Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs.

Diabetes Mellitus is one of the biggest health problems in Indonesia but the research on the disease's projection is still limited. This study aimed to make a projection model of prevalence and mortality of diabetes in Indonesia based on risk factors and NCD programs. The study was a quantitative non-experimental study through multiple linear regression models and system dynamics. The baseline projection was created by 2018 data and projections until 2045 involved the dynamization of risk factors and programs, population, and case fatality rate. The model was created from 205 districts data. This study used secondary data from Basic Health Research, BPJS Kesehatan, NCD programs, and Ministry of Health. The prevalence of diabetes in Indonesia is estimated to increase from 9.19% in 2020 (18.69 million cases) to 16.09% in 2045 (40.7 million cases). The prevalence will be lower to 15.68% (39.6 million) if interventions of programs were carried out, and to 9.22% (23.2 million) if the programs were added with prevention of risk factors. The projected number of deaths due to diabetes increases from 433,752 in 2020 to 944,468 in 2045. Deaths due to stroke among diabetes increases from 52,397 to 114,092 in the same period. Deaths from IHD among diabetes increase from 35,351 to 76,974, and deaths from chronic kidney disease among diabetes increase from 29,061 to 63,279. Diabetes prevalence and mortality in Indonesia rise significantly in Indonesia and can be reduced by intervention of several programs and risk factors. This study findings could be source of planning and evaluation of Diabetes prevention and control program at national and provincial level in the future related to risk factors control and program development.

Cardiovascular disease prediction model for Indonesian adult population with prediabetes and diabetes mellitus: The Bogor Cohort study of Noncommunicable Diseases Risk Factors.

BACKGROUND AND AIMS: This study aims to develop a predictive model of cardiovascular events in dysglycemia among the Indonesian adult population. METHODS: This is a retrospective cohort study conducted on subjects over 25 years in the "The Bogor Cohort Study of Noncommunicable Diseases Risk Factors" from 2011 to 2018. Data associated with age, gender, blood pressure, body mass index, waist circumference, blood glucose, cholesterol, smoking habits, family history of cardiovascular disease, and physical activity were obtained. Cardiovascular events in six years were observed; this included coronary heart disease, stroke, or all-cause cardiovascular mortality. Cox proportional hazards regression models were used to determine independent predictors of cardiovascular events. RESULTS: A total of 1085 subjects with prediabetes and diabetes mellitus were included in this study, with 73.5% female. The cumulative incidence of cardiovascular events in six years was 9.7%. Predictors of cardiovascular events were age ≥45 years (HR = 2.737; 95% CI 1.565-4.787) and hypertension (HR = 2.580; 95% CI 1.619-4.112). CONCLUSIONS: Age ≥45 years and hypertension were predictors of cardiovascular events in six years among the adult Indonesian population with prediabetes and diabetes, necessitating targeted intervention among these subjects.

The Role of Butyrate on Monocyte Migration and Inflammation Response in Patient with Type 2 Diabetes Mellitus.

Type 2 Diabetes Mellitus (T2DM) is a very serious global problem. In Indonesia, this disease attacks at the most productive age; consequently, it can reduce economic status and life expectancy. The pathogenesis of T2DM is very closely related to inflammation and macrophage accumulation. However, no anti-inflammatory agent has been proven to play a role in the management of T2DM. Butyrate is a short chain fatty acid produced from resistant starch fermentation in the intestinal lumen. It is able to bind to GPR41 and GPR43 receptors on monocytes, so that it can change the pattern of cytokine expression, activation, migration and cell differentiation. Hence, it is interesting to examine the anti-inflammation effect of butyrate and the effect on monocyte migration. A total of 37 subjects were examined in this study. They were divided into two groups, with and without butyrate treatment. We analyzed two pro-inflammatory cytokines (Tumor Necrosis Factor TNF-α and Interleukin IL-6) and one anti-inflammatory cytokine, IL 10. Monocytes were isolated in type 1 collagen gel for migration testing using the µ-slide chemotaxis IBIDI. Image analysis used ImageJ and Chemotaxis tool software. There was a significant difference in the TNFα/IL 10 ratio between healthy groups and T2DM. Butyrate also appears to suppress TNFα cytokine production and increase IL10 production. It also decreases the accumulation distance of monocyte migration in T2DM.

Correlation of leadership and care coordinator performance among primary care physicians.

PURPOSE: Primary care physicians have to deal with many aspects of the patients' health problem, which needs cooperation with other health professionals or even nonhealth individuals. To achieve effective results, the primary care physicians should have leadership and coordinating skills, especially when dealing with the health challenges in Asia Pacific region. The care coordinator role of primary care physicians is important to create the bridge between population and health. This study aims to determine the correlation between care coordinator performance and leadership factors among primary care physicians. MATERIALS AND METHODS: A cross-sectional study was conducted, and data collection involved a total of 84 primary care physicians who were randomly selected from a total of 44 subdistricts and worked in 40 randomly selected village government-owned primary healthcare facilities in Jakarta. Pearson's correlation, independent t-test, and one-way ANOVA were used to measure the correlation between care coordination and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as the sociodemographics of the physicians and the professional practice factors. Multiple regressions were conducted to determine the most important factors influencing care coordinator performance. RESULTS: Respondents were mainly female (94%) with an average age of 36 years and were mostly medical doctors without any additional postgraduate degrees (95.2%). There was no correlation between care coordinator scores and organizational culture or commitment. There were positive and significant correlations between care coordinator scores and clinical leadership score (r=0.66; P<0.001), transformational leadership score (r=0.54; P<0.001), job satisfaction score (r=0.31; P=0.004), physician's age (r=0.34; P=0.002), length of time since graduation (r=0.30; P=0.005), duration of employment at their health center (r=0.33; P=0.003), training in family medicine (P=0.04), and employment status (P=0.005). The most important factors in care coordinator performance were clinical leadership (r=0.53; P<0.001) and transformational leadership (r=0.23; P=0.03), with the total R 2 being 0.47. CONCLUSION: Clinical leadership and transformational leadership were the most important factors for care coordinator performance. Therefore, the leadership skills of primary care physicians are important to be considered as a certain competency in practice to manage various resources and coordinate with related healthcare providers for controlling patients' illness as well as dealing with the challenges and managing the overall health.

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis.

BACKGROUND: Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health. METHODS: Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data. RESULTS: On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension. CONCLUSIONS: Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.

Non-communicable disease risk factor patterns among mining industry workers in Papua, Indonesia: longitudinal findings from the Cardiovascular Outcomes in a Papuan Population and Estimation of Risk (COPPER) Study.

OBJECTIVES: Non-communicable diseases (NCDs) constitute an increasing slice of the global burden of disease, with the South-East Asia region projected to see the highest increase in NCD-related deaths over the next decade. Mining industry employees may be exposed to various factors potentially elevating their NCD risk. This study aimed to assess the distribution and 5-year longitudinal trends of key metabolic NCD risk factors in a cohort of copper-gold mining company workers in Papua, Indonesia. METHODS: Metabolic indicators of NCD risk were assessed among employees (15 580 at baseline, 6496 prospectively) of a large copper-gold mining operation in Papua, Indonesia, using routinely collected 5-year medical surveillance data. The study cohort comprised individuals aged 18-68 years employed for ≥1 year during 2008-2013. Assessed risk factors were based on repeat measures of cholesterol, blood glucose, blood pressure and body weight, using WHO criteria. RESULTS: Metabolic risk indicator rates were markedly high and increased significantly from baseline through 5-year follow-up (p<0.001). Adjusting for gender and age, longer duration of employment (≥10 years) predicted raised cholesterol (adjusted OR (AOR)=1.13, p=0.003), raised blood pressure (AOR=1.16, p=0.009) and overweight/obesity (AOR=1.14, p=0.001) at baseline; and persistent raised cholesterol (AOR=1.26, p=0.003), and both incident (AOR=1.33, p=0.014) and persistent raised blood glucose (AOR=1.62, p=0.044) at 3-year follow-up. CONCLUSIONS: Individuals employed for longer periods in a mining operations setting in Papua, Indonesia, may face elevated NCD risk through various routes. Workplace health promotion interventions and policies targeting modifiable lifestyle patterns and environmental exposures present an important opportunity to reduce such susceptibilities and mitigate associated health risks.

The pre-diabetic epidemiological study in Depok, West Java.

OBJECTIVE: To recognize the prevalence of impaired fasting glucose level (IFG) and impaired glucose tolerance (IGT) in general population of Depok Area, West Java. METHODS: the study was conducted in a population with age > or = 25 years, in Depok Area, West Java, which was selected by using two stage random sampling. Data were collected by using the Step Wise Approach of WHO. Subjects without previous diabetes history were categorized as diabetes if their fasting blood glucose level > or = 126 mg/dL, and or the 2-hour-after 75 gram glucose load > or = 200 mg/dL. While pre-diabetes was defined as IFG when the fasting blood glucose > or = 100 mg/dL to < 126 mg/dL or IGT when the 2-hour-after 75 gram glucose load level > or = 200 mg/dL (ADA 2003). RESULTS: of 1200 participants, there were 975 participants who fulfilled the invitation and there were 969 eligible participants to be evaluated. Among the participants aged > or = 25 years, there were 40 (4.13%) subjects with isolated IFG and 234 (24.25%) subjects with isolated IGT, 55 subjects (5.68%) with mixed IFG/IGT. CONCLUSION: the prevalence of isolated impaired fasting blood glucose in population with age > or = 25 years is 4.13%; while the prevalence of isolated impaired glucose tolerance is 24.25%. Mixed IFG/IGT is 5.68%. The total prevalence of pre-diabetic patients is 33.96%.