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Background Based on Basic Health Research (RISKESDAS) conducted by Ministry of Health, Indonesia, prediabetes prevalence tends to increase from 2007 until 2018. The numbers are relatively higher in rural than those in urban area despite of small discrepancies between the two (~ 2–4%). The purpose of this study was to identify urban-rural differences in potential determinants for prediabetes in Indonesia. Methods This analysis used secondary data collected from nationwide Health Survey in 2018. Respondents were aged ≥15 years who met inclusion criteria of analysis with no history of diabetes mellitus. Prediabetes criteria followed American Diabetes Association 2019. Multiple logistic regression was also employed to assess the transition probability of potential determinants for prediabetes in urban and rural Indonesia. Results Up to 44.8% of rural respondents were prediabetics versus their urban counterparts at 34.9%, yet non-response bias was observed in the two. Young adults aged 30 years were already at risk of prediabetes. Urban-rural distinction for marital status and triglyceride level was observed while other determinants tended to overlap across residence. Several modifiable factors might contribute differently in both population with careful interpretation. Conclusions The minimum age limit for early prediabetes screening may start from 30 years old in Indonesia. Urban-rural distinction for marital status and triglyceride level was observed, yet non-response bias between the two groups could not be excluded. A proper model for early prediabetes screening need to be developed from a cohort study with adequate sample size.

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BackgroundThe prevalence of diabetes mellitus is increasing in Indonesia due to population growth, urbanization, and lifestyle. Diabetes mellitus (DM) is the leading cause of chronic kidney disease that escalates mortality rate, but not all DM develop into chronic kidney disease.AimsTo estimate the prevalence of kidney dysfunction (KD) in DM and the associated dominant risk factors among productive age Indonesian based on the National Health Survey (Riskesdas) 2013.MethodsThe statistical data consisted of 15,791 females and 10,349 males, aged 20 to 54, who lived in rural and urban areas. The data was obtained from National Institute of Health Research and Development (NIHRD), Ministry of Health. Data were collected from 33 provinces using cross sectional method. The variables data analyzed were sociodemographic, lifestyle, anthropometric, blood pressure, blood lipid, blood glucose, and creatinine. Kidney dysfunction was defined according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Multivariable logistic regression was used to analyze the dominant associated risk factors.ResultsThe prevalence of KD in DM was 4% (CI 95% 3.1–5.1) and only 0.6% had been diagnosed. Many associated risk factors could affect DM leading to KD such as age, sex, rural, economic status, sugary food/drinks, salty food, coffee, hypertension, hypercholesterolemia, low HDL, high LDL, and hypertriglyceridemia. The dominant associated risk factors were age, sex, economic status, sugary food/drinks, and low HDL.ConclusionThe prevalence of KD in DM among productive age Indonesian was 4% and only 0.6% had been diagnosed. Early detection of identification of KD in DM is needed in order to slow progression and complications. The dominant associated risk factors of KD in DM were age, sex, economic status, sugary food/drinks, and low HDL. Controlling of risk factors in DM should be done in order to prevent diabetic kidney disease.

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Since the establishment of the Healthcare Social Security Agency (BPJS), there has been a low demand of patient demand for traditional medicine (TM) services in health care facilities. This study examined various aspects, situations/conditions and the potential use of TM in health facilities. Secondary sources, such as policies and regulations, and in-depth interviews, became the primary data. Those who in charge of the BPJS program was the key informant. The study focused on informants, particularly either Semarang or Surakarta. This study analysed the data, both descriptively and inductively. The aspects examined were services, the implementation of OT guarantees with BPJS, clinicians' readiness and government supports. The existence of JKN implies the use of OT to decrease dramatically. The health facilities did not fully utilise the presence of special allocation funds (DAK) and capitation arrangements. The list of TM was to contain the choices for preventive, promotive, curative, and palliative efforts either a compliment or an adjuvant. TM services involved in the path of preventive, promotive or curative actions either as an adjuvant, or complement with conventional medicine. TM financing may be from DAK, capitation funds or APBN II; however, these sources did not optimise yet. This condition happened due to the lack of political will from stakeholders, as well as the absence of standard reference for the Traditional Medicine Formulary, especially BPJS enrollment by the future. Therefore, the Ministry of Health RI has to issue a decree for health facilities obliged to provide services with traditional medicines.  Abstrak   Sejak dibentuknya Badan Pengelola Jaminan Sosial (BPJS),terjadi penurunan permintaan pasien atas layanan  obat tradisional di fasilitas pelayanan kesehatan (fasyankes). Tujuan  menganalisis berbagai aspek, situasi /kondisipemanfaatan obat tradisional dalam pelayanan di fasyankes. Mengkaji peraturan perundang-undangan dan kebijakan terkait pemanfaatan obat tradisional di fasyankes,dan melakukan wawancara mendalam dengan nara sumber relevan di fasilitas pelayanan kesehatan dan dinas kesehatan terpilih (Kota Surakarta dan Semarang). Analisis dilakukan secara deskriptif dan induktif. Terdapat lebih  dari 20 peraturan perundang-undangan dan kebijakan terkait pemanfaatanobat tradisional di fasyankes.Aspek yang dikaji adalah pelayanan, implementasi jaminan OT dengan BPJS, kesiapan klinisi dan dukungan pemerintah. Adanya JKN menyebabkan penggunaan  OT mengalami penurunan drastis, adanya pengaturan dana alokasi khusus (DAK) dan kapitasi, tidak dimanfaatkan fasyankes.  Komite medik rumah sakit, puskesmas serta dinas kesehatan membutuhkan adanya daftar obat tradisional yang dapat digunakan di fasyankes yang ditetapkan pemerintah. Daftar obat tradisional  diharapkan berisi pilihan obat tradisional untuk upaya preventif, promotif, kuratif ringan dan paliatif sebagai komplemen maupun sebagai adjuvan. Pelayanan dengan obat tradisional masuk jalur upaya preventif, promotif atau kuratif ringan baik sebagai adjuvant maupun komplemen dengan obat konvensional. Pembiayaan obat tradisional dapat dilakukan dengan DAK, dana Kapita si atau APBN II, namun belum dimanfaatkan. Kondisi ini karena kurangnya political will dari stake holder dan belum adanya acuan standar Formularium Obat Tradisional, terutama jika kemudian hari dapat dijamin oleh BPJS.  Masih dibutuhkan adanya regulasi ketetapan menteri bahwa fasyankes wajib melakukan pelayanan dengan obat tradisional.