KEMAS 18 (2) (2022) 266-273

Jurnal Kesehatan Masyarakat

http://journal.unnes.ac.id/nju/index.php/kemas

Determinants of Diabetes Mellitus Prevalence in Indonesia

Siskarossa Ika Oktora , Daniel Butar Butar

Politeknik Statistika STIS

Article Info Abstract

Article History: The number of people with diabetes mellitus (DM) worldwide continues to increase. In
Submitted September 2021 2019, Indonesia was the seventh country with the largest number of people with DM
Accepted September 2022 worldwide. The people with DM in Indonesia were dominated by the productive age
Published November 2022
population. This study aims to determine the variables affecting the prevalence of DM
Keywords: in Indonesia in 2018. The analysis unit used is 34 provinces in Indonesia, where the data
Diabetes mellitus, comes from the Health Ministry of the Republic of Indonesia and Statistics Indonesia.
Prevalence, Multiple Graph analysis and multiple linear regression are the methods used in this study. DKI
linear regression Jakarta has the highest DM prevalence in Indonesia, reaching 3.4 percent. The preva-
lences of obesity and hypertension have a positive effect on the prevalence of DM. The
DOI result shows that every one percent increase in the prevalence of obesity will increase
https://doi.org/10.15294/ the prevalence of DM by 0.049 percent. While, every one percent increase will increase
kemas.v18i2.31880
the prevalence of DM by 0.168 percent. The percentage of the population smoking, not
exercising, the unemployment rate, and the average length of schooling does not affect
the prevalence of DM in Indonesia.

Introduction people with DM is expected to continue until

According to the International Diabetes 2045 and will reach 700 million people. The
Federation (IDF), diabetes mellitus (DM) is a number of deaths from diabetes is estimated at
condition that occurs when the body cannot 4.2 million. This number increased from 2017,
produce enough insulin for a long time. It is which was 4 million people.
also a condition where the body cannot use Indonesia is in the seventh position, with
the insulin hormone in the body effectively, the number of diabetes mellitus cases reaching
causing glucose levels in the blood to rise. DM 10.7 million people. Based on the projections
can cause various complications, such as nerve made by the IDF, the increase in the number
damage, kidney damage, etc. World Health of DM sufferers will continue until 2045, when
Organization (WHO) claims DM is one of the the number of DM sufferers in Indonesia
top ten most common causes of death. is estimated to reach 16.6 million people.
DM contributes in increase morbidity Diabetes mellitus is the third highest cause of
and mortality worldwide. DM can cause death in Indonesia for non-communicable
serious health problems such as neuropathy, diseases, where heart disease is the highest
nephropathy, and retinopathy when not treated cause, followed by cancer. However, diabetes
and managed wisely (Alanazi, 2021). In 2019, mellitus is one of the non-communicable
the number of people with DM globally is diseases that is the target to be achieved in
estimated at 463 million in the 20-79 year age the Sustainable Development Goals, namely
group. For ten years, these cases continue to reducing complications caused by these non-
increase by about 6.24 percent annually. Based communicable diseases.
on IDF data, the increase in the number of Besides having an impact on early death


Correspondence Address: pISSN 1858-1196
Politeknik Statistika STIS eISSN 2355-3596
Email : [email protected]
Siskarossa Ika Oktora, et all. / Determinants of Diabetes Mellitus Prevalence in Indonesia

and lower quality of life, DM can also have a week is 35.7 percent. DM can cause so many
significant economic impact on countries, complications, from disability to death. Based
health systems, and individuals, especially when on the results of RISKESDAS data in 2018, only
DM treatment needs to be self-funded by the 9.3 percent of DM patients in Indonesia can
sufferer for the healing process. Based on IDF recover without treatment, and 90.7 percent
data, the total expenditure devoted to DM is need drugs to treat DM, starting with insulin
estimated at 760.3 billion dollars. This condition injections and consuming specific medicines.
is expected to continue to increase. Then DM It shows that most people with DM require
patients who experience complications can special treatment. Family history, unhealthy
also increase spending on care and treatment eating patterns, age, education, and obesity
to overcome the complications. People with are variables that influence the occurrence
DM incurred higher inpatient costs (averaging of diabetes mellitus (Stetson, Minges, &
US$1,912 per episode of admission (Malone et Richardson, 2017). In addition, research
al., 2014). conducted by Nainggolan, Kristanto, and
According to data from the Health Edison (2013) states that age, body mass index,
Ministry of the Republic of Indonesia, the hypertension, high LDL cholesterol, high
prevalence of DM patients aged 15 years triglycerides, and a family history of DM are
and over in Indonesia is 2 percent, where the variables affecting the occurrence of diabetes.
productive age group population has the highest Physical inactivity is estimated to cause
prevalence of DM when compared to other age almost 6-10% of non-communicable diseases
groups. One of the human capital to increase like DM (Lee et al., 2012). The research
productivity is health (Todaro & Smith, 2011). was conducted by Śliwińska-Mossoń and
With more DM sufferers in the productive Milnerowicz (2017) to determine the effect of
age population, this can affect the quality of smoking on diabetes mellitus. Nicotine content
the productive age population in Indonesia. in cigarettes can cause a decrease in plasma
The social determinants in which people are aminopterin levels so that it can cause insulin
born, grow, work, and age has a powerful resistance which can lead to diabetes mellitus.
influence on health problem (Brady et al., 2021; Shang et al. (2013) conducted a study to see the
Cummings et al., 2018; Kolak et al., 2019). To effect of education level and age on the incidence
date, social determinants of health associated of diabetes mellitus among Chinese adult men
with DM include health literacy and related to and women. The results show that people aged
individual education (Quartuccio et al., 2018). 18-59 years with low levels of education are
Many of the social determinants contribute to more at risk of developing diabetes than people
DM, including structural determinants (such with high levels of education. Previous studies
as race and ethnicity) and individual-level have focused more on research on diabetes
determinants (such as smoking) (Fenelon, mellitus that occurs from the individual side.
Chinn, & Anderson, 2017; Lariscy, Hummer, Biradar and Singh (2020) also found that
& Hayward, 2015; Marquez, Calman, & education had a positive influence on DM.
Crump, 2019; Rodríguez & Campbell, 2017; Thus, this study aims to analyze the prevalence
Sáenz & Garcia, 2021). Cartwright (2021) uses of diabetes mellitus in an area and the factors
education level as demographic control to the that determine it.
diabetes disparity.
A way to prevent diabetes is to do Method
physical activity such as exercise. According This study uses cross-section data
to Boden, Chen, and Stein (2001), moderate- from the Ministry of Health of the Republic
intensity exercise programs provide beneficial of Indonesia and Statistics Indonesia (BPS).
effects, including increased insulin sensitivity The diabetes mellitus prevalence data, obesity
and improved glycemic control. However, the prevalence, hypertension prevalence, smoking
awareness of the Indonesian people to exercise population percentage, non-exercise population
is still relatively low. The percentage of the percentage, unemployment rate, and the
population who do sports during the past average length of schooling for each province

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in Indonesia in 2018. The method used is the exercise in the last week is the percentage of
multiple linear regression method. Multiple the population who did not exercise during the
linear regression is an analytical method that past week to the total population. The average
aims to find the effect of the independent length of schooling is the average number of
variable on the dependent variable. years taken by residents aged 15 years and over
The prevalence of diabetes mellitus to take all levels of education that have been
based on a doctor’s diagnosis in the population undertaken.
aged more than 15 years is the percentage of the
population aged more than 15 years who suffer Result And Discussion
from diabetes mellitus to the population aged Based on data from the Health Ministry
more than 15 years. The prevalence of central of the Republic of Indonesia in 2018, the
obesity in the population aged more than 15 prevalence of DM patients aged 15 years and
years is the percentage of the population aged over in Indonesia is 2 percent. By gender, the
more than 15 years who suffer from central prevalence of the male population aged 15 years
obesity to the total population aged more and over who suffers from diabetes mellitus is
than 15 years. The prevalence of hypertension 1.7 percent. This number is smaller than the
based on a doctor’s diagnosis in the population prevalence of women aged 15 years and over
aged over 18 years is the percentage of the who suffer from diabetes mellitus, reaching
population aged more than 18 years who 2.4 percent. Based on the level of education,
suffer from hypertension based on a doctor’s the prevalence of people with diabetes aged
diagnosis of the population with an age of more than 15 years, and the population with
more than 18 years. The percentage of smoking educational status not completing elementary
is the percentage of the population who do school is the highest with 2.9 percent. Then,
smoking activities of the total population. followed by the population with education
The unemployment rate is the percentage of status who never went to school (2.8 percent)
the number of unemployed in the labor force. and the population with graduated education
The percentage of the population who did not status (2.8 percent).

Figure 1. Diabetes Mellitus Prevalence Based on Doctor’s Diagnosis in the Population Age 15
Years and Over by Province in Indonesia 2018
Based on Fig. 1, 13 provinces have a province with the lowest prevalence of diabetes
higher prevalence of diabetes in Indonesia. is the province of East Nusa Tenggara. Residents
DKI Jakarta is the highest, with 3.4 percent, who live in urban areas tend to be more at risk for
followed by DI Yogyakarta (3.1 percent) and developing diabetes due to unhealthy lifestyles
East Kalimantan (3.1 percent). Meanwhile, the such as consuming excessive carbohydrates,

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lack of physical activity, smoking, alcohol, place of residence, body mass index, drinking
etc. For example, in 2018, DKI Jakarta is the alcohol, and caffeine (Hasan et al., 2018). The
province with the highest percentage of the percentage of the population aged 15 years and
population who exercised during the past week over who smokes in North Sulawesi is 32.8
in Indonesia (44.93 percent). Based on the percent, with the average number consumed
number of days to exercise, as many as 71.24 per week being 82.19 cigarettes. In contrast, the
percent of the population who exercised do it province of Papua, with the lowest prevalence
only one day in the past week. Gothankar and of hypertension in Indonesia, has a smoking
Patil (2011) found that obesity was associated percentage of 28.97 percent, which is smaller
with DM. In 2018, the prevalence of obesity in than the national smoking percentage. As one
Indonesia in the population aged more than of the factors that can affect hypertension, the
15 years was 31 percent. The province with percentage of smokers in each province will
the highest prevalence of obesity was North certainly make a difference in the prevalence of
Sulawesi, with 42.5 percent, followed by DKI existing hypertension.
Jakarta (41.9 percent) and East Kalimantan The percentage of the smoking
(37.3 percent). The province with the lowest population in Indonesia is 32.2 percent.
prevalence of obesity is East Nusa Tenggara, The province in Indonesia with the highest
with 19.3 percent. rate of smoking population is Gorontalo
According to Hruby et al. (2016), the province, which is 36.56 percent. Meanwhile,
factors affecting the incidence of obesity are the province with the lowest percentage of
sugar-sweetened beverages, poor diet quality, the smoking population is DI Yogyakarta,
physical inactivity, prolonged screen time, which is 25.8 percent. One factor influencing
short sleep duration or shift work, and built cigarette consumption is excise duty, where
environment characteristics. Physical activity every increase in excise tax will reduce the
can be in the form of sports or activities carried population’s interest in consuming cigarettes.
out daily. The number of residents who do In 2018, the cigarette excise tax increased by
sports in North Sulawesi is 28.43 percent. 10.04 percent, but a decrease did not follow
This number is below the national average the increase in the percentage of smokers.
for people who do sports. Then based on The number of people who did not exercise in
this number, as many as 73.54 percent of the Indonesia in 2018 was 64.3 percent. By gender,
population who exercised only did it for one the male population in Indonesia has a lower
day in the past week. It means the exercise will percentage of not exercising than the female
be less effective. As the province with the lowest population, which is 61.77 percent. Papua has
obesity percentage, East Nusa Tenggara has a the highest percentage of the population who
relatively small percentage of the population does not exercise in Indonesia, and the lowest
who exercise, 26.19 percent. However, based on is DKI Jakarta at 55.07 percent. Based on the
the activities carried out, most in this province place of residence, urban residents have a
work in fields that require high physical activity, percentage of residents who do not exercise
such as agriculture, fisheries, plantations, and at 59.27 percent, lower than rural areas (70.57
industry. percent).
The prevalence of hypertension in the The factor that influences people to
population aged over 18 years in Indonesia exercise is the availability of time each individual
in 2018 was 8.36 percent. North Sulawesi has. In urban areas in Indonesia, 83.17 percent
Province, with 13.21 percent, is the highest in of the population worked 20-74 hours during
Indonesia, followed by DI Yogyakarta and East the past week. While in rural areas, 78.39
Kalimantan. Papua Province has the lowest percent of the population has a working hour
prevalence of hypertension in Indonesia, with a of 20-74 hours. It shows that in Indonesia, the
hypertension prevalence of 4.39 percent. Several availability of time does not affect the desire
factors can cause hypertension, such as age, sex, of the population to do sports. The type of
marital status, education, wealth index, working work in rural areas, which tends to demand
status, ecological zone, province of residence, higher physical activity when compared to

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work in urban areas, can be one of the causes because, on average, the Indonesian population
of the lack of interest of rural residents to do only attends up to the second grade of junior
sports. Feldman et al. (2020) showed evidence high school. DKI Jakarta has the highest
of a positive association between DM and average number of years of schooling, which
unemployment. In 2018, the unemployment is 11.06 years (high school level). Meanwhile,
rate in Indonesia was 5.13. The province with the province with the lowest is Papua province,
the highest unemployment rate in Indonesia is with an average length of schooling of 6.66
West Java, with an unemployment rate of 8.16, years (elementary school). The average length
followed by Banten (7.77) and Maluku (7.38). of schooling in Papua can be reflected in the
One of the factors that influence the literacy rate of the province of Papua, which
unemployment rate is the level of education. is 76.79 percent, where this percentage is the
The average length of schooling in the province smallest in Indonesia. In addition, only 7.86
of West Java is 8.61 years, while Bali, with the percent of the total population of 15 years and
lowest unemployment rate, has an average over had a graduate level.
length of schooling of 9 years. The population in Based on Table 1, the prevalence of
Bali who graduated from the graduate program obesity and the prevalence of hypertension
is 12.3. This number is higher than West Java, significantly affect diabetes mellitus prevalence.
which is only 7.87 percent. In addition to the While the variables of the percentage of the
level of education, population density is also population smoking, the percentage of the
one factor affecting an area’s unemployment population not exercising, the unemployment
rate. The higher the population density of an rate, and the average length of schooling are
area, the more people in the region, which can insignificant. The coefficient of determination
cause competition in the world of work to be is 0.627. It means that the prevalence of obesity,
tough and increase the number of unemployed. the prevalence of hypertension, the percentage
Feldman et al. (2020) found that of the population smoking, the percentage of the
prevalence decreased with increasing population not exercising, the unemployment
educational attainment. The average length of rate, and the average length of schooling can
schooling in Indonesia in 2018 was 8.58 years. explain the diabetes mellitus prevalence by 62.7
It shows that the average Indonesian population percent.
only has an elementary school certificate. It is
Table 1. Summary of the Results of Multiple Linear Regression
t-test Homoscedasticity
Variables B VIF
T Sig. t Sig.
Obesity Prevalence (PO)* 0.049 2.626 0.014 1.842 1.206 0.238
Hypertension Prevalence (PH)* 0.168 3.713 0.001 1.618 0.116 0.908
Smoking Percentage (PM) -0.025 -0.981 0.335 1.185 -1.515 0.141
Non-exercising Percentage (PT) -0.008 -0.512 0.613 1.497 -1.894 0.069
Unemployment Rate (PTB) 0.03 0.626 0.537 1.496 -0.563 0.578
Length of Schooling (RLS) -0.007 -0.06 0.953 2.067 0.145 0.886

Using the Kolmogorov-Smirnov test, multicollinearity, the VIF (Variance Inflation

the p-value obtained is 0.200. It is higher than Factor) value can be used. Based on Table 1, the
α = 0.05, so the error is normally distributed. VIF value of the six independent variables is
Using the Glejser test, the p-value obtained for lower than 10, so there is a non-multicollinearity.
each independent variable is more than 0.05, so Based on the model, it shows that every one
the error variance is constant. To check non- percent increase in the prevalence of obesity

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will increase the prevalence of diabetes mellitus by the Indonesian population every week is
by 0.049 percent. The following research 81.23 cigarettes, which means that, on average,
conducted by Stetson et al. (2017) shows that the Indonesian population consumes 11-12
obesity affects diabetes mellitus. Excessive cigarettes. In addition, as many as 12.75 percent
consumption patterns can cause fatty acids or of the population who smoke consumes 1-29
Free Fatty Acids (FFA) in cells. The increase in cigarettes per week.
FFA that occurs can cause a decrease in glucose The percentage of the population who
uptake into the plasma membrane and will do not exercise has no significant effect on the
cause insulin resistance in muscle and adipose prevalence of diabetes mellitus. Physical activity
tissue. This event can cause fatigue in the is categorized as less if the activity is carried
pancreas until the pancreas does not produce out continuously for less than 10 minutes
insulin as needed. It causes an increase in blood in one non-stop activity and cumulatively
sugar levels, and diabetes occurs. Biradar and does not reach 150 minutes five days a week.
Singh (2020) also found that overweight people Based on the population who do sports, the
showed the strongest association with DM. number of people who exercise in Indonesia
Parsa, Aghamohammadi, and Abazari is 35.7 percent. Almost 68.31 percent of the
(2019) found that 54.1% of DM patients population who exercise do sports only one
suffered from comorbidities. The prevalence of day a week. When viewed based on the length
hypertension affects the prevalence of diabetes of exercise, the highest percentage is at 30-60
mellitus with a positive effect. Research by minutes, which is 48.67 percent. Furthermore,
Pham and Eggleston (2016) also found that based on the purpose of doing sports, residents
hypertension was associated with a higher who do sports during the past week do more
prevalence of DM. Based on the model, it sports to fulfill the curriculum at school. Based
shows that for every one percent increase in on these things, the average exercise performed
the prevalence of hypertension, it will increase by the Indonesian population is considered
the prevalence of diabetes mellitus by 0.168 less effective. The unemployment rate has no
percent. These results follow the research significant effect on the prevalence of diabetes
conducted by Nainggolan et al. (2013), which mellitus. Based on data from the Health
states that hypertension is one of the variables Ministry of the Republic of Indonesia in 2018,
that significantly affect diabetes mellitus. In the unemployed population has the second-
addition, according to Cheung and Li (2012), highest diabetes prevalence in Indonesia, 3.2
if your blood pressure is above 120/90 mmHg, percent. The highest prevalence of diabetes
you will have a double risk of diabetes than mellitus by type of activity in Indonesia is
people with normal blood pressure. The owned by population groups who work as civil
thickening of the blood vessels will cause the servants. People who have worked can also
process of transporting glucose from the blood affect the existing level of diabetes mellitus.
to be disrupted. The average length of the school has no
The percentage of the smoking significant effect on the prevalence of diabetes
population has no significant effect on the mellitus. According to Stetson et al. (2017),
prevalence of diabetes mellitus. This result is in people with higher education levels will have
line with research conducted by Nainggolan et behavior change concepts and theories and
al. (2013), which states that smoking behavior have more health knowledge. They have an
does not affect the occurrence of diabetes awareness of maintaining their health. Less
mellitus. According to research conducted by educated people may lack resources and have
Śliwińska-Mossoń and Milnerowicz (2017), difficulties accessing information, especially
cigarettes contain 7357 chemical compounds nutrition, which can cause DM (Vasconcelos et
and 1015 to 1017 free radicals and can lead to al., 2020). More years of education people also
diabetes mellitus. In Indonesia, 2.08 percent prevent DM complications (Rovner, Haller,
of the population in urban areas and 2.14 Casten, Murchison, & Hark, 2015). People with
percent in rural areas smoke but do not do low levels of education (never attended school,
it daily. The number of cigarettes consumed did not finish elementary school, and finished

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elementary school) tend to have jobs that Determinants of Health Screening and Type
require high physical activity. Like agriculture, 2 Diabetes Mellitus. Preventive Medicine
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Latinx Diabetes Health Disparity: A Oaxaca-
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Blinder Decomposition Analysis. SSM-
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Cheung, B.M., & Li, C., 2012. Diabetes and
Conclusion Hypertension: is There a Common Metabolic
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Literacy to Diabetes Status Differs by Sex

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