Diabetes Mellitus (DM) or commonly known as diabetes is a metabolic disease which is a collection of symptoms that arise in a person due to an increase in blood glucose levels above normal values. Diabetes mellitus is caused by impaired glucose metabolism due to insulin deficiency both in absolute and relative terms [1].The global status report issued by the World Health Organization (WHO) states that the prevalence of diabetes mellitus worldwide is estimated at 9%. While the proportion of deaths due to diabetes mellitus from all deaths due to non-communicable diseases is 4% [2-3]. Deaths from diabetes mellitus occur in low- and middle-income countries with a proportion of 80%. In 2030 it is estimated that diabetes mellitus ranks 7th cause of death in the world [4].

When viewed from the number of cases and prevalence, diabetes has continued to increase over the past few years. This also makes life expectancy reduced by 5 to 10 years. Indonesia is the 7th country with the highest prevalence of diabetes, after China, India, the United States, Brazil, Russia and Mexico. Asia said that of the 1,785 people in Indonesia who experienced DM [5]. The 2018 Riskesdas report shows that the prevalence of DM diagnosed by doctors in the population aged≥15 years is 2%. This shows that there is an increase in the prevalence of DM in Indonesia compared to the results of Riskesdas 2013 which is 1.5%. Based on age grouping, most DM sufferers are in the age group of 55-64 years and 65-74 years [6]. In 2021, Indonesia rose to 5th place with the highest number of DM cases with a prevalence of 19.5 [7].

The target of DM sufferers in 2021 in Bandung City is 43,761 patients, of which 40,601 patients or 92.78% have received health services according to the standards of people with diabetes mellitus. A total of 17,825 of them are served in clinics or hospitals and cannot be determined the area of domicile. Minimum Service    Standards   (MSS) – Health mandates the minimum types of health services that must be received by community members, one of which is Health Services for people with diabetes mellitus. The MSS - Health target set is 100.00%which must be achieved by the government. The achievement of health services for people with diabetes mellitus in Bandung City in 2021 is 92.78%, which means that it is still below the set target [8]. The coverage of health services for people with diabetes mellitus per region is not evenly distributed between one another. The highest health service coverage for DM sufferers is in Bandung Wetan District (152.77%), Cinambo (101.15%), and Rancasari (84.79%). The area with the smallest DM health service coverage is in Andir District (29.19%). Garuda Health Center is located in Andir District with 1,200 DM cases.

The cause of DM is not solely by a single factor but results from a combination of various risk factors. In addition to genetic factors and socio-demographic aspects, environmental factors including lifestyle are one of the factors causing DM. Lifestyle factors include diet, lack of physical activity, smoking habits, alcohol consumption, lack of rest [9]. Previous studies stated that the lower the fiber intake consumed, the higher the fasting blood sugar levels of people with type 2 diabetes. The recommended intake of good fiber for people with type 2 diabetes is>25 grams per day in order to control fasting blood sugar levels [10]. Another study stated that fiber intake by all respondents was included in the low category. This is evident from the amount of food consumed is only small, less varied and the frequency of consumption is rare [11]. In several previous studies there have been no studies on the consumption of fruit and vegetable food consumption specifically. So in our study, we also examined fruit and vegetable variables. The purpose of this study was to analyze the relationship between fruit and vegetable consumption with the incidence of DM.

This study used a cross-sectional research design [12]. This design was used to examine the relationship between fruit consumption and syur with the incidence of DM. This research was conducted in the Garuda Health Center Working Area. The reason for choosing the place is because the number of DM cases at Garuda Health Center is one of the highest and DM health service coverage is the lowest.

The population in this study was people who visited the Garuda Public Health Center. The sample was taken by simple randomization, the number of samples in this study was 120 respondents. DM data is obtained based on patient medical records, while fruit and vegetable consumption data is obtained by distributing questionnaires. The collected data is then analyzed. The first analysis carried out was the distribution of the frequency of DM events and fruit and vegetable consumption. Furthermore, bivariate analysis was carried out, where the statistical test used was the chi square test with a significance level of 5%.

Based on Table 1, it can be seen that out of 120 respondents, those who did not suffer from DM amounted to 29.2% and those who suffered from DM amounted to 40.8%. In the variable consumption of fruits and vegetables, it can be seen that 60% of respondents consume enough fruits and vegetables, and 40% of respondents consume less fruits and vegetables.

Based on Table 1, it can be seen that respondents who consume enough fruits and vegetables and do not suffer from DM by 72.2%, while respondents who consume less fruits and vegetables and do not suffer from DM by 39.6%. Statistical tests get a p-value of 0.001, meaning that there is a relationship between fruit and vegetable consumption and the incidence of DM. Further analysis found an OR value of 3.9, meaning that people who consume enough fruits and vegetables every day have a 3.9 times chance of avoiding DM compared to people who consume less fruits and vegetables every day.

Table 1: Overview of DM Incidence and Fruit and Vegetable Consumption in Productive Age

Table 2: The Relationship between Fruit and Vegetable Consumption and the Incidence of Diabetes Mellitus in Productive Age

The frequency of consumption of fruits and vegetables must be done every day so that the adequacy of vitamin sources can be fulfilled [13-14]. The Ministry of Health generally recommends the consumption of fruits and vegetables for a healthy life of 400 grams per person per day, consisting of 250 grams of vegetables (equivalent to 2 servings or 2 glasses of vegetables after cooking and draining) and 150 grams of fruit or as many as 3-4 servings of vegetables and 2-3 servings of fruit every day [15]. The results of this study stated a relationship between fruit and vegetable consumption with the incidence of DM with an OR value of 3.9. If someone routinely consumes fruits and vegetables every day with a portion of 4-5 servings a day, then, the chance of avoiding DM is greater.

These results are in line with previous research suggesting a strong association with glucose regulation and fruit and vegetable consumption in a cross-sectional study with populations at risk of diabetes [16]. This is possible because in this analysis the consumption considered is only the consumption of fruits and vegetables, not considering the consumption of other foods which are also risk factors for impaired glucose tolerance such as foods high in energy, sugar and fat [17]. According to Rahmasari, I., &; Wahyuni, E. S in his research stated that the consumption of foods high in energy, sugar and high in fat, will change the energy balance by storing energy as stored fat that is rarely used [18].

In addition, the type and quality of vegetables and fruits consumed are also associated with high blood sugar disorders, high intake of green leafy vegetables or dark yellow vegetables is associated with a reduced risk of type 2 diabetes [19-20]. As for the fruit, the more mature the carbohydrate-containing fruit, the higher the content of flux and glucose, which is characterized by a sweeter taste. Therefore, consumption of overripe fruit needs to be limited in order to control blood sugar levels.

Most respondents who suffer from DM are those who consume less fruits and vegetables, while those who do not suffer from DM consume more fruits and vegetables. The results of this study are supported by previous research which states that less fiber consumption is closely related to the incidence of type 2 DM, if someone sponsors a diet with high fiber (eating more fruits and vegetables) it can minimize the risk of suffering from type DM 2 [21].

The conclusion of this study is that a small number of respondents are DM sufferers and most respondents consume enough fruits and vegetables. There is a relationship between fruit and vegetable consumption with the incidence of DM, where people who consume enough fruits and vegetables every day have a 3.9 times chance of avoiding DM compared to people who consume less fruits and vegetables every day. It is recommended to health workers to educate the public about the importance of fruit and vegetable consumption as an effort to prevent DM.

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