A private interview with Professor Sir George Alberti, PRCP, President International Diabetes Federation (IDF)

 

The IDF is a non-governmental organization in official relations with the World Health Organization (WHO) and the Pan American Health Organization (PAHO). The mission of the IDF is to work with its member associations to enhance the lives of people with diabetes. Since they first took up the diabetes cause in 1950, they have evolved into an umbrella organization of over 170 national diabetes associations in more than 130 countries, spread over seven IDF Regions. The IDF is the only global advocate for people with diabetes and their health-care providers.

Professor Alberti is currently President of the International Diabetes Federation (IDF),  the Royal College of Physicians in London (UK) and Professor of Medicine at the University of Newcastle-upon-Tyne. His experience and long service in the field of diabetes have led him to speak on diabetes and medical policy matters on a wide number of occasions, and to provide advice and Feedback to the UK government and the Department of Health.

Professor Alberti has also worked extensively with the World Health Organization (WHO), for whom he has been on the Expert Advisory Panel on Chronic Diseases since 1979 and Director of a WHO Collaborating Centre for many years. He also co-chaired the WHO Consultation on the Diagnosis and Classification of Diabetes whose report was recently published.

Last Saturday at the ADA symposium, we had a chance to interview Professor Sir George Alberti, PRCP.  His insight into diabetes care around the world was very enlightening.  Following is the interview:

The IDF released the results at the symposium of a survey that found that more than 1 in 2 people feel that diabetes restricts lifestyle.  The survey was sponsored by Eli Lilly.

Professor Sir George Alberti shared the results of the survey with us.

Almost 60 per cent of people feel that living with diabetes restricts their lifestyle and the same number worry about experiencing complications of their disease, according to results from a new international survey released today at the American Diabetes Association 6tht Annual Scientific Sessions.

 ‘The World Health Organization estimates that there are currently more than I50 million people worldwide with diabetes - a number which is expected to reach 300 million by 2025. This important survey highlights the staggering proportion of people whose lives are restricted by worrying about the future and the symptoms they endure on a daily basis,” said Professor Sir George Alberti PRCP President International Diabetes Federation (IDF).

 “Additionally, with millions of people still undiagnosed, the true scale of this problem remains unknown,” Professor Alberti continued.

 Developed by the IDF through extensive market research conducted over the last 12 months, the survey report expresses the views of more than 1,600 people from I I countries. All survey participants have insulin-treated diabetes. The survey focuses primarily on concerns about hyperglycemic peaks (high blood glucose levels) and bypoglycemic valleys (low blood glucose levels). Issues related to diabetes education and disease management are also addressed.

 The survey demonstrates that the majority of people surveyed across all countries worry about hyper- and hypoglycemic events —despite recent improvements in therapy that can reduce these events.

Impact on Quality of life

The survey demonstrates that a daily concern for all people with diabetes is trying to maintain a stable blood glucose level and — more importantly — avoiding the symptoms associated with hyperglycemic peaks that can lead to long-term complications, such as diabetic retinopathy (leading to blindness), kidney disease, peripheral vascular and nerve damage (leading to foot problems) and macrovascular complications (such as heart disease and stroke).

During the two months leading to the start of the survey, hyperglycemic events were reported as common, including 92 per cent of those surveyed in Poland, 82 per cent in Australia, 80 per cent in the US and 75 per cent in Western Europe. These rates occurred despite 80 per cent of the survey participants knowing that avoiding hyperglycemic events can help prevent long-term complications. The most distressing symptoms were described as being fatigue, blurred vision, frequent urination and mood changes such as irritability and anxiety.

Also addressed are the short-term effects of hypoglycemic valleys. The survey demonstrated that the percentage of people experiencing at least one event ranged from 60 per cent in Brazil to 94 per cent in Poland (with symptoms such as shaking, dizziness and sweating).With these events potentially leading to a loss of consciousness, the greatest concern for people was experiencing a hypoglycemic event while:

 

•    Living alone (69 per cent in Mexico and 77 per cent in Australia)

•    Sleeping (67 per cent in Western Europe and 85 per cent in Poland)

•    Doing tasks at work (69 per cent in Brazil)

•    Operating a vehicle or heavy machinery (60 per cent in the US)

•    Traveling or participating in leisure activities (68 per cent in Western Europe and 77 per cent in Australia)

 

People who experience a significant number of hyperglycemic peaks or hypoglycemic valleys should consult with their healthcare professional about appropriate diet, exercise, and medication.

“It is already clear that diabetes will be one of the most challenging health problems of the 21st century” Professor Albert said. “Increasing education about the importance of managing hyperglycemic and hypoglycemic events is just part of the IDF’s ongoing educational and awareness campaign with our affiliated member associations.

‘We believe that in today’s atmosphere of increasing globalization, there must be a united voice for diabetes around the world Together we can use this report to identify the areas in diabetes education and treatment that need to be addressed,” Professor Alberti added. ‘We want to empower people with diabetes to manage their own condition effectively and, ultimately help them to lead more healthy, active and productive lives.”

We then had an opportunity to ask Professor Alberti the following questions about the care and treatment of people with diabetes in other parts of the world.

The following are the responses:

Q. How does care in Europe and the rest of the world compare to the United States?

“Care in Western Europe is similar to that in the US, however in eastern European countries (those of the old Soviet Block) only a couple have any sort of care plans that come close to the rest of Europe, the others including Russia are very much behind. In Russia, due to the bad economic times, there has been a breakdown in most medical care systems and monitoring and education are practically non-existent. The rest of our member countries have varying degrees of care usually related to economic viability.”

Q. What Qualifications are required of diabetes Medical Practitioners?

“In England for instance we presently have no special education requirements in diabetes for general practitioners, but we are moving in the direction that all practitioners that see diabetes patients will have to have training in diabetes management, chronic disease management, and they will need continuing education.”

Q. How does socialized medicine affect your ability to put requirements on Physicians to do certain things?

"We have the responsibility for education of all residents (doctors in
training) and this is independent of government, so it is basically the same in private or social medicine.”

Q. With 90 % of new diabetes knowledge and products coming out in the last 5yrs, how do you keep your general practice physicians current?

" We  have a big problem in this area and we are moving towards
requiring recertification of physicians every 5 years. At present they must have yearly CME that deals with their areas of their patients care.”

Q. Do you have anything like a CDE in England?

“We do not have anything like that, but we have diabetes teams, lead by diabetes specialists, with diabetes nurse specialists, podiatrists, and dietitians. They work as a resource for the rest of the area, and about 1/3 of general practices refer to these teams or their staff interacts with a member of the team.”

Q. What are standards to determine your outcomes?

"We are in our infancy with this, but we are working towards recording
of surrogate endpoints such as HbA1c. We will have a national program for diabetes out later this year with standards that everyone who practices will be forced to meet.”

Q. How much time does your staff spend with patient over 12 month period? And how often do they come back?

“The physician may spend up to1 hour a year with a type 2 patient, up to 3hours a year with a type 1 patient. The nurses work their time based on need. The patient will also see the podiatrist, dietitian and optometrist at least once a year. Since they don’t have to pay to come back and see us, most return regularly." 

Q .How does the pharmacist fit in?

“They do not work with patients, however they will soon have the right to prescribe, which will be good, and they will also be part of hospital teams to make the drug decisions.”

Q. Do community pharmacists intercede with diabetes patients in their local setting?

“They tend to do nothing, now, but we are trying to get them more involved in preventive medicine and prevention is important for all diabetes patients.”

Q. Where does IDF get their funding?

“170 member nations pay dues, there are grants from industry, however we are currently looking for improved funding from insurance companies.”

Q. What is the IDF’s stand on postprandial glucose measurement and how it benefits the Patient?

“Postprandial is often confused with post glucose challenge in determining diabetes. We feel that by measuring postprandial glucose as well as fasting glucose,
we can help the patient lower average blood glucose, therefore possibly reducing complications.”

Q. Is there any hesitancy to move patients from oral medications to insulin in your country as there seems to be here?

“We preach hard the multiple therapy idea and that sooner or later the patient will have to be on insulin so lets move sooner, this idea has started to take hold in Europe as a whole.

 We allow our patients to use insulin as much as they like long as there is not weight gain. It seems to me that our type 2 diabetes patients are not near as obese as yours (Americans).

 We also speak of insulin in good terms and let the patient know that they can have better control of their own diabetes with insulin therapy.”

 Q. What is tight control of monitoring in your opinion?

 “This idea of tight monitoring is often dependent on the availability of strips and the cost. In our clinic we try to take a realistic approach. 4 times a day 2 days a week and 2 times a day the rest of the time.”

 Q. What is the use of pens and pumps in Europe?

 “:Pens are used very widely. In England we lag a little behind the other western countries in pen use but the use is increasing.  Pumps are almost non-existent in England but there is a move to have them covered by our national health insurance, but they are used much more widely in rest of Europe.”

 Q. As far as the release of new medicines, is Europe ahead? Where are certain medicines used more often?

  “Yes, it seems we have gotten them sooner but you (Americans) have gotten better over the past 10 years.”

 Q. What is your perspective on Low Carb diets?

 “If very low carb is high fat then this worries me, however if you are using poly- unsaturated and mono-unsaturated fats, it will probably be okay. We feel it is more important to eliminate or reduce the very high carb foods”.

 Q. What is your goal in working with the ADA?

 “We want to improve our communication with the ADA to help take information they have worldwide. Due to the economic structure in your country the ADA gets the best information and has the best working relationship with researchers and medical companies in the world. We would like to take advantage of that to make diabetes care better in the rest of the world.”

 To learn more about the IDF visit http://www.idf.org