ESPE Yearbook of Paediatric Endocrinology

J Clin Res Pediatr Endocrinol. 2024 Nov 27. PMID: 39601260 doi: 10.4274/jcrpe.galenos.2024.2024-9-4

Brief Summary: This article presents the current state of care for children with Type 1 diabetes (T1D) in Indonesia and the challenges faced in the country. These include a limited number of pediatric endocrinologists with uneven geographical distribution, limited access to insulin and blood glucose monitoring and difficulties with family education and support.

According to the Changing Diabetes in Children (CDiC) Indonesia database, in January 2024, there were 1210 children and adolescents living with T1D, mostly on the island of Java. This number is thought to be lower than actual, due to low reporting and poor ascertainment in rural areas beyond Java Island. The perception of a low prevalence of T1D contributes to the poor awareness of T1D among the general public as well as health care professionals in Indonesia. In 2024, the Indonesian Pediatric Society reported 39 pediatric endocrinologists with an unequal geographical distribution. As pediatric endocrinologists are the primary source of healthcare for those with T1D and its incidence appears to be rising in Indonesia, the insufficient number and unevendistribution is both a current issue and one that is likely to become more more marked without increases in workforce.

The main health insurance available to Indonesian citizens is Jaminan Kesehatan Nasional (JKN). Through this system, those with T1D receive a monthly supply of basal and prandial insulin based on the indicated doses, and 90 pieces of needle and alcohol swabs. However, the supply of insulin is sometimes insufficient, necessitating out of pocket payments. Insulin pump therapy is used by an estimated 2% of those with T1D, due to national health insurance restrictions. Blood glucose self-monitoring is largely by finger-stick testing, but glucometers and glucose test strips are not covered by insurance and the costs are prohibitive for many families, resulting in insufficient monitoring and therefore poor glycemic control. Continuous glucose monitors are uncommon due to restrictions on coverage.

The landscape of T1D care in Indonesia reveals issues of both insufficient manpower and access to the tools necessary for appropriate glycemic control. Resolving these issues will require improvements in healthcare infrastructure and access but also comprehensive education and support for patients and families.