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EF: What are your priorities for this year, and where are you focusing your energies in 2023?
KM: Our main objective is encouraging the Brazilian municipalities to implement, at least, the Ministry of Health’s guidelines to treat people with Type 1 (T1DM) and Type 2 diabetes (T2DM). We have led the process of introducing short-acting insulin analogues to the MH list for people with T1DM and are one of the authors of the MH clinical protocol and therapeutic guidelines for T1DM (PCDT DM1). So far, the Minister of Health has introduced short-acting insulin analogs, but the overall distribution and prescription could still be improved.
We need to better establish the demands for medicines and supplies for the treatment of people with diabetes in Brazil. This process must happen across all municipalities since Brazil is a very heterogeneous country. While cities like Sao Paulo present very high Indicators of Health, other municipalities are impoverished and do not have the conditions to treat patients, as they lack even basic equipment like refrigerators. We must to attend these variables in our country and push the implementation of our guidelines-
Furthermore, the aspect of improving diagnoses is crucial. We have medicines available, but we need to identify patients at the primary healthcare level to optimize the utilization of these resources. Therefore, we need reliable patient tracking and treatment method to improve our data. We need a cohesive and transparent system, accessible to managers, scientific societies, and representatives of people with diabetes.
To achieve this, we are pushing technologies that establish the demand and identify comorbidities such as Diabetic retinopathy. We have suggested ophthalmology exams performed by teleophthalmology and collaborated with the HEART initiative in Brazil to evaluate, follow and treat people with high cardiovascular risk. Making these screenings available for the whole country is an exciting proposition.
Today more than 70% of the Brazilian people receive follow-up health care at the primary care level. We have to act in this sector and compensate for the lack of specialists with general physicians and assessment with tools like the Cardiovascular Risk Calculator from WHO.
Patients with insulin therapy in Brazil have insufficient blood glucose control. Only 10-12% of these patients have an HbA1C of less than 7%. Apps and technologies like continuous glucose monitors and insulin pumps could alleviate the situation. Especially children under seven years would benefit enormously from these methods, as they help to express the illness. Parents can correctly identify their kid’s condition and assist their children with Type 1 diabetes better.
To reduce the risk of Type 2 diabetes, we intend to integrate new technologies for obesity treatment.
EF: Could you tell us about the PCDT for T1DM and T2DM?
KM: The guidelines are directed to health care professionals. The document includes an introduction to the disease, both T1DM and T2DM, the diagnosis and epidemiological data in Brazil, and information about how to treat patients and provide continuous follow-up care.
The PCDT T1DM contains information on how to establish glycemic goals, perform non-pharmacological treatment, calculate and adjust insulin doses and follow patients with T1DM.
Currently, patients with T1DM are mainly receiving treatment at the secondary or tertiary level of the public health system. But for patients with T2DM, the great majority are being followed by primary care professionals.
The guidelines utilize algorithms to clarify the appropriate drug usage and dosage calculations.
Only recently, we have introduced a new drug to the list that reduces blood sugar levels in adults with T2DM but also aids with heart failure and diabetes renal disease. Therefore, we intend to identify patients who could benefit from this medicine at the primary level.
Ensuring complete and available primary care for patients is crucial to ease their disease’s follow-up process.
EF: Could you tell us more about the involvement of the Diabetes Society with research and awareness?
KM: The SBD is composed of many departments focused on diagnosis, follow-up and treatment of people with different types of diabetes, non-pharmacological treatment, diabetes-related complications and the public health department. All of them include health professionals involved in the follow-up of people with diabetes. The SBD has a Guideline Department that brings relevant scientific information to all interested parties.
Most of our courses are focused on professionals. However, we introduced programs for people with diabetes. We will only see the change when the patient’s interest is bigger than the interest of the health professional. It is very important to focus education on the patients as they can improve their daily lives once they acquire the right information.
EF: How is SBD looking to reduce the burden of diabetes in Brazil and improve the patient's journey?
KM: There is a lot of room for improvement in the patient´s journey. Currently, the system is split. For people with T1DM, human insulins are available at the primary care level. However, analogs are only accessible at the secondary and tertiary levels. Meanwhile, Type 2 patients have no access to analogs at all. This distribution complicates the journey for patients, as they need to attend different units of our public health to receive their treatment.
Visiting several centers to receive medicines and supplies is costly for patients and many unaffordable. We advocate having all the medicines available in the same unit, but implementing this request is complicated. The burden of diabetes is very high in Brazil. We have a population of close to 16 million patients with diabetes and many patients with prediabetes. We have nearly 580,000 patients with T1DM, one of the highest numbers worldwide.
Only 12% of patients who use insulin achieve the ideal HbA1C level of less than 7%. Because of this statistic, we must focus on the patients in insulin therapy. To achieve the desired results, patients must know how to properly adjust their insulin administration, considering their meal’s composition and blood glucose level, mainly those with T1DM Only patient education initiatives can improve this situation.
As for our partnerships with stakeholders like the pharmaceutical industry and health insurance companies, we recognize a difficult relationship between pharmaceutical industry professionals and governmental entities. Our role as SBD is to mediate this relationship and channel it into a productive partnership.