The whole developed world is experiencing what could be described as an epidemic of type 2 diabetes and the Czech Republic is no exception. The most important factors causing the condition are obesity, inappropriate food and insufficient physical activity - in other words, our western lifestyle. People's dietary habits have changed to a great extent since the fall of communism, partly for the better, partly for the worse. The same could perhaps be said about the healthcare system. I spoke to doctor Frantisek Saudek, the head of the Department of Diabetes at the Institute of Clinical and Experimental Medicine in Prague. I asked him what has changed in diabetes treatment in the last decade after the fall of communism in this country.
"The organization of care of diabetic patients was never too bad in this country. We always had specialized outpatient clinics, so in the last ten years, I think, the major change was that more information was available. Patients could get information on the latest development in research and what was new in western countries. After the change, patients wanted to be treated according to the latest achievements, so human insulin became more available and also some oral anti-diabetic drugs. Also patients could exchange more information about diet. What is important, diabetic patients never had to pay separately for their care of diabetes and now the care is completely covered by insurance companies as well. So I think there are also some advantages for our patients."
While, according to doctor Saudek, the standard care of diabetes patients is on a high level in this country, there are two other aspects of diabetes treatment - one is prevention and the other is treatment of complications - where things could get better.
"In this field, a lot of things could be done. People who are so-called "healthy" don't think very much about the future difficulties that may result from their dietary habits or inadequate physical activity. They would need special education in this field, I think. So this is one side. The other is the treatment of more severe complications. If I start to talk about retinopathy, for example, diabetic patients are at present seen by eye specialists as it should be but still, for example, specialized treatment with laser is not adequately available. There are only few specialists who are able to do difficult eye operations. So I think here is some space for improvement."
Frantisek Saudek mentions another area of specialised treatment that could be improved.
"Diabetic foot syndrome is a big problem, there are very many patients and the therapy is very slow, very tiresome and very expensive. And there are no specialized outpatient clinics for this, because this care is not adequately appreciated by insurance companies. So there are only few centres, they spend a lot of money and usually they are criticised because they are very expensive. So it's for example the case in our hospital. Many patients come from the whole country for treatment, they need very expensive treatment, it takes a long time and the result for our clinic is that we are criticised because we lose a lot of money." So far, we've spoken about the medical aspects of the disease. But behind cold figures and technical details, there is always a human story. David Hansen is the general manager of Novo Nordisk Czech Republic, a pharmaceutical company specialising in diabetes products. He says that the social and psychological implications of the disease are often neglected. Does Mr Hansen think everyday life is more difficult for diabetics in the Czech Republic than in other developed countries?
"I believe that it is in terms of lack of awareness in the society about what diabetes is and what it means to the individual patient. I think there have been to my knowledge very few studies into the social and psychological part of living with diabetes, what it means for the individual patient. Also we are aware from discussions with different patients that there is a lot of stigma related to the disease. It is often a disease that is kept in the dark, it is not something that is well-accepted to say that you are a diabetic. There is sometimes even a notion that it is your fault that you are a diabetic. That is because you have been living your life wrongly, in a different way than you should: you have been eating too much, you have been drinking too much, you may have been smoking too much and therefore you are a diabetic."
In the case of such a strongly lifestyle-related disease as type 2 diabetes, it is too late to start thinking about changing one's habits when the condition has developed. People in post-communist countries need to realise that the state no longer bears complete responsibility for their health, but on the other hand, some kind of coordinated care, such as regular screening for diabetes symptoms would make a difference. Doctor Saudek again.
"The prevalence of diabetes is increasing in all Western world today so it's not only a problem in our country. It is very important to show people that they are responsible for their own health, that they have to change their dietary habits, to change their sedentary style of life. And then the patients could also require adequate therapy. People really should know their levels, should know what to do if they want to achieve lower levels, they should be informed about their blood pressure, for example. So this, I think, one change that is necessary - to feel more responsibility for one's own health."
Mr Hansen of Novo Nordisk thinks the key word in diabetes prevention is education.
"I believe that there is a lot of responsibilities from a lot of stakeholders here. Primarily there is the commitment from the political part - they committed themselves to establish a national diabetes programme many years ago which never happened. I believe there is definitely room for improvement in terms of education; education of patients - of which there is very little -, education of nurses, education of doctors, parents, family members. There is no structured programme for education right now for patients' parents or family members. The education that is given by the healthcare professionals is good but it's not aligned across national borders in a way that it should be."
While more could be done in terms of prevention, there are areas of diabetes treatment the Czech Republic can be proud of. Frantisek Saudek explains.
"There are some special fields of diabetes therapy which are on especially high level in our country. For example, insulin pump treatment is now quite popular in many countries because you can achieve usually better blood glucose control than with conventional means. It is also more convenient for most patients. In our country, insulin pump therapy is available almost for everybody. I am specialised in transplant therapy in diabetic patients and for example pancreas transplantation is not a very frequent procedure, except for, for example, the United States. I can say that this kind of therapy is on the same level as in other western countries."
With modern information technologies, plenty of useful information for both diabetics and their families is available. I asked David Hansen about Internet sites in the Czech Republic.
"There are a number established. We have established one for Novo Nordisk. And then we have a number of international diabetes sites. If you search for the word diabetes you will get a lot of articles on diabetes but mostly in English, there is not that much in the local language. There is plenty of literature, there is a very highly educated and strong scientific society here that has done a lot of research but maybe sometimes it can be a little hard for diabetics to get access to this research in an understandable manner. So I would suggest to visit the website and get some information. We have links to a number of healthcare professionals who can help with more information."
For those people who don't have Internet access or don't speak English, there are telephone help-lines and other sources of information. David Hansen again.
"People who don't have access to the Internet are very welcome to call us. Of course, we represent one side of the coin, so we try as much information in as neutral manner as possible. But if you want totally neutral information, the library is definitely a good place too."
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