Living with Diabetes in Europe

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Living with Diabetes in Europe How to improve
quality of life
15 July 08

• Welcome
• Diabetes across Europe
• Living with diabetes
• Discussion with representatives from Diabetes
  Associations
• What the EU can do
• Conclusions and Recommendations Towards an EU
  strategy for Diabetes

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A Policy Perspective Diabetes across Europe
Diabetes Working Group 15 July 2008 Michael
Hall, IDF Europe Anne Marie Felton, FEND
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Significance of National Diabetes Frameworks
Existence of national diabetes framework
Indication that diabetes is a government priority
Measures/funding to address disease
burden/complications
1989 St Vincent Declaration
Recognises importance of national plans
Most countries in Audit signed Declaration
Supported by WHO Europe
Commitment to multiple initiatives against
diabetes
Many countries failed to fulfil key requirement
national plans
Subsequent declarations Council of EU, MEPs, UN
Global consensus on importance of national plans
Why so little progress?
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The Diabetes Policy Puzzle Towards Benchmarking
in the EU25
2005 IDF Europe / FEND carry out first
pan-European audit assess existence and
implementation of national plans
No benchmarks to assess existence of national
plans
First Edition (2005)
National plans in
Significant differences in plans and guidelines
Inequalities Life expectancy Health
status Access to high-quality services For people
living with diabetes across Europe
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countries (EU 25)
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Why a Second Edition?
Update 2005 report
Set benchmarks to measure progress in development
of plans
Focus on national policies and practices
Prevention Screening Management
Second Edition (2008)
Timely
Explosion in incidence EU and industrialised
world
Best practice Stakeholder priorities
Aim raise standards of care
Provides strong evidence
Aim show urgent need to address diabetes through
targeted policy action
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About the 2008 Audit
Snapshot of current EU diabetes situation
Detailed country reports EU-27 3
New focus section on at-risk groups
Audit summary
Highlights growth in prevalence
Estimates cost to governments
Records status of national policies
Impact on patient access
Formal launch to Commissioner Vassiliou in Autumn
2008
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A few key findings
Prevalence rates
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11.8

United Kingdom
Germany
At least
have rates higher than
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countries (mainly new MSs)
of the adult population
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A few key findings
Prevalence rates
Country
2003
2006
2025 estimate
EU-27 average
7.63
8.62
10.31
Belgium
4.2
5.2
9.7
Germany
10.2
11.8
13.3
Ireland
3.4
5.6
6.4
Latvia
9.9
10.0
11.0
Luxembourg
3.8
6.9
8.2
Malta
9.2
9.7
11.6
Portugal
7.8
8.2
9.8
UK
3.9
4.0
4.6
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A few key findings
Cost

Significant and growing
Where data available, likely to be
underestimated lack of consideration for direct
and indirect costs of disease
Growing diabetes prevalence rates
Progress low and frustratingly slow Varying
levels of implementation, monitoring, evaluation
of national plans In some countries, differences
between reimbursement policy and access levels
suggest lack of information on treatments
Increasing cost burden
Repeated calls for action Europe and
internationally
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Conclusions
Striking differences in priorities remain on
prevention, treatment and management
National practices vary and comparable data may
be imperfect but report tells shows need for
coordination
IDF Europe and FEND believe solution lies in a
Council Recommendation urging use of best practice
Only by acting together will we begin to have an
impact on the diabetes pandemic
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Towards EU Policy on Diabetes
2004
2005
2006
2007
2008
Otocec Declaration (Nov 2004)
Austrian Presidency Conclusions (June 2006)
Commission Action ????
European Parliament Written Declaration (April
2006)
UN Resolution on Diabetes (Dec 2006)
Irish Presidency Conclusions (2004)

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COMMISSION
UN
Stakeholders
Parliament
Council
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Coming soon The 2008 Diabetes EU Policy Audit
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Report Funding

• This research was carried out by
  Burson-Marsteller Brussels, an EU public affairs
  consultancy, on behalf of IDF-Europe and FEND.
  The work was supported by unrestricted
  educational grants from Eli Lilly, Novartis,
  Pfizer and Roche. The project has been carried
  out with full transparency and independently from
  its funding sources.

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• Living with diabetes in Europe a Romanian
  perspective -

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• Some thirty years ago I felt very unlucky when
  the doctors told me that I have diabetes
• My parents were unlucky enough not to receive any
  peer support so they carried their feeling of
  guilt to their last day.

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Looking back, now I feel that I was also lucky

• because Romania has a long time tradition in
  treating diabetes, and I was correctly diagnosed
  and the best available treatment was offered to
  me
• because over the years quality medication and
  specialized services were available and supported
  by the Romanian health system
• because I was offered in due time one of the
  most comprehensive training programs, that kept
  me out of a hospital for 25 years

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Looking back I felt lucky

• because I could finish my education, get hired
  and appreciated for my performance - not judged
  through my condition
• because I could establish a family and my
  condition is not perceived as a burden
• because I can today to have a dynamic life style
  the kind I like to have

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I am saying all these because

• not all the Romanians and Europeans with
  diabetes receive tailored and continuous training
  to manage their diabetes
• people with diabetes do not have equal access to
  medication to fit their life style or specialized
  health services

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I am saying all these because

• even today people with diabetes do not have
  equal opportunities in following their careers,
  establish families or drive their own cars
• even today family members have to leave their
  careers to support some family member with
  diabetes
• even today children are refused access to the
  public education system because they have
  diabetes.

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What might be needed

• Improved awareness and prevention programs
  correct and responsible food labeling
• Public support for coherent tailored training
  programs for people with diabetes
• Continuous support for equal access to medication
  and medical services enforce informed-decision
  making treatment should match individual
  condition and life style
• Enforce equal opportunities for education and
  employment access to acquiring driving licenses.

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Romania alarming figures

• Romania has 22,000,000 inhabitants and about
  600,500 people with diabetes (in 2006 the
  Romanian Ministry of Health recorded 511,899
  persons with diabetes - 2.37 prevalence)
• A recent screening program (2008) revealed that
  out of about 8 million people, 30 have or might
  soon develop diabetes!

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Carla Duval
Diabetes care in National Healthcare Systems

• Cost are not 100 fully covered in Luxemburg
• Quality of the patients life is not an essential
  criteria in F L
• Low rate of pump therapy in F L
• Difficulties to access to latest technologies
  (continuous glucose monitoring)
• Impossibility to have a private medical insurance
  cover in Lux.

• 100 coverage in France for insulin, pump therapy
  glucose meters
• Free follow up with education nurses, dietician,
  psychologist
• No expense advance in France
• A Prestataire (services company) is taking care
  of the pump maintenance and disposables
  associated in France

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DIABETES HEALTH CARE IN SLOVENIA
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Vlasta Gjura Kaloper, MD

• Slovenian Diabetes Association, Slovenian
  Patients Forum
• Has diabetes Type 1 since 1985 with
  consequent complications arising from
  this disease
• Has been actively participating in improving
  the quality of life of people with diabetes
  and raising public awareness last 15 years

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Positive sides of Health Care for people with
Diabetes in Slovenia

• Provided by government
• Free health care for all people, stemming from
  the compulsory health insurance (patient care
  service at GPs, specialist diabetologists and
  other specialists free medications for treating
  diabetes medical technical aid for managing
  diabetes for people with diabetes Type 1)
• Initial education for new diabetes patients
• Provided by non-governmental organisations
• NGOs (SLODA, Diabetes Education Institute)
  provide continuous informing and education,
  promote physical activity through athletic
  events, organise interdisciplinary conferences on
  diabetes for all who are involved in diabetes
  health care, etc.

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Deficiencies in Health Care for people with
Diabetes in Slovenia

• Lack of statistical data on the quality of health
  care for people with diabetes in Slovenia
• Slovenia still does not have a national programme
  for diabetes health care
• The abovementioned results in the lack of
  rational planning of what our health care will be
  like in the future
• There is no systematic and continued education of
  people with diabetes

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Slovenia in pictures
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Good / Positive
João Nabais
National Program for the Diabetes Prevention and
Control
New
Portuguese Diabetes Association
Podology
Nutrition
Courses
Diabetes consultation
Physical activity
Psychology
Education
Ophtalmology
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Bad / Negative
João Nabais
Primary Care
Hospital Care
Ophtalmology Podology
Acute diseases
Difficult reimbursement for new therapies
Insulin Pumps
Chronic diseases
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• Lagrange Simon
• (Belgium, Flanders VDV)

28-Jun-12
EU DiabetesWorking Group Meeting - Brussels, 15
July 2008 IDF Promoting diabetes care,
prevention and a cure worldwide
36
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Introducing myself

• Lagrange Simon
• Age 22
• Diabetes type 1 since may 1996 (12 years)
• Student (master nursing)

28-Jun-12
EU Diabetes Working Group Meeting - Brussels, 15
July 2008 IDF Promoting diabetes care,
prevention and a cure worldwide
37
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Short reflections about national diabetes care

• Negative
• Limitations about Drivers licence
• Limitations in getting pump-therapy

• Positive
• Preventive care
• Highly professional (university hospital)

28-Jun-12
EU Diabetes Working Group Meeting - Brussels, 15
July 2008 IDF Promoting diabetes care,
prevention and a cure worldwide
38
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• Gaston Dakulovic
• Age 62
• Profession magazines editor - events organizer
  (salon du diabète)
• Type 2 diabetessince 2007 (1 year)
• Medical treatment insuline
• www.gdi.be

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• Gaston Dakulovic
• Diabetes care in Belgium
• Prevention - Press / Media info
• - Salon du diabète (1 x 3 years)
• Treatment - Regular medical check-up and
  follow-up diabetes - dieet - feet - eyes -
  kidneys
• - Good level of the intervention of the state in
  costs
• Escort - Regular and general information from
  the associations (ABD VDV)

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• Diabetes in Malta
• Chris J. Delicata,
• Vice-President IDF-Europe
• Vice-President, Maltese Diabetes Association

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Why did I get involved in Diabetes..my story

• Eldest son was diagnosed with Type 1 Diabetes in
  1999 aged 1.
• Active in the local association since 2001.
• Elected as board member of IDF-Europe in 2003.
• Re-Elected in IDF Europe Board in 2006 and
  appointed Treasurer.

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Why did I get involved in Diabetes..my story

• In 2007, appointed Vice-President of IDF-Europe
• 2007 to date member of the IDF Global Executive
  Board
• Son, now aged 10, diagnosed also with Celiac
  Condition in 2007.
• Profession Senior Underwriting Manager with a
  leading insurance company in Malta.

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Malta Some Statistics

• Population of circa 400,000 persons.
• Independent state and member of the EU since
  2004.
• Statistics show that around 10 of the population
  have diabetes.

• In Malta Diabetes
• is often referred to
• as the National
• Disease

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Diabetes in Malta Local Patient Association

• Maltese Diabetes Association
• Non govermental non-profit organisation
• Founded in 1981
• Circa 1,000 members
• Committee members are led by Ms Anna Zammit
  McKeon as President, Chris Delicata as
  Vice-president and 4 other members.
• Excellent relationships with the Diabetes
  Endocrine Centre at Mater Dei Hospital, newly
  built state of the art hospital in Malta.
• Website www.diabetesmalta.org

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Government Achievements in Diabetes during Past
years

• Free blood glucose strips for persons with Type 1
  Diabetes up to the age of 36.
• Pharmacy of your choice
• Introduction of new Insulins on the market
  (Glargin)

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The Improvements we would like to see to ensure
better Diabetes Management prevention in Malta

• National Diabetes Programme for Diabetes
• More Educational facilities at Mater Dei
  (Diabetes Endocrine Centre) including
  psychological support for patients and parents
• More dieticians - only one available for the
  whole hospital
• At the moment patients on the new insulins have
  to inject using the syringes. We have been
  promised that the change to pen is imminent
  (already approved) but still awaiting
  implementation.
• More use of Insulin Pumps subsidised by the
  Government

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The Improvements we would like to see to ensure
better Diabetes Management prevention in Malta

• We wish to see a society that does not
  discriminate against people with diabetes.
• Insurance Policies such as Life Assurance, Travel
  Insurance and Health Insurance should be
  available at reasonable and affordable rates for
  persons with diabetes.

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My son, Jack and wife Michelle with Hon. John
Bowis MEP during the World Diabetes Day
activities in Strasbourg in November 2007
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Living with Diabetes in Europe How to improve
quality of life
15 July 08

• Welcome
• Diabetes across Europe
• Living with diabetes
• Discussion with representatives from Diabetes
  Associations
• What the EU can do
• Conclusions and Recommendations Towards an EU
  strategy for Diabetes

54
(No Transcript)