This article is part of our special report Breaking silos in diabetes care.
With everyone’s minds focused on the health, economic and social catastrophe of COVID-19, World Diabetes Day, celebrated last week on 14 November, has not caught the attention of policymakers or the general public. But we neglect ‘Europe’s silent health pandemic’ at our peril.
Milena Richter is the co-chair of the EFPIA Diabetes Platform and Head of Office from Sanofi.
Imagine a 28th EU Member State with a population the size of Italy. Today, nearly 10% of Europeans (around 60m people) are living with diabetes. By 2030, it will reach 66m, becoming the third largest country by population after Germany and France.
Diabetes is a major financial challenge for healthcare systems in Europe today. The cost of managing diabetes represents approximately 9% of overall healthcare budgets – a total of €149bn in Europe in 2019 – and this share is expected to rise by 12% over the next 25 years. Yet, an estimated 75% of diabetes spending is to treat complications that are largely preventable through effective management of the disease.
Diabetes is relentless, it gets worse over time and there is no cure. People with diabetes are at risk of serious and life-threatening complications, such as heart attack, stroke, kidney failure, blindness and lower-limb amputation. Every year in Europe, 114,000 people die from these diabetes-related complications. That is almost five times as many people as the 25,000 who die in road traffic accidents. During the current global pandemic, COVID-19 patients with diabetes have so far shown a two-fold increase in mortality rate.
Despite its increasing prevalence and worsening outcomes as the disease progresses, the seriousness and severity of diabetes has been consistently underestimated in Europe. But the huge scale of the problem and its rapid rise demands a complete rethink of how we manage diabetes. We cannot expect health systems designed to care for people with acute illnesses to meet the needs of large numbers of citizens living with long-term conditions such as diabetes.
It’s time to reimagine how care is delivered.
In the week following World Diabetes Day, on 20 November, The European Federation of Pharmaceutical Industries and Associations (EFPIA) hosted an event in Brussels to launch a new report by The Economist Intelligence Unit (EIU) on integrated diabetes care across Europe.
Care for people with diabetes is complex, as it requires the coordination of a wide range of healthcare professionals across primary, secondary and specialist care. Today, in most of the EU’s Member State healthcare systems, this multi-dimensional ecosystem of care is fragmented, leading to significantly higher costs coupled with poorer health outcomes.
Better diabetes system integration is therefore needed to improve the delivery of diabetes care throughout the patient pathway, reduce the burden of complications and lead to better outcomes. An integrated system is also widely viewed as one of the key solutions to spiralling healthcare costs.
The EIU report looks at the current level of integration in the 27 EU Member States and the UK, as well as at the presence of key enabling elements – in particular integrated health IT systems and aligned finances – to provide a scorecard of integration across Europe.
So, how well is diabetes integrated across Europe?
The report found that, while there is a good foundation of integrated diabetes systems policy across European countries, effective implementation of these policies is hampered by the lack of key enabling elements, such as integrated health IT systems and integrated finances.
In particular, major barriers and gaps still remain in the implementation of integrated IT health systems, with only eight Member States receiving full marks – and only half of the 28 countries having a national diabetes registry which is considered a vital part of disease management.
Most concerning, though, are the indicators assessing the level of financial alignment within diabetes care in each country. For integration to truly work there needs to be some element of budgetary integration, but less than half of the countries had integrated diabetes funding in place and few had incentives in place for providers to encourage integration. Member States’ healthcare budgets are frequently separated for primary and secondary care, and they are often managed in silos at regional or local levels. Incentives also need to be realigned to see a real change in integrated care.
The EIU analysis concludes that this lack of financial integration is what is impeding the creation of effective integrated diabetes systems, so hampering the promise of better outcomes and reduced costs.
There is no quick and easy fix. However, three policy recommendations have been identified: people with diabetes need to be put at the centre of integrated diabetes services; budgets must be aligned to reduce fragmentation and deliver patient-centred care; and evaluation mechanisms should be established to facilitate continuous monitoring and improvement of integrated diabetes systems.
Ultimately, diabetes must be prioritised on the European health agenda! Even more in the midst of this global pandemic, the EU must help Member States shape the future provision of diabetes care. By prioritising diabetes, we will improve the lives of millions of people, while improving the efficiency and cost-effectiveness of our national healthcare systems.
Let’s turn our focus onto diabetes, Europe’s silent health pandemic.