The Jakarta Post
Diabetes remains a major health issue worldwide, including in Indonesia. This disease affects many major organs and can lead to life-threatening health problems such as heart attacks and stroke. It is the third leading cause of death caused by a preventable disease in the country after stroke and coronary heart disease.
The effects of diabetes on organs are obvious to me as I witnessed how it had severely damaged my late father’s body. His deteriorating condition was apparent when he first suffered a mild stroke.
After the first blow, he faced an array of health issues. He got bacterial infections on his skin more easily and suffered memory loss, even forgetting the names of his own children. He often repeated the same stories. This was when we learned that diabetes may increase the risk of dementia.
One evening in October 2017, my father fell on the bathroom floor in what appeared to be a second mild stroke.
At the hospital it was found that he also had sepsis in the lungs — a condition doctors later identified was the primary cause of his death after a week-long treatment. He died around two weeks before his 69th birthday.
My father’s death was a wake-up call for me to take precautions against organ damage as I was diagnosed with pre-diabetes, perhaps inherited from my father. I started thinking I should do things differently because I was fully aware that this may develop into type 2 diabetes if my high blood glucose is left uncontrolled.
According to the 2018 Basic Health Research (Riskesdas) report, the rate of diabetes mellitus in Indonesia increased 1.6 percent from 6.9 percent in 2013 to 8.5 percent in 2018.
Unhealthy lifestyle habits, such as cigarette smoking, excessive alcohol consumption, lack of physical activities and low intake of high-fiber foods (vegetables and fruits) are highlighted as major causes of the increased prevalence of non-communicable diseases (NCDs), including diabetes.
One finding included rising obesity among adults in Indonesia. Obese people made up 21.8 percent of the population in 2018, up from 14.8 percent in 2013 and 10.5 percent in 2007, according to the report.
The percentage of people who were physically inactive grew to 33.5 percent in 2018 from 26.1 percent in 2013, while 0.8 percent consumed excessive amounts of alcohol in 2018. Highly problematic is the proportion of Indonesians with a low vegetable and fruit intake, with 95.5 of the population categorized as such.
To contain diabetes, a “revolutionary change” is healthy living, according to the Health Ministry’s non-infectious disease prevention and control director, Cut Putri Arianie. “Don’t eat too many sugary foods, stop being lazy and work out, eat more fruits and veggies, and keep the waist circumference at 90 centimeters for men and 80 cm for women,” she said.
On 2018 World Diabetes Day last November, the Health Ministry called on the public to be more aware of the early symptoms of diabetes. This is because in some people, insulin disorders are present starting at birth. Routine medical checkups, especially blood glucose tests — one of six components of the ministry’s diabetes awareness slogan called “CERDIK” — are necessary.
The five other components are to stop smoking, get routine exercise, have a balanced diet, take enough rest breaks and manage stress effectively.
Early diagnosis and treatment of diabetes and hypertension is prioritized in the government’s 2014-2019 National Medium-Term Development Plan.
The People’s Healthy Lifestyle Movement (Germas), a community-based healthy living campaign launched in 2016, is among interventions that were developed to help in diabetes prevention and healthy living. The government has also prepared health facilities and encouraged early diagnosis and treatment at the primary care level.
However, without adequate resources and strategies, these programs are unlikely to produce optimal results in fighting diabetes and other NCDs.
Each year, 41 million people die of NCDs such as diabetes, cancer and heart disease, or over 70 percent of all deaths globally. The World Health Organization says this includes 15 million people who die prematurely at ages between 30 and 69, with over 85 percent of them living in low- and middle-income countries.
The number of people living with diabetes has increased fourfold over the last four decades, reaching over 400 million globally. Currently, almost one in three living diabetes patients lives in East Asia and the Pacific region. That includes Indonesia.
The World Bank has estimated that globally, about US$727 billion, or 12 percent of the total health expenditures, are estimated to be spent on diabetes alone. The global economic burden of diabetes is estimated at $1.3 trillion, or 1.8 percent of the global gross domestic product, about 35 percent of which is related to production losses, another recent study indicates.
“These numbers are bound to increase significantly given the projected increase of healthcare costs in almost all countries due to ageing, increases in NCD burdens and healthcare cost inflation,” World Bank health, nutrition and population sector manager Enis Baris told The Jakarta Post recently.
Unlike infectious disease eradication that needs disease-specific programs, Baris said combating NCDs that are driven by lifestyle requires comprehensive and integrated approaches to health promotion, prevention and care that span across disciplines and levels of care, with increased financial sustainability.
A recent study by the World Bank revealed that Puskesmas (community health centers) are more ready to address and treat diabetes than private primary care clinics. The study also pushes for urgent improvement in detection and management as only 3 percent of Puskesmas and 1 percent of private facilities were deemed to have had all readiness criteria met.
“Investment in diabetes prevention, early detection and proper care management at the Puskesmas level makes a lot of sense, not only because they are closer to the citizens and patients, but also it would be more efficient to manage an uncomplicated form of diabetes at that level for longer term financial sustainability under the national health insurance [JKN],” Baris said.
Sitting at the heart of the fight against diabetes, it is very understandable to say that the JKN should have expanded coverage and primary healthcare facilities should better promote healthy living and physical activity.
If we want to protect ourselves from NCDs, lifestyle changes are a must. We need only ask ourselves: Have we exercised for 30 minutes today? Have we reminded our families not to smoke? Have we reduced our salt, sugar and fat consumption today? Health starts from within.
The author is a staff writer at The Jakarta Post