Lifestyle and clinical risk factors in relation with the prevalence of diabetes in the Indonesian urban and rural populations: The 2018 Indonesian Basic Health Survey.

Aims: To investigate the differences between Indonesian urban and rural populations in the association of lifestyle and clinical factors with diabetes prevalence. Methods: Using database of the 2018 Indonesian Basic Health Survey, which was conducted in April-May 2018, non-pregnant respondents aged ≥15 years old with available blood glucose data (n urban = 17,129, n rural = 16,585) were included in this study. The diagnosis of diabetes was based on the combination of known diabetes, i.e., a previous history of diabetes or use of anti-diabetes medication, and unknown diabetes based on blood glucose criteria. We performed logistic regression analyses separately for the urban and rural populations to examine the association of lifestyle and clinical factors with prevalent diabetes. Results: Indonesian urban population was less physically active, had a lower proportion of adequate fruit and vegetable intake, and had higher individuals with obesity than rural population. Although there were no differences in the total prevalence of diabetes between the two populations (10.9 % vs. 11.0 %, for urban and rural, respectively), the prevalence of known diabetes was twice higher in urban than in rural population (3.8 % vs. 1.9 %). Physical activity was associated with lower risk of diabetes, especially in the urban population [prevalence OR (95 %CI): 0.91 (0.85; 0.98) for urban and 0.94 (0.89; 1.00) for rural). Obesity, hypertension, and dyslipidemia were risk factors for prevalent diabetes in both populations. Conclusions: Indonesian rural population showed relatively better lifestyle and clinical profiles compared to their urban counterparts. However, no differences were observed between the two populations in the relation between risk factors and diabetes. Special attention needs to be addressed to the high prevalence of undiagnosed and untreated diabetes in Indonesia.

Strategy of insulin intensification after basal failure for type 2 diabetes in the outpatient setting.

Type 2 diabetes has become a worldwide pandemic and the problem continues to grow. As the disease progresses, the majority of patients will require insulin therapy within 6 years of diagnosis. During the therapy, evaluation and intensification of the current treatment is required in order to achieve the good glycaemic state. In patients who are taking basal insulin or premix OD but failing to achieve the recommended glycaemic targets of HbA1c <6.5%-7%, one option is to intensify to a modern premixed insulin BID or TID. Its formulations have both basal and short or rapid-acting insulin capabilities, enabling them to cover both fasting and postprandial blood glucose levels. Other strategy is known as basal-plus method, basal plus 1 and then basal plus 2. This strategy is used by adding OD short-acting or rapid-acting insulin (analog) before having largest portion meal or before meal when blood glucose before the next meal is high. It is very important for clinicians to have the capability of choosing the right regimen based on individual's need and applying the right strategy to intensify the insulin therapy for their patients.