The Effect of Red Fragon Fruit toward Blood Glucose Levels

Decreased

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

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

Keywords: Diabetes Melitus, Fasting Blood Glucose Level, Dragon Fruit

Abstract: Diabetes mellitus prevalence continues to increase every year, World Health Organization data says about

346 million people suffer from diabetes and Indonesia is ranked fourth in the number of people with

diabetes in the world. Diets management of DM patients needs to be modified, especially fibre and

antioxidants intake. Dragon fruit can control blood glucose levels so as to prevent complications. The

numbers of respondents were 30 people, the sampling technique with purposive sampling. This research

was quasi-experimental study with non equivalent control group design. From the study results, average

blood glucose levels before treatment 349.73 mg / dl and after 323.27 mg / dl. There is decrease in

glucose levels after consuming dragon fruit juice for 14 days because of its fibre and vitamin C content so

that DM sufferers have decreased glucose levels up to 29 mg / dl.

1 INTRODUCTION

Diabetes mellitus (DM) is a disease whose

prevalence is increasing rapidly every year

throughout the world. DM sufferers in the world in

2000 totalled 171 million people, in 2011 totalled

346 million and it is expected to double in 2030

(Glauber, 2016; WHO, 2015). Indonesia is fourth

ranked that has most DM sufferers in the world.

Sedentary diet and lifestyle are risk factors that

influence the increased prevalence of DM, the shift

in eating patterns towards high-energy, fat and low-

fibre diets trigger an imbalance in nutritional intake

that leads to the development of degenerative

diseases such as DM which is as serious health

problem and difficult to overcome until now

(Widya, et al, 2016). An increasing sufferer’s

number of non-communicable diseases occurs

consistently, it shows that diabetes mellitus is health

problem that needs special attention from various

parties including the government. The health

policies that have been made by Indonesia

Government are listed in the Regulation of Health

Minister of Indonesia Republic Number: 1144 /

Menkes / per / VIII / 2010 concern the Organization

and Administration of Health Ministry, the

government has established Sub-Directorate for

controlling diabetes mellitus and metabolic diseases.

In Indonesia, DM is the main cause of

death which is 2.1% of all deaths (MOH, 2016). One

feature of DM is blood glucose levels that rise above

normal called hyperglycaemia. Uncontrolled glucose

levels cause various complications, including

cardiovascular disease such as coronary heart

disease which is characterized by high levels of

cholesterol and blood lipids (Shrivastava et all,

2016; Farnz et al, 2016: bernaurd, 2016).

Diabetes mellitus is a disease that is mostly

suffered by most Indonesian people. However,

people still perceive diabetes mellitus as elderly

disease or disease that only arises because of

heredity. In fact, anyone can have diabetes mellitus

both young and old because the main factors causing

diabetes mellitus are diet and sedentary lifestyle.

Diabetes mellitus is disorder that occurs

due to the body's lack of the hormone insulin, as a

result glucose continues to circulate in the

bloodstream and it is difficult to penetrate the cell

wall. The absence of glucose entering the cell causes

the cell experience less energy for cellular metabolic

processes.

The reported incidence of pre diabetes

continues to increase. 4-9% of pre diabetes sufferers

will become diabetic every year (PERKENI, 2011).

Based on DM prevalence illustrates the importance

of early prevention for the disease. DM management

is very effective in the early stages before the

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

The Effect of Red Fragon Fruit toward Blood Glucose Levels Decreased.

DOI: 10.5220/0009463600660073

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 66-73

ISBN: 978-989-758-460-2

symptoms of pre diabetes (Sizer, 2008). In

accordance with the criteria of American Diabetic

Association (ADA), pre diabetes is characterized by

fasting blood glucose (FBG) between 100-125 mg /

dL (ADA, 2012). Various efforts to overcome this

disease have been carried out, including by

regulating diet, regular exercise (Malawiq 2012),

oral anti diabetic drugs usage and insulin injections

(Levich 2011). Intensive administration of insulin

requires relatively expensive cost. The synthetic

drugs usage such as sulfonyl and biguanide groups

also cannot reduce glucose concentrations to normal

and restore the normal pattern of glucose

homeostasis permanently.

People/patinets with diabetes mellitus in the long

term will experience complications that can cause

organ damage such as decreased vision, weak heart,

kidney failure, liver damage, and others. Treatment

is usually done by people with diabetes mellitus is

by injection or anti-diabetic chemical drugs, such as

glibenclamide which is a derivative of sulfonylurea.

Glibenclamide works by stimulating insulin

secretion by pancreatic beta cells (Handoko and

Suharto, 2005). However, these methods of

treatment can cause side effects such as nausea,

abdominal discomfort and anorexia (Puspati et al.,

2013) and maintenance of diabetes, taking up huge

funds each year (Sovia et al., 2011).

In dietary settings, DM sufferers are advised

to pay attention to carbohydrate and fibre intake

because it is important in controlling blood glucose

levels. In fact, DM sufferers who have already run

diet program have not been able to control blood

glucose properly so that their daily levels remain

high. The reason is the lack of fruit and vegetable

intake as source of fibre and antioxidants. The

research result in United States showed that fibre

intake of DM sufferers <15 g / day, it is lower than

recommendation of 25 g / day. Based on the

research result that conducted at General Hospital,

Sanglah Denpasar reported their average fibre intake

was only 8.9g / day and according to Malaysian

Medical Faculty division said that dragon fruit

administration as much as 200-300 g / day was able

to reduce blood sugar levels and choleterol type 2 of

DM patients (Wiardiani, 2013; Khalili, 2016).

Increased blood glucose levels can be

controlled with chemical drugs besides food

regulation which also provides an effective effect on

reducing blood glucose levels that are relatively

inexpensive. Red dragon fruit (Hylocereus

Polyrhizus) is one of the best fruits in the functional

food category (Norhayati, 2006), which contains

water-soluble fibre (19 gr) and archaic acid (vitamin

c - 540.27 mg) which plays a role in the human body

to neutralize free radicals. Vitamin C which acts as

an antioxidant can reduce insulin resistance by

increasing endothelial function and reducing

oxidative stress. Based on study proving that

supplementation of vitamin C 1000 mg / day

significantly reduces fasting blood glucose levels

(Afkhami, 2007).

To overcome the above problem, previous

research has been done with the respondent method

divided into two treatments with intervention for 21

days by giving 70 ml of juice, and also with three

treatments for 10 days by giving 250 ml of juice and

two treatments for 11 days by giving juice as much

as 200 ml (Widyastuti, 2015; Wiardiani, 2013,

Roiffatul, 2017). In this study, researchers

collaborated with Karo District Health Office and

researchers proposed management dragon fruit juice

usage with the method of juice administering for 14

days at dose of 200 mg / 250 cc. Dragon fruit can be

blood sugar levels balancer because this fruit

contains variety of antioxidants namely flavonoids,

vitamin E, vitamin C, and beta-carotene which have

the ability to reduce oxidative stress and Reactive

Oxygen Species so that they can cause protective

effects on pancreatic β cells and increase sensitivity

insulin (Lianiwati, 2011).

2 METHOD

This research conducted at Barusjahe Public Health

Center, Barusjahe District, Karo District with

sample of 30 people with fasting blood glucose level

criteria ≥ 126 mg / dl, age> 30 years, did not use

insulin injection and herbal supplements, with

sampling technique used purposive sampling

technique. The research type carried out quasi-

experimental study by using non-equivalent control

group design.

In the dependent variable, blood glucose

levels measured by GCU Easy Touch tool. Diabetes

Mellitus patients are given education about the

benefits of dragon fruit firstly. After being given

education, approval is sought for action to be taken.

Before the patient is checked for blood glucose

levels, the patient advised to fast for 10 hours.

Patients advised to fast starting from 22:00 until

08:00. After fasting, blood glucose levels are

checked firstly, after checking the initial blood

glucose level within 15 minutes given 250 mL of

dragon fruit juice. After giving the intervention, the

blood glucose level is checked again 20 minutes

later. After completing the intervention, the patient

The Effect of Red Fragon Fruit toward Blood Glucose Levels Decreased

is not recommended to eat or drink sweet or high fat

foods because these foods and drinks can increase

blood glucose levels even if it is given the

intervention. So that patients can control their food

patterns, each patient is given a food recall sheet

whose purpose is to find out what foods and drinks

are consumed by the patient during the intervention.

The act of giving this intervention carried out for 14

days. During these 14 days blood glucose level is

controlled before and after the administration of the

intervention, it is expected that during the

intervention the patient does not violate the food

rules recommended by the researcher, if any patient

eats sweet or fatty foods, then the expected results is

not optimal because it cause an increase in blood

glucose levels and the administration of the

intervention considered a failure. After 14 days of

the intervention is checked again and the results

obtained from the first day until the fourteenth day

seen in comparison that the administration of the

dragon fruit has an effect on reducing blood glucose

levels or not.

During the treatment, the portion of juice

consumed was monitored and all complaints

experienced by the sample were recorded. The data

obtained was processed on a computer for univariate

and bivariate analysis. This research used paired-T

test.

Table 1: Concentration of blood sugar at time and fasting

Blood Glucose

Level (mg/dL)

Blood Not

Uncertain

In the time

that (mg/dL)

Plasma

Vena

<110

mg/dL

110-199

mg/dl

>200

mg/Dl

Fasting

(mg/dL)

Plasma

Vena

<100

mg/dL

110-125

mg/dL

>126

mg/dL

Darah

Kapiler

<90

mg/dL

90-99

mg/dL

>110

mg/dL

The intervention was by administering 250 ml

of dragon fruit juice derived from 200 grams of red

dragon that was rendered without sugar with

frequency of 1x / day for 14 days. Dragon fruit juice

is administered directly by the researcher and each

respondent must drink it in front of the researcher

until it runs out. Blood glucose levels are measured

with glucose meter. Before intervene the subject, it

is recommended fasting for 10 hours and then

measuring blood glucose levels and after 15 minutes

checking, it is given dragon fruit juice, after 20

minutes of giving dragon fruit juice is done again

checking blood glucose levels and this intervention

is carried out every day for 14 days.

After completing the intervention, it is

recommended for the patient do not to eat or drink

sweet or high fat foods because these foods and

drinks can increase blood glucose levels even if it is

given the intervention. So that patients can control

their food patterns, each patient is given a food

recall sheet whose purpose is to find out what foods

and drinks are consumed by the patient during the

intervention.

Figure 1: Research conceptual framework

3 RESULTS AND DISCUSSIONS

DM is a metabolic disorder characterized by blood

glucose levels increased due to insulin insufficiency

or resistance. Control of blood glucose levels is very

important to prevent further complications. Giving

therapy that contains fibre, antioxidants and has low

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

glycaemia value is one of the main pillars of DM

control especially DM type 2. One of the fruits that

can be utilized is red dragon fruit. Provision of red

dragon fruit juice in the sample shows good

acceptance. All samples finished the juice according

to the portion which is given because basically they

like the colour and taste of fresh juice of red dragon

fruit.

The amount of 1 gram of dragon fruit contains

50 calories which is the same as one exchange unit

on the exchange list. Dragon fruit consumption is

recommended at least one exchange unit (100 gr) to

two exchange units (200 gr) in one serving that can

be consumed with the lunch menu or as a snack

(Wiardiani, 2014). Juice therapy is given every day

with dose of 250 ml of juice for 14 consecutive days.

The samples number used by researchers were

30 people and they were given the action of

consuming 200 grams of red dragon fruit (250 ml)

for 14 days and the process of consuming the dragon

fruit was carried out for 20 minutes after breakfast

and dinner. Presentation of data includes a

description of the respondent's characteristics, blood

glucose levels before consuming red dragon fruit

(pre-test) and after consuming red dragon fruit (post-

test).

Based on study results, it is noted that the

sample of DM sufferer diagnosed between 4 months

to 2 years. The average age of the sample are 63

years, the majority are male, with an average

educational background of completing elementary

school, with agricultural work.

The analysis results of the average level from

blood glucose levels before consuming red dragon

fruit was 349.73, the median was 359.00 with a

standard deviation of 51.579 and standard error of

9.417, minimum value of 219 and maximum of 420

and the results of an average analysis of blood

glucose levels after consuming the red dragon fruit

was 323.27, the median was 339.00 with standard

deviation of 61.476 and standard error of 11.224,

minimum value of 170 and maximum value of 410.

It can be seen in Table 2 below.

There was a difference between all respondents

after being given red dragon fruit juice therapy, the

highest difference was 49 mg / dl and the lowest

difference was 10 mg / dl.

The most difference is 20 mg / dl that is equal

to 20 mg / dl; this is because each respondent has

different value of glucose levels and activity, some

of the respondents who do regular exercise so that it

looks very significant glucose levels decrease. In

addition, it also because the average respondents

were elderly and local village health center is very

encouraging for elderly gymnastics, thus making the

activities of the elderly with DM more directed and

controlled.

Table 2. Frequency of blood glucose level in diabetes

mellitus patients before and after consuming red dragon

fruit (n = 30).

No Before

Emergency

Nursing

After

Emergency

Nursing

Differe

nce

1 219 170 49

2 225 189 36

3 229 190 39

4 310 269 41

5 315 275 40

6 317 276 41

7 319 276 43

8 328 284 44

9 332 289 43

10 336 290 46

11 342 320 22

12 347 325 22

13 350 330 20

14 354 335 19

15 358 338 20

16 360 340 20

17 369 348 21

18 375 354 21

19 379 355 24

20 385 360 25

21 385 364 21

22 387 367 20

23 388 369 19

24 390 370 20

25 390 375 15

26 391 378 21

27 396 379 17

28 398 385 13

29 398 388 10

30 420 410 10

The average analysis results of blood glucose

levels in diabetes mellitus patients before consuming

red dragon fruit is mean value of 349.73 with

standard deviation of 51.579. The blood glucose

levels of diabetes mellitus patients after consuming

red dragon fruit is mean value of 323.27 with

standard deviation of 61.476.

The value of difference between blood glucose

levels before and after consuming red dragon fruit is

26.467 with standard deviation of 12.019. From the

statistical tests results, the p value = 0,000 was

obtained. Based on the provisions of hypothesis test

that if p (0,000) <α (0.05) then the decision Ho is

The Effect of Red Fragon Fruit toward Blood Glucose Levels Decreased

rejected and Ha is accepted, then it is concluded that

there is significant influence between glucose levels

of diabetes mellitus patients before and after

consuming red dragon fruit.

The results showed that most respondents did

not follow dietary rules because they were not

accustomed to and were not ready to go on a diet in

accordance with the guidelines that had been

prepared previously. Apart from dietary factors, the

average respondent also only did light activities even

though the average job was farming. Approximately

43% of respondents never did physical training due

to busy work, most also have obesity status where

the condition has an impact on inhibiting the work of

insulin so that it can cause many complications.

Giving red dragon fruit juice aims to reduce blood

glucose levels in DM sufferers.

An increase of emergency nursing in patient

can be caused due to mental factors, eating foods

that contain fat, drinks that contain excessive alcohol

and soda, and the age factor that is no longer

productive, including the elderly. DM disease will

not only attack the elderly, in adulthood can also

occur in DM disease, especially patients who are

obese and lack of activities such as sports (Perkeni,

2011).

The results showed that blood glucose level of

the sample was relatively high with an average of

349.73 mg / dl and thereafter 323.27 mg / dl. High

blood glucose indicates a disturbance in

carbohydrate metabolism, where insulin is no longer

able to transport blood glucose to cells due to

interference with the sensitivity of cells to insulin

(Nelms, 2011).

Dragon fruit, especially red dragon fruit,

contains fibre and antioxidants that are beneficial for

diabetics and cardiovascular patients. The content of

dragon fruit fibre especially in the form of pectin has

the ability to slow the absorption of glucose by

increasing the thickness of the intestinal volume

which has the potential to reduce the speed of

diffusion so that glucose levels decrease. Dragon

fruit also contains phytochemicals that function as

antioxidants that can maintain the elasticity of blood

vessels and cell permibiality which will increase

insulin sensitivity so that more blood glucose is

carried by insulin into cells to be metabolized. It has

an impact on reducing blood glucose levels (Nelms,

2011).

The content of vitamin C can also affect blood

sugar levels. Red dragon fruit contains 540.27 mg /

100 g of vitamin C or reaches 6 times from the

requirement. Vitamin C which is very rich in red

dragon fruit functions as an antioxidant can reduce

insulin resistance by increasing endothelial function

and reducing oxidative stress (Chen. Et al, 2016).

Antioxidants are useful in maintaining the elasticity

and permibiality of blood vessels. To increase fibre

intake and antioxidants of DM sufferers, dietary

improvement is needed by adding a formula in the

form of juice therapy whose source of fruits as a

source of fibre-rich foods, especially soluble fibre

can improve blood glucose control (Raihana, 2016).

In addition to vitamin C, dragon fruit also

contains flavonoids which also function to reduce

blood glucose levels. Flavonoid compounds such as

isoflavones can prevent the efficacy of prostate

cancer; reduce the risk of heart disease, diabetes,

kidney and osteoporosis. Decreased blood sugar

levels occur because flavonoids which are

antioxidants can reduce the tension of the mind

which can have an impact on the inhibition of

pancreatic beta cells to increase insulin sensitivity

(Asih, 2012).

The type of antioxidant that plays the most

roles in reducing blood glucose levels namely

flavonoids. The flavonoids content of red dragon

fruit meat is 7.21 ± 0.02 mg CE / 100 gram. The

ability of flavonoids, especially quercetin, is to

inhibit Glucose Transporters 2 (GLUT 2) intestinal

mucosa so that it can reduce glucose absorption. It

causes decrease in absorption of glucose and

fructose from the intestine so that blood glucose

levels fall. Glucose Transporters 2 (GLUT 2) is

thought to be a major glucose transporter in the

intestine under normal conditions (Song 2014 in

Roiffatul, 2017).

The fibre found in red dragon fruit is water

soluble fibre that can be used as hypoglycaemic

therapy. The role of water soluble fibre as

hypoglycaemic therapy is to improve insulin

sensitivity and reduce insulin requirements.

Consumption of fibre in sufficient quantities can

provide metabolic benefits in blood glucose control.

Water-soluble fibre increases food transit time in the

intestine, delays gastric emptying and slows glucose

absorption. If glucose absorption is slow, insulin

secretion will not be excessive so that it will reduce

insulin requirements and insulin sensitivity

increases. Fibre also has the ability to slow the

absorption of glucose and fat by increasing the

viscosity of stool which indirectly decreases the

speed of diffusion so that blood glucose levels, lipid

profiles and cholesterol decrease (Sulstyani, 2012).

The study results are in line with Hadi, et al

research (2016) who examined the effect of

consumption of red dragon fruit on glucose levels in

type 2 DM, showing a decrease in all groups and an

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

amount of 600 g most effective in reducing blood

glucose levels with decrease up to 34, 7% (Hadi. Et

al, 2016).

The same thing was stated by Raihana (2017)

that of dragon fruit pollen administration > 100 g for

1 month did not cause a negative impact on the liver

and kidneys as indicated by normal liver and kidney

function values (Raihana, 2016).

According to Englyst and Englyst (2016), one

determinant of carbohydrates absorption rate is the

degree of polymerization, where only

monosaccharides are absorbed by the small intestine

and circulated through the blood. Therefore, fruit

sugar in the form of glucose and fructose determines

the glycemic response. Raihana et al (2015) and

Khalili (2014) research stated red dragon fruit

contains fibre and antioxidants that are beneficial for

diabetics and cardiovascular patients. Dragon fruit

also contains phytochemicals that function as

antioxidants. Antioxidants can maintain blood vessel

elasticity and cell permiability. Giving red dragon

fruit therapy for 14 days with maximum amount of

200gr can be said to be relatively safe for

consumption. It is evident that during the

administration monitoring every day there were no

complaints, both physical and clinical. The same

thing was stated by Hadi et al (2016) that the red

dragon fruit pollen administration > 100gr for 1

month did not cause a negative impact on the liver

and kidneys.

Giving red dragon fruit juice therapy for 14

days with an amount of 250 ml can be said to be

relatively safe to consume, it can be proven that

during the administration or treatment there were no

physical and clinical complaints found.

The same was stated by Raihana (2016) that

the dragon fruit pollen administration > 100g for 1

month did not cause negative effects on the liver and

kidneys as indicated by the value of liver and kidney

function is still normal.

It shows that diet plays an important role in

maintaining glucose control. Diets should be varied

and integrated with other pillars of DM management

such as regular exercise, health education and drug

administration.

The study results are also in line with

Wiardani's research, 2014 which examined Red

Dragon Fruit Juice Reduce Blood Glucose Levels in

DM Patients who showed that administration of

dragon fruit juice with 200gr of dragon fruit was

more effective in reducing compared with 100 gr

therapies.

4 CONCLUSION

Dragon fruit juice therapy can significantly reduce

blood glucose and cholesterol levels. Decreased

blood glucose levels ranged from 9.1% - 29.1%.

There is a significant difference in the effectiveness

of dragon fruit juice therapy in reducing blood

glucose levels. Dragon fruit juice therapy with 200 g

of dragon fruit is more effective in reducing blood

glucose levels with the highest reduction of 29.1%.

There needs to be consistency in carrying out a

modified diet in DM patients so that blood glucose

levels are controlled.

It needs to be consistency in carrying out a

modified diet in DM patients so that blood glucose

levels are well controlled and there is further

research on red dragon fruit juice administration that

can be modified with fruits or vegetables that are

high in fibre and antioxidants so that respondents are

not saturated in running therapy.

5 SUGGESTIONS

a. For people/patients with diabetes mellitus, the

results of this study are expected to be a media of

information to increase their knowledge and

motivate them to be positive in choosing foods

that are in accordance with the recommended

diabetes mellitus diet and can use red dragon

fruit as one of the accompanying fruits of the

diabetes mellitus diet and the fruit can help to

reduce blood glucose levels.

b. For the community, the results of this study are

expected to make people more able to utilize red

dragon fruit as a natural alternative in reducing

blood glucose levels

c. For further researchers, the results of this study

are expected to be used as a reference for further

research, and it can be used to develop research

related to this research by controlling for factors

that might influence blood glucose levels such as

physical activity, stress, diet, and consumption of

anti-hyperglycemia drugs.

ACKNOWLEDGEMENTS

This research was supported by Health Institute of

Deli Husada, Health Institute of Medistra Lubuk

Pakam, Sembiring General Hospital Foundation, and

Medistra Foundation, Indonesia.

The Effect of Red Fragon Fruit toward Blood Glucose Levels Decreased

REFERENCES

American Diabetic Association. Standards of medical care

in diabetes. 2012. (cited 2014 March 19th).

Afkhami, Mohammad. 2007. Effect of Vitamin C on

blood glucose, serum lipids & serum insulin in type2

diabetes patient. Diabetes Research Center, Shahid

Sadoughi University of Medical Sciences & Health

Services, Yazd, Iran.

Asih, A.R, Ratnasaari K, Swardana B.I. (2012).Isolasi dan

identifikasi senyawa golonganflavonoid dari madu

kelengkeng (Nepheliumlongata L), (Skripsi)

Universitas Udayana.

Bernaud FS, Rodrigues TC. Dietary fiber-adequate intake

and effects on metabolism health. Arq Bras Endocrinol

Metabol. 2016;57:397–405

Bito H, Hamaguchi N, Hirai H, Ogawa K. Safety

evaluation of a newly-developed dietary fiber:

Resistant glucan mixture. J Toxicol Sci. 2016;41:33–

Breneman CB, Tucker L. Dietary fibre consumption and

insulin resistance-the role of body fat and physical

activity.Br J Nutr. 2017

Candalia, M., Lutjohan D, Brinkly L.J.. Beneficial Effect

of High Fiber Intake In Tipe 2 DM, New England

Journal Medicine, 2016. P. 1392 – 1398

Chen H, Karne RJ, Hall G, Campia U, Panza JA, Cannon

RO, et al. High-dose oral vitamin C partially

replenishes vitamin C levels in patients with type 2

diabetes and low vitamin C levels but does not

improve endothelial dysfunction or insulin resistance.

Am Physiol Heart Circ Physiol 2016; 290: Hal 37-45.

Corwin Elozabeth J. Pankreas dan Diabetes Mellitus.

Dalam : Buku Saku Fisiologi, edisi 3. Jakarta: EGC;

2009. Hal 618-629.

Enes P, Martín-Frías M, Álvarez MÁ, Yelmo R, Alonso

M, Barrio R. Achievement of metabolic control goals

set by the American diabetes association and the

international society for pediatric and adolescent

diabetes in pediatric patients with type 1 diabetes from

Spain. Diabetes Res Clin Pract. 2017;107:300–305

Englyst,KN, Potential of an in Vitro Digestion Method for

Predicting Glycemic Response of Foods and

Meals.Jounal List National Library of Medicine

National Institutes of Health. 2016

Franz MJ. Endocrine Disease. In: Hark L, Deen D,

Morrison G, editors. Medical Nutrition and Disease: a

case-based approach. 5th Ed. West Sussex: John

Wiley & Sons; 2016. p. 332–74.

Glauber H, Karnieli E. Preventing type 2 diabetes

mellitus: A call for personalized intervention. Perm J.

2016;17:74–79. doi: 10.7812/TPP/12-143.

Hadi, Abdul N. Marzhalina M., M. H. Khalili.. Effect Of

Red Pittaya Fruti Consumption in Blood Glucose

Level and Lipid Profile in Tipe 2 DM. Borneo Science.

Vl 31. 2016

Hartono A. Terapi Gizi dan Diet Rumah Sakit. Jakarta:

EGC; 2006. Hal 141.

Indonesia. Depkes..Profil Kesehatan Indonesia. Jakarta :

Badan Litbang Kesehatan,2006

Khalili, R., Norhayati, A.H, Rokiah, M.Y., Asmah,. 2016.

Hypocholesterolemic Effect of red. International Food

Research Journal 16 : 431-440 (2016)

Levich BR. 2011. Diabetes management : optimizing roles

for nurses in insulin initiation. J Multidiscip Healthc.

4:15-24.

Lianiwati, V. (2011). Pemberian Ekstrak Buah Naga

Merah Menurunkan Kadar F2 Isoprosta pada Tikus

Putih Jantan yang Diberi Aktivitas Berlebih, Jurnal

Kedokteran UNUD. 8 (17). 45-55.

Malkawi. 2012. Review Article: The effectiveness of

physical activity in preventing type 2 diabetes in high

risk individuals using well-structured interventions: a

systemic review. Journal of Diabetology. 2:1.

Mayo Clinic. Metabolic Syndrome..tersedia dalam

http//www.mayocliic.com diakses tanggal 20 februari

2017

Menteri Kesehatan, RI. (2010). Peraturan Menteri

Kesehatan Republik Indonesia Nomor:

1144/menkes/per/VIII/2010 tentang Organiasi dan

Tata Kerja Kementrian Kesehatan dalam

http://www.ppl.depkes.go.id,

Nelms,M.,Kathryn S.,Karen L.,Sara L.R.. Nutrition

Therapy and Pathophysiology USA.Wadworth.2011

Norhayati, A. H. 2006. “Komposisi Kimia dan Aktivis

Antioksidan Buah Pitaya Merah (Hylocereus Sp.) dan

Kesan atas Paras Glukosa dan Profil Lipid Tikus yang

diaruh Hiperglisemia”. Thesis M. S. Universiti Putra

Malaysia, Serdang.

Nugroho SA. 2010. Hubungan Antara Tingkat Stress

Terhadap Kadar Glukosa Darah Penderita Diabetes

Mellitus di Wilayah Kerja Puskesmas Sukoharjo I

Kabupaten Sukoharjo. Tesis Fakultas Ilmu Kesehatan,

Universitas Muhammadiyah Surakarta.

Perkumpulan Endokrinologi Indonesia. Konsesus

pengelolaan dan pencegahan diabetes mellitus tipe 2 di

Indonesia. Jakarta: PB. PERKENI; 2011.

Puspati NKS., MS Anthara, AAGO Dharmayudha. 2013.

Pertambahan bobot badan tikus diabetes mellitus

dengan pemberian ekstrak etanol buah naga daging

putih. Indonesia Medicus Veterinus 2 (2): 225234.

Raihana, S M. Rokiah.. Hipercholesterolemic of Spray

Dried Pitaya Powder Among Normocholesterolemia

subject. International conference Nutrition and Food

Science. ICBEE 12 (30). 2016

Roiffatul, Ana H. Pengaruh Buah Naga Terhadap Kadar

Glukosa Darah Pasien Diabetes Melitus Tipe IIDi

Puskesmas Temon 1 Kulon Progo Yogyakarta.

Yogyakarta : Universitas ‘Aisyiyah, 2017

Sari, Dkk, 2017. Komposisi Kandungan Gula Buah Naga

Hylocereus Costaricensis. Borneo Journal

Pharmascientech, Vol 01, No. 02

Shrivastava S, Shrivastava P, Ramasamy J, Kinra S,

Bowen L, Lyngdoh T, et al. Role of self-care in

management of diabetes mellitus. J Diabetes Metab

Disord. 2016;12(1):14.

Sizer FS, Whitney E. The Carbohydrates: Sugar, Strach,

Glycogen and fibre. Dalam: Nutrition Concept and

Controversies 11th edition. Canada: Wadsworth;

2008.p.121-38.

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

Sovia R., RR Tjandrawinata, E Setiawati, VA Gunawan, F

Ong, LW Susanto & D Nofiarny. 2011. Ekuivalensi

farmakokinetik dua sediaan kapsul pregabalin 150 mg.

Medicinus 28 (1): 15-23

Sulistyani. . Sehat deng Menu Berserat. Jakarta: Trubus

Agriwijaya. 2012

Suyono S dan Samsisalah Widya karya pangan dan Gizi.

Jakarta : LIPI, 1196

World Health Organization. (2013). Prevalensi Diabetes

Melitus di Indonesia dalam http://www.depkes.go.id,

WHO. (2015). Prevalensi Diabetes Mellitus di Indonesia

dalam http://www.depkes.go.id

Wiardani, Ni Komang. Pola Makan dan Obesitas Sebagai

Faktor Resiko Diabetes Mellitus di RSUP Sanglah

Denpasar (Tesis). Yogyakarta : UGM, 2013.

Widyastuti1, Amalia Nita. Pengaruh Pemberian Jus Buah

Naga Merah (Hylocereus polyrhizus) Terhadap Kadar

Glukosa Darah Puasa Pria Prediabetes. Semarang :

UNDIP, 2015

Wiardani, Ni Komang. Jus Buah Naga Merah

Menurunkan Kadar Glukosa Darah Penderita SMT2.

Yogyakarta : UGM, 2014, Jurnal Skala Husada Vol 11

: 59 – 66

Waspadji S.. Diabetes Melitus : Mekanisme Dasar dan

Pengelolaan yang Rasional dalam Penatalaksanaan

DM Terpadu. Cet 3. Jakarta : RSCM dan FKUI, 2008

The Effect of Red Fragon Fruit toward Blood Glucose Levels Decreased