Type 2 diabetes mellitus is a prevalent disease that affects almost 14% of the population. Like all chronic pathologies, early diagnosis and strict control prevent complications and improve the patient's quality of life. A study by Weber, with the support of Lilly, has assessed the impact that strict and early control of diabetes would have in terms of economic cost for the health system, as well as for the patient and society in general.
The conclusions reveal a significant fact: in the first five years after diagnosis, if the disease is well controlled, a social value of almost 2,700 euros per patient can be generated. The projection of this figure at the level of all of Spain supposes a generation of 185 million euros of social value in the period analyzed, according to this report. Of these, 87.9 million euros (47.5%) would correspond to savings in healthcare resources.
To find out in detail how type 2 diabetes mellitus is addressed in our health system, Diálogos en La Vanguardia brought together a multidisciplinary group of experts with the purpose of contrasting points of view and identifying possible lines of improvement and contributing to making visible a disease that each time begins to be seen in younger people, of which a high percentage are not diagnosed and that is closely related to lifestyles.
Álvaro Hidalgo, president of the Weber Foundation, explained that "our activity basically consists of comparing what it means to have an ambitious therapeutic goal achieved as soon as possible." The opposite, as the study states, means "worse quality of life for the affected person and a very important loss of economic resources for society." This social impact does not only affect health spending. It is also necessary to take into account "the losses of labor productivity that the consequences of this pathology will cause in the people affected and in those who are under their care".
The Weber study analyzed "the use of health resources of a patient with strict and early control, which translates into a glycosylated hemoglobin level below 6.5% during the first five years after diagnosis, and compared it with other people who lack that control.” In terms of social impact, the authors of this study estimate that "the difference between strict control and non-strict control is those 185 million euros of social value, half of which are health resources that could be saved and used for other purposes" .
"With this report we want to show that there is a positive social impact in the early and strict control of diabetes and that this should be part of the debate when working to address this chronic pathology," said Teresa Millán, director of Corporate Lilly's affairs. "It is very important that the parties involved are aware of how the decisions made at the onset of diabetes influence."
The director of Endocrinology and Nutrition at the Hospital de la Santa Creu i Sant Pau in Barcelona, Antonio Pérez, assures that “we are arriving late in the diagnosis. If we are talking about 14% of the population having type 2 diabetes, we have practically half undiagnosed”. The expert considers that it is also failing to "provide affected people with the appropriate tools so that they can adequately manage their disease and this has positive repercussions on their quality of life." His bet is based on "being able to get ahead, stop putting patches and from the beginning identify that this is the objective and pursue it." That implies, in his opinion, “modifying how we are doing things”.
Antonio Amor, representative of the Spanish Society of Endocrinology and Nutrition, who practices this specialty at the Hospital Clínic de Barcelona, assured that "the first step is to diagnose. It is a completely silent disease and we know that the youngest patients are the ones who are going to do worse. They are the ones with the worst prognosis, the ones we diagnose the least, because they do not go to the health centers to have an analysis done and the ones that are going to consume the most system resources”. Influencing the diagnosis of this group is a priority.
director of the Àrea Asistencial del Servei Català de la Salut, “diagnosis is very important, but so is prevention”. The representative of the Administration assured that the financial efforts are focused on treatment, "and I think we have an important margin to focus on prevention, on everything that affects lifestyles, such as diet and exercise, which are the first phase of the treatment of diabetes in adults”.
Carrasco stressed the importance of shared decisions and the fact that “not all people are the same and we have to work to establish different objectives depending on each case and the moment of the disease. A person diagnosed at 60 cannot be treated the same as a person diagnosed at 80; just as we must take into account the evolution of his diabetes”. Citizens must know about the disease "and participate in decisions."
Teresa Millán joined this point of view “starting with prevention”. Lilly's board of directors considered that "first you have to raise awareness among citizens and then people who present the disease." Being well trained is "essential and is the best way to be aware that we have to take care of ourselves." Phrases like “I just have a little sugar” or “I have sugar, but it's not diabetes” are still heard all too often, contributing to trivializing type 2 diabetes.
To improve the approach to this pathology, Pérez highlighted the importance of "looking in other places to make the diagnosis." In this line, the endocrinologist valued "the importance of health checks carried out in companies, but there are more opportunities." Pérez pointed out "the importance of the role of the pharmacy, whose professionals often have knowledge about the health of families, or the dentist's office, where the alarm can go off because diabetes is a risk factor for problems periodontal diseases such as gingivitis.
Amor claimed the need for "a change of mentality on the part of health managers, which contributes to improving preventive work." The endocrinologist at the Hospital Clínic lamented that "we are used to dealing with problems, but it is very difficult to invest in initiatives that move away from day-to-day management and that will generate a positive return, but in the long term." In this sense, Hidalgo stressed that the budgets are always calculated during the electoral period in which the immediacy of the result prevails. “To see the results of prevention in a pathology like diabetes, we have to wait 10 or 15 years,” he said.
However, the resources exist. “We have spent 175 million euros on medicines to treat type 2 diabetes in Catalonia”, reported Carrasco. But to establish a more effective prevention model "a pact is required that goes beyond the immediate".
Another relevant aspect in the approach to diabetes is “the low visibility of this pathology and that it is well below the volume of affected patients. It is even below the visibility that cholesterol has among the population,” Pérez declared. In many cases the patient is not aware of having a disease, but simply of having a little high blood sugar”.
A very relevant factor in the development of diabetes is obesity, which is growing a lot in our society. "We know that if there were no obesity, probably 70% of the cases of type 2 diabetes mellitus would not exist," said Antonio Pérez. The endocrinologist at the Hospital de la Santa Creu i Sant Pau called for the importance of concentrating efforts on fighting excess weight and developing prevention strategies such as the one implemented in his day against tobacco consumption.
"The incorporation of dietitians and nutritionists in primary care can be a measure that contributes to improving this situation," said Carrasco, who claimed that "on the issue of diabetes, our country is not one of those with the most complications. We don't do it all right, but we don't do it all that bad either.” An idea in which Pérez abounded, assuring that, "as a health system it is one of the best and that affects, above all, the care of chronic diseases."
The experts agreed when pointing out other improvement factors such as the difficulty of adherence to treatment, especially among the youngest; or the need to increase staff to have better control and encourage the use of technology for more effective monitoring of patients.
