Sunday 28 April 2013

Diabetes in Russia / Сахарный диабет в России

Welcome to my non-communicable diseases blog on Russia.

Russia is not renowned for its healthy diet... When it’s minus 30C outside your window, a deep-fried potato cake, generous dollop of sour cream and glass of sugary tea to finish, appeal infinitely more than a salad and mineral water. Oh, and that jog around the park will have to wait until May – there’s 2m of snow on the field at present…

In this first post on non-communicable disease in Russia, I’ll be considering the situation of diabetes within Russia including the opportunities and challenges facing its management.

So, what exactly is diabetes? Diabetes (also called diabetes mellitus) can be defined as an inability of the body to effectively get sugars, the body’s instant energy source, from the bloodstream into the cells. Normally, the body produces a hormone called insulin, which allows entry of sugar into the cells. The two most common types of diabetes relate to problems with insulin: diabetes type 1, where the body is unable to produce insulin; and diabetes type 2, where the cells of the body become less sensitive to the insulin that’s produced.   Without adequate treatment with either sugar controlling medications or insulin injections, diabetes will lead to major short and long-term health consequences. These include an increased risk of: heart attack, stroke, kidney disease, leg ulcers, loss of sensation, loss of vision, impotence and dementia. Unsurprisingly depression is also associated with diabetes. Whilst diabetes cannot currently be cured, it can be managed effectively, significantly reducing the likelihood of developing disease complications.

Russia has a population of around 140 million people. Around 2,8 million have an officially recorded diagnosis of diabetes [2008 estimate]. However, a health screening programme in 2006 involving 6 million Russian citizens found a diabetes prevalence of 5.5%, which if extrapolated suggests a national diabetes prevalence nearer to 8 million individuals. With an increasing in average age and level of obesity this figure is likely to rise still further. Significant under-diagnosis results in frequent late presentations – by this stage it’s often too late to reverse the disease consequences. As a result, 90% of the current health expenditure of diabetes is spent on limb amputations, heart disease, stroke complications, and kidney failure, with less than 10% being spent on insulin.

So, what are the major challenges facing diabetic care in Russia? 

1. Staffing: Until recently, little emphasis had been placed on primary care i.e. general practitioners looking out for diabetes risk factors like blood pressure, obesity, family history and raised cholesterol. The number of endocriniologists (hormone and diabetes specialists) is also low, with less than one per 50,000 population.

2. Standardisation: Until recently, there was very little in the way of official evidence based diabetes management policies, tailored towards the Russian population. Such guidelines have now been produced, however providing education for medical staff and changing deeply engrained management habits has faced some resistance. Some health facilities also possess outdated or ineffective equipment, further frustrating delivery best-practice.

3. Patient education: Many people simply aren’t aware of what diabetes is, what the risk factors and signs are, and how diabetes can be effectively managed.

4. Funding: Currently state funding only provides insulin for those registered disabled. All other diabetic medications and blood glucose monitoring equipment is provided by the regional health authorities. As the economic situation within the regions fluctuates, so too does the quality and continuity of medication and equipment supplied.

5. Geography:   Russia covers a ninth of the world landmass. Certain regions are incredibly sparsely populated and geographically isolated. Combined with extreme weather conditions, differing languages and ethnicities, and varying levels of education, providing effective on-going diabetes management is challenging to say the least.

However, things are now beginning to change. In 2002 the government of Russia embarked on ‘the federal target programme for diabetes mellitus’. The National Diabetes Institute and the Endocrinology Research Centre (ERC) were launched within the Russian Academy of Medical Sciences, Moscow. Within this, departmental subdivisions have been created focussing on each of the major complications of diabetes, with a specific department for diabetes education. Through these evidence based national guidelines and treatment algorithms have been produced and disseminated for the first time. A national register of patients with diabetes has been founded with the intention of accurately recording diabetes prevalence, incidence, disability, complications, mortality causes and rates, as well as provision of monitoring equipment.  Through the federal programme around: 150 diabetic foot units, 100 diabetic eye centres, 20 haemodialysis units and >1000 education centres have been designated as diabetes management units.  Data collected from 2003-2008 suggested an average decrease in measured HbA1c from 10.8 to 8.1 (HbA1c is a blood test measuring average blood sugar level over the past 3 months).

Steps for the future
Currently the National Diabetes Institute is pushing for greater diabetes screening and increased numbers of endocrinologists to allow more rapid referral. They are also arguing for an improved staffing ratio in rural areas to account for the distances involved.  Concerns regarding federal funding for insulin provision (independent of disability) and the continuation of the diabetes register (currently staffed by volunteers) are on-going. It is hoped that media campaigns will improve public awareness and data collected showing the cost-benefit ratio of close diabetes monitoring and so prevention of complications will build support for further improvements and thus put pressure on authorities regional and national to build upon the positive progress achieved over the past decade.

 


References
Novonordisk (2008) Diabetes in Russia: Problems and Solutions. [online] Available at: http://www.novonordisk.com/images/about_us/changing-diabetes/PDF/Leadership%20forum%20pdfs/Briefing%20Books/Russia%20II.pdf [Accessed: 22 Apr 2013].

Diabetes Voice (2013) 1 1 H e a l t h d e l i v e r y National and regional organization: the key to effective diabetes care in Moscow . [online] Available at: http://www.idf.org/sites/default/files/attachments/article_475_en.pdf [Accessed: 22 Apr 2013].

Young TK, Schraer CD, Shubnikoff EV, Szathmary EJ, Nikitin YP. Prevalence of diagnosed diabetes in circumpolar indigenous populations. Int J Epidemiol. 1992 Aug;21(4):730-6

Picture taken from: http://health.passion.ru/novosti-zdorovya/sobytiya/besplatnye-proverki-na-diabet-po-vsei-rossii.htm

Chronic Disease within Russia

How healthy is Russia?

As part of my masters coursework, I've been asked to write a weekly blog focussing on different aspects of non-communicable disease within Russia. Over the coming weeks I'll be considering diabetes, breathing disorders, heart disease, cancer, mental health and more!  Whilst it's only week two, it's been fascinating to see the different approaches, unique challenges and potential opportunites in providing heathcare to the largest country on earth.  

Any thoughts, comments and questions would be very very useful to me - either comment beneath, via facebook or email.  I'm eager to learn as much as I can from the project!


Friday 5 April 2013

Belief in Russia

The fall of communism hailed a period of religious openness within Russia.  Sadly those times seem to be fading, with increasingly tight controls on anything not perceived to be in line with government policy.  Where is Russia going?  The economist held a recent interview discussing the role of religion within Russia and the russian political sphere.  Makes for interesting viewing.  Your thoughts as comments would be most appreciated!