Factors Related To Anxy Events In Diabetes Mellitus Type 2 In Public Health Center

Diabetes mellitus or what is commonly referred to as diabetes is a metabolic disorder characterized by chronic hyperglycemia caused by disruption of carbohydrates, protein metabolism, fat due to problems with insulin secretion, insulin action, or both (WHO, 2014). The purpose of this study was to determine the factors related to the psychological health of patients with type 2 diabetes mellitus with the incidence of anxiety at the Puskesmas Kota Kab. Bantaeng 2020. Methods This study used an analytic observational research design with a cross sectional approach. The sample of this research was 63 respondents who were taken by incidental sampling method. Data analysis in this study used the Chi-square statistical test. The results of the study used the Chi-square statistical test with a significance level of 0.05. The results of data analysis using Chi-square showed that the knowledge factor p-value = 0.006, diet management p-value = 0.000, family support p-value 0.000 <0.05 means that the test is significant. This means that there is a relationship between knowledge, dietary regulation, family support and anxiety in people with type 2 diabetes. Conclusions and suggestions are DM sufferers are encouraged to control their blood sugar levels regularly and reduce consumption of foods that contain lots of carbohydrates. The suggestion suggested is that the city health center institution pay more attention to the factors that can affect blood sugar levels and be able to control this situation by creating an innovative program.


INTRODUCTION
Diabetes mellitus is a chronic disease with signs of elevated blood sugar levels and metabolic disorders. When diagnosed with diabetes mellitus, many complications will arise (Soto-Estrada et al., 2018). Diabetes mellitus or commonly referred to as sugar disease is a metabolic disorder characterized by chronic hyperglycemia caused by disruption of carbohydrates, protein metabolism, fat due to problems in insulin secretion, insulin action, or both (WHO, 2014). DM is of three types; Diabetes Type 1 Mellitus (T1DM), Diabetes Mellitus type 2 (T2DM), and Gestational Diabetes mellitus (GDM). In Vol.4  .
Anxiety is a condition of mental anxiety, concern, or a feeling or feeling of hopelessness because of a threat that will occur or a threat of anticipation that cannot be identified with oneself or a meaningful relationship. If people with diabetes mellitus experience anxiety, it will affect the healing process and hinder their ability to carry out daily activities. Physical symptoms that are often experienced when a person experiences severe or high anxiety are decreased energy, fatigue, and difficulty sleeping which can affect changes in diet. Most people complain of not having an appetite, but some complain that their eating is getting out of control. In patients with diabetes mellitus, this condition will certainly affect the diet or diet that has been determined. Diabetes mellitus who experience anxiety has poor blood sugar control and increased symptoms of the disease (Wijayanto and Pringsewu, 2019).
Based on preliminary data collection carried out at the Bantaeng City Health Center on January 23-30 2020, from 15 DM patients found 10 DM patients who experienced anxiety about their disease due to lack of knowledge possessed by these sufferers. They said that they would not be cured if they had diabetes, in addition to the lack of knowledge, patients with the female gender had more type 2 diabetes mellitus than men.
2 among the DM patients said they were no longer anxious because they had received a lot of information about DM that they suffered through both counseling and electronic media, while other patients said they needed family support to deal with their illness, accompany them when they wanted to seek treatment or wanted to check their blood sugar levels.
Public Health collaborates with the local government in controlling or reducing the number of DM sufferers by conducting counseling and mobile health centers besides that the public Health assigns staff who hold a program called POSBINDU (integrated service post) PTM (non-communicable disease) to carry out screening in the work area of city public Health bull. The purpose of this study was to determine the factors associated with the incidence of anxiety in people with type 2 diabetes mellitus at the Bantaeng city health center.

MATERIAL AND METHODS
This research is quantitative in nature, the approach used is cross sectional where this type of research focuses on time and observation of data measurement on the independent and dependent variables only once at the same time (Nursalam, 2008). The population is a generalization area consisting of objects or subjects that have certain qualities and characteristics that are determined by the researcher to study and then draw conclusions (Sugiyono, 2018). The population in this study were all Bantaeng it can use the sample obtained from that population. Everything that is learned from the sample will draw conclusions to apply to the population, therefore the sample taken from the population can truly represent (Sugiyono, 2018).   The results of the analysis using the Chi-square test obtained a significance value of 0.000 (p <0.05), it can be concluded that There is a relationship between diet management and anxiety in patients with Type 2 diabetes in the Bantaeng city health center. The results of the analysis using the Chi-square test obtained a significance value of 0.000 (p <0.05), it can be concluded that "There is a relationship between family support and anxiety in patients with Type 2 diabetes in the Bantaeng city health center. The results of the analysis using the Chi-square test obtained a significance value of 0.564 (p> 0.05), it can be concluded that "there is no relationship between gender and anxiety in patients with Type 2 diabetes in the Bantaeng city health center. The results of the analysis using the Chi-square test obtained a significance value of 6.821 (p> 0.05), it can be concluded that "There is no relationship between age and anxiety in patients with Type 2 diabetes in the Bantaeng city health center.

DISCUSSION
In this study, it can be seen that there is a significant relationship between knowledge, diet management, and family support with the anxiety level of Type 2 DM sufferers at the district health centers Bantaeng of 2020. From the results of statistical tests using the Chi-Square test, the p-value = 0.006 is smaller than the α = 0.05. So it can be concluded that there is a relationship between knowledge and the level of anxiety of people with Type 2 diabetes.
The researchers' assumptions related to the results of the study that the District Health Center. Bantaeng has activity in collaboration with the BPJS which is carried out regularly every 24th of the month. Every implementation of the prolanis carried out educational activities in the form of counseling. This counseling is carried out to minimize the lack of knowledge of Diabetes mellitus patients who seek treatment at the City Health Respondents who obeyed were more anxious because they thought that even though they often came to the health center and checked their sugar levels and obeyed their diet, their sugar levels were still high or even uncontrollable. Therefore, even though the respondents adhere to the diet, but in a state of anxiety and depression, they tend to be less accepting of the medical therapy that is given which certainly increases the blood sugar levels of the respondent. From the results of statistical tests using the Chi-Square test, the p-value = 0.000 is smaller than the value of α = 0.05. So it can be concluded that there is a relationship between family support and the level of anxiety in people with Type 2 diabetes. In this study, all respondents were patients who were members of the prolanis. Respondents said the support they usually received from their families included support and motivation to diligently control their health every month at the public health.
Besides, the family also helps in regulating diet and taking medicine hours. Family support can help improve anxiety about the prognosis of diabetes mellitus by managing blood sugar levels in diabetic patients, controlling dietary intake, and taking medication adherence.
The higher the family's support for the patient, the lower the anxiety about the future of the disease so that the patient's quality of life can be higher as well. From the results of statistical tests using the Chi-Square test, the p-value = 0.000 is smaller than the value of α = 0.05. So it can be concluded that there is no relationship between gender and the level of anxiety of people with Type 2 diabetes. Researchers assume that one of the causes of high anxiety levels in women is because there are hormones that can trigger anxiety. In women, the optimal ability of the brain to deal with anxiety, the ability to predict and feel something is different from men.
Currently, there is a change in the role of women, who initially played a role as caregiver, now a figure who works hard is careful and protective. Besides, the female brain system is more intuitive and analytical thinking compared to men who are more optimal in motor skills. Gender does not affect a person's anxiety, but individual rejection of the disease they suffer. Besides, the characteristics of someone who tends to experience greater levels of anxiety, such as dependent, occlusive abusive, and histrionic, have more effect on the level of anxiety.
From the results of statistical tests using the Chi-Square test, the p-value = 0.000 is smaller than the value of α = 0.05. So it can be concluded that there is no relationship between age and the level of anxiety in people with Type 2 diabetes. At a psychologically unstable level based on the characteristics of the respondents, the authors have the assumption, at the age of 35-55 years, the respondents think about their children's future if something happens due to diabetes mellitus they have. From the results of this study, it can be seen that the increasing age of the patient, the lower the level of anxiety. Age is related to experiences and views on something, the older the thinking process will be the better.

CONCLUSION
Based on the results of research conducted with the aim of the study was to determine the factors associated with the incidence of anxiety in people with type 2 diabetes mellitus at the Bantaeng city health center. Public health centre are expected to improve the quality of services including facilities and infrastructure so that they can identify as early as possible the incidence of diabetes mellitus.