INTRODUCTION:

Diabetes mellitus (DM) is one of the endocrine diseases that most people in the world suffer. Diabetes mellitus defined as a chronic metabolic disease with multi etiology which is characterized by high blood glucose levels accompanied by disorders of carbohydrate, lipid, and protein metabolism as a result of insufficiency of insulin function. Insufficiency of insulin function can be caused by interference or deficiency of insulin production by Langerhans β cells of the pancreatic gland (type 1 DM), or caused by lack of responsiveness of body cells to insulin (type 2 DM)¹.

Treatment of diabetes mellitus in hospitals generally uses more than one type of drug. Complications experienced by patients with diabetes mellitus will increase the complexity of treatment received by patients, this can reduce the level of patient compliance².

One of the main factors in treatment failure is non-compliance patients with the planned therapy³. Non-compliance patients are related to the level of knowledge, because in general the better of patient's level of knowledge about DM, the more blood glucose levels will be controlled. The level of knowledge of DM patients can be measured using the DKQ-24 questionnaire, this questionnaire contains 24 statements about diabetes mellitus with answers yes, no, and do not know⁴.

Several studies have been conducted stating that mobile applications can improve patient compliance with medication⁵. The results of research from 48 patients who used medication reminder applications stated that they helped improve compliance and had high satisfaction⁶. Another example is the use of an alarm application or reminder on a smartphone that can be used to remind patients to take the medication promptly to prevent patients from being late or forgetting to take medication. The digital medication reminder application (MRA) can use as an intervention to improve patient compliance by regulating the time to take medication. MRA can be used to elevate adherence of DM patients whose therapy cannot be directly monitored by pharmacists such as outpatients in hospitals⁷.

In this study, a new version of the MRA digital application use which was different from the previous research. The MRA application used in this study uses Indonesian and is tailored to the needs of DM patients in Indonesia, accompanied by information about diabetes mellitus, drug information, and schedule control reminders with doctors. Therefore, research is needed to determine the effectiveness of this application. Based on this background, it is necessary to research the Effect of Medication application remainder (MRA) on the Compliance Level of Type 2 Diabetes Mellitus Patients at the Hospital of Universitas Sumatera Utara.

METHOD:

group given an intervention in the form of an MRA application called one group pretest-posttest group design⁷. In the initial and final stages of the study, subjects were given a DKQ-24 questionnaire to measure the level of knowledge and MMAS-8 to measure the level of patient compliance. Data retrieval was conducted prospectively, namely primary data obtained by identifying parameters before and after intervention through questionnaire scores and the results of interviews with patients. Secondary data was taken from the medical records of DM patients. The research was conducted in August to November 2018 at the Outpatient Installation Hospital of the Universitas Sumatera Utara, Dr. T. Mansur No. 66 USU Campus, Kota Medan, Sumatera Utara Province.

RESULT AND DISCUSSION:

The Knowledge Level

Based on the questionnaire filled out by the respondents, the description of the level of knowledge was obtained as shown in (Table 1).

Table 1: The Knowledge Level Description of Type 2 DM Patients

Before intervention
No.	The level of Knowledge	Frequency (N)	Percentage (%)
1.	Low (<16)	6	20
2.	Moderate (16-18)	12	40
3.	High (>18)	12	40
Total		30	100
Before Intervention
No.	The level of Knowledge	Frequency (N)	Percentage (%)
1.	Low (<16)	0	0
2.	Moderate (16-18)	0	0
3.	High (>18)	30	100
Total		30	100

The results obtained an increase in knowledge in all patients. Notoatmodjo states that knowledge is an important key to shaping a person's behavior because behavior based on knowledge will be better than behavior that is not based on knowledge^8,17.

The patient's knowledge of DM is essential for patients in managing diabetes, this knowledge will change behavior so that it can control the condition of the disease and the quality of life will be better. Several studies show that the level of knowledge of people with DM is still low⁹.

Patients usually do not know about DM disease, patients should know the symptoms of DM, factors that can cause an increase in blood glucose levels, as well as the purpose of treatment and prevention of complications. Most patients experience symptoms but do not know that they are signs of diabetes mellitus, then after being exposed to DM patients do not know things that can increase blood glucose levels such as eating sweet foods, obesity, lack of rest, and lack of exercise. In addition to this, patients also do not understand how the treatment should be and the purpose of treatment, so there is no good cooperation between health workers and patients.

Knowledge generally based on two factors, namely internal and external factors. Internal factors include age, health, interests, and attention and external factors include work, education, family, learning methods, and society. Therefore, patients' knowledge of DM disease is fundamental, considering that not a few patients with DM do not understand about the condition suffered. As a result, many patients do not adhere to the planned treatment, and Knowledge also aims to establish compliance behavior in undergoing therapy management, so that therapeutic success is achieved^10,16.

Data obtained from questionnaires were tested statistically using the SPSS program. Based on the results of statistical tests using Kolmogorov Smirnov and Wilcoxon the results shown in (Table 2).

Table 2: The result of a statistical of knowledge level

Knowledge	Mean ± SE	Normality (Sig.)	*Sig. (2-tailed)*	N
Pretest	17,5667 ± 0,52	0.066	0,000^*	30
Posttest	21,0000 ± 0,20	0.000	0,000^*	30

Information: ^*Based on the results of the Wilcoxon test obtained a value with Sig (2-tailed) of 0,000 (p <0.05), meaning that the pretest with the posttest has a very strong relationship.

The Complience Level:

Control of blood glucose levels is an essential factor for maintaining system functions in the body. One effort to control blood sugar levels complies with taking medication. The successful treatment of DM can prevent complications caused by DM disease.

Patient's non-compliance with treatment is an inhibiting factor for treatment success. Therefore, the effort is needed to improve compliance. In this study, the level of compliance was measured using the MMAS-8 questionnaire. Based on the research conducted, an illustration of the compliance level of Type 2 DM patients are shown in (Table 3).

Table 3: The Compliance Level Description of Type 2 DM Patients

Before intervention
S No.	The level of Compliance	Frequency (N)	Percentage (%)
1.	Low (<6)	15	50
2.	Moderate (6-7)	15	50
3.	High (8)	0	0
Total		30	100
After intervention
S. No.	The level of Compliance	Frequency (N)	Percentage (%)
1.	Low (<6)	3	10
2.	Moderate (6-7)	19	63,33
3.	High (8)	8	26,67
Total		30	100

One factor in the failure of treatment for DM is patient non-compliance when undergoing treatment. Non-compliance with treatment therapy is an inhibiting factor for blood glucose control, so interventions are needed so that adherence to treatment can be improved. Among the interventions that can be used to help improve medication adherence include counseling, Drug Information Services (DIS), providing educational leaflets, giving reminders and short motivational messages, and the latest application, medication reminder application(MRA), in the form of reminder alarms when taking medication. Based on the results of the research before being given the (MRA) app the level of compliance obtained. Thus, it expected that the form of MRA application could increase the compliance of patients taking the medication on time. Good knowledge regarding diseases, symptoms, and DM disease control will improve patient adherence to treatment.

Data obtained from questionnaires were tested statistically using the SPSS program. Based on the results of statistical tests using Kolmogorov Smirnov and Wilcoxon the results shown in (Table 4).

Table 4: The result of a statistical of compliance level

Compliance

Mean ± SEM

Normality (Sig.)

Sig.

(2-tailed)

Pretest

5,4333 ± 0,20

0.007

0,000*

Posttest

6,7667 ± 0,17

0.005

Information: *Based on the results of the Wilcoxon obtained a value with Sig (2-tailed) of 0,000 (p <0.05), means that the relationship between the pretest and posttest is quite active.

Non-compliance of patients is usually not routine taking medication for reasons of forgetting and missing when traveling. This is due to a lack of patient knowledge about the dangers of irregularity in taking medication. Patients with a right level of adherence will adhere to taking medication to prevent the risk of complications that will worsen the clinical condition of the patient, to improve the quality of life of patients and reduce the risk of death due to complications of diabetes mellitus. Patient compliance also supports health workers to evaluate appropriate treatment for the patient's condition.

The relationship between the level of knowledge of patients with the level of patient compliance:

In the test results obtained that the level of knowledge related to disease and treatment will affect the level of patient compliance because with a good level of knowledge patients can control and maintain conditions to avoid or reduce complications of the disease that can aggravate the patient's clinical condition. Next, to see the relationship between the level of knowledge and the level of compliance carried out by the Spearman test. In this study obtained a value of 0.195 with Sig. 2-tailed at 0.301, which means the DKQ-24 and MMAS-8 have a direct relationship (positive correlation) even with a low correlation level. Increase in knowledge (DKQ-24) will also increase compliance (MMAS-8) by 19.5%.

The results of this study are also in line with several studies, Qoni'ah states that a good level of knowledge will improve DM patient compliance. Patient's knowledge affects patient compliance with drug use¹¹. The higher the patient's knowledge about compliance with medication, the higher the level of patient compliance with drug use⁸. According to Prayogo, the success of DM treatment is strongly influenced by patient compliance in therapy so that optimal results obtained. Compliance is the level of the patient implementing how to treat and the behavior suggested by the doctor or other health personnel including the pharmacist¹².

According to Alfian and Wardati in a study of the use of the Digital Pillbox Reminder application to improve adherence in hypertensive patients, results showed that there was an increase in adherence after the intervention¹³. Meanwhile, according to Agustianuri in the study with the same study, DM patients showed high adherence after an intervention¹⁴. This is supported by Tan et al., study, that applications in the form of automatic alarms on mobile phones can help remind patients to take medication and improve patient compliance^15,18.

CONCLUSION:

Medication Remainder Application (MRA) can increase patient knowledge about diabetes mellitus while improving patient compliance in taking medication regularly.

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of faculty of pharmacy, Universitas Sumatera Utara for the facilities.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 03.12.2020 Modified on 04.02.2021

Research J. Pharm. and Tech 2021; 14(11):5725-5728.

DOI: 10.52711/0974-360X.2021.00995