IMPROVING PREVENTION AND CARE OF DIABETES

INTRODUCTION On the whole, people are healthier, wealthier and live longer than 30 years ago but the nature of health problems is changing. Healthy life years may be not increasing in line with life expectancy: along with demographic change and population ageing, the burden of chronic diseases increases, individuals present with complex symptoms and multiple illnesses, and the substantial progress in health is deeply unequal [1]. Noncommunicable diseases (NCDs) are becoming the leading causes of morbidity and mortality, and the four major NCDs, cardiovascular diseases, cancers, respiratory diseases and diabetes, are responsible for 82% of NCD deaths [2]. Diabetes is often considered as a paradigmatic example of a chronic disease. It is a common and serious disease: diabetes increases the risk for many serious health problems (e.g., hypertension, cardiovascular diseases, eye problems, neuropathy, foot complications, nephropathy), but can be prevented and effectively controlled using available knowledge. With the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications. The global prevalence of diabetes, in the year 2014, was estimated to be 9% among adults 18 years and older. In 2012 diabetes was the direct cause of 1.5 million deaths, and more than 80% of these deaths occurred in low and middle-income countries. World Health Organization (WHO) estimates that diabetes will be the 7th leading cause of death in 2030 [3]. In the European Region there are about 60 million people with diabetes with national prevalence ranking from 2.4% in the Republic of Moldova to almost 15% in Turkey [4]. The challenge facing decision-makers and leaders in health care, is how to strengthen chronic disease prevention and control efforts, and how redesign health care system to better meet complex needs of persons with chronic diseases like diabetes. Persons with chronic diseases require not only effective treatment, but also continuity of care, and adequate information and support, so that they can achieve self-management to the greatest possible extent. A redesign of the care system is needed: a shift from fragmented health care delivery to an organized prevention based multicomponent approach is necessary, along with a real partnership between citizens and health professionals, and between primary and secondary care, so as to achieve long-term coordinated care.