Time to defuse the diabetes time bomb
With over 32 million people living with diabetes in the EU and a total of 52 million across the wider European region (1), it is unequivocal that diabetes is an urgent EU public health priority. These numbers are projected to increase to 37.5 million and 69 million respectively by 2035.
Identifying problems within diabetes policy, Mayur Mandalia from IDF Europe and co-author of Diabetes in Europe: Policy Puzzle, creates a template for change and shares best practices for tackling the challenge
The situation is worsened by the fact that the burden of chronic diseases is undeniably on the rise, with 86% of all deaths in the European region attributed to chronic diseases (3). It is obvious that the EU needs to make a more intensive effort towards seeking a more rational and logical strategy amongst Member States to tackle the epidemic.
While there is limited capacity on health, Article 168 of the Treaty on the Functioning of the European Union, TFEU, still allows the EU to encourage and support Member States in issues of Public Health, as well as their cooperation on the matter. This is being acted upon, as evidenced by the current Joint Action on Chronic Diseases which includes a work package specifically on diabetes, and the 2012 resolution on diabetes adopted by the European Parliament.
However, such initiatives are in no way mandatory for Members States to implement. Thus, the EU should explore the use of other legal bases and mechanisms available under the Treaty to circumvent its limited health competence.
Inequalities in diabetes care – a multi-disciplinary care team
There are noticeable disparities in the quality of diabetes healthcare delivered to and received by citizens across Member States, as indicated in the Diabetes in Europe: The Policy Puzzle report (4). As reducing health inequalities is a priority, EU Institutions should have the capacity to support national health systems in managing the diabetes and chronic disease burden. In this respect, there must be a more holistic view on care, involving multi-disciplinary diabetes care teams, as diabetes is not just a hormonal condition. Lack of good management can lead to serious and costly complications such as stroke, heart disease, blindness, kidney disease, as well as damages to the whole nerve and circulatory systems.
As an important initiative to improve diabetes care, the EU should set minimum standards of training for all health professionals working in diabetes
Further, there is a lack of qualified and well trained diabetologists and endocrinologists, with their distribution often unbalanced due to the lure of urban living. Incentives should be provided to Member States to help them retain qualified health professionals, to serve their population.
Specialist nurses have proven to be an invaluable part of a multi-disciplinary diabetes care team, with the patient placed at the centre of all prevention and treatment services. Currently, just about 14 countries in the EU have specific recognition for diabetes specialist nursing, despite their role being significantly increased in all aspects of diabetes care.
However, there is varying involvement of nurses in diabetes in the rest of the EU. Currently, the Foundation of European Nurses in Diabetes, FEND, conducts a program to train nurses from across Europe (5). This could be scaled up with the help of EU Institutions’ support, and would allow nurses to play a greater, more tangible role in diabetes care.
The importance of prevention
While management of diabetes is an immediate concern, one cannot shy away from investing in prevention. A 2013 European Commission report outlined that 97% percent of health expenditure goes on treatment, with the remaining on prevention (6). At a time where it is well recognised that most chronic diseases are preventable (as is the case of type 2 diabetes), it is quite a simple task to include well-defined screening tools in healthcare practices for diabetes, such as the FINDRISC questionnaire, aimed at assessing risks of type 2 diabetes.
In fact, an EU-wide screening measure would allow for a more standardized way of detecting those at high-risk, leadign to interventions to reduce that risk – thereby curbing the epidemic.
Furthermore, the EU should do more on engendering physical activity for both children and adults alike. It is both a preventative (type 2 diabetes) and a better management tool (type 1 and type 2 diabetes). By combining it with health promotion in schools, it can cement the right attitudes to healthy living from a young age – avoiding or at least delaying type 2 diabetes and other chronic diseases.
Lack of data
Data gathering for diabetes is also one of the major weakness across the EU and wider Europe. Only 4 countries in the EU had registries for all diabetes cases, including type 1, type 2, and gestational diabetes (diabetes during pregnancy)4. Accurate data on diabetes prevalence and incidence among different population groups is necessary to monitor the epidemic, and on a policy level, registers provide vital input on planning and resource allocation.
Establishing EU-wide registries may be a stretch, but encouraging the development of national registries on diabetes would benefit the Member States enormously – allowing the availability of up-to-date epidemiological data as well as information on patient care pathways, and estimating future needs regarding diabetes supplies.
While most policy measures are often focused on type 2 diabetes, it is imperative not to neglect the one aspect which can be directly aimed at type 1 diabetes – research. Unpreventable, type 1 diabetes research provides the best chance at finding ways to accurately understanding what triggers the body to attack the insulin-producing beta cells in the pancreas.
Further funding must be made available for educational institutions and other research establishments in order to explore the molecular and genetic causes of type 1 diabetes. At an age where the human genome is fully sequenced, one cannot underestimate the impact of deciphering the exact causes of type 1 diabetes, and the cures it could lead to
1) International Diabetes Federation (IDF) Atlas, 6th Edition – 2014 update: http://www.idf.org/sites/default/files/DA-regional-factsheets-2014_FINAL.pdf
2) International Diabetes Federation (IDF) Atlas, 6th Edition, 2013. Chapter 3, page 59.
3) WHO high level consultation: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/noncommunicable-diseases
4) Diabetes in Europe: The Policy Puzzle. The State We Are In. (2014) European Coalition for Diabetes, ECD.
5) Foundation of European Nurses in Diabetes (FEND): http://www.fend.org/projects/fend-endcup
6) European Commission – White Paper. Together for Health: A Strategic Approach for the EU 2008-2013. http://ec.europa.eu/health-eu/doc/whitepaper_en.pdf
7) European Chronic Diseases Alliance: http://www.alliancechronicdiseases.org/ECDA%20core%20messages%20for%20EU%20summit_final_24%2003.pdf