Diabetes: therapeutic education, key to good control

According to Juan José Gagliardino, a reference in the study of the disease, there are doctors who “poorly prescribe” and patients who “poorly comply.”

There are profound shortcomings in the delivery of diabetes medicines and supplies in the public health system in general, and more frequently in localities furthest from large cities. However, complications in access are not the only obstacles to achieving good control, but also the lack of a global strategy that includes education in healthy habits and diabetes as a key tool to obtain early diagnoses and better treatments.

Dr. Juan José Gagliardino, Emeritus Senior Researcher at Conicet, Consultant Professor of the Faculty of Medical Sciences of the National University of La Plata and Master of Diabetology of the Argentine Diabetes Society, emphasizes that therapeutic education is vital to optimize diabetes control and government multisectoral work to “stop the epidemic” of this disease.

“Without access to medication and medical care, there are no effective solutions. Not everything can be solved by giving medication, you have to teach how to use it. Its optimization allows to achieve the treatment goals and prevent the development and progression of chronic health complications that decrease the quantity and quality of life of the people who suffer from it and increase the cost of their care, affecting both the person and the community. “.

Considered one of the top Argentine references in diabetes, the specialist assures that “the most serious problem” that diabetes has in the country is poor disease control due to multiple factors, but mainly due to a shared responsibility of the doctor-patient duo. “It is a negative combination of someone who badly prescribes and another that badly complies. The effective solution is therapeutic education ”.

It is a hormone that is the key so that consumed carbohydrates, converted into glucose at the intestinal level, enter the cells to be used as fuel (energy). When the pancreas does not produce it in sufficient quantity, it is necessary to administer insulin and / or specific medications, depending on each case and the type of diabetes, to ensure that glucose enters the cells to fulfill its power supply function.

In this sense, Gagliardino explains that diabetes is a chronic and incurable disease so far, whose cause is a failure in the production of insulin to meet the demand of the body’s tissues. In some cases, the insulin-producing cells are destroyed by the immune system itself (type 1 diabetes) and in others it is a consequence of wear and tear: the body has a insulinorresistencia that cannot be adequately compensated for by insulin production (type 2 diabetes).

In accordance with the need for diabetes education and not just medication, in 2017 it published the results of a program that it carried out in the La Matanza district, in the province of Buenos Aires. The study involved the training of two health teams for the primary care of patients with diabetes and their follow-up for one year. One group implemented an intensified control treatment and therapeutic education; and another, a traditional one. After 12 months, the results showed significant improvements in blood glucose, blood pressure and lipid profile of the first group. Thus, he showed that, with the same inputs, therapeutic education significantly optimizes the effectiveness of treatments.

The latest National Survey of Risk Factors (ENFR) shows that elevated blood glucose increased from 9.8% to 12.7% compared to the previous edition. Gagliardino details that between 2005 and 2019 there was a 51% increase in diabetes cases and that in the same period there was a 74% increase in obesity. The report states that “in obesity there is a clear downward gradient by educational and socioeconomic level, with populations in greater vulnerability situation those with more obesity ”.

In the same vein, the expert published an editorial in the ALAD (Latin American Diabetes Association) magazine, in which he associates the prevalence of diabetes and obesity with poverty and a lower level of education, among other points. “Wouldn’t it be reasonable for different ministries to develop a consensual plan for the population to acquire from elementary school, when we develop the habits that will govern our future lives, the basic principles of what a healthy eating plan is?” and propose at the same time.

On November 26, the Argentine Diabetes Congress will be held virtually, with the presence of representatives of the National Ministry of Health and the president of the International Diabetes Federation (IDF). There, Gagliardino will develop the theme of multisectorality to face the problem of diabetes, a theme that was recently approved as a slogan of the South America and Central America (SACA) region by the IDF to work in 2021, the year in which it is commemorated a century of the discovery of insulin.

“The proposal is to include the participation of all sectors involved in the control of the disease: the Ministry of Education so that from primary school let’s teach and promote healthy habits, the ministries of Economy, Social Development, Health, the media to disseminate the correct information, the food industry to promote healthy eating and facilitate its access by cost, and the medical schools to improve the training of doctors to deal with prevalent diseases in the real world. “

There is model legislation in the country regarding this disease, but without its adequate compliance at the federal level and multisectoral work that includes education and prevention in health as a priority from an early age, it is difficult to see good results. “Education in Argentina does not promote the practice of healthy habits and that contributes to the continued growth of the diabetes epidemic. “

“In a symphony orchestra, there are strings, woods, brass, percussion and a choir – he exemplifies -. If all this is not harmonized, there will be no melody but a similar noise when tuning instruments”. And he ends: “That is what is happening with the governments. There is no coordinated action but individual from each sector regarding this problem, which is ultimately inefficient. As in an orchestra, without the proper ensemble the efficiency we need to have a healthy and productive community is not achieved ”.

Gagliardino reports that very little time is devoted to prevalent diseases in medical studies: “When all the hours in which diabetes-related issues are taught are counted, for example, they add up to between 12 and 20 hours in total.” This “deficiency” in education “facilitates late diagnosis and inappropriate treatment“.

In type 2 diabetes, patients do not have an abrupt onset and in general “spend between 5 and 10 years” without knowing that they suffer from this pathology. “The diagnosis comes when there is already a complication”points out Gagliardino, who served as Director of the Center for Experimental and Applied Endocrinology (UNLP- CONICET- CEAS CICPBA) for 37 years.

In the case of type 1 diabetes, the onset is usually more noticeable because its symptoms are highly characteristic. However, there are also problems in its diagnosis. Fabiana Agüero de Chiaro is a clear example of this. His son Emanuel had a totally traumatic debut on his diabetes, which put him on the brink of death.

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