In Poland, over 3 million people have diabetes and over 5 million have prediabetes. Prof. dr hab. n. med. Leszek Czupryniak, head of the Diabetology and Internal Diseases Clinic of the Medical University of Warsaw.

Diabetes education of GPs (Primary He althcare)

From over 3 million people with diabetes in Poland, as much as 80 percent are patients with type 2 diabetes, approx. 17 percent. patients with type 1 diabetes, and the remaining 3 percent. people with other types of diabetes, such as gestational diabetes or drug-induced diabetes. Depending on the type of diabetes, adult patients are currently treated either by diabetes specialists (mainly patients with type 1 diabetes and patients with type 2 diabetes, if insulin therapy is on), or by GPs who most often care for patients with diabetes. type 2, if their treatment requires the use of 1-2 oral medications (in tablets).

Currently, there are approximately 2 million patients with type 2 diabetes under the care of GPs, so, as it is easy to calculate, the vast majority of patients with this disease. They guide patients for many years, see them at different stages of the disease. Therefore, constant and systematic education of this group of doctors is necessary. They have to guide the patient not only to lower his blood glucose level, but also to detect cardiovascular complications in advance, which are the most common cause of premature death in diabetic patients. A well-prepared diabetic doctor will not only check the patient's blood sugar level, but also blood pressure, cholesterol, uric acid levels in the blood and all risk factors, and then be able to skillfully direct his treatment.

GPs also play an extremely important intervention role in the early diagnosis of type 2 diabetes, before the patient develops complications such as heart attack, stroke, retinopathy, kidney damage or diabetic foot syndrome. This is a very difficult task, because type 2 diabetes in the first phase does not produce symptoms that may alarm the patient and prompt to treatment. A minimal increase in glycaemia affects blood vessels and peripheral nerves. We cannot allow such situations thatthe patient learns that he has type 2 diabetes when he is already suffering from a heart attack in the cardiology department. We must ensure that type 2 diabetes is diagnosed as early as possible.

Strong division of diabetes nursing care

With such a large number of diabetic patients, GPs will be able to act effectively only with the support of nurses acting as diabetes educators. It is true that Polish nurses can do diabetes specialization, but they do it reluctantly, because no one pays them for this additional work. Unfortunately, there is no strong nursing department in Poland, as in the Scandinavian countries, Great Britain or France, where a patient, also with diabetes, goes to a nurse as if to a doctor. For years, we have been calling for the establishment of diabetes education centers in Poland with professional diabetes educators, but so far our applications have been rejected by public institutions.

Better access to specialist doctors

Access not only to diabetologists, but also to doctors of other speci alties, such as ophthalmologists, cardiologists, surgeons, is extremely important, which is extremely important in the context of treating diabetes complications. Patient access to these specialists is better in large cities with strong academic centers and worse in smaller towns. This, unfortunately, is due to, inter alia, from poor distribution of funds to diabetes centers in different regions of the country.

Therefore, it is necessary to arrange diabetes centers in such a way that all patients have easy access to them and do not have to look for specialists many kilometers from their place of residence. It is also important to ensure that these centers are able to operate efficiently, so that they can treat long-term diabetic patients with complications, e.g. cardiological.

Wider access to reimbursed drugs

Early detection of type 2 diabetes is one pillar of the system. The second is to ensure that diagnosed patients are adequately treated. For over 10 years, drugs have been available that, in addition to lowering sugar levels, also reduce the risk of cardiovascular diseases, help to postpone the introduction of insulin therapy, and support weight reduction in patients with diabetes and overweight or obesity. Unfortunately, they are not refunded. So what if an educated doctor will prescribe them to the patient, when the patient does not buy them, because he cannot afford them. Currently, antidiabetic drugs with proven beneficial effects on the circulatory system (SGLT-2 inhibitors, GLP-1 receptor agonists) have become the basic drugs in the treatment of diabetes 2, according tothe current recommendations should be widely used as they simply extend the life of the sick. In Poland, the vast majority of patients are unable to benefit from these therapies due to their cost.

National Diabetes Control Program as an element of the state strategy

There is a diabetes care system in Poland, but the fact is that it is highly imperfect, which translates into a huge number of patients undiagnosed or diagnosed too late. Public institutions are looking for solutions in diabetology that will bring quick and spectacular results, and there are no such solutions. Investments in diabetes treatment bring results, but after a minimum of 10-15 years. There is no institutional understanding of the fact that diabetes is an incurable disease of civilization and that a plan to combat it cannot be merely a list of immediate actions directly related to diabetes itself. The National Program for Combating Diabetes should be part of the comprehensive he alth strategy of the state and related to, inter alia, such elements as e.g. higher taxation of food with a high content of simple sugars, or other activities that help Poles change their lifestyle.

DECLARATION OF THE 12 PRINCIPLES IN THE FIGHT FOR A LONGER LIFE WITH DIABETES

1. Diagnosis of the disease as early as possible. 2. Comprehensive specialist care provided by diabetologists, family doctors and diabetes nurses. 3. Knowledge about the disease and self-awareness of patients. 4. Balanced diet and maintaining a he althy body weight. 5. Physical activity. 6. A he althy lifestyle (no smoking, reducing alcohol consumption, reducing stress). 7. Individualization of treatment. 8. Possibility of access to modern diabetes therapies. 9. Avoiding cardiovascular complications - heart attack and stroke. 10. Proper disease control (taking the recommended drugs, self-monitoring of glycaemia. Regular blood glucose and cholesterol tests). 11. Prevention of kidney failure, eye disease, diabetic foot. 12. Universal diabetes education.

The declaration was created on the occasion of the World Diabetes Day 2022 on the initiative of patient organizations - Active with Diabetes, Polish Diabetes Association, www.mojacukrzyca.org as part of the "Longer Life with Diabetes" campaign.

The articlewas created as part of thenationwide educational campaignen titled"Living longer with diabetes" , which aims to raisediabetes awareness- including type 2 diabetes and the risks associated with this disease, with particular emphasis on taking into accountcardiovascular complications . The organizerof the campaign is the company Boehringer Ingelheim, and the partners: Association Active with Diabetes, Polish Diabetes Association and the mojacukrzyca.org portal.

Category:

Diabetes