If not now, when. It’s a slogan that has been bouncing around for some time. And it becomes the operational track for the future on the occasion of World Diabetes Day, which is celebrated every year on November 14th. On this occasion, we are talking above all about access to care. According to the scientific societies, in fact, a little less than a century after the discovery of insulin, many drugs and technologies for the treatment of diabetes remain out of the reach of many people who would need them.
There must be no differences
“Access to treatment – explains Agostino Consoli, president of the Italian Society of Diabetology (SID) – must be guaranteed to all citizens with diabetes, as much as possible uniform throughout the national territory. This means that it is not acceptable that there are twenty or more different health services in Italy, one for each Region. It would also be important that the Diagnostic-Therapeutic Assistance Pathways (PDTAs) for diabetes were shared between the different Regions and, if not exactly the same, were at least very similar to each other. Access to drugs and aids in short, it should be regulated in such a way that people with diabetes are guaranteed the same possibility of having drugs or innovative technologies available, regardless of where they reside “.
In short, it is important that, case by case, each person with diabetes is offered the right answer in terms of treatments and the possibility of monitoring, also in terms of preventing possible complications, especially if there are also other cardiovascular risk factors that may in some way affect the dangers of developing problems. Just think that diabetes sufferer is a increased risk of myocardial infarction, because the pathology favors the development of atherosclerosis in the arteries and for the same reason the danger of cerebral strokes also increases.
Diabetic nephropathy, that is the complication of kidney disease, leads to a progressive reduction in the ability of the kidneys to “clean” the blood. And therefore the harmful substances that should be eliminated remain in the blood itself, damaging the organism. As for the nervous system, if the blood sugar is very high, the sensitivity of the nerves changes, with the appearance of erroneous perceptions. In addition, the poor blood supply damages the kidneys, resulting in severe pain.
Again: let’s not forget that for nerve damage the foot of the diabetic it is less sensitive, and the lack of blood supply due to narrowing of the arteries reduces the oxygenation of the foot itself. Therefore, it is easier to encounter unperceived wounds, which tend not to heal and cause infections. Finally, those who deal with diabetes risk a specific alteration of the retina, the part of the eye that receives visual stimuli, linked to the modification of the blood vessels that supply it. And as if that weren’t enough, hyperglycemia also increases the risk of cataracts.
What can be done
As explained by Dario Pitocco, Director of the Diabetology Unit of the Agostino Gemelli University Hospital Foundation IRCCS and associate professor of Endocrinology, Catholic University, Rome campus – “many steps forward have been made; today for the management of cardio-metabolic risk we have drugs such as SGLT-2 inhibitors and GLP-1 analogues available, and recently the association between these two classes of drugs has also been authorized “.
“These are molecules that are not only capable of giving a good control of diabetes, but also to reduce cardiovascular complications, that is heart attacks, strokes, heart failure. On the front of technological innovation, a great progress and advantage for people on multi-injection insulin treatment (all those with type 1 diabetes and some of those with type 2 diabetes) is represented by the new systems of ‘flash’ blood glucose monitoring, which save the many painful pinpricks on the finger for measuring blood glucose from capillary blood, because the sensor, applied to the arm, can be ‘interrogated’ at any time by a special reader or via smartphone “.
“The newer models are also equipped with an alarm that warns the patient in case he is experiencing hypo or hyperglycemia, and this also during the night, allowing him to take action. Even more advanced are the systems, called ‘artificial semi-pancreas’, consisting of an insulin pump and a sensor for continuous glucose monitoring (CGM) that talk to each other, thus allowing to deliver an adequate amount of insulin to the sensor glucose values ”.
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