Diabetes mellitus (DM) is a priority among the international medical and social challenges afflicting health care. According to the International Diabetes Federation, the global number of patients with DM has exceeded 463 million, while it is assumed that every second patient is not identified.
In the Republic of Belarus, at the beginning of this year, about 352,500 patients with DM were under observation, of which about 18,100 were with type 1 diabetes, incl. about 2,400 children. Over the past four years, the paediatric population of our country has retained high rates of primary incidence of type 1 diabetes with a shift in the peaks of the manifestation to a younger age. According to the Republican Register, more than half of the type 1 diabetes cases were first diagnosed in children aged 0 to 10 years. The annual increase in patients with diabetes mellitus in our country is 5-8%. Over the past 20 years, the number of patients with DM has increased by 3 times.
The organization of medical care for patients with DM is an important priority of the Belarusian population policy. In 2020, the Ministry of Health, jointly with leading endocrinologists, carried out work to improve the legal framework regulating this issue.
Insulin therapy is one of the main treatments for DM. In the republic, the prescription and preferential provision of insulin drugs is clearly regulated. All those in need have the right to free provision of insulin drugs, which are purchased in a centralized way mainly for the funds of the republican budget. About 77,300 patients with DM are on insulin therapy, of which about 2,400 are children.
In order to increase the clinical and economic efficiency of insulin therapy, by order of the Ministry of Health dated 10.04.2020 No. 417 "On providing patients with diabetes mellitus with insulin drugs", the following was approved: the concept of providing insulin drugs to patients with DM in the Republic of Belarus for the period of 2020-2025; the procedure for prescribing insulin drugs on a free basis to patients with diabetes mellitus. Algorithms for the actions of the attending physician in case of drug intolerance or ineffectiveness of insulin preparations and its analogues have been determined; unified principles for the formation of an application for the centralized purchase of insulin drugs have been prescribed.
From 2020, all children with DM are eligible for free insulin analogues. The implementation of the Concept provides phased transition to the use of insulin only in cartridge form and the expansion of indications for the provision of insulin analogs for free, which corresponds to the global trends in the development of insulin therapy. Already in 2020, the number of such patients increased by 44% (3,315 people) compared to 2019, in 2021 another 5,200 patients are subject to additional insulin supply in cartridges.
Training is a mandatory component of the treatment of patients with diabetes and largely determines its success. The Belarusian "School of Diabetes" is considered one of the best training systems for patients with chronic diseases. In order to further develop this area, an order of the Ministry of Health dated 23.01.2020 No. 47 "On improving the training system for patients with diabetes mellitus" was prepared and signed, which defines modern unified approaches to organizing the educational process. The Regulations on the school for training patients with DM, training programs in seven areas were approved, the responsibilities of each of the medical workers participating in the training were determined, and distance learning was introduced.
The increase in the number of people with DM around the world requires more and more resources of the health care system, including human resources. Currently, the main functions of providing medical care to patients with diabetes are distributed between endocrinologists, district therapists (general practitioners), pediatricians and nurses.
The International Diabetes Federation annually determines the motto and the main direction of medical and social events timed to coincide with World Diabetes Day. To raise public awareness of the important role of nurses in supporting people with diabetes, this year's theme “Nurses matter” has been identified.
According to the World Health Organization (WHO), nurses make up more than half (59%) of the world's health workforce. There are 27.9 million paramedical workers in the world, of which 19.3 million are nurses. WHO states that the global nursing shortage is about 5.9 million, of which 89% is concentrated in low- and middle-income countries.
In our country, more than 600 nurses work in endocrinological hospitals, clinics and dispensaries. Their role in managing the consequences of diabetes is becoming increasingly important. Nurses are the health professionals with whom the diabetic patient interacts most frequently and closely. The nurse organizes the implementation of the attending physician’s recommendations, including referral for examination, provision of prescriptions for drugs, self-monitoring and insulin administration. Currently, nurses are actively involved in the process of continuous training of patients with DM and their families, aimed at improving the quality of life and minimizing the negative emotional impact of the disease.
With the necessary experience, nurses provide significant assistance to patients with diabetes and other chronic comorbid pathologies. Being reliable assistants to the attending physician, they take on a significant part of the work to eliminate risk factors for type 2 diabetes and early diagnosis of the disease.
The material was prepared on the basis of WHO information and open sources
Doctor-endocrinologist A.A. Šablinskaja