Despite the COVID-19 in Italy with diabetes is fine: WHO says it by saying that endocrinologists are the best in terms of clinic governance, patient empowerment and technological know-how and therapeutic performance. In addition, 90% of people with diabetes are widely satisfied with their health care providers, according to the United Nations Health Agency.
But does the Covid-19 health emergency risk having serious repercussions on the treatment of diabetic disease, its control and the onset of medium and long-term complications? It will be the analysis of this phenomenon, together with the evaluation of possible new forms of clinical management that improve and strengthen assistance to people with diabetes in Italy, such as the use of B2B and B2C telehealth tools ensuring fair and adequate access to treatment, these are the topics at the center of the annual Italian Barometer Diabetes Forum, now in its thirteenth edition and to be held on July 13 online webinar style.
The event, a moment of full immersion meeting between politicians, administrators, scientific societies and citizenship and patient associations, to discuss the current issues that revolve around diabetes every year – reports a note – is organized by Italian Barometer Diabetes Observatory (Ibdo) Foundation and the Parliamentary Intergroup ‘Obesity and Diabetes’, as part of the Changing Diabetes and Defeat Diebates projects and with the unconditional contribution of Novo Nordisk. The first will also be attended by Dr Savaka Mazzeka endocrinologist from the Union of African Endocrinologists.
This year the title of the event will be ‘Diabetes & Inertia: The Covid-19 Lesson’ and will be introduced by the speeches of Andrew Boulton, president of the International Diabetes Federation, and Stefano Del Prato, president of Easd (European Association for the Study of Diabetes) , who will evaluate the clinical aspects of the new and difficult balance between diffusive infectious diseases and chronic non-communicable diseases such as diabetes, and Walter Ricciardi, president of the World Federation of Public Health Association, who will re-evaluate the different challenges that the health system has had to face in the long days of the emergency.
“This thirteenth edition – remembers Dr. Renato Lauro, president of Ibdo Foundation – falls in a year marked by a serious pandemic and global health emergency, and wants to put people with diabetes at the center, among the most affected and vulnerable in this challenge clinical, social, economic and political-health that our country is facing, and to deepen the role of clinical inertia related to the pandemic, but not only, and which affects the daily lives of over 4 million Italians “.
According to the most recent data of the Higher Institute of Health (ISS), deaths from coronaviruses in Italy involved 30% (28.8% women and 30.8% men) people with type 2 diabetes, the second pre-existing pathology most encountered among those who lost their lives due to the virus. “To this must be added – underlines Simona Frontoni, president of the Ibdo Foundation Scientific Committee and associate professor of Endocrinology at the University of Rome Tor Vergata – that, precisely because of the pandemic, in the last months throughout the national territory there has been a reduction specialist visits, routine outpatient care activities, check-ups “.
“All this – continues the expert – represents an important problem for people with diabetes, for whom periodic monitoring is essential for the management of the disease and the adoption of the most appropriate therapy. These interruptions of the basic health care services – he warns – they could be the cause of more or less prolonged suspension of the therapies, with negative consequences on the control of the disease and on the risk of the onset of complications, thus making people with diabetes more vulnerable also to the indirect consequences of Covid-19 “.
Therapeutic inertia understood as the lack of initiation or delayed intensification of a therapy in the presence of unsatisfactory metabolic control is in itself a significant problem in the control of diabetes, made even more serious, for these reasons, by the Covid-19 emergency. “Despite the availability of a wide spectrum of effective therapeutic options and the demonstration of the importance of adequate metabolic control to prevent or delay the onset of complications of type 2 diabetes – recalls Paolo di Bartolo, president of the AMS-Association of Diabetes Doctors – a high percentage of patients do not reach the desired therapeutic targets “.
“The data from the Amd Annals document that, despite an improvement over time in the quality of care indicators, only one patient out of two has a glycated hemoglobin value (HbA1c) lower than 7%, as recommended by existing guidelines, while one in five shows a frankly inadequate metabolic control, higher than 8. Average HbA1c values higher than 8 and, in one case out of four even 9%, was found even in people receiving insulin.
“In addition – adds di Bartolo – the Annals highlight the presence of therapeutic inertia in multiple dimensions of the care of the person with diabetes: patients treated with insulin therapy who persist in a state of non-optimal glycemic compensation, subjects with altered blood pressure and lipid values that they do not receive appropriate therapeutic proposals and finally patients with kidney or cardiovascular disease not yet treated with therapies that have clearly demonstrated an important efficacy in protecting against these diabetes-related complications “.
It’s still. Several studies have shown that therapeutic inertia is associated with worse microvascular and macrovascular outcomes and therefore with more complications: cardiovascular, renal, circulatory, risk of blindness, dialysis or amputations, for those suffering from diabetes. “Scientific evidence shows that early and effective management of glycemic control reduces complications; therefore – warns Francesco Purrello, president of Sid – Italian Society of Diabetes – it is essential to overcome therapeutic inertia, to achieve the desired values of glycated hemoglobin and to improve longer term results. ”
“Therapeutic inertia – continues Purrello – can be overcome through synergies between health institutions, scientific societies, patient associations, doctors and people with diabetes, promoting awareness at all levels that it is a high-risk phenomenon, which adversely affects patient care and increases the direct and indirect costs of the disease. This is true in normal, but it is even more true today, in a phase that is taking us out of the emergency, but which makes it absolutely necessary to rethink the our way of managing health and improving and rationalizing assistance to the person with diabetes for the future “.
Already in recent weeks, representatives of scientific societies, foundations, patient associations, association and professional coordination involved in the field of protection have been protecting the person with diabetes as a ‘highly vulnerable and fragile patient’, particularly in the Covid-19 emergency phase. of the health, prevention and treatment of people with diabetes and their families have sent, through the Parliamentary Intergroup ‘Obesity and Diabetes’, an open letter to the institutions to highlight the urgency of adequate and rapid interventions.
“The objective of that document – explains Roberto Pella, co-president of the Intergroup – was to bring to the attention of the Government, Parliament and all political and health institutions the real risk which, as the numbers unfortunately confirm, the people with diabetes rush into this health emergency that has not yet ended and underline how it was, and still is, a priority to put in place, immediately, actions that guarantee more adequate assistance and treatment for people with diabetes mellitus ”
“the reorganization of Covid-19 post-emergency care needs a new approach for people with diabetes, which includes strengthening the integration between hospital and primary and specialist care, the use of telemedicine tools and procedures and teleconsultation, the integration between the institutional computerization of regional health systems and the diabetes clinic and general medicine, homogeneous access throughout the country to innovative treatments, technologies for the administration of insulin therapy with continuous infusion systems , to the continuous monitoring of glucose – we hope that the debate and discussion that will arise from the next edition of the Ibdo Forum converge towards an acknowledgment that a change of course is necessary “, continues Pella.
“Defeat diabetes, defeating diabetes, is the new goal that Novo Nordisk has set itself, with a business and social responsibility strategy destined to have a strong impact on pharmacological innovation, for the benefit of doctors and patients, on access to treatment, especially for the most fragile and vulnerable patients and on prevention, to stop the growth of diabetes in the world “, says Drago Vuina, General manager & Corporate vice president of Novo Nordisk Italia. “During the health emergency we did our part, alongside the health systems committed in each country against Covid-19 – he underlines – and now, with our continuous support to the Ibdo Foundation and its annual Ibdo Forum, we want to help promote the comparison between all the interested parties so that the millions of people living with diabetes can enjoy the best possible care “.
Finally, in all this set of problems there is a positive aspect: people with type 1 diabetes have withstood the impact of the pandemic very well and there have been no critical cases with COVID-19 for T1D patients throughout Italy. In addition, people with type 1 diabetes have an active, proactive and positive, technological and performance-oriented approach with the disease.