Diabetes expert: Urgent need for education ‘at every level’

De Sabata: "It may sound obvious, but only people with diabetes can really understand what it is to live with it every day." [IDF Europe]

This article is part of our special report Diabetes: The next global challenge.

There is an urgent need to enhance education on diabetes, healthy lifestyles and eating habits “at every level”, Stella de Sabata, head of the International Diabetes Federation’s Europe region, told euractiv.com.

Stella de Sabata is the head of the European region of the International Diabetes Federation.

She has been involved in non-communicable disease prevention and control (cancer and diabetes) at the international level for over 15 years, with both the United Nations (International Atomic Energy Agency and International Agency for Research on Cancer/WHO) and umbrella NGOs (Union for International Cancer Control).

De Sabata spoke with EURACTIV’s Sarantis Michalopoulos.

What are the main barriers for a person with diabetes in managing their disease in everyday life? How can patients be better empowered and educated?

Barriers appear on several levels, from the personal all the way to health systems. Diabetes is a 24/7 condition: to properly manage it, people with diabetes need, on a daily basis, to take medicines, check their blood sugar level several times a day, inject insulin (if insulin dependent), adjust their lifestyle to the disease. This requires a daily commitment, and perseverance to avoid severe complications and even premature death. This is not an easy task, as shown in levels of adherence to therapy which are generally still too low.

Furthermore, there are countries in the European region where, even with the best intentions to adhere to therapy, living with diabetes can be a serious financial burden for people who do not benefit from universal health coverage systems and must cover themselves for part or all of the cost of their medical treatment.

There is certainly a great need for education at every level. People with diabetes must be supported to self-manage their condition on a daily basis and adhere to the appropriate treatment, healthcare professionals must be trained to deliver adequate care and support to patients, policy-makers must be kept up to date about the challenges faced by people with diabetes and the financial and human burden which diabetes represents for their country, so that they adopt appropriate measures. On this last point, the IDF Europe works with national and European parliamentarians and policy-makers through our IMPACT Diabetes initiative.

Education is, however, not only about medical treatment. The cultural, social and legal environment must be re-shaped to facilitate education in general on healthy living. IDF Europe calls, for example, for clear and user-friendly food labelling, for a ban on advertising of sugar-sweetened beverages and high sugar foods to children and adolescents, but also for better urban planning conducive to a more physically active lifestyle. Education is also crucial to prevent discrimination towards people living with diabetes.

What are the effects of diabetes on the sufferer’s family members? Do you believe that the proper level of awareness is present in societies?

The first months after a diagnosis are very difficult – shock, confusion, fear, apprehension, even guilt. In the long run, if proper education and access to care are there, people with diabetes realise that their condition does not have to limit their potential for a life lived to the full.

We are all concerned: for example, when a chronic disease such as diabetes hits a family, the role of the carer is crucial and in most cases, this still falls on the female family members, usually the mother.

Most of the time, they will be the ones adjusting the lifestyle of the family, including eating habits, to fit the requirements of the family member(s) with the disease. They will also be the ones looking after the therapeutic and psychological aspects of a child with type 1 diabetes. With 60 million people with diabetes in the European region (32m in the EU) and 32m more at risk of developing it in the coming years, diabetes is a major health issue and an economic threat to the continent.

Unfortunately, diabetes is still not recognised as a major economic and human threat by policy-makers and society. €145 billion was spent on the direct cost of treating diabetes in Europe in 2015. If indirect costs are added, you can triple this number. Nevertheless, this alarming information does not seem to reach the general public, nor is it sufficiently taken into account by policy-makers. On a larger scale, non-communicable diseases (NCDs) including diabetes dominate the global burden of death and disability in the world but attract less than 2% of all global health funding.

Definitely, the level of awareness is too low. Raising it is one of the tasks of IDF Europe and its 70 members in 47 European countries.

Adopting a healthy lifestyle could significantly help a person with diabetes avoid a fast progression to complications. How can this healthy lifestyle be presented in an appealing way?

Adopting a healthy lifestyle is the best way to prevent the vast majority of new cases of type 2 diabetes (up to 70%), and to prevent complications in all people with diabetes.

For people with diabetes, healthier eating habits and increased physical activity also mean better control of their diabetes and lesser or delayed complications, so it should be appealing as such. But let’s face it, it is not that easy and the social environment generally does not help.

Most of us live in cities nowadays and we need urban planning that favours safe and accessible environments for physical activity, such as green areas, large sidewalks, bicycle paths, etc. Healthy food and drink should be the most affordable option, but this is very often not the case.

Education starts in the family and at school and both should be empowered to instil positive behaviour early on. All of this requires political will, strong regulations and incentives to support and encourage healthier behaviour.

Are you satisfied with the policies adopted at EU and member state level to prevent diabetes?

In the past years, there have been several actions from the European Union in areas such as the CHRODIS Joint Action, the European Platform on Diet, Physical Activity and Health, and discussions around food reformulation.

Last year, 405 Members of the European Parliament signed a Written Declaration on Diabetes, calling on the European Commission and the European Council to prioritise diabetes as a major European health, social and economic concern and to develop an EU strategy for diabetes prevention, diagnosis, and control.

But we are still to hear back from the Commission and Council.

Much could be achieved through harnessing political will at the EU level. Let’s take sugar consumption: over the past fifty years, the global per capita sugar consumption has increased by over 50%. The World Health Organisation recommends a reduction in sugar intake throughout the course of life to less than 10% of the total energy intake per day for adults and children, with additional benefits for an intake of less than 5%.

However, in Europe, sugar intake in adults ranges from about 7- 8% of total energy intake in countries such as Hungary and Norway, to 16-17% in Spain and the United Kingdom. Worryingly, sugar intake is much higher among children, ranging from about 12% in Denmark, Slovenia, and Sweden to nearly 25% in Portugal.

Sugar intake can be reduced by limiting the consumption of foods and drinks containing high amounts of sugars (e.g. sugar-sweetened beverages, sugary snacks and sweets) and eating fresh fruits and raw vegetables as snacks instead of sugary ones.

It has been proven that taxing sugary drinks can lower consumption and reduce obesity, type 2 diabetes and tooth decay. The balance between protecting internal market interests and promoting public health, though, is proving difficult to achieve, with, for example, effective national fiscal policies being challenged on grounds of internal market concerns.

Progress on such matters is a priority.

EHealth takes centre stage in the EU’s policy-making. How could the introduction of technology in the health sector help people with diabetes better manage their disease?

Many people with diabetes now use mHealth solutions to manage their condition on a daily basis. They log their glycaemia and eating habits, they discuss their condition, exchange ideas and experiences on a forum and check medical or peer blogs for information.

It may sound obvious but only people with diabetes can really understand what it is to live with it every day. They often go through similar periods and transitions in their ‘diabetes life’, which typically include diagnosis, hospitalisation, first child and first encounter with complications.

It is often during these times that they are most likely to reach out for help and search for new or better solutions. And mHealth tools can be of great support – but apps and other solutions must be adapted to the needs and requirements of people with diabetes.

Unfortunately, this is rarely the case and most apps are used for 2-3 months and soon become obsolete. Privacy and data protection are of course very sensitive issues and of the utmost importance.

The connected world is an area which IDF Europe is watching closely, and we will release a statement early in 2017.