Discovered 100 years ago by Frederic Banting, insulin was a breakthrough in the treatment of diabetes. Since then, medicine has made many successive advances in transforming diabetes from a fatal disease into a chronic disease. This does not change the fact that there are nearly half a billion people in the world suffering from diabetes and the number is still growing.
The International Diabetes Federation estimates that if decisive steps are not taken, the number of diabetics will exceed 25 million in the next 700 years. The hundredth anniversary of the discovery of insulin is an opportunity to summarize the state of diabetes care also in Poland. Because although the knowledge about diabetes is increasing in our society, it does not mean that diabetes care does not require optimization. This is evidenced primarily by the still growing number of diabetic patients in Poland, currently estimated at approx. 3 million.
If not now then when?
The International Diabetes Federation (IDF), organizer of the annual World Diabetes Day event, has decided to use the centenary of the discovery of insulin to mobilize the public to take decisive action to put an end to the growing diabetes epidemic.
- See also: “Silent Epidemic”. A child with diabetes is already in every school in Poland
The goal of IDF for the international community is access to constant diabetes care for every patient, regardless of their financial status and place of residence. Diabetes is a huge problem worldwide, especially in low and middle-developed countries, and 79% of them live there. sick. The seriousness of the situation is evidenced not only by the fact that nearly half of the world’s patients are not diagnosed, but also by the fact that access to insulin – 100 years after its discovery – is not universal everywhere.
- Editors recommend: He saved the lives of millions of people. Previously, diabetes was a death sentence
It is now, with the ongoing COVID-19 pandemic, that it is time to pay even more attention to the current threats to the health and lives of patients with diabetes. The Ministry of Health estimates that 16 percent. the so-called The “excess deaths” in Poland during the 2020 pandemic concerned patients with diabetes. In absolute numbers, this means as many as 10,6 thousand additional deaths from diabetes.
In the case of coronavirus infection, the course of the disease with concomitant diabetes is burdened with a greater number of complications. This is especially true of the elderly and patients with decompensated glycaemia, as well as those who have already developed complications such as cardiovascular disease and renal insufficiency.1 Many diabetologists are concerned that the impact of the COVID-19 pandemic will unfold. fully only in the next few years with a greater number of cases of serious diabetes complications, therefore they postulate broadening the access to the already reimbursed in a limited amount of floins and incretins and using their full clinical potential for all patients who may benefit from their therapeutic use.
Diabetes care in Poland
100 years after the discovery of insulin – recognized by most experts as the greatest medical discovery of the 40th century – Polish patients now have nearly 2 insulin preparations at their disposal, differing in speed and duration of action. Among the modern drugs for patients with type XNUMX diabetes, there are already those that lower blood sugar levels without causing equally dangerous hypoglycaemia, and additionally have a beneficial effect on the cardiovascular system and reduce the risk of both developing cardiovascular disease and cardiac deaths.
Scientists are still working on new therapies in the treatment of diabetes, and in parallel, research is being carried out on more and more precise and patient-friendly glycemic control systems, more and more modern insulin pumps or dedicated smartphone applications that facilitate everyday life. Progress is also being made in transplantology.
Despite the fact that the reimbursement covers other groups of modern drugs, their availability for Polish patients is still not widespread enough to translate into an increase in the number of patients with effectively controlled glycaemia. In Poland, about 3 million patients suffer from diabetes, while only 1200 diabetologists are professionally active. Without good organization, it will be difficult to ensure adequate diabetes care for all patients. Its main goal is, in the first stage, the prevention and early detection of the disease, and in the next stage, counteracting the development of diabetes complications and reducing the risk of premature death, says Prof. Dorota Zozulińska-Ziółkiewicz, President of the Polish Diabetes Society, Head of the Department and Clinic of Internal Diseases and Diabetology at the Medical University of Poznań.
In response to this challenge, the diabetic community has developed recommendations for the diabetes care standard, which introduces a precisely described division of tasks between basic health care, outpatient specialist care and hospital treatment. A patient with type 1 diabetes is under the constant care of a specialist diabetologist. In the care of patients with type 2 diabetes, the primary care physician plays a special role, who is assigned not only to identify risk factors, educate and promote health, but also to monitor diabetes control on an ongoing basis. The proposed novelty is the obligation of the primary care physician to refer a patient with type 2 diabetes to a diabetic consultation in defined situations in order to verify the control of diabetes and establish a treatment plan. As part of the standard, patients should also be referred to other specialist consultations: cardiology, neurology, for complications from the kidneys or, which is often less discussed, fundus assessment and control by an ophthalmologist.
With primary care physicians in mind, dedicated projects are created to educate people on the intensification of diabetes treatment. The Polish Diabetes Society is currently implementing such projects in cooperation with the Polish Society of Family Medicine. “We Dbamy Badamy” is an educational initiative accompanied by a free program of assessing the value of glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes. The analysis of HbA1c values is of great diagnostic importance, as it allows to assess the effectiveness of the current treatment and is the basis for the physician to make decisions about the possible the need for its modification.
Over the past 100 years, tremendous progress has been made in treating diabetes and improving the quality of life for the patient. More and more new therapies and medical technologies allow the doctor to adjust the treatment to the patient’s lifestyle and even his eating habits. The challenge is still broadening the access to modern drugs, the reimbursement of which applies to a small group of patients, and good coordination of patient care, which will ensure early diagnosis, effective ongoing diabetes control and regular access to diabetes consultations. It is also necessary to create a treatment program for patients with diabetic foot syndrome – concludes Prof. Krzysztof Strojek, national consultant in the field of diabetology.
More information on the World Diabetes Day celebrations can be found on FB: https://www.facebook.com/10tysiecyKrokow and on Twitter: @ 1Krokow