Characteristic Of Demographic Neuropathy Diabetic Perifer In The Agriculture Area

Jember Regency is a superior area in the agricultural sector, but it is contrary to the health conditions of the people. It was noted that Jember experienced an increase in cases of Diabetes Mellitus (DM). DM causes various complications, one of which often occurs is peripheral neuropathy. This study aims to analyze peripheral neuropathy based on the characteristics of people with diabetes in the agriculture area under the auspices of the Health Department of Jember Regency. This type of research is descriptive with the cross-sectional approach. The sampling technique used is consecutive sampling. The number of respondents in this study was 102 people with diabetes. The instrument used was a modification of the MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score). Univariate analysis is performed, which is presented in the form of frequency distribution tables and cross-tabulation. The results of this study indicate that all respondents experienced peripheral neuropathy (100%) in the mild (43.1%), moderate (44.2%), and severe (12.7%) categories. Domination of neuropathy by women (53.9%), has comorbidities (68.6%), middle adult age categories (71.6%), blood glucoses 90-199 mg/dL (57.8%), and duration of DM ≥ 1 to 5 years (58.8%). A small percentage of people with diabetes who have peripheral neuropathy have a history of DFU (9.8%) and ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY

. This is related to the possibility of exposure to pesticides which are often used in agriculture. Reinforced by previous research which states that exposure to pesticides can affect beta cells in producing the hormone insulin, so that blood glucoses become high and DM will occur (6).
Complications that are often experienced by people with DM are peripheral nerve damage (peripheral neuropathy) and the incidence of amputations as much as 40% -60% (7).
Peripheral neuropathy as a manifestation of peripheral nerve damage is autonomic, sensory, and motoric (8,9). The problem of peripheral nerve damage in Indonesia has not been great managing, which often ends in disability and death (Purwanti & Maghfirah, 2016). Due to nerve damage causing a decrease in sensation, leg skin becomes dry, fissures are formed, calluses of muscle atrophy, changes in shape, a history of smoking (32.4%). This nursing intervention is needed to prevent worsening of peripheral neuropathy.

MATERIALS AND METHODS
This study used a cross-sectional design.
This study was carried out in the agriculture Area   Table 1 shows that the majority of respondents who suffer from DM are experienced in the middle adult age category (71.6%), with a long time of suffering more than 5 years (95.1%), and have a history of comorbidities (68.6%).   Table 3 shows that women had more peripheral neuropathy events than men (53.9%).

Analysis of Peripheral Neuropathy with
Comorbidities/ Complication Table 5 shows that peripheral neuropathy is more commonly experienced by DM clients who have as many comorbidities / complications (68.6%). Table 6 shows that peripheral neuropathy tends to be experienced by DM clients who suffer from DM s 1 to 5 years (58.8%) and more than five years (36.3%).  Table 7 shows that respondents who had blood glucose in the range of 90-199 mg / dL had a higher incidence of neuropathy as many as 59 people (57.8%).  Table 8 shows that clients who have no history of smoking have a higher incidence of neuropathy compared to clients who smoke as many as 69 people (67.6%).  Table 9 shows that ten respondents (9.8%) who had a history of DFU had peripheral neuropathy.

Characteristics of people with diabetes
In this study, (Table 1) Table 1). In theory, the increasing age of eating the body will decrease its function as well as the ability of β cells to produce insulin to metabolize glucose (18,19). Likewise, the results of primary health research in 2014 showed that the proportion of people with diabetes increased with age and the category of adult age was in the highest proportion (14).
This study shows that people with diabetes are dominated by long sufferers of more than five years (95.1%) (  (29). Likewise, the results of this study indicate that hypertension is the most frequent accompanying disease experienced by people with diabetes and as many as ten people (9.8%) have a history of DFU.

Levels of Peripheral Neuropathy
All people with diabetes in the agricultural area who were respondents experienced peripheral neuropathy (100%) ( This difference can occur, one of which is because there are differences in demographic characteristics that will affect the disease process of the people with diabetes.

Overview of Peripheral Neuropathy based on Demographic Characteristics
The results showed that the incidence of peripheral neuropathy was more experienced by women (Table 3). By some previous studies, it is stated that about 53% more who experience peripheral neuropathy are women (30,31).
Contrary to this result, it is mentioned that it is precisely the male sex more experiencing diabetic peripheral neuropathy (32). Researcher's assumption, differences in the results of this study can occur because, in this study, the number of female respondents is higher than that of men. Thus, it was concluded that men and women had the same chance of experiencing peripheral neuropathy.
This study shows that the incidence of diabetic peripheral neuropathy is more experienced by middle and late adult age categories (Table 4). Corresponding to this states that the average person with diabetes who has neuropathy in middle adulthood is around 51 years (30). Strengthened by research in Manado states that the age range of 46-65 years is the most frequent category of diabetic peripheral neuropathy (33). Old age is related to the accumulation of damage due to free radicals such as increased enzyme activity which ends with tissue damage and decreased bodily functions (34). The more mature age of someone with DM it will have great potential in experiencing diabetic peripheral neuropathy. This is caused by a decrease in bodily functions that are increasingly down in late adulthood.
The results showed that hypertension had the highest percentage of complications experienced by DM clients with diabetic peripheral neuropathy (Table 5). Other research states that hypertension has a significant relationship with the incidence of diabetic neuropathy. Most groups of cases with diabetic neuropathy have a history of hypertension of 66.67% (35). As much as 51.8% of the proportion of DM clients experiencing hypertension, this will affect the incidence of neuropathy due to DM (33).
Diabetes complications that often occur are hypertension, the incidence of hypertension itself causes thickening of the blood vessels resulting in narrowing of the diameter of blood vessels. The narrowing of blood vessels will affect the process of transporting metabolism in the disrupted blood vessels, and blood glucose levels will be disrupted (36). So that if someone who has DM and hypertension complications, the possibility of experiencing diabetic peripheral neuropathy disorders is higher due to the ineffectiveness in maintaining blood glucose balance due to the narrowing of blood vessel diameter.
The results showed that clients who experience diabetic peripheral neuropathy most occur in DM clients who have suffered for approximately 1-5 years ( is around four years so that someone who has had diabetes for a long time then the likelihood of diabetic peripheral neuropathy will be even higher (37). The longer a person suffers from DM, the balance of glucose levels in the blood will be disrupting, and if it occurs in a long duration, then it will damage the blood vessels (38).
The results showed that GDS levels> 199 mg / dL had a relatively high incidence of neuropathy ( The results showed that ten respondents who had a history of DFU experienced peripheral neuropathy (Table 9). It can be explained that in the condition of chronic hyperglycemia, it will cause ischemia in various organs and can cause diabetic ulcers (29). According to Sulistiari's reasearch (2013) that the factors that influence ulcers are neuropathy.
Peripheral neuropathy is the primary pathogenesis of DFU. The loss of pain and temperature sensation due to sensory neuropathy causes a loss of alertness to trauma or foreign bodies, which in turn results in unconscious injuries and worsens due to decreased pressure (43). Damage to the innervation of the intrinsic muscles of the foot due to motor neuropathy causes an imbalance between leg flexion and extension and foot deformity, which then causes changes in the distribution of pressure on the soles of the feet which in turn triggers callus. A callus that is not managed correctly will be a source of trauma to the foot. Autonomic neuropathy causes a decrease in the function of sweat glands and sebum. The foot will lose its natural ability to moisturize the skin; the skin becomes dry and cracked so that it is easily infected (43). Thus it is necessary to promote and preventive efforts from primary health care for people with diabetes, especially in the agricultural area of Jember Regency. This effort was made to avoid the worsening of peripheral neuropathy, such as diabetic ulcer, amputation, and even death.