BACKGROUND : Diabetes mellitus (DM) remains a major global health challenge, and its burden is intensified by comorbidities, such as obesity, hyperglycemia, and kidney dysfunction. Diverse geography and population, such as Indonesia, create unique provincial variations in DM risk factors, necessitating detailed sub-nationwide analyses to guide policymaking. This study aimed to evaluate regional disparities in diabetes-related mortality and associated risk factors across Indonesian provinces and to examine whether population density influences the distribution of these risk factors. METHODS : We analyzed age-standardized DM mortality and summary exposure values for 9 comorbidities across 34 provinces (GBD 2021), using Pearson's/Spearman's correlations nationally and provincially. Coefficient power was classified as weak (0.01–0.29), moderate (0.30–0.69), or strong (0.70–1.00). RESULTS : At the national scale, DM mortality was moderately associated with high BMI, high FPG, and kidney dysfunction (all R = 0.60; p<0.001). Associations were stronger in high-density provinces and negligible in low-density provinces. Across provinces, BMI and FPG were the most consistent correlates of DM mortality while diet-related factors (e.g., sugar intake) showed the largest gradient by density. CONCLUSIONS These findings support the development of tailored strategies based on population density to effectively reduce diabetes-related mortality. These results indicate that interventions in urban provinces should prioritize curbing sugar intake and reducing obesity prevalence. In intermediate-density regions, the focus should shift to the intensification of management for kidney disease and the optimization of blood pressure control. For low-density provinces, a critical approach involves expanding systematic screening programs and enhancing patient access to healthcare services.
comorbidity ; diabetes ; mortality ; Indonesia ; policy ; regional health planning

Objective:To investigate the clinical efficacy of local injection of platelet-rich plasma (PRP) combined with double-layer artificial dermis in treating wounds with exposed tendon on extremity.Methods:A retrospective observational study was conducted. From December 2017 to October 2022, 16 patients were admitted to Department of Orthopaedic Trauma of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, and 32 patients were admitted to Department of Burns and Plastic Surgery of Guiyang Steel Factory Staff Hospital. All the patients had wounds with exposed tendon on extremity caused by various reasons and met the inclusion criteria. There were 39 males and 9 females, aged 26 to 58 years. The patients were divided into PRP alone group, artificial dermis alone group, and PRP+artificial dermis group, with 16 patients in each group. The wounds were treated with autologous PRP, double-layer artificial dermis, or thei combination of autologous PRP and double-layer artificial dermis, followed by autologous split-thickness scalp grafting after good growth of granulation tissue. On the 7 th day after the secondary surgery, the autograft survival was observed, and the survival rate was calculated. The wound healing time and length of hospital stay of patients were recorded. At 3 and 6 months after wound healing, the Vancouver scar scale (VSS) was used to score the pigmentation, height, vascularity, and pliability of scars, and the total score was calculated. Adverse reactions during the entire treatment process were recorded. Data were statistically analyzed with chi-square test, Fisher's exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, Nemenyi test, and Bonferroni correction. Results:On the 7 th day after the secondary surgery, there was no statistically significant difference in the autograft survival rate of patients among PRP alone group, artificial dermis alone group, and PRP+artificial dermis group ( P>0.05). The wound healing time and length of hospital stay of patients in PRP+artificial dermis group were (20.1±3.0) and (24±4) d, respectively, which were significantly shorter than (24.4±5.5) and (30±8) d in PRP alone group ( P<0.05) and (24.8±4.9) and (32±8) d in artificial dermis alone group ( P<0.05). At 3 and 6 months after wound healing, the pliability scores of patients in PRP+artificial dermis group were significantly lower than those in PRP alone group (with Z values of 12.91 and 15.69, respectively, P<0.05) and artificial dermis alone group (with Z values of 12.50 and 12.91, respectively, P<0.05). There were no statistically significant differences in pigmentation, vascularity, height scores, and total score of scar of patients among the three groups ( P>0.05). In artificial dermis alone group, one patient experienced partial liquefaction and detachment of the double-layer artificial dermis due to local infection of Staphylococcusepidermidis, which received wound dressing change, second artificial dermis transplantation, and subsequent treatment as before. No adverse reactions occurred in the remaining patients during the whole treatment process. Conclusions:Local injection of PRP combined with double-layer artificial dermis is effective in treating wounds with exposed tendon on extremity, which can not only significantly shorten wound healing time and length of hospital stay, but also improve scar pliability after wound healing to some extent in the long term. It is a clinically valuable treatment technique that is worth promoting and applying.