The Effectiveness of Original Honey Treatment toward Diabetic

Foot Infection Wounds Healing

Rentawati Purba, Rostiodertina Girsang,Dewi Tiansa Barus, Nur Mala Sari

Health Institute of DELI HUSADA, Jl.Besar Delitua No 77, Medan

Keywords: Diabetic Foot Infection and Original Honey

Abstract: Diabetes Mellitus (DM) is a group of heterogeneous abnormalities characterized by an increase in blood

glucose levels or hyperglycemia. The impact is very broad which will affect the quality of patient’s life.

One of the most common complications is diabetic foot infection wounds; it is predicted surge up to 14.1

million people with prevalence rate of 6.67% in the adult population. Dysabetic wounds are very easy to

cause complications in the form of infections due to bacterial invasion and the presence of hyperglycemia

being the optimal place for bacterial growth. Honey is believed since the time of ancestors in curing various

diseases, including wound infections. This study aimed to determine the effectiveness of honey treatment

for diabetic foot infection wounds healing. The study design was one group pre-post test with comparison

group. The samples number were 20 respondents with wound care for 50 days, the study results were good

indicators seen from changes in wound diameter from day to day. In this study, the data were analyzed with

Wilcoxon test and the results were 0.001 (p <0.05). Then it showed that original honey usage was more

effective in diabetic foot infection wounds healing. Recommendations from the study results that honey

therapy can be done as one of the replacement therapies to treat wounds caused by diabetic foot infections.

1 INTRODUCTION

Word Health Organization (WHO) 2012 estimates

that the number of people with diabetes mellitus in

Indonesia will increase by two to three times in

2030, coming from 8.4 million to even 21.3 million

people. While Indonesia ranks fourth most DM

sufferers in the world as many as 8.4 million, after

that India reached 31.7 million, China 20.8 million,

and US reached 17.7 million people with diabetic

patients. Diabetic foot due to its complications is the

most common non-traumatic cause. Extremities

under the risk of amputation are more than 15-46

times higher in diabetics than non diabetics.

Complications of foot injuries in diabetic patients

are very difficult to treat and more routine in treating

diabetic foot injuries so as not to expand the diabetic

patient's foot injuries. In the treatment of these

wounds it is better to use Honey because it has been

widely used for the treatment of various types of

infections with many types of wounds such as burns,

venous legs of mixed etiology, diabetic foot ulcers).

While according to RISKESDA report

(2016), the prevalence of diabetes diagnosed by

doctors is 2.1%. The prevalence is higher than

RISKESDA (2007), which is around 1.1%. There

are some provinces that have a higher prevalence

than the national average, namely Central Sulawesi

(3.7%), North Sulawesi (3.6%), South Sulawesi

(3.4%) and East Nusa Tenggara 3.3%. The

prevalence of diabetes tends to be higher in women

than in men and is more common in urban

communities (RI Health Ministry, 2016). Unlike in

Western countries, in Indonesia there are several

studies on the prevalence and factors related to DFU.

The main complications of DM in Indonesia are

neuropathy (13% - 78%), vascular

microcomplications (16% - 53%) and DFU (7.3% -

24%) (Nuwa, 2018).

Diabetes Mellitus (DM) is a group of

heterogeneous abnormalities characterized by an

increase in blood glucose levels or hyperglycemia.

The impact is very broad which will affect the

quality of patients life, especially in patients with

diabetic foot ulcer complications, one of the causes

of this complication occurs due to nerve damage

(neuropathy), in this condition patients can no longer

distinguish between hot temperatures and cold, less

pain. The patient leg who has neuropathy is twice as

likely to develop a diabetic wound. Diabetic foot

Purba, R., Girsang, R., Barus, D. and Sari, N.

The Effectiveness of Original Honey Treatment toward Diabetic Foot Infection Wounds Healing.

DOI: 10.5220/0009462200360042

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 36-42

ISBN: 978-989-758-460-2

ulcers are a major cause of morbidity and disability

in diabetic patients. They often lead to lower limb

amputations especially when associated with

neuropathy and / or ischemia. At the national level,

foot ulceration often occurs, it affects 6.9% of

diabetics throughout their lives, moreover ulceration

is the most common cause of hospitalization and

precedes 80% of amputations of the lower

extremities ( Jeffcoate W, 2017).

Some researchers conducted research by

using diabetic-foot herbs treatment namely original

honey. Wound care used honey because it contains

fructose and glucose which is a type of

monosaccharide sugar that is easily absorbed by the

intestine. Then the way to treat diabetic foot wounds

regularly with honey would be better, from the era

when it was very trusted by the public for various

types of treatment including honey wounds, it was

also easy to obtain besides it was effective in the

wound healing process because of its low water

content, also the PH of the acidic honey and its

content of hydrogen peroxida could kill bacteria and

microorganisms that enter our body. In addition,

honey also contains antibiotics as an antibacterial

and antiseptic to protect the wound from worsening

(Nabhani and Widiyastuti, 2017).

Diabetic foot injury is a serious complication

of diabetes, which can result prolonged

hospitalization and can lead amputation of the lower

limbs in. Research has shown more than 15% of

diabetics suffer from diabetic foot. The annual

incidence of diabetic foot injury is estimated at 25–

80%. The prevalence of diabetic foot injuries

worldwide has been reported to be 4–27%. In

developed countries, more than 5% people with

diabetes suffer from diabetic feet, and 20% health

care resources spent on treating diabetic foot

injuries. In US, the cost of diabetic foot is 7,000-

10,000 USD, and this figure increases by 65,000

USD in complicated cases which require amputation

of what diabetic foot injury, which indicates the high

cost of health care (Karimi, 2019).

Diabetic foot injury is an important factor in

the mortality and disability of diabetics. Despite,

there is much progress in the diagnosis and

treatment of diabetes; diabetic foot problems have

not been resolved. Many patients suffer some degree

of diabetic foot; as result, they are treated with

drugs. After ineffective medical treatment, surgery is

considered for the patient. One of the most

challenging tasks in diabetes foot health care is the

treatment of diabetic foot injuries. One of them is

honey. Honey is used to cure diabetic feet, and its

efficiency and effectiveness have been investigated

by many studies (Karimi, 2019). Honey has been

known for thousands of years which can be used in

the process of wound healing. Honey has

antibacterial characteristics, stimulates the release of

cytokines, and stimulates cell growth, so that the

wound can undergo a healing process (Nuwa, 2018).

Diabetic wounds easily develop into

infections due to the entry of germs or bacteria and

the presence of high blood sugar becomes a strategic

place for germ growth. If the diabetic wound is not

handled properly it will cause disability and even

lead to amputation. Honey has been used as a natural

medicine for healing various diseases since

thousands of years ago. Previous people have been

using honey as a therapeutic treatment for several

millennia and lately it has been rediscovered as a

potential treatment in wound care mentioning that

honey can accelerate the wound healing process.

The study results conducted by Subrahmanyam et al

(2015) about the effectiveness difference of wound

care by using honey and sulphadiazin silver on 21

day, all wounds treated with honey underwent

epithelialization, whereas wounds treated with silver

sulphadiazine only 20% undergo epithelialization

(Nuwa, 2018).

The benefits of honey are curing heartburn,

enhance immunity, for beauty and moisturize the

skin, cure asthma, increase intelligence and memory,

and can also heal wounds quickly and can cure

various other diseases. The research problem is to

find out the effectiveness of original honey treatment

is diabetic foot infection wounds healing. Several

studies have shown that honey has the ability to

repair, protect and prevent infection and make

antibacterial moist healing. In addition honey has a

debriding effect by osmotic action that causes lymph

flow out, remove dead skin tissue from the bottom

of the wound quickly, tissue regeneration, reduce

pain during wound care and reduce edema by anti-

inflammatory action. The same results seen in the

Farouk A et al research mentioned in their study that

many patients had ulcers that did not heal due to

different causes and did not improve with

conventional treatment; the results were good by

giving honey to repair tissue in the wound (El-Nahas

M, 2018).

By using native honey the wound healing

process occurs faster, as evidenced within 2 weeks

of tissue gradation in growing diabetic wounds. in

honey contains a lot of vitamins, acids, minerals, and

enzymes, which are very useful for the body as

traditional treatment, antibodies, and inhibit the

growth of cancer cells or tumors. In addition to

organic acids, honey also contains amino acids that

The Effectiveness of Original Honey Treatment toward Diabetic Foot Infection Wounds Healing

are related in making body proteins (non-essential

amino acids). In addition to non-essential amino

acids there are also essential amino acids including

lysine, histadine, tryptophan, etc. (Fain, A. 2017).

According Saldi's study (2012), the wound

treatment by using 0.9% NaCl liquid to wash the

wound and provide honey dressing to the wound.

The observation results obtained wound healing

process treated with 0.9% NaCl liquid and honey

showed the results of the granulation process is quite

fast, the tissue looks moist, and the pus contained in

the wound dries quickly. Under these conditions, the

researchers are interested in further researching

about the effectiveness of wound cleansing by using

0.9% NaCl liquid and honey is given for the healing

of diabetic wounds. Diabetic patients have poor

blood circulation and lack the ability to fight

infections. Diabetic foot infections can be treated by

systemic antibiotics with long time usage that can

develop drug-resistant organisms toward medicine

and honey in wound treatment that have antibiotic-

resistant bacteria.

Dunford C, et al, (2016), examined the

effectiveness of honey in diabetic foot injuries and

found that on the seventh day of observation, 87% of

patients treated with foot injuries by using honey

showed satisfactory epithelialisation and on the 21

day 92% epithelalization was achieved by wounds

treated using honey. He identifies that time of

diabetic foot wound healing by using honey is more

effective.

To prevent diabetic wounds complications

that last long time and prevent worse, it should be

noted how to treat wounds in diabetics where there

are four principles of diabetic wound management to

optimize the process of healing diabetic foot

wounds, namely: basic preparation of wounds,

wound protection, wound dressing, and wound

oxygenation. The usage of this principle is expected

to be 80%, the problem of diabetic wounds will be

cured, so as to avoid the amputation occurrence (El-

Nahas M, 2018).

2 METHODOLOGY

The population in this study were all patients who

suffered diabetic foot infection wounds of 20

respondents. This study used sampling technique

with total sampling by using quasi-experimental

method with one-group pre-post test approach.

This research used original honey which has

water content less than 18%, gauze, anatomical

tweezers, cirugis tweezers, plaster, nierbeken, NaCl

liquid, and observation sheets. Based on research

conducted on 20 respondents with the provision of

original honey for respondents as much as 3-5 cc,

coupled with wound cleansing by using 0.9% NaCl

liquid, then it is done dressing bandage on the

wound which is applied original honey within period

of 50 days conducted in 1 day treatment for diabetic

foot injury. By inclusion criteria is willing to be

respondents in writing, the foot injuries degree in

grades 1 to 3. The exclusion criteria are not willing

to be respondents, the degree of diabetes foot

injuries in grades 4 and 5.

Figure 1: Research Conceptual Framework.

3 RESEARCH RESULT AND

DISCUSSION

Based on the study results, it is known that the

sample were all DM patients who have diabetic

wounds. For the respondents of characteristics,

based on the age of 40-49 years old and ≥ 60 years

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

old as many as 4 people or about 20%. And the age

of the majority aged 50-59 years old as many as 9

people or about 45% and for minority ages aged 35-

39 years old as many as 3 people or about 15%.

Based on gender characteristics, the majority

were male as many as 16 people or about 80% and

the minority were women as many as 4 people or

about 20%.

Based on Occupation characteristics, the

majority work were farmers as many as 9 people or

around 45% and the minority work were civil

servants as many as 3 people or around 15%. It can

be seen in Table 1 below.

Table 1: Respondent’s characteristics distributon of giving

original honey for diabetic foot injuries based on age, sex,

and occupation

Characteristic N %

Age

35-39 thn 3 15

40-49 thn 4 20

50-59 thn 9 45

>60 thn 4 20

Total 20 100

Gender

Male 16 80

Female 8 40

Total 20 100

Occupation

Entrepreneurship 4 20

Farmer 9 45

Housewife 4 20

Civil Servant 3 15

Total 20 100

Based on univariate analysis on the diabetic

foot injury degree before being given honey to

diabetic foot injuries, the results showed that the

majority of grade 3 injuries were 9 respondents or

around 45.0% and the minority of grade 1 injuries

were 4 respondents or around 20.0%. Based on

univariate analysis on the diabetic foot injury degree

after being given original honey to diabetic foot

injuries, it was found that the majority of grade 2

injuries were 7 respondents or about 35.0%, and the

minority of wound degrees in grades 0 and 3 were 4

people or around 20, 0%. It can be seen in Table 2

below.

Table 2: Respondent’s distribution before and after

original honey administration toward diabetic foot

injuries.

Injuries

Degree

Before After

Subject % Subject %

Grade 0

4 20

Grade 1 4 20

5 25

Grade 2 7 35

7 35

Grade 3 9 45

4 20

Total

20 100

The research results with wound care by using

0.9% NaCl liquid to wash the wound and provide

honey dressing for the wound. The observation

results obtained wound healing process treated with

0.9% NaCl and honey showed the results of the

granulation process is quite fast, the tissue looks

moist, and the pus contained in the wound dries

quickly. Under these conditions, the researchers are

interested in further researching about the

effectiveness of wound cleansing by using 0.9%

NaCl with Honey for Diabetic Wound Healing

(Andriana, 2016).

It is proven by other studies, according to

Faisol's research (2015), the Effectiveness of Giving

Honey on Diabetic Wounds shows that after

treatment, new granulation tissue growth, absence of

inflammatory reactions, and reduced wound depth,

reddish tissue color, and reduced amount of

exudates.

Based on bivariate data, the results of willcoxon

statistics on pre-test were conducted for 20

respondents and obtained a mean of 2.25 and std,

deviation of 0.786, then the post carried out to 20

respondents and obtained a mean of 1.55 and std

deviation of 1.050 then it was obtained p-value of

0.001<α 0.05 then Ho is rejected and Ha is accepted,

which means there is significant influence between

the administration of original honey toward diabetic

foot injuries.

It is also in accordance with Andriana opinion

(2016), which states that honey helps the process of

wound debridement and prevents the scar formation.

Honey also increases the contraction time. If

necrotic tissue around the wound is reduced, the

wound base becomes more aligned indirectly with

the skin around the wound. In addition, tissue

growth gradation and epithelialization cause the

wound base to be lifted so that the wound depth is

reduced.

It is also in accordance with Professor Jennifer

Eddy's theory from the University School of

Medicine and Public Health; honey can kill bacteria

because it is acidic, besides that honey is also

The Effectiveness of Original Honey Treatment toward Diabetic Foot Infection Wounds Healing

effective in avoiding the resistant nature of bacteria

because it has antibiotic content. This chemical fact

has been confirmed by scientists who met at the

World Apculture Conference which was held on

September 20-26, 2015 in China. The conference

discussed treatment using herbs derived from honey.

American scientists say that honey, royal jelly,

pollen, and propolis can be used as traditional

medicine. Poland doctors also stated at the

conference that honey can help heal diabetic foot

injuries (Al-Maskari, 2015).

Wound care using 0.9% NaCl + Original Honey

has many benefits such as being cheaper, easier to

use and can be used in areas that are difficult to

reach and are not toxic to tissue. NaCl 0.9% liquid is

isotonic, which means it has the same properties as

the liquid in the human body. NaCl 0.9% liquid is

more recommended as a wound care fluid when

compared with other fluids such as H2O2, povidone

Iodhine, rivanol and other liquids that are toxic to

tissue. The principle of wound care products is to

maintain the wound environment to remain moist to

facilitate the healing process of the wound, maintain

tissue fluid loss and cell death. A moist wound

environment can accelerate the wound healing

process by helping to eliminate fibrin that is formed

in chronic wounds quickly (fibrinolytic) by

neutrophils and endothelial cells in a humid

atmosphere, reducing the incidence of infections

compared with dry treatment, helping to accelerate

the formation of growth factors which plays a role in

the healing process, and accelerates neutrophil

invasion followed by macrophages, monocytes and

lymphocytes into the injured area (Riani, Handayani,

2017).

Based on Riani, Handayani research (2017) state

that DM patients with diabetic foot injuries receiving

wound care, a significant degree of wound reduction

was obtained by using 0.9% NaCl + Honey. It shows

improvement in wound condition i.e. reduced wound

size, type and amount of necrotic tissue, amount of

exudate in the wound, and increased epithelialization

on the wound surface. In wound care management,

the result from Honey + NaCl 0.9%, the most

frequently encountered part by researchers is the

number of exudates patient that appear to be

diminishing, measurements of tissue granulation

before wound care show that most (80%) patients

have bright red granulation tissue or red flesh

covering 25% of the wound area. While a small

proportion (20%) of other patients have not yet

experienced tissue granulation. Observation and

measurement of tissue granulation after wound care

showed that all (100%) patients had bright red or

flesh-red granulation tissue covering 75% to 100%

of the wound area. Observation on the parameters of

tissue epithelialization before treatment of wounds

has not seen the appearance of tissue

epithelialization in all patients.

Nuwa research, 2018 used original honey,

honey works with its moist nature so that it supports

the growth of granulation tissue and epithelialization

which can support the reduction in wound size.

Lomatull works by reducing edema of the wound, so

that the size of the wound looks smaller. Necrotic

tissue type shows that the majority (8%) of patients

treated with honey do not have necrotic tissue. A

small portion (2%) of patients have necrotic tissue in

the form of non-living white tissue and / or peeling

tissue that is yellowish and non-sticky. Patients

treated with honey do not have necrotic tissue and

only small proportion (2%) of patients have necrotic

tissue with <25% of the wound bed. Researchers

assume that the effects of moisture caused by honey

in necrotic tissue will soften the necrotic tissue so

that necrotic tissue in wounds treated using honey is

easier to do. The parameter of exudates number in

the wound care group using honey is obtained by the

majority of patients do not release the exudate and it

is only small proportion of patients still produced a

small amount of exudate.

Honey that is used certainly has the same content

or composition, namely amino acids, total

carbohydrates, protein, vitamin A, vitamin C,

calcium, iron, sodium (sodium), total fat and

cholesterol, but the differenciate is water

composition in honey. Quoted from The National

Honey Board (2004) in Faisol Al Fady research

(2012) Original honey has a water content of 17.10

grams. Honey quality standards in Indonesia,

especially for commercial purposes, refer to SNI 01-

3545-1994. Maximum water content from honey is

22%, however, laboratory testing must still be

carried out beforehand. The activity of low water

content and with high osmolarity in wound care

agents is believed to be something that can prevent

infection and speed up the wound healing process.

This osmosis process absorbs water from bacteria in

the wound so that it can inhibit the growth of

bacteria due to lack of water and dry the bacteria so

that the bacteria are difficult to grow and eventually

die. Besides the water content contained in honey

will provide moisture to the wound, so that the

wound granulation process grows well (Rahman,

Rahmayani, 2016).

Other content in honey that influences wound

granulation is the presence of iron and sodium

solution (NaCl). The content of iron is able to help

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

the process of red blood cells formation that function

to provide a supply of nutrients and oxygen in the

wound area, so that with this supply it is very helpful

to stimulate the growth of new tissue in diabetic foot

wounds. The sodium content (NaCl) which functions

as a safe isotonic solution to assist in wound care

(Rahman, Rahmayani, 2016).

The difference in the degree of diabetic wounds

before and after honey is given to patients with

diabetic foot injuries is due to the process of honey

content that maintains and keeps the wound

environment moist to facilitate the healing process

of wounds, maintain tissue fluid loss and cell death

so as to accelerate the regeneration of wound

healing. It is influenced by the achievement of good

intensity during the intervention. When the

intervention of honey is conducted in a pleasant

place and atmosphere, it can increase the enthusiasm

and motivation of respondents during the

intervention. Some respondents who did not

experience a reduction in diabetes after an

intervention were affected by the condition of the

wound (extent, depth of the wound, and length of

wound care) and the costs incurred during wound

care. Management of diabetic wounds should be

carried out on a continuous basis which includes

dietary foods that trigger delay in wound healing, so

that no further complications such as amputation

occur, so wound care is a nursing action aimed at

preventing the risk of amputation, an analysis of the

cost effective use of honey will beneficial in wound

care (Al-Maskari, 2015).

Nabhani and Yuli Widiyastuti (2017), treated

diabetic foot wounds using NaCl and natural honey

(water content less than 1896), where if the wound

was treated using both combination, because NaCl

has isotonic properties (safe for used as a clean

wound) and the nature of honey itself can grow good

granulation of tissue, and cause a moist effect (the

wound will experience healing if the conditions

around the wound are moist). To find out whether

honey is used as natural or not and whether the

water content is really below 1896, laboratory tests

must be done first. But in this study, researchers

used original honey and its water content was tested

at 17%. In addition, it is not only honey that affects

wound healing. The size, the depth and the degree of

wound are also important factors in the wound

healing process. The smaller of wound, the

shallower the wound, and the smaller of wound

degree, the healing is faster. Conversely, if the

wound gets bigger, the deeper and the higher of

wound degree, it will take quite long time to make

the wound healing.

It proves that honey is suitable for grade 1 to 3

diabetic foot injuries. But honey can also be used for

wounds that have more than 3 grades. Judging from

the benefits of honey that can attract pus and make

moist wound, honey can also given more than grade

3. For example in grade 3 or 4 diabetes injuries, the

wound has pus and there is a lot of dead tissue as a

result, lack of oxygen in the wound area. Because

the honey benefits can lift dead tissue, so the wound

that has a lot of dead tissue can be removed easily by

professional / expert nurses (surgeons). It is done so

that no errors occur when removing dead tissue,

because if wrong cut will result bleeding in the

wound.

The wound acidification process, on average,

heals wounds very quickly as seen from when the

wound is covered with honey because it can create

moisture that is not affected by the environment.

Honey is effective as a topical therapy because it

contains nurtition which speeds up healing in the

diabetic foot injury. Besides speeding up the wound

healing, honey also helps debridement and prevents

necrotic formation. The effect of honey on wound

healing produces kind of chemical substance for

debridement of damaged and dead tissue (Fain, A.

2017).

According Karimi, 2019, the honey usage in the

treatment of diabetic foot wounds has proven to be

effective. Research conducted on 33 respondents

who were treated with honey, 29 respondents

showed success marked by a good healing process,

and 3 respondents did not show good results because

the client experienced immunodeficiencies. In this

study diabetic foot wound healing was characterized

by wounds becoming cleaner, signs of infection

disappeared, inflammation, swelling, and pain were

quickly reduced, odor was reduced, slough, and

necrotic tissue was reduced, granulation and

epithelialization increased and minimal wound

healing in scars / tissue scar.

4 CONCLUSIONS

Honey is very good as bandage in cases of diabetic

foot injuries, especially in developing countries.

Treatment of diabetic foot wound uses considerable

amount of money and clinically effective pads. More

important, it is very safe because it does not produce

complications (local or systemic), or the emergence

of bacterial resistance. It is very necessary to

improve the general condition of patients to achieve

optimal results. Furthermore, when taking the action

of original honey administration, it must be patient

The Effectiveness of Original Honey Treatment toward Diabetic Foot Infection Wounds Healing

and there is trust between patient and medical staff,

besides that the treatment must be routine and the

patient must be obedient when done by the nurse so

that it will get good results. From the data analysis

results and willcoxon test with 20 respondents

obtained p = 0.001 <α = 0.05, it can be concluded

that there is an influence of original honey usage on

the diabetic foot infection wounds healing.

5 SUGGESTIONS

After the research concludes the research results, the

researchers expect the following advices:

a) For nurses, it is expected to further enhance their

knowledge and be able to apply treatment of

diabetic foot infection wounds given honey

(alternative therapy)

b) It is hoped that further studies can examine

diabetic foot infection wounds to different

degrees using other wound care techniques

REFERENCES

Al-Maskari F, El-Sadig M. Prevalence of Risk Factors for

Diabetic Foot Complications. BMCFam Pract

2015;8:59.

American Diabetic Association. Preventive Foot Care in

Patients with Diabetes. Diabet Care 2015;26:S78–9.

Andersen CA, Roukis TS. The diabetic Foot. Surg Clin

North Am 2017;57:1149–77.

Andriana, 2016. Standar Of Medical Care In Diabetik.

Vol 1, Universitas Pahlawan Tuanku Tambusai.

Arikunto, S 2014, Prosedur Penelitian Suatu Pendekatan

Praktek. Jakarta: Rineka Cipta.

Bryant, R. A., and Nix, D. (2017). Acute and chronic

wounds: current management

Burns, N., and Groove. (2015). The Practice of Nursing

Research-Conduct, Critique

Chandalia, & Shah. (2016). Endocrinology, Metabolism &

Diabetes.(1sted.). Mumbai: Printedby United Printers.

Concepts. (3rded.).USA : Mosby Elsevier.

Dunford C, Cooper R, Molan P, White R. The use of

Honey in Wound Management. Nurs Stand

2016;15(11):63–8

El-Nahas M, Gawish H, Tarshoby M, State O, Boulton A.

The prevalence of risk factors for foot ulceration in

Egyptian diabetic patients. Diabetes Res Clin Pract

2018;25(9):362–6.

Fain, A. (2017). Diabetes mellitus - Medical surgical

nursing. (6thed.). Harcourt India

Faisol .a (2012), Perbedaan Efektivitas Perawatan Luka

Menggunakan Madu Dab Saffatulle terhadap Proses

Penyembuhan Luka DM Diwilayah Kerja Puskes

Rambipuji Jember.

Jeffcoate W. The incidence of amputation in diabetes.

Acta Chir Belg 2017;105:140–4.

Karimi, 2019. Impact Of Olive Oil And Honey On

Healing Of Diabetic Foot: A Randomized Controlled

Trial. Doi: 10.2147/Ccid.S198577.

Kazemi-Khoo N. Successful treatment of diabetic foot

ulcers with low-level laser therapy. Foot

2016;16(4):184–7.

Kozier, B., et. al. (2015). Fundamentals of nursing-

concepts, process and practice. (7thed.). J. B.

Philadelphia: Lippincott company.

Lerrer B, Zinger-Yosovich K, Avrahami B, Gilboa-Garber

N. Honey and Royal Jelly, Like Human Milk,

Abrogate Lectindependent Infection-Preceding

Pseudomonas Aeruginosa Adhesion. ISME J

2017;1(2):149–55.

Montgomery G, David D, Winkel G, Silverstein J,

Bovbjerg D. The Effectiveness Of Adjunctive

Hypnosis With Surgical Patients: A Meta-Analysis.

Anesth Analg 2015;94(6):1639–45.

Nabhani dan Yuli Widiyastuti, (2017). The Effect of

Honey To Provide Gangren Wound Healing on

Mellitus Diabetes Patients. DOI: 10.26576.

Notoadmodjo, S 2012, Metodologi Penelitian Kesehatan,

Jakarta: Rineka Cipta. Philadelphia: W.B. Saunders

Company.

Nuwa, 2018. Effectiveness of Honey in Treatment

Diabetic Foot Ulcer : A Systematic Review. Faculty

Of Nursing, Universitas Airlangga. International

Nursing Conference. https://www.researchgate.net/

publication/324005567

Rahman, Rahmayani, (2016). Efektivitas Penggunaan

Madu terhadap Proses Penyembuhan Luka Di Poli

Kaki Diabetik Rumah Sakit Umum Daerah Ulin

Banjarmasin. STIKES Sari Mulia Banjarmasin. ISSN:

2086-3454.

Reganson-Tennvaill G, Apelqvist J. Cost effective

management of diabetic foot ulcers. A review.

Pharmacoeconomics 2015;12(1):42–53.

Riani, Handayani, (2017). Comparison Of The

Effectiveness Of Modern Moist Wound Healing Care

And Complementer Therapy 0.9% Nacl + Original

Honey On Healing Of Diabetic Foot Weld Degree II.

ISSN 2580-2194

Saldi, 2012. Tissue Management, Inflamation And

Infection Control, Moisture Balance, Epithelial

Advancement. PPNI

Sari, A.S. (2014). Analisa Faktor- Faktor yang

Mempengaruhi Perawatan Diri Pasien Diabetes

Melitus Tipe 2 Di Kecamatan Medan Johor. Skripsi.

Diakeses Pada Tanggal 6 Maret 2016 Dari

Http://Www.Skripsi keperawatan.Com/Analisa-

Faktor-Faktor-Yang Mempengaruhi-Perawatan-Diri-

Pasien-Diabetes-Melitus-Tipe-2-Dikecamatan-Xx/.

Saunders. Kothari, C. R. (1988). Research methodology,

methods and techniques. (2nded.).

Suparni, Ibunda dan Wulandari, Ari. (2012). Herbal

Nusantara: 1001 Ramuan Asli Indonesia. Yogyakarta:

ANDI utilization (4thed.). Philadelphia: W.B.

Saunders Company.

WHO. (2013). Jumlah Penderita Diabetes Mellitus.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology