This article is part of our special report Breaking silos in diabetes care.
The European Union has a critical role to play in optimising the management of diabetes care, by setting clear boundaries and precise objectives through its research funds, an expert has told EURACTIV.
Professor Chantal Mathieu, who is president of the European Diabetes Forum (EUDF) and Chair of Endocrinology at the University Hospital Gasthuisberg Leuven, explained the daily difficulties of diabetes patients in handling a complex disease, highlighting the structural shortcomings along the care pathway.
“I think the EU needs to set the boundaries and the big examples of what should happen via the budget for research,” Mathieu said.
Member states will get the message, she said, if the EU mandates research, for instance through the Innovative Medicines Initiative, in a big data registry in Europe and specifically for diabetes.
“If Europe says non-communicable diseases, like diabetes, are a healthcare priority in our region, then the countries will see this example,” she said, adding that one should not underestimate Europe’s peer pressure and how countries look at each other.
She stressed that by pushing for research and tools, where data can be gathered, where registries and diabetes national plans can be created, integration and novel technologies can be promoted.
There are countries such as Belgium, the expert added, which claim that they have a diabetes national plan but in practice, they do not.
A report published last week by The Economist Intelligence Unit found that 60 million people suffer from diabetes in Europe, a figure expected to rise to 68 million by 2045, while diabetes management already represents as much as 10% of overall health budgets.
“Diabetes is not an easy disease. As a patient, you need to do your best every day, you need to adapt to what you eat, you need to adapt to what you do. And you live with diabetes every day.”
“These people need to do their best every day for a disease that they don’t feel,” she stressed, adding that, unlike headache, this cannot be fixed with a pill.
“It’s sometimes very strange that patients have to do their best now, spend money to buy drugs now, or tools that would help them to live a good life, but only in 20 years, 30 years, will they be rewarded by having less complications,” she said.
A fragmented care pathway
Diabetes care is described as complex, as it requires the involvement of different professionals across the healthcare spectrum, ranging from primary and secondary to specialist care settings.
The Economist report noted that due to the lack of integrated health IT systems and integrated finances, avoidable costs are increased while poorer patient outcomes are observed.
She cited the example of Belgium, which has a pay-for-performance remuneration of doctors, nurses, dieticians, or psychologists.
“And so many years, these people have worked in silos. They did not talk to each other; they did not interact,” she said, adding that this is confusing for a diabetes patient.
“Can you believe it that 15 years ago, even in our big university hospital, nurses and dietitians could not access the medical dossier of a patient because it was considered medical,” she said.
She emphasised that an integrated approach is needed in order for the doctor to be aware of what the nurse said, for the nurse to know what the dietitian said, and for the psychologist to be informed of what the whole team did.
“Imagine, a doctor tells a patient that he needs two pills and exercise half an hour per day. And the dietician says exercise one hour a day. And then the nurse says why do you take so many pills and exercise half an hour, that’s a lot, exercise 20 minutes.”
The hidden costs
Projecting the annual care costs for a diabetes patient is difficult considering that healthcare systems across Europe have adopted different approaches.
According to Mathieu, there is first the direct cost, which is often reimbursed, but that is not always the case for the indirect cost.
“In Belgium, I always say we are a paradise for diabetes because most of the cost is covered. But if you live in Poland, for instance, or in another country where insulin analogues or novel technologies are not reimbursed, this starts to add up to the cost.”
She added, though, that the big differentiator is the presence of complications, which eventually leads to a lot of out-of-pocket expenses.
“When you talk to our minister, he will say there are no out-of-pocket expenses. We reimburse everything: pills, insulin, we reimburse dialysis etc. Yes, but you don’t reimburse the cane you need to walk if you have a problem with your feet. You don’t reimburse the loss of economic activity due to impaired eyesight,” she said.
[Edited by Zoran Radosavljevic]