In the last year, good and bad news has accumulated regarding diabetes, which requires analysis and evaluation by the main professionals dedicated to the care of this disease, as well as by the people affected.
On the occasion of World Diabetes Day, which takes place on November 14, representatives of the Spanish Diabetes Society (SED) and its Foundation (FSED), as well as the Spanish Diabetes Federation (FEDE), took stock of the situation that is positive, in general, but some concerns are noted.
Technological and pharmacological advances
The good news is limited to technological and pharmacological advances, which enable earlier and more effective control of the different forms of diabetes (mainly type 1 and 2), thanks to the appearance of new treatments that provide important benefits in prevention and management of complications associated with this metabolic disease.
In patients with type 1 diabetes, the breakthrough is hybrid closed-loop automated insulin delivery systems. Although the patient still has to take insulin to cover intake and adapt its administration to exercise, they automatically adjust basal insulin to changes in glucose and allow the automatic release of additional doses of insulin.
In the field of type 2 diabetes, the president of the SED, Dr. Antonio Pérez, considers that “we have many reasons to be optimistic”, because research “does not stop and offers new treatments and tools that improve the prognosis and quality of life and that, in the future, may allow prevention and, why not, the possible future cure of this disease.
Among the main advances recorded, the head of the SED highlighted the development of technology applied to the treatment and monitoring of people with diabetes and the availability of new oral and injectable drugs (GLP1 receptor agonists and SGLT2 inhibitors). for the treatment of hyperglycemia and comorbidities associated with diabetes. “These drugs have greatly modified the treatment strategies of patients with type 2 diabetes, since they do not increase the risk of hypoglycemia, reduce body weight and have beneficial effects on cardiovascular and renal protection, in addition to glycemic control,” he explained.
Dr. Sonia Gaztambide, president of the FSED, also highlighted the appearance of “new drugs that not only improve glycemic control,” but also “offer a beneficial cardiovascular and renal profile.” Along with this, “there are new resources that facilitate earlier intervention in type 1 diabetes, which can have a positive effect on their future,” and continuous insulin infusers in DM1, with stop systems in situations of hypoglycemia, whose operation based on automated blood glucose levels “are making the lives of people with diabetes much easier,” he stressed. Thus, Gaztambide insisted that “we must continue educating people with diabetes, without forgetting the education of the corresponding professionals: education is the key to a good future.”
Supply problems
Despite important scientific advances, the prevalence of diabetes “continues to increase and, although we have made great progress in reducing the impact it has” on people’s lives, “we are still not able to eliminate the high morbidity and mortality associated with the disease itself.” disease and its complications, improve the quality of life of people with diabetes and reduce the high use of health resources that it entails,” acknowledged Antonio Pérez.
As the main factors involved in this apparent paradox, the director of the Endocrinology and Nutrition Service Unit at the Hospital de la Santa Creu i Sant Pau in Barcelona pointed out that “the progressive increase in obesity at increasingly earlier ages and the difficulties of access of some people to diagnosis, quality care programs and therapeutic innovation are some of the obstacles that prevent progress.”
Above all, the most worrying news comes from the unstoppable increase in the prevalence of diabetes and the maintenance of certain stigmas and socioeconomic obstacles for many people who suffer from this disease. Furthermore, there are concerns about the difficulties in accessing and supplying some innovative drugs for type 2 diabetes. In fact, the shortage of drugs from the GLP-1 receptor agonist family has not only been a problem this year but, as predicts the president of the SED, “this supply deficit is expected to continue throughout 2024.”
“The increase in demand for these medications resulting from the increase in their use in approved indications, but also outside their indications for weight loss in people without diabetes, and the lack of capacity of manufacturing plants to cope with “This increase in demand has caused problems in its supply since the end of 2022 that are conditioning our daily work, by not being able to start or continue treatment in many patients with type 2 diabetes,” denounced the president of the SED.
In his opinion, “this shortage represents an overload for professionals and has a relevant impact on the health of patients.” For this reason, and with the aim of avoiding or alleviating these problems, “it is recommended to use it only according to the authorized conditions, and to replace the treatment with the increasingly fewer drug options available from the same therapeutic group.”
Concern for people with diabetes
The Spanish Diabetes Federation (FEDE), which brings together 18 regional federations and 123 local associations, expresses some concern about this problem. Its president, Juan Francisco Perán, believes that “health professionals should be asked why they prescribe this medication for obesity, if it is only indicated for diabetes,” and admits that, “logically, this shortage generates discomfort among the group of people I represent.”
The actions that FEDE carries out in relation to this problem have focused on contacting and requesting information from the main sources that should be consulted in these cases: the Spanish Agency for Medicines and Health Products (Aemps) and the laboratory that markets the molecule. “Both the Aemps and the laboratory have informed us that they are trying to solve the problem as soon as possible,” added Perán. In any case, “this shortage has not been a serious problem for the group of people with diabetes, since there are therapeutic alternatives that can replace the use of these medications.”
Much more than a day
The SED takes advantage of the commemoration of World Diabetes Day to raise awareness about the impact of this disease on the health and quality of life of people who suffer from it; focus attention on its causes, prevention and treatment; and disseminate advances in relation to the prevention, diagnosis and treatment of diabetes and its complications. Furthermore, Antonio Pérez points out that “it allows us to reflect on the efforts necessary to improve the care of people with diabetes.”
The president of FEDE recalls that “on November 14 we celebrate the most important day for us, which serves to give visibility to the needs of the almost 6 million people who suffer or suffer from this pathology.”
‘Knowing the risks is knowing the answer’
In 2021, the International Diabetes Federation (IDF) began a campaign, which runs until 2023, to promote better access to care for people with diabetes. This year, the chosen motto is ‘Knowing the risks is knowing the answer’.
“This motto helps us highlight the importance of preventing type 2 diabetes, a disease that can be overcome with a healthy lifestyle, trying to avoid obesity and overweight, and with regular physical exercise,” he says. Juan Francisco Perán. “It also highlights the importance of early diagnosis to avoid complications derived from poor control of the disease, as well as self-care, once the disease is diagnosed, highlighting the importance of correct diabetes education,” he adds.
With all this, FEDE estimates that many of the complications derived from poor diabetes control would be avoided, the quality of life of patients would be improved and the expense generated by diabetes would be reduced, which currently represents 18.4% of the total expenditure of the National Health System.
Although much progress has been made in diabetes in recent years, there are still great difficulties. “Diabetes continues to have a social visibility and in the health system far below what it should due to the numbers of people who are diagnosed with diabetes each year, the complications associated with the disease and the socioeconomic repercussions that it entails,” explains Antonio. Perez. “Within people with diabetes there is an unjustifiable lack of equity in access to the resources necessary to receive adequate care,” concludes the president of the FED.