The use of new technologies: how to ensure better medical support for diabetic patients ?

# 11/03/2017 à 12:45 Ceren TAŞDEMİR (site web)

Diabetes is a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Diabetes is a long-term condition that causes high blood sugar levels. According to Diabetes Atlas there are 415 million adults have diabetes. This means one person in every eleven has diabetes. It is estimated the number of diabetic will reach 640 million by 2040. There are 6.3 million adults have diabetes in Turkey according to 2015 data. At one in every seven people, Turkey has the highest diabetes prevalence in Europe. By 2035, more people with diabetes will live in Turkey than in any other country in Europe. Moreover, HbA1c – a measurement of blood sugar and diabetes control – is considerably higher among Turkish people with diabetes than in other European countries.

There are three types of diabetes called as Type 1, Type 2 and gestational. All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2 usually lasts a lifetime, however, some people have managed to get rid of their symptoms without medication, through a combination of exercise, diet and body weight control. Diabetes takes a significant social and economic toll. Uncontrolled diabetes can lead to disabilities and complications. People with diabetes are four times more likely to have a stroke. Nearly half of the people requiring dialysis in Turkey have diabetes. Type 2 diabetes increases the risk of heart attack by 2.5-5 times. Of people with diabetes in Turkey, 28% have diabetic retinopathy. The progression of diabetes can also be life-threatening and reduce life expectancy by around 5–10 years. In 2013, about 60,000 deaths in Turkey were diabetes-related.

Lowering HbA1c levels and achieving treatment targets is key to reducing complications and mortality. Control begins with an understanding of the condition. Only half of people with diabetes are diagnosed. In Turkey, only 55 % of people with diabetes have been diagnosed. The rest are living unaware of their condition. Not all who are diagnosed with diabetes receive care, and the evidence suggests that only about half who receive care achieve treatment targets. Fewer than half of those reach desired outcomes, which means living free of diabetes-related complications. In Turkey, people living with diabetes have an average HbA1c level of 10.6%. This is far above both the level recommended by treatment guidelines, which is 7%, and the average HbA1c level in comparable European countries. Poor HbA1c control may explain the fact that almost 60% of all Turkish diabetes patients have at least one complication.

The Turkish healthcare system has undergone substantial change since a sweeping reform programme was implemented in 2003 to make healthcare more accessible. At the time, 64% of the Turkish population had health insurance. Today, that share has risen to 87%. Through social security schemes, citizens have free access to primary and secondary healthcare. One of the effects of this has been an improvement in major health indicators. Since 2003, life expectancy has increased 2.3 years to 74.6 years and infant mortality rates have fallen. Patients in Turkey visit physicians eight times a year – more frequently than in peer countries. High demand for services has placed stress on the system. On a per-capita basis, Turkey has only half the number of physicians compared to Europe as a whole.
For many people with diabetes, insulin is life-saving. There has been great progress since the first isolation of insulin in 1921. The pace of product innovation is accelerating; today, patients have more choice and greater flexibility in treatment than they had even 15 years ago. Still, with HbA1c levels high, there is a need for innovative and tailor-made solutions where public and private organisations work together.
The major goal in treating type 1 and type 2 diabetes is to control blood sugar (glucose) levels within the normal range, with minimal excursions to low or high levels. Type 1 diabetes is treated with insulin, exercise and type 1 diabetes diet. Type 2 diabeted treated firstly with weight reduction, type 2 diabetes diet and exercise. Oral medications are prescribed when these measures fail to control the elevated blood sugars of type 2 diabetes. If oral medications become ineffective treatment with insulin is initiated. When considering an ideal diabetic diet, a number of factors must be taken into consideration, including the amount and type of carbohydrates consumed as well as the amount of fiber, fat, and protein contained in foods. Glycemic index and glycemic load are further considerations. Foods with low glycemic index and load raise blood sugar more slowly than high glycemic index/load foods. Glycemic index refers to a standardized measurement, while glycemic load takes a typical portion size into account. Weight reduction and exercise are important treatments for type 2 diabetes. Weight reduction and exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations.
Finally, varying combinations of medications can control diabetes. Newer medications allow tailoring of treatment options to meet individual needs. Not every patient with type 2 diabetes will benefit from every drug, and not every drug is suitable for each patient. Patients with type 2 diabetes should work closely with their health-care professionals to achieve an approach that provides the greatest benefits while minimizing risks and adverse events. People with diabetes must remember the importance of diet and exercise. Control of diabetes begins with a healthy lifestyle, regardless of prescribed medications.

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