The Minister of Health and Consumer Affairs, Catalina Garciahas highlighted la “clinical effectiveness” of the inclusion of the implantation of the flash glucose monitoring system in adults with type 1 diabetes in the benefits offered by the Andalusian Health Service (SAS), as well as the diabetes education process designed by the Comprehensive Diabetes Plan of Andalusia (PIDMA), at the inauguration of the Andalusian Diabetes Congress. During the meeting, organized by the Federation of Diabetes Associations of Andalusia (FADA) at the Juan Ramón Jiménez University Hospital in Huelva, the counselor concluded an improvement in the quality of life of almost 50,000 Andalusian patients, thanks to the technologies applied to diabetes.
Thus, García has detailed that the follow-up of 13,846 adult patients with type 1 diabetes with flash glucose monitoring shows a reduction in the incidence rates of 27.2% of severe hypoglycemia episodes that require urgent health care for 061 in the total study population, going from 3.5 emerging hypoglycemias per 100 person-years to 2.5 emerging hypoglycemias per 100 person-years. The reduction is especially striking in older people (reduction of 59% in people between 61-75 years old and 48% in people over 75 years old) and in those people with metabolic control understood as optimal by Glycated hemoglobin prior to surgery. monitoring in which the reduction is 35%.
“In addition to the quality of life of patients, this improvement results in a decrease in the clinical, health impact and costs”the counselor has assessed.
A success, stated García, which justifies the “effort” for the incorporation of technology applied to diabetes that the Ministry of Health and Consumer Affairs is making, with insulin pumps, pump-sensor systems and continuous sensors and flash monitoring of glucose, technologies from which more than 26,000 patients with type 1 diabetes in the autonomous community already benefit. Thus, he has pointed out that Andalusia’s service portfolio is one of the most extensive in including technologies applied to diabetes in the entire National Health System.
The consolidation of the functional units of Diabetes, which started in 2020, has favored the implementation of these technologies in selected regional hospitals and high-resolution hospitals by improving accessibility to endocrinological care, and “it has been possible thanks to the provision of specific human resources for endocrinological care and diabetes education,” pointed.
Along these lines, specific actions have been developed that guarantee full accessibility of the sensors by the end of 2021 for all patients with type 1 diabetes and other forms of insulin-deficient diabetes for whom they are authorized, including continuous glucose monitoring systems in patients under 4 years of age, financed specifically in the Andalusian community. “The experience in the implementation of flash-type sensors has been successful, because it allows optimization of patient control, effective telecare and, ultimately, a better quality of life,” he added.
With this experience, and following the recommendations of the Technology Assessment agencies, “in Andalusia we have opted for the extension of flash monitoring to patients with type 2 diabetes being treated with multiple doses of insulin. “Our community is one of the pioneers in financing this group”, explained the head of Health and Consumer Affairs. In fact, since April 2022, flash monitoring has been extended to people with type 2 diabetes on intensive insulin therapy in a basal bolus regimen, following a progressive implementation schedule based on clinical priority, and in a pioneering manner in Spain, involving to primary care teams.
Currently, a total of 14,855 people with type 2 diabetes benefit from this technology. Its use stands out in some prioritized groups, such as dependence or functional disability (5,035), severe hypoglycemia (1,542) or due to pregnancy (173).
In recent months, an intense training program has been developed for primary care professionals, which will be maintained continuously to ensure that the educational process of patients and their follow-up is carried out not only by the hospital teams but mainly by the healthcare teams. Primary care.
Prevalence and early detection
The estimated prevalence of diabetes in Andalusia for the population over 18 years of age is 15.3%, the second highest rate in Europe. However, García pointed out, “only about 780,000 diagnosed cases are known.” Of this population, 90-95% correspond to patients with type 2 diabetes mellitus (DM2), a form of diabetes closely linked to obesity and a sedentary lifestyle. Hence the importance, the counselor stressed, of “educating to protect the future.”
In this sense, García has pointed out as “indispensable” the actions aimed at the prevention of diabetes and many other chronic diseases that share risk factors with diabetes and which, he recalled, “we have specified in the Strategy to promote a healthy life in Andalusia”.
However, one in three people with diabetes in Andalusia is unaware that they have the disease, which represents, he stressed, “a great risk”, because “untreated diabetes can cause serious and life-threatening complications, such as a myocardial infarction, a stroke, kidney failure, blindness or the amputation of lower limbs. “Complications that reduce the quality of life and increase the health costs associated with the disease.”
For this reason, the counselor has encouraged that, “at the slightest symptom, it is best to consult with your Primary Care team, and periodically perform diabetes screening for those who have a family history of diabetes or a personal history of gestational diabetes or any other factor.” such as being over 45 years old, obesity, hypertension or dyslipidemia.
Comprehensive Diabetes Plan of Andalusia
Along with the prevention and early detection of the disease, the PIDMA includes the organization of care, the prevention and early detection of complications, therapeutic education in diabetes and the development of technologies applied to diabetes.
One of the most successful programs of the plan is Early Detection of Diabetic Retinopathy, in which the Primary Care centers and the Endocrinology and Nutrition services of the Andalusian public health system actively participate, and in which 570,000 patients are included. In 2022, 166,180 patients were reviewed within the framework of this program and 167,457 retinographs were performed, which is the highest figure in the entire historical series since 2005. Until the end of August 2023, 94,015 patients have been reviewed and 94,262 retinography scans have been performed.
“Along with the record that this represents, the result of the efforts of professionals, the most important thing is that in more than 67,000 tests, diabetic retinopathy lesions have been detected in more than 56,000 patients, of which about 3,000 were forms of retinopathy with threat. of vision”, highlighted the counselor, who stressed that, “thanks to this early detection, these patients have been able to be treated early in the Ophthalmology services, with which we have significantly reduced the risk of visual disability due to diabetes in the autonomous community”.
Likewise, the Network for the Prevention and Care of the Diabetic Foot of Andalusia (RePAP) aims to ensure comprehensive, individualized and quality care that responds to the specific needs of the person with high-risk foot and diabetic foot, and their family, guaranteeing continuity of care. The 36 Advanced Practice nurses in Chronic Wounds and Diabetic Foot play a fundamental role in this network, reinforcing prevention work in primary care and communication with multidisciplinary hospital care teams for early and coordinated care. “Podiatrists will soon join these teams, once this professional category is incorporated into the SAS,” Catalina García said.
The first deputy mayor of the Huelva City Council, Felipe Arias, also participated in the inauguration; the president of the FADA, Ana María Álvarez, and the president of the Huelva Diabetes Association, Diego Gómez. In addition, García has been accompanied by the territorial delegate of Health and Consumer Affairs in Huelva, Manuela Caro; the delegate of Infrastructure and Public Services of the Huelva City Council, María Dolores Ponce; the acting manager of the Juan Ramón Jiménez University Hospital, Alejandra Álvarez; and the director of PIDMA, María Asunción Martínez.