If the progression of the disease is favorable, he has a chance to live as long as his peers.
Diabetes is one of the most widespread diseases worldwide. The Czech Republic is one of the countries with the highest number of patients in Europe. It has been estimated that there will be approximately 1.3 million diabetics in the Czech Republic in 2030. The most common type is type 2 diabetes, which in 85% of cases usually occurs in adulthood. Type 1 diabetes starts in childhood and must be treated with insulin.
Diabetes is not a homogeneous disease. Patients may suffer from thirst and weight loss in spite of having normal appetites; due to an inconstant blood glucose concentration, some patients may experience “wolf hunger” attacks, frequent nocturnal urination, infections and fatigue. A high blood glucose level (hyperglycemia) leads to frequent complications, such as cardiovascular diseases (heart attack, stroke), neuropathy (dysfunction of nerves and loss of sensitivity of the lower limbs in particular), eye problems (diabetic retinopathy) and kidney problems (diabetic nephropathy) that may result in renal failure. The integrity of the skin, especially of the lower extremities, may be impaired. Purulent diabetic ulcers often require limb amputations. In the Czech Republic alone, almost 10,000 diabetics had a lower limb amputated in 2016.
Thanks to the progress in diabetes treatment, we are now able to prevent dangerous and costly complications or delay their onset. Patient education is very important because diet and physical activity are as important as medications.
More than 20 new medicines have been approved and marketed over the past 13 years. The introduction of insulin pumps (currently available for type 1 diabetics only) or blood glucose level sensors has significantly helped patients to accurately monitor their blood sugar level and to dose their insulin.
“Combining different classes of medications into one pill has greatly simplified dosing, which has helped to adhere more thoroughly to the treatment plan and thus to increase treatment effectiveness,” says Mgr. Jakub Dvořáček, MHA, executive director of the Association of Innovative Pharmaceutical Industry (AIFP).
Diabetics’ life expectancy is now comparable to that of the rest of the population. The life expectancy of patients is increasing (to 79 years in 2018) and so is the total number of patients with diabetes in the population. Despite the higher prevalence, the number of hospitalized patients keeps declining and more than half of patients return from the hospital in less than a week.
Treatment of diabetics burdens the healthcare budget. The biggest problem, both from a health and economic point of view, are the late complications of diabetes, which can be averted or delayed by good quality treatment.
Current treatment also saves money on disability pensions. Patients are able to remain economically active longer and do not need to receive a disability pension. “Between 2010 and 2018, cumulative savings on disability pensions for type 2 diabetes amounted to 171.7 million Czech Crowns. The number of hospitalized patients decreased by 28,000 between 2010 and 2017. In 2030, thanks to innovative medicinal products, the state could save up to 40 million Czech Crowns per year on disability pensions paid to diabetics,” adds Jakub Dvořáček.
Innovative treatment offers patients with diabetes a better perspective in preventing late complications of diabetes because it makes it much easier to achieve individually set therapeutic goals than conventional treatment. Innovative treatment is currently available, but public health insurance reimbursement has a large number of prescription restrictions, e.g. innovative medicinal products are reimbursed in the case of too high Glycated hemoglobin and body mass index. Treatment with innovative medications is not added unless classical therapy failed. In addition, some combinations of current and innovative therapies are not eligible for reimbursement, although they work and have good results. This often means that late complications of diabetes start before the diabetologist has a chance to initiate reimbursed innovative treatment.
Treatment brings improvement to patients especially if the switch to innovative therapy is complemented with a new targeted education that includes glucose self-monitoring, which is important for setting the optimal dosage of new therapy correctly. The quality of patients’ lives considerably improved particularly when they started using certain non-insulin injectable preparations that can be administered once a week. Patients who have a natural aversion to injecting any medication are much more willing to accept it once a week (it is not a problem for them unlike injecting insulin four times a day). Thanks to innovative treatment, the prospect of a good quality life with diabetes is much higher because it will significantly reduce or delay the onset of late complications that considerably disable people with diabetes.
However, treatment results depend on the patient's motivation and willingness to follow the treatment team's recommendations, especially those concerning the treatment plan and diet, and to perform SMBG. In the case that good results are achieved relatively quickly after the switch to innovative therapy, which seems to be the case, the therapy will be more likely effective. Ultimately, patients are willing to pay extra for therapy that is effective and efficient, provided that the co-payment is within acceptable limits. However, this is very individual and does not apply absolutely to all patients who have so far been switched to innovative therapy. Patients are often very disappointed to find out that this very effective therapy, which they had paid for because the chosen combination proved to be highly effective for them, was not included in the maximum drug reimbursement limit by their health insurance company.
Mgr. Vlastimil Milata,
DIAKTIV CZECH REPUBLIC z.s.
Materiály z tiskové konference Asociace inovativního farmaceutického průmyslu s názvem "Moderní léčba diabetu. Co čeká pacienty po koronavirové epidemii?" konané 14.05.2020.
