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In Poland, there are about 2,1 million patients treated with diabetes and a group of several hundred thousand people who are not aware of their disease and do not undertake treatment. Most of them are patients with type 2 diabetes. It is a progressive disease that requires gradual intensification of treatment. For many years, the diabetic community has been striving for the availability of modern therapies for Polish patients.
Professor, this year on April 7 we celebrated the World Health Day, which was devoted to diabetes. Is it really such a serious problem that even WHO around the world has decided to deal with it?
The scale of the challenge is already evidenced by its epidemiology, because diabetes affects 400 million people worldwide. This number is slightly smaller than the population of the entire European Union. If we do nothing, another 25 million people will be sick over the next 200 years. This is a huge challenge for the health care system and national budgets. These people require medical care and the creation of an organizational and financial framework for this care. Moreover, these are people who often have reduced productivity, are sometimes disabled and are dependent on the state, and die prematurely. Aside from the fact that this is a huge social issue, it is important to remember that it is first and foremost a personal, individual problem. We will not look at it from any perspective – we are dealing with a big challenge.
What is the current situation in Poland?
The latest data published by Prof. Tomasz Zdrojewski and his associates say about 2,1 million patients with diabetes. These data were created on the basis of the National Health Fund registers, which are kept for payment purposes and refer to patients who bought insulin, hypoglycemic drugs or blood glucose meter strips in Polish pharmacies in 2013. These are approximate data, as this group also includes patients who treat pre-diabetes, and there are no patients who do not treat actively diagnosed diabetes because they do not follow the prescribed prescriptions. Diabetes does not cause symptoms for a long time, so we also have a group of several hundred thousand people who have never been diagnosed with diabetes and work with this disease. Nevertheless, the numbers mentioned are the most reliable data we have.
How do we treat diabetes?
We must be aware that we have two types of diabetes. About 1 people suffer from type 200 diabetes. patients in our country, nearly 20 children, about 180 adults. They are treated with insulin from the beginning of the disease until the end of their lives. In the pediatric population, most patients are currently using personal insulin pumps, and the multiple injection model is still dominant among older patients. Type 2 diabetes affects approximately 80-85% of patients; in their case, the first drug is metformin. Nevertheless, the disease is progressive and intensification of therapy is required by including further preparations into the treatment.
Do Poles have full access to modern therapies?
With type 1 diabetes, generally yes. For many years, however, we have been looking forward to the availability of modern therapies in type 2 diabetes. Incretin drugs, which have been available for 10 years, are reimbursed in virtually all European countries, but not in Poland. Two years ago, among the new therapies, there were floaters, i.e. drugs that reduce glucose absorption in the kidneys. Both of these groups are preparations for which there are convincing data that they allow for a more balanced control of diabetes, i.e. lowering glucose levels with a simultaneous reduction in body weight and no risk of hypoglycaemia, and that they prolong the life of our patients and reducing cardiovascular events such as heart attacks and strokes. Polish patients can be treated in a modern way, but it requires them to fully share in the costs of treatment.
What are the unmet needs of insulin therapy today?
As in pre-insulin therapy, we care about the effective control of diabetes, but with a low risk of hypoglycaemia and not causing excessive weight gain; therefore, modern forms of insulin therapy, including short- and long-acting analogies, should gradually replace the older generation preparations. Clinical data show that it is easier to achieve a balanced treatment of diabetes with these newer formulations because they provide good glycemic control and reduce the risk of hypoglycaemia. A patient who undertakes treatment should be able to use insulin preparations that guarantee effective treatment of diabetes, while minimizing the risk of hypoglycaemia. Unfortunately, many Polish patients have a problem with their availability, because either they cannot afford co-payment or the clinical criteria for reimbursement of these preparations eliminate them as eligible persons.
Professor, on May 5-7, Kielce will host the XNUMXth Congress of the Polish Diabetes Society, what will it be about?
It is the most important annual diabetes event in Poland, attended by approximately 2 doctors, scientists and nurses every year. The subject of the conference is very extensive – from the pathogenesis of diabetes, through its proper treatment and modern technologies, to experimental therapies. Experts who have been serving us with their knowledge for decades and those who have distinguished themselves in recent years with their scientific work, as well as nurses and nutritionists will speak out. We all share our concern for the health of diabetics. During the lectures, we will refer to the latest PTD recommendations, implementing important information that appears in world and national literature. We cordially invite you!
The interview is part of the nationwide educational campaign “Life with diabetes” published by Medical Media Solutions. MedTvoiLokony is a Media Partner of the campaign and especially for our readers the publication “Życie z diabą”, which was published on April 27 together with the Rzeczpospolita daily, is available online.
Prof. dr hab. n. med. Maciej Małecki
President of the Polish Diabetes Society, head of the Department and Clinic of Metabolic Diseases of the Collegium Medicum of the Jagiellonian University in Krakow