A New National Diabetes Prevention

Program

Hikmat Permana
Issues
Type 2 Diabetes and Chronic Disease

The trend towards chronic disease programs rather than diabetes

prevention and management programs reflects the common risk
factors and co-existence of a number of chronic diseases in
individuals.

However, there is a risk that this leads to underestimating the

seriousness, complexity and challenge of type 2 diabetes and its
impact, and reduces the focus on diabetes which, arguably, is the
most preventable chronic disease.
Issues
Type 2 Diabetes and Obesity
The close association of the obesity and type 2 diabetes epidemics
has meant that, to many, these are seen as the same.
People with type 2 diabetes are often stigmatized and blamed for
not looking after their diet and weight and the link is seen as direct
and causal by many
Simplistic solutions are often put forward which focus on short
term weight loss which is not sustained and has no lasting benefit
Many thousands of people at a healthy weight and who eat a
healthy diet and maintain physical activity will still develop type 2
diabetes and are often forgotten.
The possible link between the development of diabetes, the
maternal environment and in-utero factors is at risk of being
neglected.
The risk of diabetes can be intergenerational
 We have an Epidemic of diabetes
Proportion DM ( 15 years old) :
Male : 5,6 %
Female : 7.7%
Urban : 6.8 %
Rural : 7.0 %

Proportion Diagnosis DM with Health worker in population 15

years old) :
Cumulative : 24%
Male : 2.2 %
Female : 2.5 %
Urban : 3.3 %
Rural : 1.5 %
RISKESDAS 2013
 Risk Stratification Pyramid for Diabetes Prevention
Trend Nasional develop to DM ; 2.1%

Urban Rural Male Female Cumulative

Very
High Risk
29.9% 29.8% 25.0 % ( IGT) 32.7 % 29.9%
High Risk
34.9% 38.2% ~40.4 % (FPG > 100); 34.4 % 36.6%
Central Obesity

Moderate Risk
19.7% (Obese, 32.9%
over WC 26.6%
Low Risk
RISKESDAS 2013
BURDEN NON-COMMUNICAL DISEASE IN >15 YEARS OLD

DISEASEs (%) (cost)

Stroke 1.21 1,2 M
Hipertension 25.8 42,1 M
Central Obesity 26.6 44,3 M
Diabetes Mellitus 6.9 8,9 M
Note:
Coverage Hipertension with health worker 36.8%
Coverage DM with health workers 30.4%
Almost 2/3 patients : not known have NCD

Source: Riskesdas 2013

 CONTRIBUTING FACTORS TO INFLUENCE
HYPERTENSION AND DIABETES MELLITUS
CONTRIBUTING
RISK FACTOR TO
INCREASED
DIABETES AND
COMPLICATIONS

RISK FACTOR CARDIOVASCULAR

ATTITUDE DISEASES

Unhealty diet Hypertension

Globalitation Heart attack
smoking Obesity
Urbanitation Stroke
Low physycal activity Diabetes
aging Heart failure
Alcohol Increase dyslypidemia
Income
Education RISK FACTOR Renal failure
Recidency
METABOLISM
Determine social
and motivate
 What is a national diabetes
programme?
A National Diabetes Programme is a systematic and co-ordinated
approach to improving the organisation, accessibility, and quality of
diabetes prevention and care which is usually manifest as a
comprehensive policy, advocacy and action plan covering the:

Main types of diabetes ie. type 1 diabetes, type 2 diabetes and

gestational diabetes
Whole continuum of care from primary prevention to treatment
and palliative care
Resources, services and systems that support prevention and
care
PRINCIPLES OF THE PROGRAMME
1. Complementarity.
2. Equal accessibility.
3. Comprehensive care.
4. Quality, effectiveness and safety of patient care.
5. Including and empowering patients
6. Partnership
7. Continuous monitoring.
8. Taking into account scientific achievements and ensuring
advancement by investing into research and development of the
field.
THE PROGRAMME'S MAIN GOALS

The main goals of the Programmed are:

to reduce the incidence of type 2 diabetes,
to prevent or to delay type 2 diabetes in high-risk
individuals,
to increase the possibility for early detection of
diabetes and decrease complications and mortality
related to diabetes.
GERAKAN MASYARAKAT SEHAT is a premeditated to act
committed jointly by all components of the nation with
awareness, willingness and ability to adopt healthy behaviors to
improve the quality of life.

GERAKAN MASYARAKAT SEHAT were stressed on promotive and

preventive community.
Aims :
Improving the quality of life;
Increasing the productivity of the population
Lowering the burden of financing health services due to
increased sickness and health spending.
 DEFINING HEALTHY PARADIGM

(Health Promotion)
1. PRIMARY PREVENTION
DEFINING HEALTHY

(Specific Protection) GERAKAN

MASYARAKAT
PARADIGM

SEHAT
2. SECONDARY Early Diagnosis &
PREVENTION Prompted Treatment

Disability Limitation
3.TERTIATY PREVETION
Rehabilitation
 INDONESIA HEALTHY PROGRAMME
Strategy planning
2015-2019

Pillar 1. Healthy Pillar 2. Strengthen Pillar 3.

Paradigm Health facility Healthy insurance
Program Program
Program Increased access to Benefit
Promotif PHC Finance system:
preventif as the Optimalitation insurance - of
basic to healthy referral system mutual
develops Quality cooperation
Penerapan
Improvement
community Quality and cost
pendekatan control
empowerment Approach
continuum of care Target: PBI & Non
Multi sector continuumberbasis
of care
Intervensi PBI
involvement
resiko kesehatan
Intervention by Membership ID
(health risk)
health risk KIS

HEALTHY
FAMILY
ACTION DIABETES PREVENTION PROGRAM
 Prevent
Complications
ACTION 1
Develop and implement
national programs with
national targets and goals for
primary care, hospitals and
diabetes centres to focus on
prevention of complications by
creating integrated,
coordinated, multidisciplinary
care and measuring and
reporting prevention of
complications
GERMAS
Prevent Prevent Prevent
Complications Complications Complications
ACTION 2 ACTION 3 ACTION 4
Ensure early detection Develop and Take all types of diabetes
implement national seriously and enhance the
of silent, undiagnosed
structured self- quality of care through:
type 2 diabetes
through: management Optimised management of
education and support newly diagnosed diabetes
Promotion of programs for type 1
systematic risk Targeting world leading
and type 2 diabetes care for type 1 diabetes,
assessment/screening
with particular focus type 2 diabetes and
across the community
on: gestational diabetes
using all People
The newly diagnosed National social marketing
Referral of people
with a high risk score Insulin campaigns for all types of
for clinical assessment commencement and diabetes and focusing on
with integrated ongoing therapy the seriousness, challenge
assessment of support and burden
diabetes, absolute Youth and transition Resourcing and utilising
cardiovascular risk, and from children to adult the Health National
kidney health risk services Association for clinical and
Targets, plans, Older people and academic leadership,
resources and reporting their carers. national benchmarking, and
of early detection for all quality initiatives.
primary care services
 Prevent
Complications
ACTION 5
Regulatory and approval processes should take
account of measures and benefits beyond HbA1c and
include wellbeing measures
Diabetes management guidelines should reflect best
clinical practice
People with diabetes in certain high risk groups
should have government supported access to
Continuous Glucose Monitoring technology (for
example hypoglycaemia unawareness)
Targeted use of the National Broadband Network
and other technologies, such as telehealth and the e
Med and e Ref to provide support to people with
diabetes
Prevent
Complications
ACTION 6
Ensure that all people with all types of diabetes
have access to appropriate, affordable healthcare,
as well as equitable access to information and
education about living with diabetes.
Put an end to the social stigma surrounding
diabetes, which promotes a culture of secrecy
about diabetes and creates a barrier to
appropriate self-care in public and accessing
services, restricts employment and work-related
opportunities, and may prevent people with
diabetes from playing an active role in society
Promote and protect the rights of all people with
all types of diabetes
To develops the center of the diabetes and
related policies and strategies and determining
ways in which services are delivered
 Reduce the impact Reduce the impact Reduce the impact Reduce the impact
of diabetes of diabetes of diabetes of diabetes
in pregnancy for mothers in pregnancy for mothers in pregnancy for mothers in pregnancy for mothers
and children and children and children and children
ACTION 1 ACTION 2 ACTION 3 ACTION 4

Develop national pre- Ensure optimal

pregnancy education
programs to ensure women
who do not have diabetes
are aware of risk factors,
including healthy weight for
and during pregnancy.
management (pre- Systematic Enhance the
conception to post- identification and newly-established
pregnancy) of pre-existing optimal National Gestationa
diabetes in pregnancy and management for all Diabetes Register
women who
integrating: Implement a
develop gestational
Previous gestational program to monitor
diabetes.
diabetes and support the
early years needs
Pre-existing type 1 of children born to
diabetes
women after
Pre-existing type 2 diabetes in
diabetes. pregnancy.
Strengthen prevention, Strengthen prevention, Strengthen prevention, Strengthen prevention,
care and cure care and cure care and cure care and cure
through knowledge through knowledge through knowledge through knowledge
and evidence and evidence and evidence and evidence
ACTION 1 ACTION 2 ACTION 3 ACTION 4

The national research A national research

agenda must be Implementation Research into
agenda must have world and translational the economic and
leading diabetes research comprehensive and
include: research should be social burden of
including diabetes prevention a specific focus for diabetes should
and diabetes management Basic science all research funders be a national
as a cornerstone focus. Clinical and national focus.
Complications programs.
Prevention
Implementation and
translation
Health service delivery
Behavioural
Social, economic,
demographic and
environmental
Partnerships for Implementation
The successful implementation of a new National Diabetes Strategy and
Action Plan will require some new structures and processes.

The following is proposed:

1. National Diabetes Commission
This Commission should oversee reporting and facilitate integration and
leadership.
2. National Diabetes Prevention Program Leadership
Leadership, management and delivery of the National Diabetes
Prevention Program for the high risk population should be provided by a
consortium led by PERKENI AND PERSADIA with IDI .
3. National Diabetes Strategy Implementation Group
Coordination of leadership and implementation should be facilitated by a
new National Implementation Group comprised of nominees of the
Department of Health and others with IDI
 Hospitals Household
e-Med Surveys
e-Ref

Vital statistics NATIONAL DIABETES REGISTRY POSBINDU

RISKESDAS POSYANDU

Telephone
Surveys
Registries
e-KTP
e-Med Questionaries'
e-Ref Surveys
FACILITATE TO PREVENTION, PROMOTION, AND
REHABILITATION NATIONAL DIABETES PROGRAM
 THANK YOU

Questions & Discussion

National Center for Chronic Disease Prevention and Health Promotion