Every year on November 14 throughout the world passes World Diabetes Day. In Belarus, World Diabetes Day is an initiative of the Ministry of Health of the Republic of Belarus taking into account the recommendations of the World Health Organization and the International Diabetes Federation (IDF). The aim of the World Diabetes Dayis to raise public awareness of the problems of diabetes and related complications. In this regard, the theme of World Diabetes Day, proposed by the International Diabetes Federation in 2015 - "Healthy nutrition as a component of the prevention and treatment of diabetes" is relevant
Diabetes is a serious medical and socialproblem of the XXI century. The importance of the incidence of diabetes in the world is underlined by the adoption of the Declaration on diabetes, by the General Assembly of the United Nations in December 2006, which expresses concern about the increasing incidence of diabetes in the world - a non-infectious diseases with the nature of the epidemic. In recent years the political processes in the field of diabetes has reached significant progress. In support of the UN Political Declaration on Non-Communicable Diseases (NCDs) 2011the 66th World Health Assembly unanimously adopted a World Plan of Action aimed at the prevention and control of NCDs in May 2013 . Currently, diabetes is a leader in global health programs, where special attention is given to the availability of essential drugs, prevention of obesity and diabetes.
The structure of medical care organization to patients with diabetes in the Republic of Belarus and its information technology in the for, of a republican register "Diabetes" were highly appreciated by the mission of WHO experts that visited the Republican Center of Endocrinology in June 2014. The experts concluded that the presented structure is the most appropriate and effective for the treatment of patients with diabetes.
According to the International Diabetes Federation, twenty years ago, the number of people with a diagnosis of "diabetes" in the world did not exceed 30 million.Today, the number of patients with diabetes is 370 million, and by 2025 their number will increase to 550 million people. In various countries, from 40 to 80% of individuals with a diagnosis of "diabetes" do not realize the seriousness of their illness, and often do not receive adequate treatment for preventing the development of irreversible complications.
In the Republic of Belarus in the course of the Republican action "Early detection and prevention of diabetes type 2 " was held in 2011 and was including an assessment of the risk of developing diabetes type 2 (scale FINDRISC) among 15 478 people, the received information about the presence of high and very high 10-year risk of developing diabetes type 2 among 15.51% of the patients that emphasizes the presence of similar trends in prognostication prevalence growth of diabetes type 2 in the world and the feasibility of preventive measures. 26% of the participants have body mass index greater than 30 kg / m 2, indicating the presence of obesity.
In the Republic of Belarus as of January 1, 2015, there were 269,976 patients with diabetes at the dispensary, including type 1 diabetes - 16,696 people, with type 2 diabetes - 251 476 people (prevalence 3.3%), gestational diabetes - 315, other specific types of diabetes - 1 480. In 2014, the first time diagnosed diabetes among 16,696 people (an increase of 6-8% per year over the last 5 years). In the overall structure of the prevalence of diabetes in Belarus the diabetes type 2 takes 93%.
It should be noted that diabetes type 2 is a type of general therapeutic problem in the system of health care and is supervised by a general practitioner, if necessary, patient is sent to the doctor-endocrinologist.
At the same time, patients with diabetes type 1 make up one of the most challenging subset of patients requiring regular systematic teaching of self-management skills, risk assessment and progression of chronic complications of diabetes. In addition, the introduction of new therapeutic and diagnostic technologies in the conduct of diabetes type 1 makes it possible to significantly reduce the risk of chronic complications of the disease, which significantly improves the length and quality of life of these patients.
Primary diabetes morbidity at the beginning of 2015. was only 278.1 per 100 thousand. population, including type 1 diabetes - 8.73; type 2 diabetes - 260.6. The overall incidence of diabetes was 3030,3 per 100 thousand of population. .
Approaches to treatment. One of the priorities of modern diabetology is training patients in the "School of diabetes." The training system of patients with diabetes in the "School of diabetes" in the Republic of Belarus began to form in the early 90-ies. At present, the country operates 232 "Schools of diabetes", where in 2014 on the basis of a unified program approved by the Ministry of Health, were trained 37 650 patients with diabetes.
Strategy of the treatment of patients with diabetes in Belarus is traditionally based on the basis of international consensus documents in the field of diabetology. In the diagnosis of diabetes type 2 the attention is focused on the use of glycosylated hemoglobin with a coefficient variation indication of not more than 4%, which was the first attempt to initiate a standardization of methods of assessment of glycosylated hemoglobin in the Republic of Belarus and, accordingly, get more accurate results of the study.
In accordance with the existing regulatory and legal framework the citizens of Belarus, patients with diabetes are provided with insulin and antidiabetic drugs free from the national (insulin) and local (tablet formulations) budgets. In Belarus in 2014 were treated with insulin 56 044 patients with diabetes, insulin domestic production (manufacturer RUE "Belmedpreparaty") constitutes 82.2% of all used insulins in vials.
To optimize glucose-lowering therapy in the Republic of Belarus was introduced the method of long-term monitoring of blood glucose levels (CGMS), and as part of the national demographic security program for 2011-2015 all regional endocrinology clinics (branches) were provided with these systems. The republic provides thepatients with diabetes means like insulin and self-monitoring of blood glucose (test strips, glucometers).
Chronic complications. In Belarus the growth of chronic complications of diabetes was observed until 2000, at the time these complications were reported among 75% of patients with diabetes, then began the systematic reduction and stabilization of numbers. In 2012, the figure was 46.7%, in 2015 - 46.0%.
In 2014, the prevalence of severe chronic complications of diabetes per 1000 patients with diabetes was 3.53% 0 (2010. - 4,0% 0, 2013. -3,64% 0), chronic complications of the underlying disease in patients with diabetes
Over the last 15 years the structure of long-term complications of diabetes has also changed. If previously in the structure of lower limb amputations was dominated by "high" (at the level of the thigh, calf), now 64% are "low" or "minor" amputations (foot, toes). During 2014 was made 455 amputations (1.85 per 1 thousand. Patients; 2012. - 2.0 (254 amputations) 2013. - 1.85 (443 amputations).
An important issue in the treatment of venous ulcers among patients with diabetes is the introduction of new technologies, created by genetic engineering techniques - human recombinant epidermal growth factor Heberprot-P, manufactured by «Manufacturer Center for Genetic Engineering and Biotechnology», Cuba. In order to implement the agreements reached during the official visit of the Belarusian delegation headed by the President of the Republic of Belarus Alexander Lukashenko to the Republic of Cuba on June 24-25, 2012, regarding the adoption of a joint program for the treatment of patients with diabetic foot syndrome with drug Heberprot-P treatment, a clinical trial is conducted in the Republic of Belarus , which is scheduled for completion in late 2015., A preliminary positive results of Heberprot-P drug threatment by patients with severe stages of venous ulcers in the diabetic foot have been received.
Diabetes is the leading cause of blindness in the world. Early detection of diabetic retinopathy is the most effective strategy for the prevention of blindness. In 2014 in Belarus blindness was detected among 49 (0.2 per 1 thousand. Patients; 2013 - 0.2, 48) people.
For the early detection of diabetic nephropathy the definition of early marker of diabetic nephropathy –called albuminuria was introduced. During 2015 it is planned to move to overnosological classification of chronic kidney disease (CKD), which takes into account the rate of glomerular filtration, the presence of albuminuria for a more accurate assessment of kidney function in the early stages of formation, and departmental reporting among diabetic patients comparable to international standards.
The index of availability of kidney replacement therapy in Belarus (hemodialysis, peritoneal dialysis and kidney transplantation) in 2014 amounted to - 432 patients / million. Population (in 2007 - 189.3 / million. population), In 2013. - 307 patients.
It is important to note that the mortality rate per 100 patients with diabetes, fell from 4.3% in 1995. to 3.3% in 2013. In addition, according to the national register "Diabetes" life expectancy of patients with diabetes type 2 for all registered deaths (n = 34 905) for the period 2007-2014. among women - 74.1 years, among men - 69.8 years.
Increased life expectancy and reduced mortality among patients with diabetes in the Republic of Belarus is the result of an integrated approach to the organization of medical aid to the population of the republic with diabetes.
Among the priorities in the development of diabetes care in Belarus isthe improvement of work continuity with related professionals, especially physicians, general practitioners, cardiologists in relation to informing the general public about the risk factors, the possibilities of prevention and early detection of diabetes, diagnosis and prevention of chronic complications , increasing the motivation of patients to self-management within the education system in the "School of diabetes" and the dynamic monitoring of patients through the use of modern medical technology.
The main freelance endocrinologist of
Ministry of Health A.P. Shepelkevich