A real pandemic, confirmed by epidemiological data: there are more than 400 million of people with diabetes in the world.
The numbers are pitiless. In 2015, the prevalence of diabetes in the adult population is estimated at 8.8%: 415 million patients, i.e. one in eleven adults. In 2040, the figure is expected to increase reaching a prevalence of 10.4% with 642 million patients.
The alarm is triggered by a prestige group of scientists who collaborate at the Italian Barometer Diabetes Observatory (IBDO) Foundation and was brought to the attention of the Italian Parliament during an official presentation held on last April 4th at the House of Representatives.
The diabetes pandemic is in fact a big issue in Italy, where it is estimated to be responsible for 73 deaths per day. An emergency behind the birth of a network between Institutions and experts for years dealing with in-depth analysis and information about the risks of this disease.
The Italian Barometer Diabetes Observatory (IBDO) Foundation is a think tank with the aim of addressing diabetes through a continuous scientific dialogue on clinical, social, economic and health-related issues.
One of the main results of the expert collaboration is the publication of the Diabetes and Obesity Barometer Report, which was released in its tenth edition and presented to Italian politicians.
From this year, ISTAT-National Institute of Statistics also participated in the publication coordinated by Professor Domenico Cucinotta. The Report is an important stimulus for meditation on major issues related to diabetes and obesity in Italy.
Extra pounds are indeed bad and frequent allies of diabetes. In 2014, the number of overweight adults was estimated at 1.9 billion or 39% of the world’s population. On the other hand, obesity affects 600 million people.
“In Italy,” says Professor Cucinotta, “there are today more than 3.5 million people with diagnosed diabetes, about 1.5 million unaware of having it, and 4.5 million with prediabetes. So, 10 million of Italians and their families have to deal with this disease. In 10 years, every Italian family will have a person with diabetes or prediabetes.”
Diabetes accounts for the 8% of the National Health System (SSN) spending, with a total cost of about 8.25 billion euros per year. This is to be added to the individual costs not covered by SSN, the tangible indirect costs such as absence from work with loss of revenues, family involvement, and indirect intangible or moral costs related to disability, quality and “quantity” of life.
It is said of obesity, but the complications associated with this powerful killer must also be remembered: 15% of people with diabetes suffer from coronary heart disease, 22% has retinopathy and is at risk of blindness, 38% has renal impairment and is at risk of dialysis, 3% has problems with the feet and is at risk of amputation.
What scientific evidence allows to measure is that effective treatment can reduce by 50% the risk of developing costly complications of diabetes. But still, it is far from truly satisfactory results, often due to the underestimation of the disease.
Dr. Antonio Nicolucci, one of the main international experts in clinical epidemiology of diabetes, is a member of the Executive Board of IBDO and chair of the Foundation’s Data Analysis Board. We meet him in Pescara at CORESEARCH’s headquarter, the company he directs, engaged in analyzing and compiling data, indicators and statistics published in the Diabetes and Obesity Barometer Report.
Dr. Nicolucci, in the face of such a widespread and worrying prevalence of diabetes, what is the role of the Barometer Report?
The Barometer Report was born from the collaboration between IBDO Foundation, ISTAT and CORESEARCH, and represents an important reference document that summarizes data on the clinical, social and economic impact of diabetes and obesity in Italy.
We have reached its 10th edition and the Barometer Report is now a unique document, even on the international scene, for its wealth of information. There is a 360 degree reading of the diabetes/obesity binomial in our country, enabling to trace its evolution over time. In addition to Country data, there are regional details, useful for resource allocation, and organization of healthcare even at a local level.
The work of analyzing and monitoring this massive amount of data makes us able to evaluate a variety of indicators to inspire short-, medium- and long-term strategies that can lead to real change in health management.
How does your Company collaborate on the project?
Within this collaboration, CORESEARCH has played a key role in collecting, evaluating and summarizing all the documentary sources that led to the drafting of the Report. CORESEARCH’s contribution was particularly important in the light of the established experience in clinical epidemiology and pharmacoeconomy applied to the study of chronic diseases, particularly diabetes.
Regarding Health in Italy, do differences emerge from a geographical point of view?
The report clearly shows that the southern regions are above all faced with the high prevalence of diabetes and obesity. The percentage of people with diabetes in some regions of the South is more than double compared to northern regions. An analogous trend is found in obesity and sedentary, much more frequent in southern Italy.
Even more alarming is the picture in scholar age: one in two children in the South is overweight or frankly obese. Unfortunately, the highest frequency of diabetes is found in the population groups with more socio-economic problems, more present in southern Italy, also suffering from welfare problems due to economic deficits and organizational issues.
Drugs and devices are available that dramatically improve diabetes control over the past. The cost of innovation, however, is often too high for the public health system, in chronic financial difficulties. What are the most sustainable and effective therapeutic practices?
The therapeutic armamentarium for the treatment of diabetes has been enriched in recent years with new classes of drugs that combine clinical effectiveness with a better safety profile than many of the traditional therapies.
In particular, new drugs do not have two unpleasant effects such as the risk of hypoglycaemia and weight gain, which often condition the patient’s adherence to therapy and, in the case of hypoglycaemia, may be responsible for very serious consequences. Greater adherence to therapies means greater chance of obtaining good metabolic control, with a positive impact on the risk of developing complications and quality of life. In evaluating the cost-effectiveness profile of new drugs, therefore, we cannot focus on the cost of treatment alone, but we must necessarily consider the savings resulting from reduced hospital admissions for hypoglycaemia and chronic complications, as well as by the reduction in indirect costs associated with loss of productivity. I would like to remind you that more than 50% of the direct costs of diabetes are attributable to hospital admissions, while the cost of anti-diabetes drugs is less than 7%.
The Barometer Report seems to identify a current disease scenario too often underestimated. Is there any arising indicator for confidence and positivity in the fight for the regression of diabetes?
The picture emerging from the Report is varied and there are some positive signals. For example, the reduction in mortality for diabetes and the decrease in the rate of inappropriate hospitalizations, suggesting improved healthcare support. However, there is no slowdown in the prevalence of diabetes, indicating that preventive actions are still not sufficient to counteract the phenomenon. Some other positive signs seem to come from the stabilizing prevalence of obesity, but we cannot lower the guard because it continues to be too much common in adults and, even more worrying, in children.
Could you recommend three fundamental anti-diabetes weapons/strategies to be highly considered by health organizations, scientific societies, patients, etc.?
The fight against diabetes should include three crucial points. First, primary prevention of the disease through information of the population and the promotion of healthy lifestyles. Second, early diagnosis and effective treatment of new cases of diabetes. Third, we need to ensure equity of access to effective and appropriate treatment for people with diabetes, in order to prevent the acute and chronic complications of the disease.
Report available on the Italian Barometer Diabetes Observatory website http://www.ibdo.it/