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Correlation between economic status and severity of type 2 diabetes mellitus in Indonesia: analysis of claim data from the national health insurance scheme, 2018-2022

Por: Ahsan · A. · Baros · W. A. · Siregar · D. R. · Pertiwi · Y. B. A. · Utami · M. G. · Aminde · L. · Manurung · K. K. · Febriyanti · M.
Objectives

This study investigated the correlation between the type of health insurance membership as a proxy for the economic status of patients and the severity of their type two diabetes mellitus (T2DM) in Indonesia.

 Design

The study conducted a secondary analysis of National Health Insurance (Jaminan Kesehatan Nasional) claim data provided by the Indonesian Social Security Agency, Badan Penyelenggara Jaminan Sosial (BPJS). We used ordered logistic regression with four severity levels for T2DM (0=outpatient, I=mild, II=moderate, III=severe) as dependent variables. The main independent variables (insurance membership categories) included subsidised insurance members (PBI), a combination of formally employed and nonsalaried informal workers (PBPU & PPU) and nonworkers (BP).

 Setting

Secondary healthcare facilities in Indonesia.

 Participants

The dataset included 2 989 618 claims for hospital visits of people with T2DM from 2018 to 2022.

 Primary outcome measures

Severity level of T2DM patients.

 Result

A higher percentage of T2DM patients who visited healthcare facilities with subsidised insurance (PBI), which represents a low-income group, have severe disease (6.9%) than patients in the PBPU & PPU (4.9%) and BP categories (5.5%). Moreover, regression analysis revealed that having PBI membership status was associated with a greater OR of having severe T2DM than nonsubsidised members. Among T2DM patients in the nonsubsidised insurance category, workers (PBPU & PPU) had an OR of 0.74 (95% CI: 0.735 to 0.745; p

Conclusion

These findings illustrate the lack of optimal access to health services for diabetes patients in low-income insurance membership categories and the challenges of better treatment in health facilities for low-income patients.

Clinical evaluation of intralesional umbilical cord‐derived mesenchymal stem cells, conditioned medium and triamcinolone acetonide injection for keloid treatment: A pilot study

Por: Anastasia Dessy Harsono · Ismail Hadisoebroto Dilogo · Theddeus Octavianus Hari Prasetyono · Marcel Prasetyo · Retno Asti Werdhani · Sri Widia A. Jusman · Nuryati Chairani Siregar · Hardisiswo Soedjana

Abstract

Topical keloid therapy is performed with triamcinolone acetonide (TA) intralesional injection. However, the recurrence rate is high with various side effects. Mesenchymal stem cells (MSCs) have high proliferative abilities and reduce the activity and proliferation of fibroblast cells in keloids. To overcome the costs and limitations, conditioned medium (CM) is used. This study aims to evaluate feasibility of intralesional injection of umbilical cord MSC (UC-MSC) and conditioned medium (UC-CM) compared to TA for keloid therapy. Twenty-four patients with keloids who met the inclusion criteria were included, randomized into three treatment groups and then got assessed for the sociodemographic data, keloid volume, histopathology (type 1:3 collagen ratio), interleukin-10 (IL-10) levels and Patient and Observer Scar Assessment Scale (POSAS) score during visits. Largest volume regression occurred in the UC-MSC group, followed by UC-CM and then the TA group (UC-MSC: 45.32% ± 2.61%; UC-CM: 43.61% ± 3.67%; TA: 28.34% ± 3.81%; p = 0.003). Similar pattern was also observed in increase in IL-10 levels, the decrease in POSAS scores and the reduction of type 1:3 collagen ratio. Hence, UC-MSC and UC-CM are promisingly more effective than TA for keloid therapy, showcasing their superiority in reducing keloid volume, symptoms and type 1:3 collagen ratio, as well as increasing the levels of IL-10.

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