Changes in Behavioral Risk Factors for Diabetes in Indonesia: Evidence from National Surveys Before and After the COVID-19 (2018 and 2023)

Background: This study assessed whether associations between key behavioral risk factors and diabetes mellitus (DM) changed between 2018 and 2023. Methodology: A repeated cross-sectional analysis was conducted using pooled data from Riskesdas 2018 and SKI 2023, including 54,299 adults aged ≥15 years. DM was defined using fasting or 2-hour postprandial glucose. Poisson regression with robust variance estimated adjusted prevalence ratios (PRs), including interaction terms for survey year. Results: Low physical activity remained associated with higher DM prevalence (PR=1.11; 95% CI: 1.03-1.20), with no significant change over time. Dietary risk showed an inverse association with DM (PR=0.79; 95% CI: 0.71-0.88), which was significantly attenuated over time (PR interaction=1.27; 95% CI: 1.09-1.48). A similar pattern was observed for smoking (PR=0.75; interaction PR=1.18). Alcohol consumption became inversely associated with DM in 2023 (interaction PR=0.55; 95% CI: 0.31-0.96), although no significant association was observed overall. Conclusions: Low physical activity remained a consistent risk factor for diabetes in Indonesia, while other behavioral associations varied between 2018 and 2023, underscoring the need for continuous surveillance and behavior-based interventions.