Diabetes Milletus (DM) is a major health problem associated with metabolic disorders, blood vessels and inflammation that can cause long-term complications [1]. According to the International Diabetes Federation’s (IDF) 2017 report, 451 million people (aged 18) suffer from diabetes globally. The number of patients will reach 693 million by 2045 [2]. This is a real burden on the health system and this creates a need for improved care and facilities that support people with diabetes mellitus [3]. Diabetes mellitus has a great impact on the quality of life [4]. Diabetes mellitus is not contagious [5]. This non-communicable risk factor is divided into two parts: the first is the unchangeable age, gender and genetic factors. The second are the risk factors that can be changed, namely polanhidup and the health status of the patient [6]. Seeing this problem with year-on-year increasing numbers has an impact on the quality of human resources and a considerable increase in healthcare costs [7]. In this case, it is necessary to control diabetes mellitus [8]. Diabetes response can be controlled or brought under control by controlling risk factors [9].

One of the steps that can be taken to inhibit and prevent the occurrence of DM complications is through medical nutrition therapy (TNM) and physical activity with or without the presence of pharmacological intervention with antihyperglycemic drugs [10]. Diet therapy is the primary therapy that will be performed in the implementation of diabetes mellitus [11]. The principle of dietary therapy in patients with diabetes mellitus includes a balanced diet with a number of calories that corresponds to the condition of the body, the accuracy of eating times and the food consumed, mainly for patients who use insulin [12]. This diet therapy helps control metabolism, lipids and blood pressure in the body. The success of TNM in DM patients can be measured using diet compliance indicators [13]. It is related to the purpose of research to describe how self-management experiences differ from physical, emotional and spiritual perspectives [14].

The research design uses descriptive data using a cross-sectional approach. The research was carried out in the village of Larik Rejo, Kecamatan Undaan Kabupaten Sveti. The guidelines in this review are followed by five. This is based on the Arksey & O’Malley framework.

Step 1: Identifying Research Questions

The research question used in this review is "How do patients with diabetes mellitus behave?"

Step 2: Identifying Relevant Research

The research used as an evaluation meets the following criteria [15]: a) participants in the study were patients with hyperglycaemia, b) the results of the study measure self-efficacy, c) the study is a cross-sectional descriptive, d) year of publication of the research in the period 2018–2022 and e) this study uses Indonesian language. The electronic databases used are Scopus, CINAHL, MEDLINE, EBSCO and Taylor & Francis. The search for the research article was conducted in February 2023. The keywords used in the search “Behaviours” OR “Acceptance Processes” OR “Acceptance Process” OR “Process, Acceptance” OR “Processes, Acceptance” AND “Diabetes Meletus”. 

Step 3: Selection of Research

The first selection is done by looking at the relevant title, while the irrelevant is removed and the duplication of the article is eliminated using Mendeley's reference manager. The complete text of the abstract research is read to determine which research is included in the survey.

Step 4: Mapping the Data

Data extraction is done in Microsoft Word by creating a table that contains Several components are: the researcher, year of publication, research objectives, research design, research location, interventions used, technologies used, characteristics of participants, methods of measurement, size of results and relevant key findings. The International Diabetes Federation's (IDF) 2017 report reports that 451 million people (aged 18) suffer from diabetes globally. The number of patients will reach 693 million by 2045 [2]. This is a real burden on the health system and this creates a need for improved care and facilities that support people with diabetes mellitus [3]. Diabetes mellitus has a great impact on the quality of life [4]. Diabetes mellitus is not contagious [5]. This non-communicable risk factor is divided into two parts: the first is the unchangeable age, gender and genetic factors. The second are the risk factors that can be changed, namely polanhidup and the health status of the patient [6]. Seeing this problem with year-on-year increasing numbers has an impact on the quality of human resources and a considerable increase in healthcare costs [7]. In this case, it is necessary to control diabetes mellitus [8]. Diabetes response can be controlled or brought under control by controlling risk factors [9].

One of the steps that can be taken to inhibit and prevent the occurrence of DM complications is through medical nutrition therapy (TNM) and physical activity, with or without the presence of pharmacological intervention with antihyperglycemic drugs [10]. Diet therapy is the primary therapy that will be performed in the implementation of diabetes mellitus [11]. The principle of dietary therapy in patients with diabetes mellitus includes a balanced diet with a number of calories that corresponds to the condition of the body, the accuracy of eating times and the food consumed, mainly for patients who use insulin [12]. This diet therapy helps control metabolism, lipids and blood pressure in the body. The success of TNM in DM patients can be measured using diet compliance indicators [13]. It is related to the purpose of research to describe how self-management experiences differ from physical, emotional and spiritual perspectives [14].

Step 5: Formulate, Summarize and Report Results

The research was summarized descriptively and compared with the articles that were reviewed. A summary of the more specifics that contain the results that are significant and non-significant, types of non-interventions (temporary or non-complex), long-term non-interventions, methods of intervention and measuring tools used.

Searches that have been carried out using keywords yielded 283,910 articles covers Science Direct (n = 80,948), Scopus (n = 42,333), Pubmad (n = 76,319), Proquest (n=84,276) and Ebsco (n=34). As much 3 duplicate articles were issued. Of the 283,907 articles a selection was carried out. title, abstract and identification based on inclusion criteria, the results obtained where 106,535 articles were excluded and 51 articles entered the criteria for review (Figure 1). The results of the identification search process and the selection of research articles are explained in detail in 5 articles (Table 1).

Figure 1: PRISMA search and inclusion flowchart

Table 1: Article Search Results

These five studies discuss psychosocial aspects as part of the research. This study informs us that respondents who have bad attitudes tend not to adhere to diets, while respondents who have good attitudes mostly adhere to the diet recommended by the doctor. Respondents who support that a hypertension diet must be carried out to prevent complications of diabetes mellitus Respondents will comply with the diabetes diet by reducing the amount of salt in the food and drink they consume [21]. Assessment and measurement of attitudes are important tools for understanding human attitudes and behaviour [22].

This research also informs us that attitude is a response; this is based on an evaluation process within the individual that will ultimately provide conclusions in the form of a value for the stimulus in the form of good or bad, positive or negative, pleasant or unpleasant, likes or dislikes. then crystallizes or not as a potential reaction to objects [23]. Thus, attitude is a dynamic aspect of behaviour that can be changed, shaped or influenced [24]. The results of this study revealed that most diabetes patients had less knowledge. So, we recommend all stakeholders (the Ministry of Health, health agencies, health workers and national and international NGOs) to improve the behaviour, knowledge and attitudes of diabetes patients [25]. Forming positive behaviour or action can be done through a process that takes place in the interaction of humans and the environment. One of the factors that influence the following actions is knowledge, perception, emotion, motivation and others [26].

This research informs articles that have concluded that the health of diabetes mellitus patients is greatly influenced by behaviour, culture and knowledge about health. The information that patients with diabetes mellitus need to get includes the causes of the disease, the treatment of the disease, the complications of the disease and the risk of the disease. It is important for health workers to provide services, care and education to patients with diabetes mellitus.

1. Daneshzad, E. et al. “Hubungan antara kepatuhan terhadap diet Mediterania dan biomarker fungsi ginjal dan faktor risiko kardiovaskular di antara pasien diabetes dengan nefropati.” Clinical Nutrition (ESPEN), vol. 40, 2020, pp. 156–163.

2. Wajid, F. et al. “Therapeutic potential of melatonin as a chronobiotic and cytoprotective agent in diabetes mellitus.” Journal of Diabetes and Metabolic Disorders, vol. 19, no. 2, 2020, pp. 1797–1825. https://doi.org/10.1007/s40200-020-00585-2.

3. Gatina, J. and F. Legrand. “Tahun di perawatan primer di wilayah barat Pulau Reunion: Studi percontohan.” Primary Care Review, vol. 2, 2023, pp. 1–6.

4. El Masri, D. et al. “Barriers and facilitators to perceived diabetes self-management in Arab American patients with diabetes.” Primary Care Diabetes, vol. 14, no. 3, 2020, pp. 232–238. https://doi.org/10.1016/j.pcd.2019.09.002.

5. Grech, J. et al. “Helping smokers with diabetes quit: A scoping review of the interventions utilised and the challenges and barriers to smoking cessation.” Primary Care Diabetes, vol. 17, no. 2, 2023, pp. 119–128. https://doi.org/10.1016/j.pcd.2023.01.005.

6. Fitriyani. Faktor Risiko Diabetes Melitus Tipe 2 di Puskesmas Kecamatan Citangkil dan Puskesmas Kecamatan Pulo Merak, Kota Cilegon. Universitas Indonesia, 2012.

7. Langendoen-Gort, M. et al. “Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review.” Reviews in Endocrine and Metabolic Disorders, vol. 23, no. 5, 2022, pp. 931–977. https://doi.org/10.1007/s11154-022-09734-9.

8. Idorenyin Imoh, U. and T. Charity. “Cultural and social factors in care delivery among African American caregivers of persons with dementia: A scoping review.” Gerontology and Geriatric Medicine, vol. 9, 2023. https:// doi.org/10.1177/23337214231152002

9. Simon, T.G. and A.T. Chan. “Lifestyle and environmental approaches for the primary prevention of hepatocellular carcinoma.” Clinics in Liver Disease, vol. 24, no. 4, 2020, pp. 549–576. https://doi.org/10.1016/j.cld.2020.06.002

10. Suhartatik, S. et al. “Faktor-faktor yang mempengaruhi tingkat kepatuhan diet penderita diabetes mellitus.” Healthy Tadulako Journal (Jurnal Kesehatan Tadulako), vol. 8, no. 3, 2022, pp. 148–156.

11. Vallis, M. et al. “Understanding strategies to improve medication adherence among persons with type 2 diabetes: A scoping review.” Diabetic Medicine, vol. 40, no. 1, 2023. https://doi.org/10.1111/dme.14941.

12. Nørlev, J. et al. “Game mechanisms in serious games that teach children with type 1 diabetes how to self-manage: A systematic scoping review.” Journal of Diabetes Science and Technology, vol. 16, no. 5, 2022, pp. 1253–1269. https://doi.org/10.1177/19322968211018236.

13. Due-Christensen, M. et al. “Psychosocial aspects and perspectives of adult-onset type 1 diabetes: A systematic scoping review.” Diabetic Medicine, vol. 40, no. 5, 2023. https://doi.org/10.1111/dme.15073.

14. Elamurugan, K. et al. “Social inequities contributing to gestational diabetes in Indigenous populations in Canada: A scoping review.” Canadian Journal of Diabetes, vol. 46, no. 6, 2022, pp. 628–639.e1. https://doi.org/10.1016/j.jcjd. 2022.05.003.

15. Amsah, N. et al. “Biopsychosocial and nutritional factors of depression among type 2 diabetes mellitus patients: A systematic review.” International Journal of Environmental Research and Public Health, vol. 19, no. 8, 2022. https://doi.org/10.3390/ijerph19084888.

16. Biddle, G.J.H. et al. “Differences in objectively measured physical activity and sedentary behaviour between white Europeans and South Asians recruited from primary care: Cross-sectional analysis of the PROPELS trial.” BMC Public Health, vol. 19, no. 1, 2019, p. 95. https://doi.org/10.1186/ s12889-018-6341-5.

17. Burns, R.J. et al. “Dyadic associations between physical activity and body mass index in couples in which one partner has diabetes: Results from the Lifelines cohort study.” Journal of Behavioural Medicine, vol. 43, no. 1, 2020, pp. 143–149. https://doi.org/10.1007/s10865-019-00055-y.

18. Kayaroganam, R. et al. “Profile of non-communicable disease risk factors among nurses in a tertiary care hospital in South India.” Asian Nursing Research, vol. 16, no. 4, 2022, pp. 241–248. https://doi.org/10.1016/j.anr.2022.07.001.

19. Campbell, J.A. et al. “Examining the relationship between delay discounting, delay aversion, diabetes self-care behaviours and diabetes outcomes in U.S. adults with type 2 diabetes.” Diabetes Care, vol. 44, no. 4, 2021, pp. 893–900. https://doi.org/10.2337/DC20-2620.

20. Littman, A.J. et al. “Associations between racial and ethnic groups and foot self-inspection in people with diabetes.” Diabetes Care, vol. 43, no. 5, 2020, pp. 956–963. https:// doi.org/10.2337/dc19-1486.

21. Phitri, H.E. and Widiyaningsih. “Hubungan antara pengetahuan dan sikap penderita diabetes mellitus dengan kepatuhan diet diabetes mellitus di RSUD A.M. Parikesit Kalimantan Timur.” Jurnal Keperawatan Medikal Bedah, vol. 1, no. 1, 2013, pp. 58–74.

22. Hasyim, H. et al. “Analysis of COVID-19 preventive behaviour in diabetes mellitus patients: A literature review.” Kesmas: National Public Health Journal, vol. 17, no. 1, 2022, pp. 49–53. https://doi.org/10.21109/KESMAS.V17ISP1.6052.

23. Ghisi, G.L.D.M. et al. “Patient education for people living with diabetes in the Philippines: A scoping review of information needs, diabetes knowledge and effectiveness of educational interventions.” Diabetes and Metabolic Syndrome: Clinical Research and Reviews, vol. 16, no. 5, 2022. https://doi.org/10.1016/j.dsx.2022.102494.

24. Flanagan, E.W. et al. “Assessment of eating behaviours and perceptions of time-restricted eating during pregnancy.” The Journal of Nutrition, vol. 152, no. 2, 2022, pp. 475–483. https://doi.org/10.1093/jn/nxab397.

25. Yusuf Mohamud, M.F. and M.O. Omar Jeele. “Knowledge, attitude and practice regarding lifestyle modification among type 2 diabetes patients with cardiovascular disease at a tertiary hospital in Somalia.” Annals of Medicine and Surgery, vol. 79, 2022, 103883. https://doi.org/10.1016/j.amsu.2022.103883.

26. Manuntung, A. “Analisis keyakinan diri pasien diabetes mellitus tipe 2 dalam pengelolaan diabetes mellitus.” Jurnal Kesehatan Manarang, vol. 3, no. 1, 2018, p. 31. https://doi.org/10.33490/jkm.v3i1.32.