INTRODUCTION
The prevalence of Diabetes
Mellitus (DM) shows an increase from year to year (Sudyasih & Asnindari, 2021). Data from the International
Diabetes Federation in 2017 shows that Indonesia is currently ranked 6th in the
world with the largest number of diabetics, namely 10.3 million people (Azriful et al., 2018). The high prevalence of
diabetes mellitus is generally caused by an imbalance in food intake, where
consumption of foods that tend to be high in fat, sugar, and low in fiber can
lead to obesity and result in an increase in blood glucose 2 hours
postprandial.
����������� Diabetes mellitus cannot be cured but can be managed so
that blood sugar levels can be controlled. Management of DM patients can be
carried out with non-pharmacological and pharmacological therapies (Yanti & Mertawati, 2020). Non-pharmacological
management can be done by adjusting diet, exercise and consuming herbal
ingredients (Festi, 2020). Meanwhile, pharmacological
management can be in the form of oral hypoglycemic drugs or antihyperglycemic
agents and insulin, but these treatments have unwanted side effects such as
swelling in the peripheral areas. This reason has led to increased public interest,
especially DM sufferers, in using non-pharmacological therapies using natural
ingredients, one of which is through the consumption of foods that do not cause
a rapid increase in blood glucose (Franz, 2012).
����������� Consumption of foods with high amylose content (> 25%)
and low GI (<55) can improve insulin sensitivity in people with diabetes
mellitus, reduce the rate of absorption of glucose, and is beneficial in
controlling blood glucose so that it can reduce the risk of complications in
patients with type 2 DM (CARELLA, n.d.). Breadfruit (Artocarpus
communis) is a local plant whose distribution is very wide and evenly
distributed in tropical climates, including Indonesia (Masita et al., 2017). Breadfruit is an important
commodity because of its high productivity (Omobuwajo, 2003). Nonetheless, the use of
breadfruit is still limited due to difficult storage problems in fresh fruit
form (Pratiwi, 2013). So far, breadfruit has not
been used properly, only limited to being used traditionally, namely by
boiling, frying, or making chips.
����������� Breadfruit flour is gluten-free flour produced from
naturally cultivated breadfruit. This flour contains high calcium and fiber and
is suitable as a substitute for wheat flour. This flour can be used to make
pastries, cakes, brownies, and market snacks (Sukandar et al., 2014). Breadfruit has a GI of
around 23-60, which means that breadfruit is safe for consumption. The glycemic
index (GI) of food is influenced by the amount of amylose (Prahandoko et al., 2013).
����������� Amylose is a straight chain polymer of glucose connected
by α-(1,4)-glycosidic bonds. Amylopectin is a simple, branched, open
structure sugar polymer(Santos et al., 2016). The higher amylose content
causes slower digestion because amylose is a glucose polymer that has an
unbranched structure a more crystalline structure with more extensive hydrogen
bonds). Amylose also has stronger hydrogen bonds than amylopectin, making it
more difficult to be hydrolyzed by digestive enzymes (Behall & Hallfrisch, 2002). The purpose of this study
was to determine the provision of breadfruit flour as feed to decrease blood
sugar levels in mice.
METHODS
The method used in this study
is the mixed methods. Mixed methods are research methods that combine
quantitative methods with qualitative methods to be used together in a research
activity, so that more comprehensive, valid, reliable and objective data are
obtained.
In this study, quantitative
data played a role in obtaining measurable data that was descriptive,
comparative, and associative. Qualitative data plays a role in proving,
deepening, expanding, weakening, and aborting quantitative data that has been
obtained.
The type of research used in
this study is with observational analytics with a cross-sectional design. This
study compares independent variables with dependent variables at the same time
which aims to determine the relationship between independent variables
(completeness of medical records and conformity of diagnosis codes with ICD 10)
with dependent variables (approval of BPJS claims).
����������� Based on the concept of variable thinking as stated
above, the variable mindset studied is compiled as follows: Location and Time
of Research This research was carried out in the Medical Record Management
section of Citama Hospital. The implementation time of this study is July 2022
� August 2022. C. Population and Research Samples The population in this study
is the entire inpatient medical record file of the BPJS patient inpatient care
unit in January 2022-May 2022 at Citama Hospital which was returned by the BPJS
verifier. The population in this study is the entire inpatient medical record
file of the BPJS patient inpatient care unit which was returned by the BPJS
verifier from January to May 2022 at Citama Hospital. Data Collection of data
taken both qualitative data and quantitative data will support each other. In
this study, data collection used several ways, namely: a) Questionnaire, which
is data collection using questions asked to respondents. Scale using the Likert
scale. b) Interview, is a meeting of two people to exchange information and
ideas through question and answer, so that meaning can be constructed in a
particular topic. c) Documentation, a method of collecting data obtained by
viewing or analyzing documents created by the subject himself or others on the
subject.
In this study, a quantitative
approach was used. Research with a quantitative approach emphasizes its
analysis on numerical data (numbers) processed with statistical methods.
Basically, a quantitative approach is carried out on inferential research (in
order to test the hypothesis) and leans the conclusions of the results on a
probability of error in the rejection of the hypothesis nil. With quantitative
methods, it will obtain the results of the significance of group differences or
relationships between the variables studied. In general, quantitative research
is a large sample research.
RESULTS
Reducing Sugar Levels
The test results for reducing sugar levels in breadfruit flour are presented in Table 1.
Table 1. Standard absorbance
|
Const. Standard (ppm) |
Absorbance |
|
20 |
0,006 |
|
40 |
0,017 |
|
60 |
0,025 |
|
80 |
0,032 |
|
100 |
0,046 |
Based on the
results in Table 1, a standard calibration curve of reducing sugar is obtained
as shown in Figure 1.
Figure 1. Standard reducing
sugar calibration curve
_files/image002.gif)
From Figure 1 it can be seen that the regression equation of the
calibration curve with the regression equation y = 0.0005x + 0.0033 with a
correlation coefficient R2 = 0.9866. The R value obtained in this
study is close to 1, which means there is a correlation between absorbance and
concentration. From the calibration curve, the reducing sugar content of
breadfruit flour can be calculated. The calculation results obtained reducing
sugar content of breadfruit flour of 3.26%. From these results it can be seen
that the reducing sugar content in breadfruit flour is very low so that breadfruit
is very safe for consumption by the public, especially those suffering from
diabetes mellitus.
Amylose Levels
Test results for
amylose levels in breadfruit flour are presented in Table 2.
Table 2. Test results for
amylose content of standard solutions
|
Const. Standard (ppm) |
Absorbance |
|
100 ppm |
0,115 |
|
200 ppm |
0,176 |
|
400 ppm |
0,218 |
|
600 ppm |
0,302 |
|
Starch standard |
0,352 |
|
Breadfruit flour
sample |
0,152 |
����������� Based on the results in Table 2, the
amylose standard calibration curve is obtained as shown in Figure 2.
Figure 2. Standard amylose
calibration curve
_files/image004.gif)
From Figure 2 it can be seen that the regression equation of the
calibration curve with the regression equation y = 0.0003x + 0.0094 with a
correlation coefficient R2 = 0.9835. The R value is close to 1 which means
there is a correlation between absorbance and concentration. From the
calibration curve, it is possible to calculate the reducing sugar content of
breadfruit flour and obtain a reducing sugar content of 19.3%. The amylose
content in breadfruit flour is still relatively low when compared to the
amylose content in several other food ingredients. Comparison of starch content
in several food ingredients is presented in Table 3.
Table 3. Comparison of amylose
content in several food ingredients
|
Type of food ingredient |
Amylose content (%) |
|
Mango |
20,0 |
|
Banana flour |
93,50 |
|
Purple sweet potato |
19,61 |
|
Sweet potato paste |
35,64 |
|
Breadfruit flour |
19,3 |
Based on the results in Table 3 it can be seen that the amylose content
in breadfruit flour is almost the same as in purple sweet potato. The low
amylose content found in this study indicates that breadfruit flour is very
good and safe for consumption by people with diabetes mellitus.
Blood Sugar
Levels
The results of
tests on blood sugar levels (KGD) in the normal control group (KN), the
negative control group (K-), the positive control group (K+), and the
STZ-induced group of mice and were given breadfruit flour can be seen in Table
4.
Table 4. Results of KGD
measurements
|
Treatment |
Blood Sugar Level
(mg/dl) � SD |
|||
|
Day 0 |
Day 3 |
Day 10 |
||
|
KN |
97,00� 21,93 |
98,00 + 12,67 |
103 � 13,53a |
|
|
K (-) |
120,00�15,71 |
183,00�3,61 |
277,67�10,51b |
|
|
K (+) |
110,67�9,29 |
288,67�17,95 |
91,33 � 9,45c |
|
|
P1 |
123,33�43,29 |
206,67�5,86 |
116,33 � 3,51c |
|
|
P2 |
115,67�24,83 |
255,33�15,70 |
96,00 � 18,36c |
|
|
Total |
113,33�23,73 |
186,73�104,32 |
136,87�74,10 |
|
Description : Superscripts with the same letters are not
significantly different (P > 0.05).
Based on the results in Table 4, it shows that the average of the normal
mice group glucose at the first measurement was 97.00 � 21.93 mg/dl, the
average of the K(-) group was 120.00 � 15.71 mg/dl, the K (+) group averaged
KGD of 110.67 � 9.29 mg/dl and the P1 and P2 groups respectively 123.33 � 43.29
and 115.67 � 24.83 mg/dl. In the K(-), K(+), P1 and P2 groups, they were
induced with STZ and checked the KGD on day 3 after induction and the
measurement results showed that the K(-) KGD group had an increase of 183.00 �
3.61 mg /dl, in the K(+) group of KGD it was 288.67 � 17.95 mg/dl, in P1 KGD it
was 206.67 � 5.86 mg/dl and in P2 it was 255.33 � 15.70 mg/dl. After that, the
K(+) group was given metformin, P1 was given 5 g of breadfruit flour and P2 was
given 10 g.
On the 10th day of measurement, the KGD in KN was 103 � 13.53 mg/dl, K(-)
was 277.67 � 10.51 mg/dl, K(+) was 91.33 � 9.45 mg/dl , P1 was 116.33 � 3.51
mg/dl and P2 was 96.00 � 18.36 mg/dl. The results showed that the treatment of
breadfruit flour could affect the decrease in STZ-induced KGD in mice. The
results in Table 6 can be seen in Figure 3.
Figure 3. Histogram of Average
Blood Sugar Levels
_files/image006.gif)
�����������
Based on the results of the Analysis of Variance (ANOVA) using the SPSS
16 program, it was shown that breadfruit flour treatment had an effect on
reducing blood sugar levels in mice with diabetes mellitus (sig <0.05) where
the calculated F value was 126.316 with an F probability of 0.000. The results
of further tests using the Least Significant Difference Test (LSD) at a
significant level of 0.05% showed that there was a significant effect on the
average blood sugar levels in the KN and K- group of mice but there was no
significant effect between K +, P1 and P2.
DISCUSSION
Reducing Sugar Levels
Based on the results of the study, it can be seen that the reducing sugar
content in breadfruit flour is 3.26%. Reducing sugar levels obtained in this
study were very low. This indicates that the quality of sugar in breadfruit
flour is very good. Who argued that the lower the reducing sugar content, the
better the quality of the sugar, conversely, the higher the reducing sugar
content, the lower the quality of the sugar.
����������� States that reducing
sugars (glucose and fructose) correlate with the amount of sugar and sweetness
in a product. In general, reducing sugars are produced through the process of
breaking down carbohydrates (starch) by the enzyme amylase into sugars. The
sugars produced from this decomposition process are glucose, sucrose and
fructose (Zhang et al.,
2002).
����������� Reducing sugar content
also correlates with the glycemic index (GI) of a food ingredient and product
where low reducing sugar levels often give a less sweet taste to food
ingredients or products indicating a low GI. The GI value of a carbohydrate
food source shows how much blood sugar levels increase after consuming these
carbohydrates which is expressed in the percentage response to a portion of
carbohydrates which is equivalent to a standard reference of 50 g of glucose.
The glycemic index of foodstuffs is divided into three categories: foodstuffs
with a low glycemic index (GI < 55), foodstuffs with a moderate glycemic
index (55 ≤IG ≤70), and foodstuffs with a high glycemic index (GI
> 70) (Pereira et
al., 2014).
����������� Based on the existing
reducing sugar levels, it can be concluded that the GI value of breadfruit
flour is very low, so it is very safe for consumption for people with diabetes
mellitus. Breadfruit has a GI of around 23-60. Also added that breadfruit has a
glycemic index or a number that shows the potential to increase blood glucose
from low carbohydrates so that it can play a role in controlling blood sugar
levels.
Amylose Levels
Amylose is a straight chain polymer of glucose connected by α-(1,4)-glycosidic
bonds. The higher amylose content causes slower digestion because amylose is a
glucose polymer that has an unbranched structure a more crystalline structure
with more extensive hydrogen bonds) (Behall &
Hallfrisch, 2002).
Amylose content is often used to
predict starch digestibility, glycemic index of blood glucose response and
insulin response to rice. Breadfruit flour has a low amylose content which
tends to have low hypoglycemic activity as well. The results of a study which
used 3 types of feed with different levels of amylose (Treatment With High
Amylose Content (TAH); Treatment With Intermediate Amylose Content (TAI);
Treatment With Low Amylose Content (TAL) on digestibility observed in mice
showed that feeds given with high amylose content (TAH) were digested more
slowly. This is indicated by the value of Apparent Starch Digestibility (ASD)
which is lower than TAI and TAL.
Starch granules that contain more amylose have a more crystalline
structure caused by intensive hydrogen bonds. Thus amylose is difficult to
gelatinize and difficult to digest. In addition, amylose is also easy to
combine and crystallize so that it easily undergoes retrogradation which is
difficult to digest (Widowati,
2009).
Blood Sugar
Levels
�In
general, the induction of streptozotocin in mice in this study led to an
increase in blood sugar levels. This can be seen by the high blood sugar levels
in the K-, K+, P1 and P2 groups of mice. There was an increase in blood sugar
levels in the study because streptozotocin was selective, causing damage to
pancreatic � cells (Pathak et
al., 2008). Damage to pancreatic β cells due to
streptozotocin occurs through several processes simultaneously, namely through
the oxidation of sulfidyl groups and the formation of free radicals. The mechanism
of action of streptozotocin results in damage to pancreatic β-cells
primarily attacking cellular compounds containing sulfhydryl groups, amino
acids cysteine and proteins that bind to SH groups (including enzymes
containing SH groups). Streptozotocin reacts with two SH groups that bind to
the sides of proteins or amino acids to form disulfide bonds, thereby
inactivating proteins which result in impaired protein function (Pathak et
al., 2008).
The average blood sugar level in
the K+ group of mice (treated with metformin) was lower than that of P1 and P2.
This is because metformin can lower blood glucose levels where insulin is able
to control post prandial glucose while metformin controls fasting blood glucose
so that blood glucose is controlled at all times. Metformin helps the liver to
be more sensitive to insulin and insulin to work better.
The results in table 4 also show
that in the group of mice that were given breadfruit flour 5 gr (P1) and 10 gr
(P2) there was a decrease in blood sugar levels but it was still higher when
compared to K+. The decrease in blood sugar levels in groups P1 and P2 was due
to breadfruit flour containing very low levels of reducing sugar and amylose. Low
reducing sugar levels can help diabetics limit the consumption of sugar in
their food Sifat Kimia Dan Kesukaan Cookies Yang Disubstitusi Dengan
Tepung Uwi Ungu (Dioscorea Alata L.).
Amylose can slow the absorption of
glucose from the digestive system (small intestine) into the blood. Delaying
the absorption of glucose into the blood results in the rate of rise of blood
glucose being inhibited so as to lower blood glucose levels in the body. In
addition, amylose has an unbranched and compact structure compared to
amylopectin so that it takes longer to digest and the increase in blood glucose
is lower than foods high in amylopectin (Ravika et al., 2022). Showed that the glycemic response decreased
after consuming foods containing 45% amylose and 55% amylopectin compared to
foods containing 100% amylopectin.
CONCLUSION
Reducing sugar and amylose
levels in breadfruit flour are still very low, where the reducing sugar content
in breadfruit tubing is 3.26% and the amylose content in breadfruit flour is
19.3%. Breadfruit flour can reduce blood sugar levels in mice with diabetes
mellitus. The effective dose of breadfruit flour in lowering blood sugar levels
is 10 g/kg BW.
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