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According to estimates, 380 million people in the world have diabetes, and in Poland - over 3 million. This is a lot, but the most disturbing fact is that the number of sick people is rapidly increasing. Is the treatment of diabetes in Poland in line with global trends? We are talking about it with prof. dr hab. Ewa Pańkowska, head of the Institute of Diabetology in Warsaw.

Diabetesis being diagnosed more and more often. The rapidly growing number of patients is a challenge not only for the he alth care system, but also for the state budget, which will take care of an increasing number of disabled people, unable to work.

Diabetes is a big problem for a patient, poorly treated diabetes is a disaster for you.

And this is not a disillusionment, but a cold assessment of the situation, because in our country there is a shortage of diabetologists, diabetic complications multiply, and access to modern therapies is limited. We are talking about it with prof. dr hab. Ewa Pańkowska, head of the Institute of Diabetology in Warsaw.

  • Diabetes is one of the most common chronic diseases in Poland …

Prof. Ewa Pańkowska : It's true. It is important to remember that diabetes can affect anyone, regardless of gender and age - from infants to seniors. It is a disease that affects many aspects of the life of the patient and his family. And although it does not happen directly, it also affects society as a whole - on education, the labor market, and social security systems.

  • What do you think is the most worrying?

E.P .: Currently, the most worrying is the increasing number of young children diagnosed with type 1 diabetes. In the last 15 years, the number of cases among preschool children has quadrupled, and each year there are about 4% of patients in developmental age. We now have twice as many patients under the age of 18 as 15 years ago. And we must remember that these children will stay with the disease for the rest of their lives, so it is easy to imagine the social and economic consequences of this state of affairs. Among European countries, Poland and the Czech Republic are the leaders in the increase in the incidence of type 1 diabetes.

  • How do specialists explain this increase in the number of children among children?
  • E.P .: We do not know yet where the dynamics of the disease come fromamong young people. Nevertheless, it is a great challenge for the he althcare system. It is very important for children to enter adult life normally, not to be excluded from social life, to get a profession, work, not to experience severe complications of this disease and develop properly. The problem is that in our country there is no system of care for this group of patients. In Warsaw, we have the same number of clinics as 20 years ago and the same number of doctors. The situation is similar, and sometimes even worse, all over Poland, and this - taking into account the much greater number of patients than a few years ago - translates into poor quality of treatment.

  • In the Diabetes Institute managed by you, there is a proven model of patient care. What is it?
  • E.P .: In our opinion, every diabetic patient should be under the care of a team of specialists, i.e. a diabetologist, dietitian, psychologist and diabetes nurse. Such a team guides the patient, educates him and his relatives. Every day we meet new patients who require training. The patient then has meetings with me and a dietitian and diabetes educator. It happens that for young people the news about the disease is a big shock and they need the help of a psychologist.

    Worth knowing

    Anyone can develop diabetes
    The myth that it is a disease of obese people is constantly repeated. Thin people get sick too. It seems to be influenced by stress and occupational overload. Many people work too hard, eat unhe althy, on the run, or eat nothing substantial all day to catch up in the evening, i.e. overeat. This is also conducive to getting sick because insulin resistance develops first, and then diabetes develops.

  • Why in Poland we do not know the real number of diabetics so far?
  • E.P .: The data are estimates, as we do not have a sick registry. We can only guess how many people are affected by diabetes. Perhaps, if there were a reliable patient registry, it would turn out that there are far more patients than we believe, and perhaps then the government would finally address the issue. For several years, successive ministers have been closing their eyes to the problems associated with the treatment of diabetes. For years, specialists and scientific societies have been demanding a patient registry, a treatment quality control system, and educating diabetologists and family doctors. We call for proper education, access to modern treatment, for prophylaxis - for basic measures when all the data indicate that there will be more and more diabetics.

  • That is why diabetologists attach so much importance to the need to personalize treatment?
  • E.P .: Well, in many cases it is only talked about. Meanwhile, if we only modify the treatment when something is happening to the patient, e.g. he has a heart attack, there is a high risk that he will fall out of the circle of active and professionally active people. And they are often in the prime of life. Therefore, it is important to optimize treatment at different stages of the disease.

  • Is diabetes treatment in Poland in line with global trends?
  • E.P .: The standards developed by the American Diabetes Association are valid only on paper. There is no system for assessing the quality of treatment. It does not matter whether a patient is treated effectively or not, and diabetes is such a disease where the he alth and future of the person depends on the quality of treatment. Either he will be disabled in a wheelchair and retired, or he will earn money for himself and others. If there is no such system, then there is no data that would allow an objective assessment of whether a given drug works, what effects it brings, or whether it is simply imposed by other considerations - not substantive. Currently, Poland is in the fourth place in terms of morbidity in Europe, and there is no policy behind it, so it is certain that Poles will more and more often die of diabetic complications. Our model of medical care is "fire fighting". Children are treated in hospitals, despite the fact that in developed countries it has long been done in an ambulatory. It's time to introduce economics to medicine. A simple bill: it is better to invest in better diagnostics, modern treatment and education than to pay 10 times more for the consequences of poor treatment in the future. I have the impression that we were mentally treated with diabetes in the 1990s. Our patients do not have access to modern treatment because it is said to be too expensive. And this takes their blood glucose meter strips away, and that gives them blood glucose meters, or vice versa. We cover the current needs, but we do nothing to use the money properly.

    Worth knowing

    A program is needed

    Diabetes is a ticking time bomb that causes kidney failure, blindness, heart disease, and leg amputation. We open the infamous statistics of the countries with the highest percentage of amputations due to the so-called diabetic foot. It is time to look at diabetes in a systemic and long-term perspective. Diabetes, as a chronic disease, should be controlled, and the treatment should be adjusted to the patient, so that the disease does not limit him. Medicine offers such possibilities, and this is what patients and doctors have been fighting for for years. The government remains deaf to this, and perhaps that is why modern drugs that would change the fate of many patients are dropping from reimbursement lists.

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