Meeting the diabetes challenge & Turning the tide on diabetes 

Diabetes remains one of the most misunderstood and underestimated of all common medical conditions even though an astonishing 61m Europeans live with it. Society has no real sense of what living with diabetes means: the sheer scale of the health indicators one must constantly track and trace; the omnipresent threat of dangerous complications; the fear and anxiety about the future.

The Diabetes Crisis 

Diabetes is a rapidly accelerating public health crisis demanding immediate policy attention. It's an emergency hiding in plain sight: Ιn Europe today, 1 in 11 adults or 61m live with diabetes; this is more than the population of Italy. Over one million deaths per year are attributed to diabetes. Nor does the diabetic epidemic show any sign of abating. Its prevalence is expected to grow a further 13% in the European region by 2045.

These are not just abstract statistics: The effects of diabetes can be debilitating. People living with diabetes are at risk of developing severe and life-threatening complications, lowering the quality of life, increasing the need for care, and heightening the risk of premature death. 

The disproportionate impact of COVID-19 on people with diabetes has highlighted the severity of the crisis – one that that can no longer be ignored. Earlier in the pandemic, for instance, as many as one in three COVID-related deaths were of people with diabetes.

Fortunately, there are grounds for optimism. There are proven strategies and tools in place that can turn the tide of this silent epidemic; we just need the political and social will to deploy them. 

The European Diabetes Forum (EUDF) aims, moreover, to inject momentum by bringing together actors from across Europe to advance fresh ideas and solutions and to improve and modernise diabetes care. To that end, EUDF has focused its efforts in three areas which are key to improving the lives of people with diabetes – in integrated care, registries, and digital tools. 

The time to act is now. We can save lives and ease the burden on health systems by spearheading a more data-driven, person-centred approach to diabetes care. 

The Burden

Diabetes presents a growing burden – for the individuals affected and their families, for health systems, and for the larger society. 

People with diabetes are exposed to the greater risk of developing severe complications including cardiovascular and kidney disease. It is a leading cause of afflictions such as blindness and severe interventions such as lower-limb amputation. All told, diabetes shortens lifespans by up to 15 years. Moreover, managing it is a full-time commitment that exacts a physical and emotional burden on patients and their families.

Diabetes also poses unique stresses to health systems and economies. This is not just in terms of direct medical expenditures, now €170bn and rising, but also – in an age of health staff shortages – of allocating health resources. Diabetes also engenders indirect costs, including diminished productivity, absences due to sickness, disability, early retirement, and premature loss of life. Moreover, diabetes is increasingly affecting people at a younger age, which means people are developing complications at a younger age. This only magnifies the total burden. 

Taking a wider view, diabetes is pernicious in the way it preys on existing socioeconomic inequalities. Diabetes disproportionately affects the least well-off, who are not only more likely to get diagnosed with the condition, but also to suffer its severest consequences. Diabetes-related deaths are 3.5 times more likely in lower-income groups in the richest countries in the EU. 

The Challenge

This growing social and economic burden requires strong and decisive action across the board to meet the challenge it poses. Any comprehensive plan must address the issue of primary prevention to stem the rising case loads of diabetes.   
       

However, this focus on prevention should not be allowed to crowd out effective responses to the tens of millions of Europeans already diagnosed with diabetes. Too often the overriding emphasis on prevention reinforces the stigmatisation of diabetes as a “lifestyle disease,” allowing the absence of an effective diabetes policy or actions in other areas to be brushed aside. That's why the EUDF has focused its own policy recommendations on concrete solutions that enhance the delivery of diabetes care, in ways that will secure better health outcomes and ease the daily burden imposed on people with diabetes.  

Stepping up action on care is becoming more urgent by the day as the situation deteriorates. Outcomes are stagnating, with targets for metrics like glycaemic, lipid, or blood pressure control levelling off or declining. This is the case even though most cases of diabetes can be controlled, and most diabetes-related complications avoided, through lifestyle modifications, careful monitoring, and stricter adherence to clinical guidelines.  It is estimated that 75% of health expenditures in diabetes can be attributed to preventable complications. 

Yet health systems are ill-equipped to meet the unique challenges diabetes poses. Diabetes is a complex condition that is very hard to manage. Managing the care of people with diabetes requires a high level of ‘self-care’ and empowerment, as well as the support and coordination of many different healthcare professionals and disciplines. Health services, however, are highly fragmented, with the organisation and funding of care tailored to the healthcare setting rather than the patient and her/his needs. The result can be that diabetes is often treated as an acute rather than a chronic condition. 

The Solutions

What can be done to address the diabetes challenge? The EUDF's recommendations pinpoint three areas where – if certain steps are taken – progress is readily within reach: integrated care, registries, and digital technologies

First, we must rethink and redesign care in ways that are better suited to the needs of people with diabetes. That is why integrated care is really the lodestar for assessing all other aspects of diabetes care.  At its heart is a longer-term and more holistic approach towards people with diabetes that deals with the condition's complexity.

With this in mind, the EUDF has outlined pragmatic strategies to improve integration in all care settings, including implementing assessment models, developing patient centred pathways for diabetes care, revamping educational curricula, and putting incentives in place to encourage cooperation and teamwork within and between primary and secondary care settings. 

Second, it is time to unlock the vast potential of data. Diabetes registries are essential to enable a more evidence-based and data-driven approach to diabetes management. Registries ensure quality control and better adherence to guidelines; track performance across clinics or regions and help identify the reasons for variation in outcomes; and inform the delivery of care and treatments, which can reduce costly complications.  Policymakers, health authorities, healthcare professionals, industry, and people with diabetes must work together to advance the development of registries throughout Europe where they do not exist, or to expand and strengthen those where they do. The EUDF has set out recommendations to help make this happen.

Finally, it is essential to hand people with diabetes with the knowledge and tools they need to better manage their condition. Improving the self-management capacities of people with diabetes is key to achieving a high level of compliance to therapy (matching behaviour to medical advice), improved health outcomes and a better quality of life with reduced long-term complications. Here, digital tools including mobile apps can serve as the patient-facing interface for digitally enabled care, giving people with diabetes and their care teams tools to manage their condition through better day-to-day support, greater flexibility and more connectedness with healthcare providers, which can help enable remote monitoring and more data-driven decision-making. 

Conclusion 

Diabetes is one of the greatest if neglected health challenges Europe faces today. But there are reasons to believe we can face up to and overcome this challenge if we deploy the tools available and take the concrete policy actions needed. 

Last year marked one hundred years since the discovery of insulin, a truly ground-breaking innovation in the history of medicine. 

But diabetes no longer gets the attention it deserves, let alone the breakthrough treatments patients need. It is vital to think outside the box and push for more innovative methods of diabetes care, ensuring people with diabetes are able to live productive, healthy and fulfilling lives. 

Spearheading these solutions in digitalisation and self-care, registries, and integrated care will promote a more data-driven and person-centric approach to healthcare and diabetes management that should pay off in terms of fewer complications, improved quality of life and more efficient use of clinical resources. 

The EUDF will continue to serve as an expert partner to promote these efforts, acting as a forum for a collaborative campaign for policy change. Our vision is to achieve better outcomes for people with diabetes and enable health care systems to cope with a devastating epidemic that can no longer be swept aside. 

EUDF policy recommendations

Integrated care is an emergent set of practices that seeks to move away from care that is fragmented, episodic, and service-based, with care that is continuous, coordinated, and outcomes-focused. As the WHO describes it, integrated care is “seamless, smooth, and easy to navigate.”  

Diabetes registries, which collect, track, and analyse patient data on parameters ranging from clinical characteristics, risk factor control indicators, diabetes complications, and treatments, can become an essential tool for improving the quality of diabetes care and securing better outcomes for people with diabetes when integrated in the diabetes care system. 

Digital technologies are driving significant changes in healthcare, offering new solutions to assist in preventing, diagnosing, and treating chronic diseases. Diabetes is ideally suited to benefit from these types of digital tools, given it is a largely a self-managed condition, and especially data-driven.