On April 30, 2021, the European Commission (EC) closed its feedback period for all interested stakeholders to share their list of priorities in the context of the EU Non Communicable Diseases (NCDs) Initiative – Healthier Together.
The Healthier Together Initiative was launched by the EC in December 2021, with the aim of helping Member States (MS) reduce the burden of major NCDs such as diabetes. A final consensus document, described as a “toolkit to guide and coordinate action on NCDs” will be published by the EC in June. This document will summarise best practices, best buys, research results, and innovative ideas shared by stakeholders. It will also include a list of available legal and financial tools to support the implementation of the initiative. Funding will first be allocated to diabetes, CVDs and health determinants in 2022, with additional focus on chronic respiratory diseases and mental health and neurological disorders as of 2023.
Below is a list of diabetes priorities shared with the EC by IDF Europe. We hope this Initiative will help improve the prevention of diabetes and other chronic conditions, as well as the treatment, health outcomes and quality of life of the 32 million adults living with diabetes the European Union.
Primary prevention of Type 2 diabetes (T2D)
T2D accounts for about 90% of all diabetes cases in the EU – around 28 million adults. Diabetes is often termed a silent disease, as many people can live with T2D, unaware that they have the disease, for many years. In the Europe-region as a whole, it is estimated that 36% of people living with diabetes (PwD) are undiagnosed and 7% live with impaired glucose tolerance. Risk of developing pre-diabetes and T2D can be lowered through early interventions. To tackle undiagnosed diabetes / sub-optimal management that leads to costly diabetes-related complications, IDF Europe recommends:
- Implementing national diabetes prevention plan/national diabetes observatories, integrated as part of a broader vision on the prevention of NCDs and specific action targeting people at risk/people living with “pre-diabetes”. Action on tackling modifiable risk factors and addressing socio-economic determinants and specific interventions such as lifestyle intervention programmes and medication have to be combined into a national diabetes prevention plan for maximum impact. A complement to national diabetes plans are national diabetes observatories. Combining a host of data – epidemiological data, health outcomes and health service quality, mortality and health economics – such observatories help support the setup of public health strategies and policies, from prevention through to management.
- Raising awareness and tackling stigma and discrimination. Awareness is the first pillar of any action designed to lower the risk of people developing diabetes and its complications. Low awareness levels lead not only to fewer people identifying their risk and seeking care, but they also foster stigma and discrimination, which themselves are a major barrier to effective diabetes prevention and management. There remains a need for more concerted and targeted awareness campaigns, designed to reach both the general public and primary care professionals.
Screening and early action
Half the PwD have developed one or more complications by the time they are diagnosed. Delays in diagnosis and effective treatment can lead to the development of severe complications such as blindness, cardiovascular and kidney diseases and lower limb amputation. Screening of at-risk populations can reduce the number of undiagnosed people and must be followed by immediate action. We recommend:
- Improving population health management through improved data collection and analysis – investing in more comprehensive data and in data management/artificial intelligence capabilities. Population-level data that takes into account both healthcare and non-healthcare data (e.g., socio-economic) can be used by healthcare systems to identify people with the greatest need and ensure they receive care and support in a timely manner. In this area, the use of big data is emerging that can help diagnose people who have not yet been diagnosed as well as help clearly identify specific individual characteristics, with a view to better tailoring treatments.
- Improved population health management through national screening programmes for T2D in the community and primary care settings. Screening can easily be performed during primary care consultations in the at-risk groups or in the community, with great potential for identifying the 36% of currently undiagnosed PwD in Europe. It can also be combined with screening for other chronic diseases for maximum impact. A specific population group, which should be screened and followed-up as a matter of course, are women who developed gestational diabetes (GDM) during their pregnancies.
- Strengthening primary care through investment in relevant resources and expertise and setup of multi-disciplinary teams. Key to strengthening the primary care systems include: investing in developing effective primary care systems’ frameworks and infrastructure, providing comprehensive education to primary care health professionals on recognising and managing diabetes, fostering the integration of care across all sectors and specialities, and promoting the development of multidisciplinary teams.
Improved diabetes management – secondary prevention
Appropriate management of glycaemia and key other risk factors (e.g., blood lipids, blood pressure) is fundamental to prevent and delay diabetes-related complications. Hence, we recommend:
- Achieving early, optimal glycaemic control. Ensuring that PwD can achieve optimal glycaemic control requires access to the necessary interventions, medication and tools and technologies, combined with broad awareness raising among and education of, healthcare professionals, supported by detailed care guidelines. One key aspect of promoting access to the necessary tools and technologies is to promote the adoption of innovation within national health systems.
- Ensuring patient empowerment and improving self-management/education. Empowered patients are generally more actively engaged in their own care, follow and manage their treatment more closely, show increased satisfaction with care and have positive interactions with other patients, helping them to cope with the disease. Useful tools for the education and empowerment of PwD include web portals, telemedicine, digital education services and digital therapeutics. Contact with peers has also proven to be a very effective way both of educating and supporting PwD.
Developing integrated, patient-centred care models and value-based care for improved quality of life and outcomes
The complexity of diabetes and its many co-morbidities requires juggling a number of different healthcare professionals and healthcare teams. European health systems tend to be single-disease focused and this needs to change.
- Implementing a fully integrated, patient-centred and value-based system of care. For PwD, many of whom live with diabetes-related complications or with other conditions too, the lack of integration prevents the realisation of optimal health outcomes and is often the source of waste. National health systems should conduct an extensive review and, as appropriate, re-design of their national models of care, ensuring that care is centred around the patient. One building block to this is the development of national patient registries and electronic health records. Another building block is Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs).
Reducing inequalities in health outcomes
The COVID-19 pandemic has clearly demonstrated the inherent inequalities in access to care across Europe, themselves leading to significant inequalities in health outcomes for European citizens. Differences in access to care, medicines and technologies is discriminatory.
Reducing inequalities requires an EU-wide common digitalisation/data framework alongside more transparency in medicines procurement, including fair pricing models, review of incentives and improvements in logistics. It also requires support to national governments in health technology assessment.
IDF Europe is committed to improving the lives of people with diabetes, and would welcome the opportunity of continuing working closely with the European Commission and Member States to ensure that the final Healthier Together Initiative is an ambitious framework, supported by proposed policies which enable a harmonised approach, ensure equitable access to care and improve health outcomes for people living with diabetes across Europe.