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
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