Diabetes: Europe’s silent health pandemic

Diabetes is a highly prevalent condition that is often undertreated and underestimated. It is a relentless disease which has a huge physical and emotional toll. For people with diabetes (PwD), self-managing the disease is a fulltime responsibility and life-changing commitment, yet PwD are usually only able to see a healthcare professional for a few minutes, up to four times a year. For the rest of the time, PwD are all on their own.

Our vision is an environment where PwD are diagnosed earlier, and provided with the tools and education to self-manage effectively. Ultimately, we want all PwD to live life to its fullest.

And that’s why, a number of EFPIA member companies have come together in the EFPIA Diabetes Platform. As an industry we are committed to improving diabetes diagnosis and management and focusing on delivering better healthcare for people living with diabetes.

EARLY DIAGNOSIS AND SCREENING CAN SAVE LIVES

Early diagnosis of diabetes and optimal management can reduce the risk of complications, improve health outcomes and strengthen healthcare system resilience[1]^,[2]. There is currently significant political momentum, as 10 years after the last Motion for Resolution on Diabetes, the European Parliament adopted a new “European Parliament resolution on prevention, management and better care of diabetes in the EU on the occasion of World Diabetes Day” in November 2022. It calls on Member States to adopt ambitious targets to improve diagnosis, care and management of the condition. The development and implementation of National Diabetes Plans in all Member States should include clear risk reduction and screening components [3].

Today, over 61 million people, approximately the population of Italy, live with diabetes in the European Region, with projections indicating a rise to 67 million by 2030 [4]. Over 1 in 3 adults (21.9 million people) living with diabetes are undiagnosed and do not receive any treatment ⁵, while data shows that onset of T2D may occur 9-12 years before a diagnosis [5].

Delayed diagnosis and access to appropriate care contribute to worse health outcomes and increase the risk of complications for PwD, inevitably increasing healthcare costs in the future. The science is clear: timely screening and appropriate follow-up need to be crucial components of diabetes policies.

The EFPIA Diabetes Platform is supporting a multi-stakeholder advocacy effort by the diabetes and cardiovascular health communities that calls for joint cardiovascular and diabetes health checks at the primary care level.

“The case for investing in primary care policies in diabetes” policy brief, developed with the Health Policy Partnership, calls for political prioritisation of diabetes and primary care, including dedicated investments and proposes policy recommendations for decision-makers. Investing in primary care can help tackle current health system weaknesses and reduce the burden of diabetes. Decision-makers need to consider primary care not as a cost but rather as an investment that will improve diabetes care and provide significant savings.

REDUCING DIABETES MORTALITY AND COMPLICATIONS

In 2021, 1.1 million Europeans died due to diabetes-related complications¹. The seriousness and severity of diabetes has been underestimated despite worsening outcomes as the disease progresses.

Earlier diagnosis, innovative treatments and optimal management of diabetes can reduce the risk of complications, contributing to better health outcomes for PwD [6]^,[7] and lower preventable costs that are currently weighing heavily on healthcare systems.

Currently, an estimated 9% of total health expenditure goes towards diabetes, and this share is expected to rise by 12% over the next 25 years [8]. But 75% of these costs are ‘preventable’ – that is, they are due to avoidable complications of the disease [9].

IMPROVING CARE AND OUTCOMES

Despite the potential presented by pharmaceutical innovation and optimal treatment pathways, outcomes targets are achieved by less than 50% of PwD across Europe [10]. A key reason for this failure is that the implementation of clinical guidelines for T2D management is inconsistent across Europe. This trend is contributing to today’s widespread clinical inertia, the recurring failure to establish appropriate targets and escalate treatment to achieve outcome goals. IDF Europe’s position paper “Type 2 Diabetes: a preventable catastrophe?” aims to raise awareness of the urgent need to adopt recent evidence-based recommendations in the management of T2D.

There are several reasons for poor adherence to these guidelines, including systemic policy and process barriers, identified at the healthcare system level. Examples include delayed access to innovation, limited ability to prescribe and bureaucratic hurdles. As highlighted in the “EFPIA Patients WAIT Diabetes 2021 Survey”, there are important disparities across Europe and within countries regarding the availability of innovative diabetes products. Today, no market has all 17 products available and the average delay between market authorisation and patient access varies from 3 months to over 4 years.

The full implementation of the most recent scientific and evidence-based recommendations can optimise the management of diabetes and reduce the risk of complications. This can only be achieved by uncovering the “hidden” policy barriers that affect guideline adherence, and proposing pragmatic solutions to overcome them. The “Revealing policy barriers in diabetes care: how we can improve outcomes” policy brief outlines concrete solutions and recommendations for policy-makers, implementable at the national level in the short-to-mid term.

Insufficient investment in outcomes-focused registries, integrated health IT systems, and financial integration have also been identified as clear barriers to better diabetes care. Vertical integration of healthcare systems in diabetes care can improve outcomes and be a logical solution to spiralling healthcare costs. Read more.

EUDF: WORKING TOGETHER TO UNITE THE DIABETES COMMUNITY

EUDF, with the support of the EFPIA Diabetes Platform, has been strengthened every year since its creation, uniting the diabetes community and communicating key policy asks with one voice, calling for improved health outcomes for all PwD. The policy recommendations of the three EUDF Strategic Forums outline a data-driven, person-centric approach to diabetes care, aiming to improve integration of care with a focus on measuring and registering outcomes that matter to PwD.

A Diabetes Community Pledge has been developed by a broad coalition of organisations working in the field of diabetes and supporting people with diabetes ahead of the June 2024 European parliamentary elections, a critical moment for setting the EU policy agenda. The Pledge contains 15 concrete policy recommendations addressed to the European Union and to Member States to improve the lives of People with Diabetes and those at risk.

Learn more

[1] 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. Holman RR, et al. N Engl J Med 2008;359:1577-89

[2] Legacy benefits of blood glucose, blood pressure and lipid control in individuals with diabetes and cardiovascular disease: Time to overcome multifactorial therapeutic inertia? Khunti K, et al. Diabetes Obes Metab. 2018;20:1337–1341

[3] MOTION FOR A RESOLUTION on prevention, management and better care of diabetes in the EU on the occasion of World Diabetes Day 18.11.2022 - (2022/2901(RSP))

[4] IDF Diabetes Atlas Tenth Edition, International Diabetes Federation 2021

[5] Maureen et. al. Diabetes Care, Volume 15, Number 7, July 1992

[6] American Diabetes Association Professional Practice Committee (2022). 6. Glycemic Targets: Standards of Medical Care in Diabetes-2022. Diabetes care, 45(Suppl 1), S83–S96. https://doi.org/10.2337/dc22-S006

[7] Fang, M., Wang, D., Coresh, J., & Selvin, E. (2021). Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018. The New England journal of medicine, 384(23), 2219–2228. https://doi.org/10.1056/NEJMsa2032271

[8] Solomon et al. Diabetes Care 2017; 40: 412-418

[9] Stone, M. A., Charpentier, G., Doggen, K., Kuss, O., Lindblad, U., Kellner, C., Nolan, J., Pazderska, A., Rutten, G., Trento, M., Khunti, K., & GUIDANCE Study Group (2013). Quality of care of people with type 2 diabetes in eight European countries: findings from the Guideline Adherence to Enhance Care (GUIDANCE) study. Diabetes care, 36(9), 2628–2638. https://doi.org/10.2337/dc12-1759

[10] Stone MA, Charpentier G, Doggen K, Kuss O, Lindblad U, Kellner C, et al. Quality of care of people with type 2 diabetes in eight European countries: findings from the Guideline Adherence to Enhance Care (GUIDANCE) study. Diabetes Care. 2013;36(9):2628-38.