The Unmet Need and Diabetes

Management
in Primary Health Care System
Pradana Soewondo
Diabetes and Lipid Center,
Department of Internal Medicine
Faculty of Medicine University of IndonesiaCipto Mangunkusumo National Referral Hospital
Jakarta, Indonesia

Agenda
Introduction
Results of IDMPS
Indonesia
Perkeni Guidelines and
Awareness Survey
Prolanis T2DM
Conclusion

of
Type 2 Diabetes in Indonesia

Population : 230 million

GDP/capita +3000 USD

Known DM

Undiagnosed DM

Total DM

IGT

1,5 %

4,2 %

5,7 %

10,2 %

National Health Survey 2007

24.417 subjects, >15 years old, from 33 provinces in Indonesia.

List of South East Asia Countries with The

Estimated Cases of Diabetes (WHO)
2010
Country

1. Indonesia
2. Thailand
3. The Philippine
4. Malaysia
5. Vietnam
6. Myanmar
7. Singapore
8. Cambodia
9. Lao Peoples
Democratic
Republic
10.Brunei
11.Timor Leste

2030
Number

Number

Country
(age 20
79)
6.963.50 1. Indonesia
0 2. Thailand

(age 20
79)
11.980.0
00

3.
4.
5.
6.
7.
8.
9.

The Philippine
4.956.200
Malaysia
6.163.800
Vietnam
3.244.500
Myanmar
3.414.900
Singapore
1.754.900
Cambodia
742.000
Lao Peoples
724.200
Democratic
301.500
Republic
28.200 10.Brunai
53.500
16.300 11.Timor Leste
Atlas IDF,33.500
2010

3.538.000
3.398.200
1.846.000
1.646.600
921.800
436.600
354.000
143.300

Ideal Intervention Would Directly Address Key

Elements Of Disease Progression

IDMPS
Indonesia
715 DM patients
686 met inclusion/exclusion
criteria
12 T1DM and 674 T2DM
Location : 85% urban vs 15%

rural
Age : mean 55.16 (SD 10.20)
years
BMI
Sex : female
54.6% vs male
52.6
60
50 45.4%
34.3
40
30

BMI : mean 24.78 (SD 4.02)

20
8.6
3.5 2
10
1.1
kg/m
0
<18.5

18.5-25

25-30

30-35

>35

90

76.7

80
70
60
50
40
30

16.8

20
10

6.4
0.1

<40 40-65 65-85 >85

Age Group

IDMPS Indonesia

40.6

HbA1c
Measurement

59.4
A1c Measurements
No A1cMeasurements

OGLD
HbA1c
OGLD Insulin
+
Group
Insulin
<7%
14.3
32.9
15.8
HbA1c
8.49
8.12
8.58
Mean (SD) (1.42) (2.12)
(2.61)

Diet +
Exerci Total
se
44.4
30.5
7.04
8.27
(1.18) (2.19)
IDMPS Indonesia

Comorbidities and
Complications Type 2
Variable
Hypertension
Yes with treatment
Yes but no treatment
No hypertension
Dislipidemia
Yes with treatment
Yes but no treatment
No dislipidemia
Late complication
At least one
No complication

Lifestyle

OGLD

Insulin +

Total

8 (38.1)
0
13 (61.9)

230 (44.2)
17 (3.3)
273 (52.5)

59 (45.4)
5 (3.8)
66 (50.8)

297 (44.3)
22 (3.3)
352 (52.5)

8 (40.0)
4 (20.0)
8 (40.0)

179 (42.6)
36 (8.6)
205 (48.8)

53 (50.0)
12 (11.3)
41 (38.7)

240 (44.0)
52 (9.5)
254 (46.5)

9 (69.2)
4 (30.8)

290 (70.6)
121 (29.4)

97 (85.8)
16 (14.2)

396 (73.7)
141 (26.3)

Most diabetic patients have at least one late diabetic complication

Diabetic Complications
60

Microangiopathy >>
Macroangiopathy

54

50

Re nopathy
Neuropathy
Proteinuria

40
30

Dialysis

33.4

Foot Ulcer
26.5

Amputa on
Angina
MCI

20
10.9

8.7
10
0.5
0

7.4
1.3

5.3

2.7

5.3

Heart Failure
Stroke
PAD
IDMPS Indonesia

Resource Use
Variable
Specialty
GPs/ internists
Endocrinologists
Follow up in the last 3
months
By GPs/ internists
Followed up
None
By endocrinologists
Followed up
None

Type 2

Lifestyle

OGLD

Insulin +

Total

13 (61.9)
8 (38.1)

387 (74.0)
136 (26.0)

71 (54.6)
59 (45.4)

471 (69.9)
203 (30.1)

1 (33.3)
2 (66.7)

105 (60.7)
68 (39.3)

23 (47.9)
25 (52.1)

129 (57.6)
95 (42.4)

13 (100.0)
0

332 (95.4)
16 (4.6)

96 (98.0)
2 (2.0)

446 (96.1)
18 (3.9)

Indirect Cost
Variable
Working productivity
Unemployed
Normal work
Sick leave
Unable to work
Hospitalized
Yes
No
Mean (SD)
Median

Type 2 DM
359 (53.3)
234 (34.8)
64 (9.5)
16 (2.4)
69 (15.8)
369 (84.2)
1.1 (0.5)
1.0

Only 34.8% of diabetic patients had normal work

IDMPS Indonesia,2007

Education Session

Variable
Lifestyle
Diabetes education
Given
None
Mean (SD)
Median

8 (40.0)
12 (60.0)
6.8 (4.7)
3.0

Type 2
OGLD
168 (34.6)
317 (65.4)
4.1 (3.3)
3.0

Insulin +

Total

49 (41.2)
70 (58.8)
4.3 (3.9)
7.0

225 (36.1)
399 (63.9)
4.2 (3.5)
3.0

Only 36.1% of diabetic patients had formal diabetic education session

% Target Achievement

70

58

60
50

44

40

40

37.4

34.45

30

16

20
10
0

China

South Korea

Panama

Egypt

Indonesia DIabCare-Indonesia

Conclusion
DIABETES
Chronic condition with comorbidities and
complications
Huge resource use and significant cost
ACTION
early diagnosis
prompt treatment
effective metabolic control
screening for diabetic complications

The
Indonesian Society of
Endocrinologist's
Diabetes Mellitus
National Clinical
Practice Guidelines

DM

PERKENI Guideline 2011

Lifestyle
Modification

Phase-I
Lifestyle
Modification
+
OAD Monotherapy

Phase-II

Lifestyle
Modification
+
2 OADs
Combination

Alternative :
Insulin not available
Patient preference
Glucose control not
optimal

Notes :
Fail : not achieving A1c target <7% after 2-3
months of treatment.
(A1c = average blood glucose conversion, ADA
2010)

Lifestyle
Modification
+
3 OADs
Combination

Phase-III

Lifestyle
Modification
+
2 OADs
Combination
+
Basal insulin

Intensive Insulin

HbA1c Level
7-8%

Lifestyle
Modification

Lifestyle
Modification

PERKENI Guideline 2011

<7%

+
Monotherapy
Met, SU, AGI,
Glinid, TZD,
DPP-IV

8-9%

>9%

9-10%

>10%

Lifestyle
Modification
+
2 OADs
Combination
Met, SU, AGI,
Glinid, TZD,
DPP-IV

Notes :
Fail : not achieving A1c target <7% after 23 months of treatment.
(A1c = average blood glucose conversion,
ADA 2010)

Lifestyle
Modification
+
3 OADs
Combination
Met, SU, AGI,
Glinid, TZD,
DPP-IV

Lifestyle
Modification
+
2 OADs
Combination
Met, SU, AGI,
Glinid, TZD
+

Lifestyle
Modification

Basal Insulin

+
Intensive
Insulin

Awareness, agreement and adherence of

physicians to
type 2 diabetes guideline in Indonesia
Indah S. Widyahening, Geert JMG van der Heijden, Pradana

Soewondo, Yolanda van der Graaf

Background

Diabetes has been recognized as an emerging health

problem in Indonesia. While guideline on the management
of type 2 diabetes mellitus (T2DM) was available for almost
two decades, 68% of the patients were in poor control.
Aim
To study the awareness, agreement and adherence of
physicians to T2DM guideline in Indonesia.
Methods
Questionnaire survey of General Practices (GPs) regarding
recommendations in theIndonesian T2DM guideline based
on the awareness-to-adherence model of behavioral
change.
Journal: BMC Family Practice

Characteristics

n (%)

Media
n

Minmax

Age (n=399)

43 years 22-73 years

Year of practice (n=383)

15 years

0-45 years

Gender (n=399)
Male / Female

126 (32) / 273

(68)

Practice type (n=392)

Solo practice

208 (53)

Private clinic

64 (16)

Public health center

96 (22)

Private hospital

20 (5)

Public hospital (non academic)

8 (2)

Academic hospital

6 (2)

Practice location (n=359)

Jakarta

119 (33)

Outside Jakarta but within Java

island

127 (35)

Journal: BMC Family Practice

Characteristics
Participation in DM training
(n=367)
Yes
Number of DM patients seen in
a week (n=343)
Proportion of DM patients
among all patients seen
(n=381)
<10%
10-30%
>30%
Awareness to DM consensus
(n=383)
Never know
Heard but never had
Had but never read
Read and implement

n (%)

Media
n

Minmax

1-120

234 (64)

243 (64)
117 (31)
21 (5)

43 (11)
138 (36)
78 (20)
124 (33)

Journal: BMC Family Practice

Guidelines recommendations assessed in

the questionnaire.
Screening for T2DM should be performed to all patients with

any of the risk factor listed in the guidelines.

In patients with classic DM symptoms, one random blood
glucose test with result >200 mg/dL is enough to confirmed
the diagnosis.
For newly diagnosed patient, management should be started
with meal planning and exercise for 2-4 weeks.
SUis the drug of choice for normal and underweight patients.
Most patients should achieve Fasting Blood Glucose of <100
mg/dL and 2-hour post-prandial Blood Glucose of <140
mg/dL.
Blood pressure should be reduced to below 130/80 mmHg.
Statin should be prescribed to people with T2DM who are
over 40 years old or have CVD risk.
Journal: BMC Family Practice

GPs' awareness of, agreement with, adoption of, and

adherence to selected recommendations of the Indonesian
T2DM guidelines

Journal: BMC Family Practice

Conclusion
Despite high awareness GPs may not adopt

recommendations let alone adhere to it.

The updating process of the guideline should
also consider some effective means to
disseminate it and include a system to ensure
its adherence.
This also pertains to those who plan to
develop guidelines.
Further research will be needed to identify
the barriers to adhere to each of the
recommendation.
Journal: BMC Family Practice

The unmet need in type 2 diabetes

PPG, postprandial glucose

Over time, glycaemic control deteriorates

*Diet initially then sulphonylureas, insulin and/or metformin if FPG >15 mmol/L
ADA clinical practice recommendations. UKPDS 34, n=1704
UKPDS 34. Lancet 1998:352:85465; Kahn et al (ADOPT). N Engl J Med 2006;355:242743

Most therapies result in weight gain over time

*Conventional treatment (

); diet initially then sulphonylureas, insulin and/or metformin if FPG >15 mmol/L

UKPDS 34. Lancet 1998:352:85465; Kahn et al (ADOPT). N Engl J Med 2006;355:242743

Impact of poor compliance

Poor compliance with treatment for chronic diseases is a

worldwide problem of considerable magnitude

Around 50% compliance with long-term therapy for

chronic illnesses in developed countries

Compliance rates are expected to be lower

in developing countries

WHO. Compliance to long-term therapies: evidence for action. Geneva: WHO,

2003.

Consequences of poor compliance

Lack of compliance leads to:1
Reduction in effectiveness of treatment
Poor health outcomes and increased

health care costs

Reduced quality of life
Increasing the effectiveness of adherence interventions may

have a far greater impact on the health of the population than

any improvement in specific medical treatments 2

1. WHO. Compliance to long-term therapies: evidence for action. Geneva: WHO, 2003;
2. Haynes RB et al. The Cochrane Database of Systematic Reviews 2002, Issue 2.

Compliance: influenced by several factors

Compliance is frequently compromised by more than one

barrier
Social and economic factors
Healthcare team/system
Condition-related factors
Therapy-related factors
Patient-related factors

WHO. Compliance to long-term therapies: evidence for action. Geneva: WHO, 2003.

Patients need support, not blame

Patient-related factors not necessarily

the biggest barrier to compliance

focus on provider/health system-related

determinants (e.g. feedback, short consultations etc.)

Support patients in their efforts at

self-management
More effective interventions are essential

WHO. Compliance to long-term therapies: evidence for action. Geneva: WHO, 2003.

Poor compliance: an important medical problem

Poor or erratic compliance is most common when:
The treatment is preventive
The patient is frequently asymptomatic
Therapy is long-term
Therapy is associated with significant side effects

Rand C. Am J Cardiol 1993; 72: 68-74D.

The Cost of Diabetes

Direct Costs Personal
Drugs, supplies,
insurance

Indirect Costs
Loss of productivity

Direct Costs healthcare

System
Treatment and
rehabilitation
Hospital and healthcare
professional services
Products, supplies, tests
Hospital admissions

Premature retirement
Premature mortality
Pain, anxiety and inconvenience

decrease quality of life

Work discrimination
Negative effect on relationships,

mobility and leisure activities

WHO Fact Sheet 2012

Economic burden of type 2 diabetes continues to rise in

both developed countries and emerging markets
Direct costs for diabetes-related care are projected to reach USD 376
billion globally in 2010 and USD 490 billion by 2030
Estimated 2010 Total Costs
for Diabetes (US$ Bn)

Estimated 2010 Cost

per Patient (US$)

12/25/16

12
/2
5/
16

12
/2
5/
16

12/25 12/25/1
/16
6

12/2
5/16

Source: IDF Diabetes Atlas 2009 www.eatlas.idf.org

12/2
5/16

12
/2
5/
16

12
/2
5/
16

12/25 12/25/1 12/2

/16
6
5/16

12/2
5/16

Treating diabetes reduces risks of

complications and costs of
diabetes

Reduction in incidence risk

per 1% reduction in HbA1c

Risk reduction by lowering

HbA1c with 1%

Diabetesrelated
death

Myocardial
infarction

Microvascular
complications

Costs related to type 2 diabetes

Peripheral
vascular
disease

Diabetes drugs only constitute 7%

7%

10

14%*

20
30
40
50

Other drugs

18%

Ambulatory
Hospitalization

37%*
*p<0.0001

Source: UKPDS, Stratton et al. BMJ 2000;321:40512

Dat
e

20%
55%

21%*

Antidiabetic drugs

43%*
Source: Revealing the cost of Type II diabetes in
Europe, B. Jnsson in Diabetologia (2002)

Diabetic Cost : ASKES Data

25

23

20
14

15
10

5
0

ASKES

126.104 pts

258.208 pts

384.312 pts

Million US$
Without Complications
Data
Total

With Complications

Annual cost for each diabetes patient

Without Complications + 40 US$
258.208 patientsWith Complications + 900 US$

Diabetic Cost : ASKES Data

US$
1000
900
800
700
600
500
400
300
200
100
0

900

40

US$

Restructuring of Health Sevices

u
tr

ed
ma
Pri

ry

re
Ca

ru
St

ur
ct

l
Se

ed

Tertiary
Secondary

e
ar
fC

Se
c
da on
r
Ca y
re

s
Un

ur
ct

Rujukan Kewenangan

Primary Care
Tertiary Care
RS/PUSKESMAS
DAERAH

GATE KEEPER

INTERVENSI 3 :

Self Care

PRAKTEK SWASTA

RSHS & RSD

PUSKESMA
S
RAKSASA

PELAYANAN
PELAYANAN
TIDAK
TIDAK
OPTIMAL
OPTIMAL

RS/PUSKESMAS
DAERAH

PUSK
ESMA
S

RS
DAER
AH

PRAKTEK SWASTA

RS
DAER
AH

PUSAT RUJUKAN

PUSK
ESMA
S
DOKTER KELUARGA

38

ERA BPJS: Managig The Health Care System

GATE KEEPER CONCEPT PROMOTIF PREVENTIF
Strengthen its position as primary service door to tiered health
care refferal system

Persentase Biaya Pelkes

Askes

NHS
England

28 %

INA CBGs

76 %

56 %

Kapitasi

Gate Keeper
15 %

BPJS Kesehatan

24 %

Personal Healthcare Service

Flow *

*Diambil dari alur pelayanan kesehatan PT. Askes

Whats Benefit for Diabetic

Patients

BASIC CONCEPT
Managed
Care

Integration of Cost &

Quality

Gate Keeper Concept (Primary Care

Provider)

Referral system
Selected Provider (Credentialling)
Provider Payment System
Utilization Review
Preventive & Promotive
Drugs Formulary Fornas and Refer Back Program

quality assurance and cost

containment

BPJS Personal Health Benefit

Primary care services
Secondary and tertiary care services
Drug Services
Cathastrophic disease:
Heart disease
Cancer
Dialysis
Thallasemia & Haemofilia

SURAT EDARAN MENTERI

KESEHATAN
HK/MENKES/32/I/2014
Petunj
uk
Teknis

Surat Edaran Direktur

Pelayanan BPJS Kesehatan
Nomor 0038/Ed/0114

Penjelasan Poin 2 Obat Penyakit

Kronis
a. Yang dimaksud penyakit kronis adalah penyakit yang membutuhkan
obat untuk pemakaian rutin selama 30 hari setiap bulan sesuai
indikasi medis, diluar yang sudah diatur dalam poin 3 Surat Edaran
Menkes Nomor HK/Menkes/32/I/2014 tahun 2014 yaitu tentang Program
Rujuk Balik (DM, Hipertensi,jantung,asma,PPOK,epilepsi,skizofren,sirosis
hepatis,stroke,SLE). Pasien yang tidak memerlukan pengobatan rutin
selama 30 hari setiap bulan tidak termasuk dalam ketentuan ini dan
keseluruhan obat sudah termasuk dalam paket INA CBG
b. Dalam hal dokter Spesialis/Sub Spesialis menyatakan pasien dengan
penyakit kronis tersebut dalam kondisi stabil maka pasien dirujuk balik
ke faskes tingkat pertama. Pengobatan selanjutnya diteruskan oleh
faskes tingkat pertama sesuai dengan rekomendasi Dokter
Spesialis/Sub Spesialis.
c. Peserta yang menderita penyakit kronis yang belum stabil diberikan
resep obat untuk kebutuhan 30 hari sesuai indikasi medis :
i. Kebutuhan obat untuk sekurang-kurangnya 7 (tujuh) hari
disediakan oleh Rumah Sakit, biaya sudah termasuk dalam
komponen paket INA CBG
ii. Kebutuhan obat untuk sebanyak-banyaknya 23 (dua puluh tiga)
hari dapat diambil di Instalasi Farmasi Rumah Sakit. Biaya obat
ditagihkan sesuai ketentuan yang berlaku secara fee for service
dengan software/aplikasi khusus obat.

Penjelasan Poin 2
Obat Penyakit
Kronis
e. Pelayanan obat mengacu kepada Formularium Nasional baik nama
generik, jenis, kekuatan maupun restriksinya. Brand obat dan
peresepan maksimal mengacu kepada DPHO PT. Askes (Persero) Tahun
2013
f. Dalam hal obat yang diresepkan tidak tercantum dalam Formularium
Nasional, maka biaya obat tersebut sudah termasuk dalam komponen
paket INA CBG
g. Obat yang diresepkan pada poin 5.d hanya untuk obat kronis. Apabila
pasien membutuhkan obat akut maka obat tersebut disediakan oleh
Rumah Sakit dan biaya sudah termasuk dalam komponen paket INA
CBG
h. Obat pada poin 5.d.ii. dibayar oleh BPJS Kesehatan mengacu pada ecatalogue obat Tahun 2014 ditambah dengan faktor pelayanan dan
embalage sesuai SE Menteri Kesehatan RI Nomor HK/31/Menkes/I/2014.
Sebelum adanya ketetapan e-catalogue obat Tahun 2014, maka harga
obat mengacu pada DPHO PT Askes (Persero) Tahun 2013 dan/atau ecatalogue obat Tahun 2013.

Poin 3 Chronic Disease Drugs

Can be provided by primary care provider
Refer Back Program (PROGRAM RUJUK BALIK
PRB)

DM, hipertensi,
jantung,asma,PPOK,epilepsi,skizofren,sirosi
s hepatis,stroke,SLE

Health Care Services Flow

Members

Captiation

Primary Care
Provider

Referral

Hospital

Emergency

Claim Ina
CBG

BPJS Center

Drug Prescription

Apotek

BPJS
Branch Office

Primary Care Provider as a Gate Keeper

Disease Management Program (DM Type2)

Why DM Type 2:
big trigger for other
chronic
Hospital
Start from June 2010
(Medical Specialist)
Members Database
Reminder activity
Health Promote
(Media)
- Club Chronic for
Members
-

PT Askes
(Persero)

Referral
Comprehensive & Continued
control
Care
Mentor &
(Guidelines Evidence Based)
consultant for
- Referral to the advanced level GPs
- Health Education
- Health Status Monitoring
- Prescription chronic
drugs
Health status evaluation and
feedback
Health care cost
Workshop for family Physician (DM
Family Physician
Type2)
by endokrin specialist

Members
Chronic Disease
DM Tipe2
(individual
treatment)

DM Guidelines
MEDICAL PROFESIONAL ORGANIZATION
PERHIMPUNAN ENDOKRINOLOGI INDONESIA (PERKENI)

Primary Care
for Members Diagnosed DM Type 2
Members
Diagnosed
DM Type 2

Register to Primary
Care
Family Physician

Primary Care for Members of PT.Askes (Persero):

Individual Physician
500 to 2.000 members

Group Physicians
with maximum 50 members

Clinics
diagnosed DM Type 2

Community Health Center (Puskesmas)

Ensure that members are to be handled directly by the doctor

and the certainty of the service time
Members in DM Type2 program (per Aug 2011): 8.858 person
Managed by 668 Primary Care Providers

7 PILAR PPDM 2
KONSU
L-TASI
MEDIS
REMINDE
R

KLUB
RISTI
PENYULU
HAN
OLAHRAGA

CLINICA
L
GUIDELI
NE

7
PILAR
PPDM

PEMANTAUAN STATUS
KESEHATAN

PELAYAN
AN OBAT
SCR
TEPAT &
CEPAT

HOME
VISIT
51

Target of Treatment
Risk CVD (-)

Risk CVD (+)

Blood Glucose
-

FPG (mg/dL)

< 100

< 100

Post Prandial BG(mg/dL)

< 140

< 140

< 7,0

< 7,0

A1C (%)
BMI (kg/m2)
Blood Pressure

18,5

- < 23

18,5

- < 23

< 130/80

< 130/80

Total Cholesterol(mg/dL)

<200

<200

Triglyceride (mg/dL)

<150

<150

HDL cholesterol (mg/dL)

>40/>50

>40/>50

LDL cholesterol (mg/dL)

< 100

< 70

Lipid

PERKENI Guidelines 2011

Health Status Monitoring For Type 2 DM

Spesialistic Provider
Item
Periode

Primary Care Provider

Item

Periode
EKG
ECHO

Blood
Glucose
Test

1 per
Month

Sistole /
Diastole

1 per
Month

Body Mass
Index

1 per
Month

Albumin

HBA1C

1 per 6
Month

SGPT

Rontgen Thoraks
Funduscopy
ABI
Ureum
Creatinin
SGOT
Protein Kualitatif
Cholesterol Total
Choleterol LDL
Cholesterol HDL
Trigliserida

1 per
Year

Drug for Refer Back Programe

NO.

URAIAN

BPJS KESEHATAN

1.

Landasan Hukum

Peraturan BPJS

2.

Pemberi Layanan

Apotek atau depo farmasi Fasilitas

Kesehatan tingkat pertama yang
bekerja sama dengan BPJS
Kesehatan untuk Program Rujuk
Balik

3.

Cakupan PRB

4.

Acuan Daftar Obat Daftar Obat Fornas untuk Program

PRB

5.

Sistem
pembiayaan Obat
PRB

6.

Acuan Harga Obat E-Catalog (HNA + Ppn) + Faktor

Pelayanan + Embalage

DM dan HT
Fee For Service langsung kepada
Apotek

PT. Askes (Persero)

Drug List for Diabetes and

Hypertention
Nama Generik

Sediaan dan
Kekuatan

OPR
B

Keterangan:

Acarbose

Tab 50, tab 100

Diberikan pada pelayanan

Tingkat lanjut saja

Glibenklamid

Ta 2,5 , 5 mg

Glicazid

Tab MR 30 mg

Glikuidon

30 mg

Glimepirid

Tab 1, 2 ,3,4 mg

Glipizide

Tab 5, 10 mg

Metformin

Tab 500 dan 850

mg

Pio Glitazon

Tab 5 dan 10 mg

Antidiabetes
Oral

Antidiabetes parenteral

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Drug List for Diabetes and

Hypertention
Nama Generik

Sediaan dan
Kekuatan

OPRB

Keterangan:

Antihipertensi Oral
amlodipin

tab 5, 10 mg

atenolol

tab 50 , 100 mg

beraprost sodium

tab 20 mg

v
v
x

bisoprolol

tab 5 mg

diltiazem
doksazosin

Tab 30 mg, kaps SR

100 mg, kaps 200
mg
tab 1 dan 2 mg

hidroklortiazid

tab 25 mg

imidapril

tab 5 dan 10 mg

irbesartan

kaptopril

Tab 150 dan 300

mg
Tab 8 mg dan 16
mg
tab 12,5 dan 25 mg

klonidin

Tab 0,15 mg

kandesartan

v
v
v
v
v
v
v
v

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Drug List for Diabetes and

Hypertention
Nama Generik

Antihipertensi
oral
klortalidon
lisinopril
metildopa
nifedipin

Sediaan dan
Kekuatan

tab 50 mg
Tab 5, 10 dan 20
mg

Tab 250 mg
kap 10 mg, tab
20 mg SR, tab 30
mg oros

perindoprilarginin tab 5 mg
propranolol
tab 10 mg
ramipril

OPRB

v
v
v

tab 2,5 ; 5 dan

10 mg

telmisartan

tab 40 ; 80 mg

valsartan

tab 80 ; 160 mg

verapamil

tab 80, 240 mg

Keterangan:

Orphan Drugs

Expected HbA1c reduction according to

intervention
Intervention

Expected in HbA1c (%)

Lifestyle interventions

1 to 2%

Metformin

1 to 2%

Sulfonylureas

1 to 2%

Insulin
Glinides

1.5 to 3.5%
1 to 1.5%1

Thiazolidinediones

0.5 to 1.4%

-Glucosidase inhibitors

0.5 to 0.8%

GLP-1 agonist

0.5 to 1.0%

Pramlintide

0.5 to 1.0%

DPP-IV inhibitors

0.5 to 0.8%
1. Repaglinide is more effectie than nateglinide
Adapted from Nathan DM, et al. Diabetes Care
2009;32:193-203.

Drug List for Diabetes and

Hypertention
Obat Tambahan
tiamin (vitamin B1)

tab 50 mg
v

vitamin B kompleks

Tab

piridoksin (vitamin B6)

Tab 10 mg dan 25 mg

Members Education Activity

Members Fitness Activity

Reimbursment System
Primary Care

Health Care + Drugs Capitation

Health Education for Members Education Fee
Health Status Monitoring package for service

Specialist Care

Health Care Inpatient & Out Patient (Contract to Hospital)

Health Status Monitoring package for service
Health Education for Primary Care Consultant Fee

Supporting Activity by BPJS

Workshop for Primary Care & for Members

Club Activity
Health Promotion Media
Information System, Reminder & Communication

Conclusion
Diabetic cost is increasing
High rate of undiagnosed diabetes
High rate of uncontrolled blood glucose
High rate of complications
Efficacy of treatment depends not only on
medication but also on patients
compliance and healthcare system
The need of health care restructurization to
fit the management of chronic diseases
Improving the quality of care may increase
the cost efectiveness of diabetes
management