently, the treatment of diabetic ulcers is expensive. Hence, other alternative

therapies in the form of complementary therapies in the healing of diabetic ulcers are by

using other media that are simple, inexpensive, and accessible to the community, one of

which is palm sugar. According to the findings of several literature studies, there are

similarities in the content of honey, dates, and palm sugar.

One of the components of palm sugar that affects wounds is riboflavin, ascorbic

acid (Vitamin C), and water. Riboflavin compounds found in palm sugar can aid in the

formation of red blood cells and stimulate the formation of immunoglobulins

(Antibodies) produced in bone marrow, thereby improving tissue function. Furthermore,

ascorbic acid (Vitamin C) found in palm sugar acts as an antibiotic, weakening and

killing bacteria that cause infection in diabetic ulcer wounds, while water media serves as

an absorption medium as well as an antiseptic (Heryani, 2016). Researchers used palm

sugar as one of the alternative media that can be used in the process of treating diabetic

ulcer wounds because Indonesia is one of the largest and best palm sugar producing

countries in the Asian region, particularly in Southeast Asia. Furthermore, palm sugar is

almost universally available, and the cost is relatively low in the community.

Diabetic ulcer treatment services necessitate a lengthy hospitalization (2-3

weeks), but government policies and regulations implemented through the Social Security

Protection Agency (BPJS) health reduce the length of the hospital day to 4-7 days,

requiring patients to receive follow-up care at home.

RESEARCH METHOD

This study used a quasi-research experiment design with one group pre-test and

Eduvest – Journal of Universal Studies

Volume 1 Number 12, December 2021

1475 http://eduvest.greenvest.co.id

post-test designs. All patients with post-hospitalization diabetes mellitus were included in

the study. Meanwhile, the study sample consisted of 8 patients who develop diabetic

ulcers after hospitalization.The sampling technique employed was criteria-based

consecutive sampling which led to:

1. Patients who were willing to participate as respondents.

2. The patient's first post-hospitalization day.

3. Patients diagnosed by doctors as having type 2 diabetes mellitus with

complications of grade II and III diabetic ulcers.

4. The patient's blood sugar levels were under control and close to the normal

value limit, with the current blood sugar level value (GDS) greater than 50 mg/dl and less

than 200 mg/dl prior to palm sugar wound treatment.

5. Diabetic ulcer patients with a degree 2-3 classification at stages A-D (based on

the University of Texas ulcer classification).

6. Post-acute care patients at Dr. Slamet Garut in 2021

The research instrument deployed diabetic ulcer treatment standard operating

procedures (SOPs) and a Leg Ulcer Measurement Tool (LUMT) observation sheet. The

mean score of diabetic ulcus characteristics before and after action was used in univariate

analysis. The analysis was based on the data normality test results. Bivariate analysis

employed a dependent t-test based on the results of the one KS and Shapiro-Wilk tests for

data normality.

RESULT AND DISCUSSION

According to the characteristics of the respondents, the majority of the

respondents (55.6 percent) were male. Almost all of the respondents (88.9 percent) had a

history of smoking and almost all of the respondents (88.9 percent) were elderly (56->65

years). Most of the respondents (66.7 percent) had type 2 diabetes mellitus less than 2

years and 55.6 percent had diabetic ulcer less than 6 months, and the majority of the

respondents (66.7 percent) had grade II diabetic ulcers.

Wounds were treated with palm sugar media once a day for two weeks, followed

by a post test on the fourteenth day, which involved assessing wounds again using LUMT

observation sheets.

Table 1 provides an overview of wound care with sugar aren pre-action and post-

action:

Diabetic Ulcer

Mean

Std. Deviation

Minimal

Maximal

Pre- Care

38. 56

5. 855

Post- Care

19. 89

4. 833

The following table 2 shows the results of the analysis on the effectiveness of

wound care with palm sugar media against the process of repairing pre-care diabetic

ulcers and post-care in Type 2 DM patients:

Table 2 The Effect of Palm Sugar Wound Care on Diabetic Ulcer Repair Before

and After Surgery in Type 2 Diabetes Patients

Different Values on Pre-care and Post-care Pairs

Pre-Post

Care

Mean

95% Confidence

Interval of the

Difference

value

Lower

Upper

18,667

5,074

14,766

22,567

11,036

0,000

Devi Ratnasari, Eva Daniati, Eti Suliyawati, Zahara Farhan

The Effect of Wound Care with Palm Sugar on Diabetic Ulcer Repairing in Type 2

Diabetes Patients 1976

According to table 2, the average diabetic ulcer post-wound treatment action with

palm sugar is 18,667 with a standard deviation of 5,074. Based on a confidence interval

of 95 percent greater than one, it can be concluded that wound treatment with palm sugar

media is effective in the process of repairing diabetic ulcers. The results of statistical tests

using the t-test dependent test yielded a value of P = 0.000, implying that wound

treatment with palm sugar media was effective against the process of repairing diabetic

ulcers in patients with type 2 diabetes mellitus.

In diabetic ulcer patients, wound care is a critical step in preventing infection and

complications. The basic principle of diabetic ulcer treatment is to create a moist wound

healing environment or to keep the wound moist at all times (ADA, 2013). In addition to

preserving moisture, dressings should take into account the size, depth, and location of

ulcers (Clayton, Warren, Jr. & Elasy, T.A., 2009). In this case, the researchers used palm

sugar to treat wounds. Palm sugar contains several macro and micronutrient elements,

with palm sugar having a higher content of both than white sugar. Thiamine (Vitamin

B1), Riboflavin (Vitamin B2), Nicotinic Acid (Vitamin B3), Pyridoxine (Vitamin B6),

Cyanocobalamin (Vitamin B12), Ascorbic Acid (Vitamin C), protein, and mineral salts

are among the micronutrients found in palm sugar. Palm sugar contains vitamin C, an

antioxidant that promotes skin health and protects against skin damage. Riboflavin, which

aids in the formation of red blood cells, produces antibodies, as do enzymes, which

produce the energy required by the human body, vitamin A, which improves the tissue

working system, and the substance Ascorbic Acid, which has antibiotic properties

(Heryani, 2016).

The researchers determined the intervention time for two weeks, based on the

wound healing phase theory, in which the fourth to the twenty-first day is the

proliferation phase (Bryant, R & Nix, D., 2007). During this phase of proliferation,

vascular integrity improves, the incision basin is filled with connective tissue, and the

wound surface is coated with a new epithelium. This phase is marked by epitheliization,

neoangigenesis, and matrix deposition/collagen synthesis. The study used a LUMT

observation sheet before administering the first and 14th day (post-test) observation

sheets to determine the characteristics of diabetic ulcers before and after wound treatment

with palm sugar media 1x per day for 2 weeks. The results showed that the average

number of post-treatment diabetic ulcers with palm sugar in type 2 DM patients was

19.89 (LUMT assessment 0-68), while the average number of post-action diabetic ulcers

was relatively low.

CONCLUSION

Based on the study's findings, it is concluded that wound treatment with palm sugar

media is effective in the process of repairing diabetic ulcers. The wound treatment with

palm sugar media can be developed and used to treat diabetic ulcer wounds as one of the

wound treatment media with topical complementary therapies.

REFERENCES

American Diabetes Association. (2013). Standards of Medical Care in Diabetes-2013.

Diabetes Journal. 36(1):S11-S50

Aragón-Sánchez, J., Lázaro-Martínez, J. L., Pulido-Duque, J., & Maynar, M.

(2012). From the diabetic foot ulcer and beyond: How do foot infections spread in

patients with diabetes? Diabetic Foot and Ankle, 3, 1–7.

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Eduvest – Journal of Universal Studies

Volume 1 Number 12, December 2021

1477 http://eduvest.greenvest.co.id

Bryant, R & Nix, D. (2007). Acute and Chronic Wound Current Management Concept.

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Christia, S., Yuwono, A., & Fakhrurrazy. (2015). Kejadian Neuropati Vaskulopati Pada

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