Progress and Inequality in The Diabetes Care Cascade in Indonesia: A National Health Survey Analysis (2013-2023)

ABSTRACT Background: To examine trends in Indonesia's diabetes care cascade from 2013 to 2023, identify key determinants, and assess progress toward global targets of 80% diagnosis and 80% glycemic control among those diagnosed. Methods: We analyzed nationally representative data from Indonesia's Health Surveys in 2013, 2018, and 2023. Diabetes was defined using fasting plasma glucose and oral glucose tolerance tests. We estimated diagnosis, treatment, and control rates and examined sociodemographic predictors of cascade progression using survey-weighted logistic regression models. Results: Between 2013 and 2023, the prevalence of diabetes among adults aged [≥]15 years remained stable, ranging from 10.7% to 11.8%. Diagnosis increased from 15.1% (95% CI: 13.4-16.7) to 20.7% (18.5-22.9), treatment nearly doubled from 10.5% (9.1-11.9) to 19.0% (16.9-21.2), and control rose modestly from 4.6% (3.6-5.6) to 6.5% (5.2-7.8). Older age, urban residence, higher socioeconomic status, and insurance coverage were associated with greater progression through the cascade. Wealth-related inequalities persisted in 2023: one-third of cases were diagnosed among the richest (35.3% [29.0-41.7]) versus only 11.0% (7.9-14.2%) among the poorest. Compared with the lowest quintile, wealthier individuals had higher odds of diagnosis (AOR 3.55 [2.11-5.98] for diagnosis, 3.59 [2.01-6.41] for treatment, and 2.24 [1.12-4.51] for control). Conclusions: Indonesia achieved meaningful improvements in the diabetes care cascade over the past decade, yet remains far below global 80/80 targets, with nearly 80% of cases undiagnosed and control below 10%. Persistent wealth-based inequities highlight that near-universal insurance coverage has not been translated into equitable care access, underscoring the need for equity-focused screening and primary care strengthening. Keywords: Diabetes, Care Cascade, Health Services, Indonesia