Diabetes Mellitus is a major public health concern in Indonesia but research on the future burden and projected trends of the disease remain limited. The burden of Diabetes, one of the major Non-Communicable Diseases (NCD), in term of prevalence and mortality becomes a serious problem in the world as well as in Indonesia. The prevalence of diabetes increased from 2.968 to 5.943 cases per 100.000 population between 1993 and 2019. Meanwhile, the diabetes mortality rate increased from 12,37 to 20,5 deaths per 100.000 population in 1990. In Indonesia, the reported prevalence of diabetes among adults increased from 5,7% in 2007 to 6,9% in 2013 and 8,5% in 2018.

Diabetes prevention and control have been incorporated into Indonesia’s National Health Policy framework including the National Medium – Term Development Plan 2020 – 2024, Strategic Plan of the Ministry of Health 2020-2024, and indicators in the Minimum Service Standards for district government. Furthermore, there are also screening programs including obesity and central obesity, as well as the provision of diabetes-related health service under the minimum service standards (SPM) in accordance with the responsibilities of district government.

The prevalence of diabetes morbidity and mortality in Indonesia is projected to increase significantly between 2020 and 2045. The prevalence of diabetes is projected to increase by 75,1% over 25 years, with an average of 3% from prevalence per year. The number of deaths from diabetes and its complications is projected increase by 117% over 25 years or an average of 4,7% per year.

There are several types of diabetes. The main categories include the following:

• Prediabetes: This type is the stage before type 2 diabetes. The blood glucose levels are higher than normal, but not high enough to be officially diagnosed with type 2 diabetes.
• Type 1 diabetes: This type is an autoimmune disease in which your immune system attacks and destroys insulin-producing cells in your pancreas for unknown reasons. Up to 10% of the people who have diabetes have type 1. It’s usually diagnosed in children and young adults, but it can develop at any age.
• Type 2 diabetes: With this type, the body doesn’t make enough insulin and/or the body’s cells don’t respond normally to the insulin (insulin resistance). This is the most common type of diabetes. It mainly affects adults, but children can have it as well.
• Gestational diabetes: This type develops in some people during pregnancy. Gestational diabetes usually goes away after pregnancy. However, if someone have gestational diabetes, that person at higher risk developing type 2 diabetes later in life.

A patient with diabetes has the potential for hyperglycemia. The pathology of diabetes can be unclear since several factors can often contribute to the disease. Hyperglycemia alone can impair pancreatic beta-cell function and contributes to impaired insulin secretion. Consequentially, there is a vicious cycle of hyperglycemia leading to an impaired metabolic state. Blood glucose levels above 180 mg/dL are often considered hyperglycemic, though because of the variety of mechanisms, there is no clear cutoff point. Patients experience osmotic diuresis due to saturation of the glucose transporters in the nephron at higher blood glucose levels.

The cause of diabetes include:

• Insulin resistance: Type 2 diabetes mainly results from insulin resistance. Insulin resistance happens when cells in your muscles, fat and liver don’t respond as they should to insulin. Several factors and conditions contribute to varying degrees of insulin resistance, including obesity, lack of physical activity, diet, hormonal imbalances, genetics and certain medications.

Insulin resistance is attributable to excess fatty acids and proinflammatory cytokines, which leads to impaired glucose transport and increases fat breakdown. Since there is an inadequate response or production of insulin, the body responds by inappropriately increasing glucagon, thus further contributing to hyperglycemia. While insulin resistance in component of T2DM, the full extent of the disease results when the patient has inadequate production of insulin to compensate for their insulin resistance.

• Autoimmune disease: Type 1 diabetes develops when your immune system attacks and destroys insulin-producing pancreatic beta cells, resulting in severe insulin deficiency.
• Hormonal imbalances: During pregnancy, the placenta releases hormones that cause insulin resistance. Gestational diabetes may develop when pancreatic beta cells cannot increase insulin secretion sufficiently to compensate for this increased insulin resistance.
• Pancreatic damage: Pancreatic damage caused by disease, surgery, or injury can impair pancreatic function and reduce insulin production, potentially leading to diabetes.

Symptoms of diabetes include:

• Increased thirst (polydipsia) and dry mouth
• Frequent urination
• Fatigue
• Blurred vision
• Unexplained weight loss
• Numbness or tingling in your hands or feet
• Slow-healing sores or cuts
• Frequent skin and/or vaginal yeast infections

Additional details about symptoms per type of diabetes include:

• Type 1 diabetes: Symptoms of TD1 can develop quickly, over a few weeks or months. May develop additional symptoms that are signs of a severe complication called diabetes-related ketoacidosis (DKA). DKA is life threatening and requires immediate medical treatment. DKA symptoms include vomiting, stomach pains, fruty smelling breath and labored breathing.
• Type 2 diabetes and prediabetes: The patient may not have any symptoms at all, or may not notice them since they develop slowly. Routine bloodwork may show a high blood sugar level before someone recognize symptoms. Another possible sign of prediabetes is darkened skin on certain parts of the body.
• Gestational diabetes: Typically, the pregnant women won’t notice symptoms of gestational diabetes. The healthcare provider will test for gestational diabetes between 24 and 28 weeks of pregnancy.

What are the complications of diabetes?

Diabetes can lead to acute and long-term complications – mainly due to extreme or prolonged high blood sugar levels.

Acute diabetes complications

• Hyperosmolar hyperglycemic state (HHS): This complication mainly affects people with type 2 diabetes. It happens when your blood sugar levels are very high for a long period, leading to severe dehydration and confusion.
• Diabetes related ketoacidosis (DKA): This complication mainly affects people with type 1 diabetes or undiagnosed T1D. It happens when the body doesn’t have enough insulin. If the body doesn’t have insulin, it can’t use glucose for energy, so it breaks down fat instead. This process eventually releases substances called ketones, which turn blood acidic.
• Severe low blood sugar (hypoglycemia): Hypoglycemia happens when the blood sugar level drops below the range that’s healthy. Severe hypoglycemia is very low blood sugar. It mainly affects people with diabetes who use insulin. Signs include blurred or double vision, clumsiness, disorientation and seizures.

Long term diabetes complications

Blood glucose levels that remain high for too long can damage the body’s tissues and organs. It is mainly due to damage the blood vessels and nerves, which support the body’s tissues.

Cardiovascular (heart and blood vessel) issues are the most common type of long-term diabetes complication. They include:

• Coronary artery disease
• Heart attack
• Stroke
• Atherosclerosis

Other diabetes complications include:

• Nerve damage (neuropathy), which can cause numbness, tingling and/or pain
• Nephropathy, which can lead to kidney failure or the need for dialysis or transplant
• Retinopathy, which can lead to blindness
• Diabetes related foot conditions
• Skin infections
• Amputations

Diagnosis and Tests

Healthcare providers diagnose diabetes by checking the glucose level in a blood test. Three tests can measure the blood glucose level:

• Fasting blood glucose test: For this test, the people don’t eat or drink anything except water (fast) for at least eight hours before the test. As food can greatly affect blood sugar, this test allows the provider to see the baseline blood sugar. A person is diagnosed as diabetes if the fasting blood glucose 126 or higher.
• Random blood glucose test: Random blood glucose test means that people can get this test at any time, regardless of if you’ve fasted. A person is diagnosed as diabetes if the blood glucose is 200 or higher (with classic symptoms or hyperglycemia).
• HbA1c: This test called HbA1C or glycated hemoglobin test, provide the average blood glucose level over the past two or three months. A person is diagnosed diabetes if the HbA1c 6,5% or higher.

Early diagnosis can be accomplished through relatively inexpensive testing of blood glucose. Diabetes is a complex condition, so its management involves several strategies. In addition, diabetes affects everyone differently, so management plans are highly individualized. People with type 1 diabetes need insulin injections for survival. One of the most important ways to treat diabetes is to keep a healthy lifestyle.

The four main aspects of managing diabetes include:

• Diet: Meal planning and choosing a healthy diet are key aspects of diabetes management, as food greatly impacts blood sugar. If someone take insulin, counting carbs in the food and drinks which consume is a large part of management. The amount of carbs eaten determines how much insulin need at meals. Healthy eating habits can also help manage weight and reduce the heart disease risk. Limit alcohol intake and quit smoking.
• Exercise: Physical activity increases insulin sensitivity (and helps reduce insulin resistance), so regular exercise is an important part of management for all people with diabetes. Aim for 30 minutes a day at least five days a week to achieve an ideal weight.
• Manage stress and get adequate sleep
• Blood sugar monitoring: Monitoring blood sugar (glucose) is key to determining how well the current treatment plan is working. It gives information on how to manage the diabetes on daily.
• Oral diabetes medications: Oral diabetes medications (taken by mouth) help manage blood sugar levels in people who have diabetes but still produce some insulin – mainly people with type 2 diabetes and prediabetes. People with gestational diabetes may also need oral medication.
• Insulin: People with type 1 diabetes need to inject synthetic insulin to live and manage diabetes. Some people with type 2 diabetes also require insulin.

For many years, Metformin has been the first line pharmacotherapy preferred in the United Kingdom, Europe and numerous other regions globally, unless contraindicated due to renal impairment or intolerable gastrointestinal side effects.

The multifaceted treatment requirements for T2D extend well beyond glycaemic control, encompassing intensive management of the interconnected cardiovascular risk factors: dyslipidaemia, hypertension, and central obesity. However, monotherapy with Metforrmin consistently fails to achieve target HbA1c levels (≤7,0% for most patients; ≤6,5% for select younger individuals without comorbidities). Failure to achieve rapid glycaemic control in T2D may be compounded by therapeutic inertia, which delays timely intensification of therapy, allowing hyperglycemia to persist.

Dual therapy with Metformin plus any additional agent was significantly more effective than Metformin monotherapy. Sitagliptin and metformin combination is used together with proper diet and exercise to treat high blood sugar levels caused by type 2 diabetes. Sitagliptin helps to control blood sugar levels by increasing substances in the body that make the pancreas release more insulin. It also signals the liver to stop producing sugar (glucose) when there is too much sugar in the blood. Metformin reduces the absorption of sugar from the intestines, reduce the release of stored sugar from the liver, and helps the body use sugar better.

PT Simex Pharmaceutical Indonesia, as one of the pharmaceutical companies in Indonesia, offers MAXSIMET® a fixed dose combination Metformin and Sitagliptin for the management of type 2 diabetes mellitus. By combining complementary glucose-lowering mechanisms, the two active ingredients can help improve glycemic control when combination therapy is clinically indicated. MAXSIMET® are available in two dosage, MAXSIMET® - 500 (Metformin 500 mg and Sitagliptin 50 mg) and MAXSIMET® - 1000 (Metformin 1000 mg and Sitagliptin 50 mg).

Reference

Antar SA., Ashour NA., Sharaky M., et.al. 2023. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomedicine & Pharmacotherapy 168 (2023) 115734.

Wahidin M., Achadi A., Besral B., Kosen S., et.al. 2024. Projection of diabetes morbidity and mortality till 2045 in Indonesia basen on risk factors and NCD prevention and control programs. Scientific Reports (2024) 14:5424.

Kelly M., Saluja S., Ellis HL., et.al. 2026. A systematic review and meta-analysis of the relative benefit of dual versus single oral hypoglycaemic therapy following diagnosis with type 2 diabetes (T2D). Diabetic Medicine, 2026; 43:e70337

Hayes J., Anderson R., Stephens JW. 2016. Sitagliptin/metformin fixed-dose combination in type 2 diabetes mellitus: an evidence-based review of its place in therapy. Drug Design, Development and Therapy 2016:10 2263-2270

https://my.clevelandclinic.org/health/diseases/7104-diabetes

https://www.ncbi.nlm.nih.gov/books/NBK551501/

https://www.who.int/news-room/fact-sheets/detail/diabetes

https://www.mayoclinic.org/drugs-supplements/sitagliptin-and-metformin-oral-route/description/drg-20559685

https://hospitalsmagazine.com/making-life-easier-and-smoother-for-diabetic-patients/

https://www.startstemcells.com/diabetes-type2-treatment.html

https://prescriptionhope.com/blog-what-is-the-difference-between-type-1-and-type-2-diabetes/

https://www.drjpkotlasmedicalcentre.com/type-2-diabetes-treatment.php

https://newsinhealth.nih.gov/2014/11/preventing-type-2-diabetes