Diabetes: “We draw the right lessons from Covid-19 to adapt the system of care”

July 13, thirteenth edition of Italian Barometer Diabetes Forum. Scientists, policymakers, administrators and civil society meet virtually, thanks to Ibdo Foundation and Parliamentary Intergroup "Obesity and Diabetes," to rethink care for people with diabetes in Italy in light of the "Covid-19 lesson"

Therapeutic inertia

Therapeutic inertia, understood as failure or delayed intensification of treatment in the presence of unsatisfactory metabolic control, is a major problem in diabetes: only 1 in 2 sufferers have glycated hemoglobin values below 7 percent; even those on insulin therapy frequently have values above 8, and as many as 1 in 4 exceeds 9 percent. The picture is likely to worsen due to the reduction of specialist visits and follow-up examinations for the Covid-19 emergency

If people with diabetes have been among the greatest victims of the Sars-Cov-2 virus, it is precisely the Covid-19 health emergency that risks 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, along with the evaluation of possible new forms of clinical management that would improve and strengthen care for people with diabetes in Italy, ensuring fair and adequate access to care, that will be the focus of the annual Italian Barometer Diabetes Forum, now in its 13th year and taking place on July 13 in virtual.
The event, a time for politicians, administrators, scientific societies, and citizen and patient associations to meet and discuss current topics revolving around diabetes each year, is organized by the Italian Barometer Diabetes Observatory (Ibdo) Foundation and the Parliamentary Intergroup on Obesity and Diabetes, as part of the Changing Diabetes and Defeat Diebates projects and with an unconditional contribution from Novo Nordisk.

Diabetes & Inertia: The Covid-19 Lesson

It will be titled this year "Diabetes & Inertia: The Covid-19 Lesson" and will be introduced by talks by Andrew Boulton, President International Diabetes Federation and Stefano Del Prato, President EASD-European Association for the Study of Diabetes, who will assess the clinical aspects of the new and difficult balance between infectious communicable diseases and chronic noncommunicable diseases such as diabetes, and Walter Ricciardi, President WGPHA-World Federation of Public Health Association, who will reassess the different challenges the health care system has faced in the long days of the emergency. "This thirteenth edition, in fact, falls in a year dramatically marked by a serious pandemic and global health emergency, and wants precisely to focus on people with diabetes, among the most affected and vulnerable in this clinical, social, economic, and political-health challenge that is facing our country, and to delve into the role of clinical inertia related to the pandemic, but not only, and affecting the daily lives of more than 4 million Italians," explains Renato Lauro, President of IBDO Foundation.

According to the most recent data from the National Institute of Health

According to the most recent data from the Istituto Superiore di Sanità (ISS), coronavirus deaths in Italy involved 30 percent (28.8 percent women and 30.8 percent men) people with type 2 diabetes, the second most prevalent pre-existing condition among those who lost their lives to the virus. "In addition, it should be added that, precisely because of the pandemic, in recent months throughout the country there has been a reduction in specialist visits, routine outpatient care activities, and follow-up examinations.

All this represents a major problem for people with diabetes, for whom regular monitoring is essential for the management of the disease and the adoption of the most appropriate therapy. These interruptions in primary health care services could be the cause of more or less prolonged suspensions of therapies, with negative consequences on disease control and the risk of onset of complications, thus making people with diabetes more vulnerable to the indirect consequences of Covid-19 as well," says Simona Frontoni, Chair of IBDO Foundation Scientific Committee and Associate Professor of Endocrinology, University of Rome Tor Vergata.

Therapeutic inertia, understood as failure to initiate

Therapeutic inertia, in the sense of failure to initiate or delayed intensification of therapy in the presence of unsatisfactory metabolic control, is in itself a major problem in diabetes control, made even more serious, for these reasons, by the Covid-19 emergency. "Despite the availability of a broad spectrum of effective treatment options and evidence of the importance of adequate metabolic control in preventing or delaying the onset of complications of type 2 diabetes, a high percentage of patients do not achieve the desired treatment targets.

Data from the AMD Annals

Data from the AMD Annals document how, despite improvements over time in indicators of quality of care, only one in two patients has a glycated hemoglobin (HbA1c) value below 7 percent, as recommended by existing guidelines, while one in five shows frankly inadequate metabolic control, above 8. Average HbA1c values above 8, and in one out of four cases even 9 percent, are found even in people on insulin treatment," recalls Paolo di Bartolo, President AMD-Association of Diabetes Physicians.

"In addition, 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 suboptimal glycemic compensation, individuals with altered blood pressure and lipid values who do not receive appropriate therapeutic proposals, and finally patients with renal or cardiovascular disease who have not yet been treated with therapies that have clearly demonstrated important efficacy in protecting against these diabetes-related complications," he adds.

Several studies have shown

Several studies have shown that therapeutic inertia is associated with worse microvascular and macrovascular outcomes and thus more complications: cardiovascular, renal, circulatory, risk of blindness, dialysis or amputations, for those with diabetes. "Scientific evidence shows that early and effective management of glycemic control reduces complications; therefore, it is critical to overcome therapeutic inertia, to achieve desired glycated hemoglobin values and to improve longer-term outcomes.

Therapeutic inertia can be overcome through synergies between health institutions, scientific societies, patient associations, physicians and people with diabetes, promoting at all levels awareness that this is a high-risk phenomenon that negatively affects patient care and increases the direct and indirect costs of the disease. This is true in normalcy, 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 also rethink the way we manage health care and improve and rationalize care for the person with diabetes for the future," cautions Francesco Purrello, President SID-Italian Society of Diabetology.

Protecting the person with diabetes

Already in the past few weeks, in order to protect the person with diabetes and, particularly in the Covid-19 emergency phase, the person with diabetes as a "highly vulnerable and fragile patient," representatives of scientific societies, foundations, patient associations, association and professional coordinations, engaged in the field of health protection, prevention and care of people with diabetes and their families addressed, 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 was to bring to the attention of the government, parliament and all political and health institutions the real risk that, as the numbers unfortunately confirm, people with diabetes are running in this health emergency that has not yet ended, and to emphasize how it was, and still is, a priority to put in place, in the immediate future, actions that guarantee more adequate care and treatment for people with diabetes mellitus," says Roberto Pella, Co-Chair of the Parliamentary Intergroup "Obesity and Diabetes".

Building on the proposals in the letter

"Building on the proposals contained in the letter, aimed at a reorganization of care in the post-emergency COVID-19 phase with a new approach in favor of people with diabetes, including the strengthening of integration between hospital and primary and specialty care, the use of telemedicine and teleconsultation tools and procedures, the integration between the institutional computerization of regional health systems and that of clinical diabetes and general medicine, homogeneous access throughout the country to innovative treatments, technologies for the administration of insulin therapy with continuous infusion systems, and continuous glucose monitoring, we hope that the debate and discussion that will arise from the next edition of the Ibdo Forum will converge toward a recognition that a change of course is necessary.

The Covid-19 emergency has profoundly affected our established lives and habits, let's draw from what has happened in the past four months a cue to start again, not simply from where we stopped in early March 2020, but with new goals and a different vision of healthcare and approach to diabetic disease as well," Pella concludes.

Defeat diabetes, defeat diabetes

"Defeat diabetes, defeating diabetes, is the new goal Novo Nordisk has set for itself, with a corporate and social responsibility strategy designed to have a major impact on drug innovation, for the benefit of doctors and patients, on access to treatment, especially for the most frail and vulnerable patients, and on prevention, to halt the growth of diabetes around the world. During the health emergency we did our part, alongside the health systems engaged in every country against Covid-19, and now with our continued support for Ibdo Foundation and its annual Ibdo Forum we want to help foster discussion among all stakeholders so that the millions of people living with diabetes can enjoy the best possible care," says Drago Vuina, general manager & Corporate vice president of Novo Nordisk Italy.