Diabetes care performance in Indonesia: a serial cross-sectional analysis of behavioral, clinical, and laboratory outcomes from 2013 to 2023

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Background: The growing diabetes burden in Indonesia necessitates a comprehensive understanding of national diabetes care performance, which remains inadequately characterized. Evaluating care quality across domains is essential to inform chronic disease policy and improve health outcomes. This study assesses trends in behavioral, clinical, and laboratory outcomes of diabetes care in Indonesia from 2013 to 2023. Methods: We conducted a serial cross-sectional analysis of pooled data from the 2013, 2018, and 2023 Indonesian national health surveys (N = 42,224 for behavioral-clinical and N = 2957 for laboratory outcomes). Diabetes care performance was assessed across behavioral (treatment, smoking, diet, activity), clinical (blood pressure, BMI, waist length), and laboratory (glucose, lipids, renal function) domains. Composite scores and multilevel models were used to identify geographic and sociodemographic disparities. Findings: Although linkage to diabetes care significantly improved from 68% to 92% between 2013 and 2023, performance in most other indicators remained stagnant or declined. In 2023, only 2.9% (95% CI 2.5-3.3%) met dietary fiber intake targets, 62.4% (95% CI 61.2-63.6%) achieved physical activity goals, and 83.9% (95% CI 82.9-84.8%) abstained from smoking. Clinical control was suboptimal, with 43.5% (95% CI 42.3-44.8%) meeting blood pressure targets and only 26.7% (95% CI 25.6-27.9%) and 33.1% (95% CI 32.0-34.3%) achieving BMI and waist circumference goals, respectively. Laboratory control was limited: only 25.2% (21.6-28.8%) achieved fasting glucose targets, 32.0% (95% CI 27.6-36.3%) had HbA1c <7%, and only 22.6% (95% CI 19.1-26.2%) met LDL-C goals. Fewer than 5% of participants met all behavioral-clinical or laboratory composite targets. Composite performance declined in nearly all provinces, with disparities linked to older age, male sex, lower education, and rural residence. Interpretation: Despite expanded healthcare coverage, Indonesia's diabetes care performance remains critically inadequate, particularly for achieving multiple targets. Strengthening national guidelines, embedding structured chronic care, and addressing social determinants are essential to improving diabetes outcomes. Funding: None.

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