Despite Omicron's perceived milder symptoms, some 4,200 people nationwide have died since the Omicron-fueled wave struck Indonesia in early January, with some 46 percent having underlying medical conditions, according to Coordinating Maritime Affairs and Investment Minister Luhut Panjaitan.

"On average, patients with comorbidities died only five days after being treated at a hospital. We found that diabetes is the most prevalent underlying health condition among [these patients]," Luhut, who leads the COVID-19 response in Java and Bali, said recently.

Various foreign studies suggest that diabetes has caused an increased fatality rate among COVID-19 patients.

The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study conducted in France last year found that some 20 percent of patients with diabetes who were hospitalized for COVID-19 died within 28 days of admission, while a study by the United States' Centers for Disease Control and Prevention (CDC) showed that 40 percent or more of the people who died with COVID-19 in the early days of the pandemic also had diabetes.

A 2021 World Health Organization report, analyzing COVID-19 data from 13 countries in Africa, revealed that the fatality rate among people with diabetes was twice as high as the fatality rate among patients suffering any other comorbidities.

Soebagijo Adi Soelistijo, an endocrinologist from the Indonesian Society of Internal Medicine (PAPDI), said COVID-19 fatalities could be seven times higher among those with diabetes than those who did not have the disease.

"People with diabetes are more prone to contracting COVID-19, more likely to develop severe symptoms and die if infected, and more likely to develop post-COVID-19 conditions after they recover," Soebagijo said on Thursday.

He explained that diabetic people were more susceptible to developing infections, including COVID-19, because high blood sugar levels can weaken the patient's immune system. People with uncontrolled diabetes, he said, also produced lots of inflammation-inducing cytokine cells that might worsen with coronavirus infections, leading to a life threatening condition called "cytokine storm".

Diabetics are also more prone to blood clotting, a condition that could be exacerbated by COVID-19. Over time, diabetes also damages and degrades the function of major organs, including the lungs, the main organ affected by the coronavirus.

Growing problem

Indonesia is believed to have seen an exponential surge of diabetes prevalence among its population in the past few years, with experts attributing the phenomenon to a growing societal shift toward sedentary lifestyles and unhealthy diets.

According to the 2021 estimation report from the International Diabetes Federation (IDF), 19.5 million adults in Indonesia have diabetes, making it the country with the fifth-highest number of people with diabetes globally.

The figure increased almost twofold from 2019 and threefold from 2011, when Indonesia was estimated to have around 10.7 million and 7.3 million diabetic people respectively.

The report suggested that diabetes prevalence among people aged 20-79 years old in Indonesia was around 10.8 percent – meaning that one in 10 adults in the country suffers from the chronic disease.

Making matters worse, the IDF estimated that 74 percent of the 19.5 million Indonesian adults with diabetes, or 14.3 million people, are currently undiagnosed and untreated. 

PAPDI's Soebagijo said a lot of people only found out they had diabetes when they were hospitalized as a result of COVID-19 and since the noncommunicable disease was untreated, it significantly increased their risk of severe illness and death from the coronavirus infection.

Health Ministry official Siti Nadia Tarmizi said vaccination remained key to reducing the risk of death among COVID-19 patients with diabetes and other comorbidities.

"To prevent deaths, we advise people with comorbidities not to self-isolate if they catch the virus. But if they decide to go into home isolation, medical professionals will constantly monitor their condition,” she said on Monday.

Nadia said the government also was continuing to carry out various efforts to diagnose noncommunicable diseases among the public as early as possible, including through integrated health service posts for the elderly (Posyandu Lansia), as well as by offering free blood glucose tests.

Pandemic challenges

Sony Wibisono, an endocrinologist and the head of the Indonesia Diabetes Federation (PERSADIA), said that even among diabetes patients who did not contract the coronavirus, the pandemic had brought another layer of challenge to their lives.

"People with diabetes are afraid of seeking care at hospitals over fear of COVID-19 infection. Diabetes education classes and patient support groups are also temporarily stopped. During the pandemic, many patients could no longer get their medications and their regular blood checks, causing their condition to get out of control," he said.

Soebagijo of PAPDI also concurred, saying that although telemedicine had helped to fill the void, the service was only accessible to higher income diabetes patients as it was not yet covered by many private and national health insurance plans.