Introduction  

Diabetes mellitus (DM) is the most common degenerative disease.^[1] It is characterized by elevated blood sugar levels (hyperglycemia) and high levels of sugar in the urine^[2]. Diabetes Mellitus (DM) is a metabolism of carbohydrates, proteins, and fats that is characterized by hyperglycemia or elevated blood glucose levels due to abnoemalities in insulin secretion or decreased insulin function (American Diabetes Association)^[3]

International Diabetes Federation (IDF) statistics show that the prevalence of DM worlwide from 371 million in to 592 million in 2035. Indonesia itself ranked fourth in the country with the largest diabetes mellitus population in the world after India, China, and the United States of 8 million people (IDF, 2010). Diabetes Mellitus if not treated seriously, is expected to cause the explosion of Diabetes Mellitus to 21.3 million in 2030 ^[4]. Indonesia's Health Profile in 2012 shows that DM is ranked 6th out of 10 main diseases in outpatients in Indonesian hospitals ^[4].

Diabetes Mellitus is a chronic disease that requires long-term care and requires the thorough management of all medical teams at a health care center in the hope that the patient will be able to self-management to prevent acute and chronic complications (Ika, 2014). Diabetes mellitus management according to Perkeni (2011) has been identified as four main pillars namely: health education, meal planning/diet, physical exercise, and pharmacological interventions ^[5].

Health education is the first four pillars of diabetes mellitus management. According to the American Diabetes Association (2003) report 50% - 75% of patients with type 2 DM have undergone lower extremity amputation ^[6]. Over 50% of amputations can be prevented by providing health education and foot care training and daily exercise.All medical personnel, especially the nursing profession who plays a major role in providing health care of people with diabetes mellitus. The low knowledge of people with diabetes mellitus providing opportunities for nurses to providean educational role for people with diabetes mellitus.

The role of nurses not only provides medical services but can also provide education through health education to individuals, families, and communities. Health education provided by nurses can improve the knowledge of patients with diabetes mellitus and family, which is expected to form good behavior for people with diabetes mellitus to achieve their ultimate goal of health education blood sugar levels of people with diabetes mellitus. Rantauprapat regional hospital itself is a local hospital with 14 polyclinics, where polyclinic internal medicine is one of the polyclinics where diabetes mellitus ranks the first (41%). Data from patients with diabetes mellitus that went to the polyclinic of disease in Rantauprapat hospital on average every month from January to September 2016 as many as 410 patients. A preliminary study by the authorsconducted in September in 40 diabetic patients  showed that most of the patients who were referred for treatment were still unaware of the importance of glicemic control, how to control blood sugar, due to uncontrolled blood sugar and how much the tolerance limit Blood sugar levels were proven by the average patient who was included in the preliminary survey of researchers having uncontrolled blood sugar levels. Judging by the patient's history of control month, it was found that blood sugar levels as the patient tended to be high month (> 200mg / dl). Patients say they are unable to control appetite and tend to frequently consume foods/beverages containing high sugar content such as sweet tea with the reason patients are easily hungry. Patients also do not know that rice has a high sugar content and are reluctant to substitute for the main replacement carbohydrate intake such as sweet potatoes, potatoes with concerns digestive disorder experienced by patients if they donot consume rice.

Patients and families are also rarely exercised based on fear of injury that difficult to treat. For pharmacology, most patients are diligent in taking medicine according to doctors' recommendations, but of the 40 respondents involved in the preliminary survey, only 12 respondents have their blood glucose checkbox at home / routine blood glucose checks. Respondents’ reasons vary, from an inability to purchase the KGD check tool to failureto know how to use it, and most responses just enough to carry out KGD checks while in hospital-only control. Most patients and families say they have never received a health education on how to control blood sugar and treat patients with diabetes mellitus and do not have sufficient knowledge of how to treat people with diabetes mellitus. Patients say they have diligent control and eat medicine continues, but the sugar content remains high, all the foods are still being challenged and we still don’t know how to control the sugar content that has increased our patience.

Seeing the increasing phenomenon of diabetes mellitus and patients’ low knowledge of how to control blood glucosewhere health education plays a very important role to improve the knowledge of patients and their families about how to control blood glucose in people with diabetes mellitus. In  Rantauprapat general hospital-district researching the effect of health education on awarenessnof blood sugar control of diabetes mellitus patients in polyclinic diseases Rantauprapat general hospital.

Research hypothesis

There is the Influence of Health Education on Patient Knowledge on controlling blood sugar level of diabetes mellitus patient in polyclinic of disease in Rantauprapat general hospital.

Research Methods

This study was conducted using an experimental design method, and with the research design of a single variable before the experimental design of a pretest-postest. The researchers compared the results of blood glucose testing before and after determining health education to determine the effect of health education on blood sugar in polyclinic disease at Rantauprapat general hospital. This study was conducted at the Rantauprapat general hospital, internal medicine Polyclinic from January 2 to February 4, 2017, with a population of 416 respondents with a sample of 41 respondents. Data were analyzed using paired Sample T-Test design. To see the result of significance of statistical calculation used (0, 05), so if the result of the statistical research indicates that Ho accepted if: -tc <tH <tc which means there is no significant difference, otherwise Ho is rejected.

Research Result

The level of Knowledge of controlling blood sugar level before and fater health education. Respondents pre-knowledge level of diabetesrealted health education was 19 respondents (46.3%) at the highestlevel while knowledge level was less than 14 people (34.1%) and only 8 for good knowledge level respondents (19.5%) For the frequency distribution of the respondent's knowledge level after health education, significant changes were observed in the number of respondents at the knowledge level of 24 persons(58.5%), while the knowledge level decreased to only 1 person (2.4%) and for the level of knowledge enough for16 respondents (39%).

Frequency distribution based on demographic data of respondents  before to health education on knowledge level in internal medicine Polyclinic of Rantauprapat general hospital based on gender with medium knowledge level before health education for women as many as 11 people (26.8%) and knowledge level of fewer than 7 persons ( 17%) in women. For the age category, the age range of 30-40 years has the highest level of knowledge that is 4 persons (9.7%). The knowledge level is less based on the highest level of education on respondents who have a high school education level of 7 people (17%). And the knowledge level data is less based on the type of work performed by the patient, who works as civil servantsas many as 5 people (12,2%). For the best level of knowledge based on respondent duration, the highest rate of diabetes mellitus was in the group of 1- <5 years (12.5%), but for the highest level of knowledge, 7 respondents (17%) were also in this group followed by the respondents in the 5- <10 years group as many as 6 people (14.6%).

Frequency distribution of respondents demographic data after health education on knowledge level at Polyclinic of internal disease of Rantauprapat general hospital based on gender with the level of post health education knowledge change of many respondents in knowledge level less become 1 person (2.4%) in both women and 0 % of male respondents. For the age category, the age range of 41-50 years has the highest level of knowledge, which is as much as 10 people (24.4%). The lowest knowledge level based on the category of education level is only in respondents with junior secondary education level and only 1 person (2.4%). The level of knowledge is less based on the type. of work that comes from the research before the health education is the patient who works as a civil servant, that is as much as 5 people (12,2%) but after health education, the number of respondents that knowledge was reduced to 1 person (2.4%) respondents only. For the good knowledge level based on the duration of the respondent suffering from diabetes mellitus mostly in a group of 1- <5 years as many as 5 people (12.2%) decreased to 1 person (2.4%) respondents after health education.

Sugar Levels description of respondents before and after health education

From Table 1, it was found that before health education, none of the respondents had blood glucose levels of ≤90 mg / dL before and after health education. Most respondents had blood glucose levels> 200 mg / dL as many as 33 people (80.6%) and only 6 respondents (14.6%) who had sugar content ≤200 mg / dL. Only 1 respondent (2.4%) had to fast blood glucose and 1 respondent also measured blood glucose level 2 hours after 75 grams of glucose load and the 2nd blood glucose> 200mg / dL. After health education, a significant decrease was observed in the number of respondents who had blood sugar levels> 200 mg / dL to 17 respondents (41.5%) and the number of respondents who had blood sugar levels> 90-≤200 mg / dL increased to 15 respondents (36.6%). Respondents with fasting blood glucose measurement were 5 respondents where 2 respondents (4.9%) had blood sugar> 90-≤200 mg / dL and 3 respondents (7.3%) had fasting blood sugar> 200mg / dL. For measurement of blood glucose 2 hours after loading 75 grams of post health education glucose counted 4 respondents (9.8%) and all respondents were in blood sugar group> 200mg / dL.

Influence of health education on patient knowledge about blood sugar level control