The glycemic control of type-2 diabetic patients in the reversed referral program of Indonesia’s healthcare and social security agency: a cross-sectional study

Background
Indonesia ranks fifth globally with 19.5 million diabetic people, which is projected to increase to 28.6 million by 2045. The Indonesian government, through the Healthcare and Social Security Agency (BPJS Kesehatan), runs the reversed referral program (PRB) in primary healthcare facilities to ease access to services for patients with chronic diseases like type-2 diabetes mellitus (T2DM).

Objectives
This study analyzes glycemic control and its influencing factors among T2DM patients in PRB.

Material and methods
A cross-sectional study design retrospectively collected secondary data from patients’ medication records in PRB and monitoring forms. Logistic regression was used to analyze the factors influencing glycemic control (p < 0.05).

Results
This study involved 253 T2DM patients, most of whom were elderly (65.2%), with T2DM for over five years (56.9%), undergoing monotherapy (83%) or non-insulin therapy (56.5%), and with complications (67.6%). Good glycemic control was seen in only 36% patients, with the significantly influencing factors being drug therapy (OR = 5.455, 95% CI = 2.942–10.116), age (OR = 1.949, 95% CI = 1.059–3.585), and gender (OR = 0.454, 95% CI = 0.275–0.802).

Conclusions
More than 60% of patients had poor glycemic control. Geriatrics, male patients, and patients with non-insulin therapy increased the risk of uncontrolled glycemic control by 2, 2.2, and 5.5 times, respectively. Early insulin therapy should be considered as a strategy of choice, particularly for high-risk patients. The government needs to review the patient management system in PRB, especially the large number of patients with seemingly stable clinical conditions but poor glycemic levels, thus being at risk of complications.