Progress and Inequality in Diabetes Care Cascade in Indonesia: A National Health Survey Analysis (2013–2023)

Background

To examine trends in Indonesia’s diabetes care cascade from 2013 to 2023, identify key determinants, and assess progress toward global targets of 80% diagnosis and 80% glycemic control among those diagnosed.

Methods

We analyzed nationally representative data from Indonesia’s Health Surveys in 2013, 2018, and 2023. Diabetes was defined using fasting plasma glucose and oral glucose tolerance tests. We estimated diagnosis, treatment, and control rates and examined sociodemographic predictors of cascade progression using survey-weighted logistic regression models.

Results

Between 2013 and 2023, the prevalence of diabetes among adults aged ≥15 years remained stable, ranging from 10.7% to 11.8%. Diagnosis increased from 15.1% (95% CI: 13.4–16.7) to 20.7% (18.5–22.9), treatment nearly doubled from 10.5% (9.1–11.9) to 19.0% (16.9–21.2), and control rose modestly from 4.6% (3.6–5.6) to 6.5% (5.2–7.8). Older age, urban residence, higher socioeconomic status, and insurance coverage were associated with greater progression through the cascade. Wealth-related inequalities persisted in 2023: one-third of cases were diagnosed among the richest (35.3% [29.0–41.7]) versus only 11.0% (7.9–14.2%) among the poorest. Compared with the lowest quintile, wealthier individuals had higher odds of diagnosis (AOR 3.55 [2.11–5.98] for diagnosis, 3.59 [2.01– 6.41] for treatment, and 2.24 [1.12–4.51] for control).

Conclusions

Indonesia achieved meaningful improvements in the diabetes care cascade over the past decade, yet remains far below global 80/80 targets, with nearly 80% of cases undiagnosed and control below 10%. Persistent wealth-based inequities highlight that near-universal insurance coverage has not been translated into equitable care access, underscoring the need for equity-focused screening and primary care strengthening.

Twitter Summary

Indonesia has improved diabetes diagnosis and treatment since 2013, but glycemic control remains low and unequal, especially by wealth and rurality. Targeted screening + quality care are urgently needed.

ARTICLE HIGHLIGHTS

• Why did we undertake this study?

  We aimed to evaluate Indonesia’s progress in diabetes management from 2013 to 2023 and to identify sociodemographic inequalities affecting the care cascade, in line with global 80-80 targets.

• What is the specific question(s) we wanted to answer?

  We asked how diagnosis, treatment, and control rates changed over time and which factors including age, residence, socioeconomic status, and insurance—predict better cascade progression.

• What did we find?

  Diabetes prevalence remained stable at 10–12%. Diagnosis rose from 15% to 21%, treatment nearly doubled, but control increased only slightly. About 80% of adults remained undiagnosed, with pronounced wealth-related disparities.

• What are the implications of our findings?

  Findings highlight diagnosis as the main bottleneck and call for equity-focused strategies, stronger primary care, and expanded screening and insurance coverage.