1151 http://sosains.greenvest.co.id
JURNAL
SOSAINS
JURNAL SOSIAL DAN SAINS
VOLUME 2 NOMOR 10 2022
P-ISSN 2774-7018, E-ISSN 2774-700X
EFFECT OF THE COMBINATION OF ALOE VERA AND PALM
SUGAR ON THE IMPROVEMENT OF DIABETIC ULCERS IN
PATIENTS WITH TYPE 2 DIABETES MELLITUS
Devi Ratnasari
1
, Zahara Farhan
2
, Dani Sujana
3
, Kurniawan Dewi Budiarti
4
1,2,3,4
STIKes Karsa Husada Garut, Indonesia
Email : nersdevi@gmail.com, zaharafarhan585@gmail.com,
dani.sujana87@gmail.com, umifitiya78@gmail.com
Keywords:
Palm Sugar; Aloe
Vera; Diabetic
Ulcer; Type 2
Diabetes Mellitus.
ABSTRACT
Background: Diabetic ulcer treatment with aloe vera and palm sugar is one of the
treatment measures to prevent infection in diabetic ulcers. Aloe vera contains auxin,
gibber-relin, anthraquinone, and vitamins A, C, and E as an anti-inflammatory,
antipyretic, antioxidant, antiseptic, antimicrobial, as well as antiviral. Aloe vera can
diffuse properly and can withstand the loss of body fluids from the surface of the skin so
that moisture is maintained, while palm sugar contains vitamin C, Riboflavin, vitamin
A, and ascorbic acid as antibiotics and improves the tissue work system which can
weaken and kill bacteria that cause infections in diabetic ulcers.
Purpose: The purpose of this study was to determine the effect of the combination of
aloe vera and palm sugar on the improvement of diabetic ulcers in patients with type 2
diabetes mellitus.
Method: One group pretest and posttest design research design in one subject group
with a total sample of 8 people, sampling technique using consecutive sampling, the
research was carried out in August 2022 at the Wanaraja health center, Garut Regency
Results: Based on the results of the study, it is known that the highest activity that occurs
in Macaca fascicularis at Sangeh Tourism Object is in the behavior of moves (moving)
with a percentage of 17%, and Grooming behavior (Looking for lice) by 15%, then for
other activities such as rest (rest) by 14 %, mating 8%, feeding 13%, social 14%,
agonistic 13%, for behavior with the lowest percentage of sleep (sleep) of 6%.
Conclusion: Conclusion of the study, the combination of aloe vera and palm sugar
affects the improvement of diabetic ulcers in patients with type 2 diabetes mellitus.
INTRODUCTION
One of the most frequent complications of neuropathy in patients with type 2
diabetes mellitus is a diabetic ulcer caused by three factors namely; peripheral
innervation disorders (neuropathies), infections, and impaired blood flow (Christia,
Yuwono, & Fakhrurrazy, 2015). The existence of this condition results in a delay
in the wound healing process, causing susceptibility to the spread of infection which
can cause tissue death (gangrene) and end in amputation actions (Maryunani, 2013).
Efforts to prevent the spread of diabetic ulcer infection, one of which is by treating
wounds with appropriate treatment methods will improve the wound healing
process. The principle of the method of treatment of diabetic ulcers by retaining
moisture at the base of the wound to prevent the colonization of bacteria (Aragón-
Sánchez, Luis Lázaro-Martínez, Pulido-Duque, & Maynar, 2012). The main focus
of diabetic ulcer treatment is to increase blood flow to the wound area, adequate
Effect Of The Combination Of Aloe Vera And Palm
Sugar On The Improvement Of Diabetic Ulcers In
Patients With Type 2 Diabetes Mellitus
2022
Devi Ratnasari, Zahara Farhan, Dani Sujana, Kurniawan Dewi Budiarti 1152
blood flow can increase the supply of oxygen and nutrients to the ulcer area so that
the process of regeneration and tissue granulation runs well. At the initial stage, it
is necessary to create an environment for the wound area that is clean and free from
infectious fluids (pus/pus) and dead tissues (necrosis) (Enikmawati, 2019). One of
the treatments for diabetic ulcers that can be used is with aloe vera and palm sugar
(Wahyu Arjuna, 2020).
Treatment of diabetic ulcers with aloe vera and palm sugar is one of the
complementary treatment measures to prevent infection in diabetic ulcers. Aloe
vera contains several substances such as auxin, gibber-relin, anthraquinone,
vitamins A, C, E which have proven efficacy as anti-inflammatory, antipyretic,
antioxidant, antiseptic, antimicrobial, as well as antiviral . Aloe vera is able to
penetrate and absorb and diffuse properly so that it can resist the loss of body fluids
from the surface of the skin so that moisture is maintained (Enikmawati, 2019),
(Khoirunnisa & Gati, 2021). In addition, aloe vera contains active ingredients such
as essential oils, amino acids, minerals, vitamins, enzymes, glycoproteins, and
chrysanthemum acids which are beneficial for healing damaged skin. The enzyme
protease in collaboration with glucomannan serves as a pain reliever when there is
a wound. Saponins as a soap-like substance form a 3% gel as a cleanser that has
antiseptic properties (Puspitosari, Nuridayanti, Wahdi, & Jayanti, 2021), while
palm sugar contains vitamin C, riboflavin, vitamin A, and ascorbic acid which has
a function as an antibiotic. Riboflavin contained in palm sugar can help the
formation of red blood cells and stimulate the formation of immunoglobulins
(antibodies) produced in bone marrow. In addition, the substance ascorbic acid
(vitamin C) contained in palm sugar has an effect as an antibiotic that can weaken
and kill the bacteria that cause infection in diabetic ulcer wounds (Ratnasari,
Daniati, Suliyawati, & Farhan, 2021).
The results of the research that has been carried out, there is an influence of
aloe vera on the healing of diabetic ulcers with a p-value of 0, (Puspitosari et al.,
2021) , sedangkan hasil penelitian yang telah dilakukan oleh pengusul ditemukan
bahwa, gula aren merupakan media yang efektif dalam mempengaruhi perbaikan
luka ulkus pada pasien diabetes mellitus tipe2 dengan p-value sebesar 0,000
(Ratnasari et al., 2021). Based on the two results of the study, the authors are
interested in researching the combination of aloe vera media and palm sugar against
the improvement of diabetic ulcers in patients with type 2 diabetes mellitus. In
addition, diabetic ulcer treatment requires a long treatment (2-3 weeks), but the
treatment process is constrained by the policies and regulations of the Social
Security Protection Agency (BPJS) for health that limit the length of days of patient
care in the hospital, where the length of the patient's hospitalization day is only 4-7
days so that the patient needs follow-up care at home. To help the process of
diabetic ulcer repair and health recovery in type 2 diabetes mellitus patients at
home, the combination of aloe vera and palm sugar media can be used as an easy,
cheap, and affordable alternative medium in the process of repairing diabetic ulcer
wounds.
Analyze the influence of the combined medium of aloe vera and palm sugar in the
process of improving diabetic ulcers in patients with Type 2 diabetes mellitus after
Volume 2, Nomor 10, October 2022
p-ISSN 2774-7018 ; e-ISSN 2774-700X
1153 http://sosains.greenvest.co.id
hospitalization. Analyze the process of repairing diabetic ulcers after wound treatment with
a combination medium of aloe vera and palm sugar.
RESEARCH METHODS
Research design using quasi-experiment with one group pre-test and post-test design
(Marsden & Torgerson, 2012). Measurements were taken twice before treatment and after
diabetic ulcer treatment with a combination of palm sugar and aloe vera media in one group
of subjects. The study population was all patients with post-hospitalization diabetes
mellitus, while the study sample of patients who had post-hospitalized diabetic ulcers was
8 people. The sampling technique uses consecutive sampling with the criteria of patients
who are willing to be respondents. Patients on the 1st day after hospitalization. Patients
diagnosed with type 2 diabetes mellitus by doctors with complications of grade II and III
diabetic ulcers. The patient's blood sugar level is controlled and close to the normal value
limit with the value of the blood sugar level during the > 50 mg / dl and ≤ 200 mg / dl pre-
wound treatment with palm sugar. Patients with a classification of diabetic ulcers of degrees
2-3 at stage A-D (based on the Classification of Ulcers of the University of Texas) (Marissa
& Ramadhan, 2017). Post-hospitalization patients.
RESULTS AND DISCUSSION
A. Results
The results of the study on the characteristics of patients who experience diabetic
ulcers can be seen in table 1 as follows:
Table 1. Frequency Distribution characteristic of Diabetic Ulcer Patients (N=8)
Characteristic patients
F
Gender
Man
5
Girls
3
Age
Late adulthood = 36- 45 years
1
Early old age = 46 - 55 years
3
Masa lansia akhir = 56 - 65 years
4
Long Diabetes Mellitus
3-4 years
1
4-5 years
4
6-7 years
3
Long Ulkus Diabetik
<1 years
4
1-2 years
3
>2 years
1
Woks
Doesn’t work
2
Entrepreneur
4
Laboer
2
Blood Sugar During (GDS)
Good (110 - 145 mg/dL)
0
Middle (145 - 179 mg/dL)
0
Effect Of The Combination Of Aloe Vera And Palm
Sugar On The Improvement Of Diabetic Ulcers In
Patients With Type 2 Diabetes Mellitus
2022
Devi Ratnasari, Zahara Farhan, Dani Sujana, Kurniawan Dewi Budiarti 1154
Bad (>180 mg/dL)
8
Grade Ulkus Diabetik
Grade I
2
Grade II
6
Grade III
0
Based on table 1 above, it is known that, most (62.5%) of diabetic ulcer
patients are male, half (50.0%) are in the category of late elderly (aged 56 - > 65
years), half (50.0%) have suffered from type 2 diabetes mellitus for 4-5 years,
half (50.0%) have suffered from diabetic ulcers for < 1 year, half (50.0%) have
self-employed jobs, almost all (100.0%) have blood sugar levels while (GDS) >
180 mg / dl, and some another large (75.0%) had complications of grade II
diabetic ulcers.
The results of the analysis regarding the effect of giving a combination of
aloe vera and palm sugar on clinical assessment on the process of improving
diabetic ulcers in type 2 diabetes mellitus patients can be seen in table 2 as
follows :
Table 2.
Effect of Aloe Vera and Palm Sugar Combination on Clinical Assessment
(N=8)
Clinical Assessment Indicators
Mean Score
p Value
Day 1
Day 14
Exudate
3.13
1.13
0.005
Amount of Exudate
3.25
1.25
0.000
Size
2.50
1.50
0.023
Depth
2.63
1.38
0.008
Undermining
3.12
2.38
0.034
Necrotic Network
2.13
0.88
0.007
Amount of Necrotic Network
1.63
0.63
0.011
Granulation Tissue
2.50
1.00
0.010
Amount of Granulation Network
3.75
2.75
0.005
Wound Edges
2.63
1.50
0.007
Periulcus Skin Viability
2.63
1.00
0.010
Edema Type
1.88
0.13
0.010
Location of Foot Edema
1.25
0.13
0.007
Bioburden
1.50
0.50
0.005
Average
2,47
1,15
0,01
Based on table 2 above, it is known that, the overall average value of the
clinical assessment indicators of diabetic ulcers based on the LUMT score on the
first day before the procedure (pre-treatment) was 2.47 and the average value
after the procedure (post-treatment) was 1.15 with an average p value of 0.01 at
a confidence level of 95%. From these data, it is known that there is an influence
of the administration of a combination medium of aloe vera and palm sugar on
clinical assessment on the process of improving diabetic ulcers in type 2 diabetes
mellitus patients.
Volume 2, Nomor 10, October 2022
p-ISSN 2774-7018 ; e-ISSN 2774-700X
1155 http://sosains.greenvest.co.id
The results of the analysis regarding the effect of giving a combination
medium of aloe vera and palm sugar on patient assessment on the process of
improving diabetic ulcers of type 2 diabetes mellitus patients can be seen in table
3 as follows :
Table 3.
Effect of The Combination of Aloe Vera and Palm Sugar on Patient
Assessment (N=8)
Indikator Penilain Pasien
Mean Score
p Value
Hari 1
Hari 14
Pain Scale
3.13
2.00
0.007
Pain Frequency
3.63
0.88
0.008
Quality of Life
3.38
0.75
0.011
Average
3,38
0,67
0,008
Based on table 3 above, it is known that the average value of the overall
patient assessment indicators based on the LUMT score on the first day before
the procedure (pre-treatment) was 3.38 and the average value after the procedure
(post-treatment) was 0.67 with an average p value of 0.008 at a confidence level
of 95%. From these data, it is known that there is an influence of giving a
combination of aloe vera and palm sugar on the patient's assessment of the
diabetic ulcer repair process of type 2 diabetes mellitus patients.
The results of the analysis regarding the effect of the combination of aloe
vera and palm sugar on the process of improving diabetic ulcers in type 2
diabetes mellitus patients in general can be seen in table 4 as follows :
Table 4.
Effect of The Combination of Aloe Vera and Palm Sugar on the Improvement
of Pre-Treatment and Post-Treatment Diabetic Ulcers in Type 2 Diabetes
Mellitus Patients (N=8)
pre-post
treatment
Different Values Of Pre-action and Post-action Pairs
t
df
p
Value
Mean
Std.
Deviation
Std. Error
Mean
95% Confidence Interval
of the Difference
Lower
Upper
24.875
6.034
2.133
19.830
29.920
11.660
7
.000
Based on table 4, it is known that, the average value of diabetic ulcer pre-
post treatment diabetic ulcer treatment diabetic with a combination of aloe vera
and palm sugar is 24,875 with a standard deviation of 6,034. The results of
statistical tests with a dependent t-test obtained a p value of 0.000 at a confidence
level of 95% which means that the combination media of aloe vera and palm
sugar affects the improvement of diabetic ulcers in patients with type 2 diabetes
mellitus.
B. Discussion
Effect Of The Combination Of Aloe Vera And Palm
Sugar On The Improvement Of Diabetic Ulcers In
Patients With Type 2 Diabetes Mellitus
2022
Devi Ratnasari, Zahara Farhan, Dani Sujana, Kurniawan Dewi Budiarti 1156
The principle of wound care in diabetic ulcer patients is a very important
measure in preventing the occurrence of infections and complications. The
principle of diabetic ulcer treatment is to create a moist wound healing
environment or keep the wound always in a moist state (Association, 2013).
Besides aiming to maintain moisture, the use of dressings should also consider
the size, depth and location of the ulcer (Clayton Jr & Elasy, 2009). The main
focus of diabetic ulcer treatment is to increase blood flow to the wound area,
adequate blood flow can increase the supply of oxygen and nutrients to the ulcer
area so that the process of regeneration and tissue granulation runs well. At the
initial stage, it is necessary to create an environment for the wound area that is
clean and free from infectious fluids (pus / pus) and dead tissues (necrosis)
(Enikmawati, 2019). Wound treatment methods that can be used to promote
wound healing by retaining moisture at the base of the wound to prevent
colonization of bacteria (Aragón-Sánchez et al., 2012). One of the treatments of
diabetic ulcers that can be used is with aloe vera and palm sugar.
Based on the results of the study above, it is proven that the process of
repairing diabetic ulcers using a combination of aloe vera and palm sugar is
caused by an increase in the osmosis process between the exudate in the diabetic
ulcer area and the combination of media from the two ulcer treatment materials
given, thereby increasing the absorption of exudate in diabetic ulcers to the
wound treatment media. In addition, the combination of aloe vera and palm sugar
is able to resist the loss of body fluids from the surface of the skin and maintain
moisture which makes it easier for the epithelium from the edges of the wound
to migrate to the wound site along with myofibroblast contractions that will close
the wound. In addition, the beta-sitosterol content of aloe vera has angiogenesis
activity which is an important process in healing diabetic ulcers. The content of
vitamin C, riboflavin, vitamin A, and ascorbic acid in palm sugar provides an
effect as an antibiotic and stimulates the formation of immunoglobulins
(antibodies) produced in the bone marrow, this gradually causes the wound area
to be clean and the process of repairing the tissue around the wound goes well
and the process of spreading infection can be prevented.
Treatment of diabetic ulcers with aloe vera and palm sugar is one of the
complementary treatment measures to prevent infection in diabetic ulcers. Aloe
vera contains several substances such as auxin, gibber-relin, anthraquinone,
vitamins A, C, E which have proven efficacy as anti-inflammatory, antipyretic,
antioxidant, antiseptic, antimicrobial, as well as antiviral. Aloe vera is able to
penetrate and absorb and diffuse properly so that it can resist the loss of body
fluids from the surface of the skin so that moisture is maintained (Enikmawati,
2019), (Khoirunnisa & Gati, 2021). In addition, aloe vera contains active
ingredients such as essential oils, amino acids, minerals, vitamins, enzymes,
glycoproteins, and chrysanthemum acids which are beneficial for healing
damaged skin. The enzyme protease in collaboration with glucomannan serves
as a pain reliever when there is a wound. Saponins as a soap-like substance form
3% of the gel as a cleanser that has antiseptic properties (Puspitosari et al., 2021),
aloe vera exerts a good influence in the healing process of diabetic wounds
(Aminanto & Ruhyana, 2015). While palm sugar contains vitamin C, riboflavin,
Volume 2, Nomor 10, October 2022
p-ISSN 2774-7018 ; e-ISSN 2774-700X
1157 http://sosains.greenvest.co.id
vitamin A, and ascorbic acid which has a function as an antibiotic. Riboflavin
contained in palm sugar can help the formation of red blood cells and stimulate
the formation of immunoglobulins (antibodies) produced in bone marrow. In
addition, ascorbic acid (vitamin C) contained in palm sugar has an effect as an
antibiotic and improves the tissue work system which can weaken and kill
bacteria that cause infection in diabetic ulcer wounds (Ratnasari et al., 2021)
(Hesty, 2016).
The formation and growth of granulation tissue in wounds treated using
aloe vera can grow well, because aloe vera can provide a moist environment for
wounds (Puspitosari et al., 2021). Aloe vera also accelerates the healing of
epithelial tissue damage in wounds through the provision of essential
micronutrients, anti-inflammatory effects, anti-microbial effects, and
stimulating skin fibroblasts (Khoirunnisa & Gati, 2021). In addition, the beta-
sitosterol content of aloe vera has angiogenesis activity which is an important
process in healing diabetic ulcers (Avijgan, Kamran, & Abedini, 2016).
CONCLUSION
The results showed that the combination medium of aloe vera and palm
sugar had an effect on improving diabetic ulcers in patients with type 2 diabetes
mellitus.
BIBLIOGRAPHY
aminanto, Slamet, & Ruhyana, Ruhyana. (2015). Efektivitas Gel Aloe Vera Sebagai
Primary Dressing Pada Luka Diabetes Melitus Di Praktik Perawatan Luka Indaryati
Sleman Yogyakarta. Stikes’aisyiyah Yogyakarta.
Aragón-Sánchez, Javier, Luis Lázaro-Martínez, Jose, Pulido-Duque, Juan, & Maynar,
Manuel. (2012). From The Diabetic Foot Ulcer And Beyond: How Do Foot
Infections Spread In Patients With Diabetes? Diabetic Foot & Ankle, 3(1), 18693.
Association, American Diabetes. (2013). Standards Of Medical Care In Diabetes—2013.
Diabetes Care, 36(Supplement_1), S11–S66.
Avijgan, Majid, Kamran, Asghar, & Abedini, Amin. (2016). Effectiveness Of Aloe Vera
Gel In Chronic Ulcers In Comparison With Conventional Treatments. Iranian
Journal Of Medical Sciences, 41(3 Suppl), S30.
Christia, Srisabrina, Yuwono, Agus, & Fakhrurrazy, Fakhrurrazy. (2015). Kejadian
Neuropati Dan Vaskulopati Pada Pasien Ulkus Diabetik Di Poliklinik Kaki Diabetik.
Berkala Kedokteran, 11(1), 25–32.
Clayton Jr, Warren, & Elasy, Tom A. (2009). A Review Of The Pathophysiology,
Classification, And Treatment Of Foot Ulcers In Diabetic Patients. Clinical
Diabetes, 27(2), 52–58.
Enikmawati, Anik. (2019). Penerapan Lidah Buaya Untuk Penyembuhan Luka Diabetik.
Profesi (Profesional Islam): Media Publikasi Penelitian, 17(1), 69–84.
Hesty, Heryani. (2016). Keutamaan Gula Aren Dan Strategi Pengembangan Produk.
Khoirunnisa, Itsna, & Gati, Norman Wijaya. (2021). Penerapan Gel Aloe Vera Untuk
Penyembuhan Luka Diabetik.
Marissa, Nelly, & Ramadhan, Nur. (2017). Kejadian Ulkus Berulang Pada Pasien Diabetes
Mellitus. Sel Jurnal Penelitian Kesehatan, 4(2), 91–99.
Marsden, Emma, & Torgerson, Carole J. (2012). Single Group, Pre-And Post-Test
Research Designs: Some Methodological Concerns. Oxford Review Of Education,
Effect Of The Combination Of Aloe Vera And Palm
Sugar On The Improvement Of Diabetic Ulcers In
Patients With Type 2 Diabetes Mellitus
2022
Devi Ratnasari, Zahara Farhan, Dani Sujana, Kurniawan Dewi Budiarti 1158
38(5), 583–616.
Maryunani, Anik. (2013). Perawatan Luka Modern (Modern Woundcare) Terkini Dan
Terlengkap. Jakarta: In Media.
Puspitosari, Dewi Retno, Nuridayanti, Anik, Wahdi, Achmad, & Jayanti, Eka Ama Putri.
(2021). Pengaruh Lidah Buaya Dan Madu Terhadap Penyembuhan Luka Diabetik
Pada Pasien Diabetes Mellitus. Well Being, 6(1), 66–78.
Ratnasari, Devi, Daniati, Eva, Suliyawati, Eti, & Farhan, Zahara. (2021). The Effect Of
Wound Care With Palm Sugar On Diabetic Ulcer Repairing In Type 2 Diabetes
Patients. Eduvest-Journal Of Universal Studies, 1(12), 1–473.
Wahyu Arjuna, Putra. (2020). Perbandingan Daya Hambat Kombinasi Ekstrak Lidah
Buaya (Aloe Vera L.) Dengan Antibiotik Eritromisin Terhadap Bakteri
Staphylococcus Aureus Penyebab Ulkus Diabetik. Universitas Perintis Indonesia.
This work is licensed under a Creative Commons Attribution-ShareAlike
4.0 International License.