Last updated on April 19, 2014 at 21:20 EDT

High Number of People With Diabetes in Europe Receiving Inadequate Care

November 13, 2013

BRUSSELS, November 13, 2013 /PRNewswire/ –

Hundreds of thousands of people living with diabetes in Europe do not have access to
the treatment they need, putting their health at risk. These are the initial findings of a
study by the International Diabetes Federation Europe (IDF Europe) on Access to Quality
Medicines and Medical Devices for Diabetes Care in Europe.

The first of its kind in the field of diabetes, the study highlights constraints and
disparities in access to diabetes treatment in 47 European countries.

Half of the countries surveyed reported stock and shortage issues. Respondents in more
than one third of the countries covered also reported increasing difficulties in getting
their prescription as they face delays of up to several months to see their healthcare
professional, or because there are no healthcare professionals close to where they live.

The economic crisis exacerbates these issues. This is particularly true for
Mediterranean countries, such as Greece and Portugal, where local healthcare centres have
had to reduce their staff or have simply closed down due to austerity measures.

Overall, the study also identified a general lack of access to continuous diabetes
education for people living with diabetes, their families and healthcare professionals in
all the countries surveyed.

Due to quotas on subsidized or free diabetes medicines and devices, many people either
have to pay for their own treatment or just do without. People with diabetes in Spain
reported spending on average 300 euros per year on their diabetes medicines and devices.
This is a considerable amount of money as millions of people in Spain live with a net
salary of less than 1000 euros per month. In Poland people with diabetes reportedly spend
around 400 euros per year for their treatment. This represents more than half of the
average monthly salary, which currently stands at 654 euros. In Bulgaria, Russia and
Azerbaijan, people reported having to spend well over 700 euros a year.

Within countries, differences in regional implementation of national guidelines also
create growing inequalities as to who can get certain diabetes medicines or devices.
“Access to diabetes care should not be a lottery,” comments Joao Nabais, President of IDF
Europe. “In more and more countries, we see that access to quality diabetes care depends
on your age, where you live or even whether or not you have a job.”

Inadequate access to medicines and devices has dire consequences for people with
diabetes and healthcare systems, which are faced with spiraling costs. Poorly managed
diabetes leads to serious and costly health complications including blindness, stroke,
kidney failure and amputations.

“Unwise budget cuts in public healthcare expenditure are proving to be
counterproductive. Investment in comprehensive, quality diabetes care saves lives and
avoids unnecessary suffering,” adds Joao Nabais. “It saves money too. With adequate
treatment, people with

diabetes can manage their condition properly and lead long, healthy and productive
lives.” For most countries, the largest single element of diabetes expenditure is hospital
admissions for the treatment of diabetes complications. Many of these are preventable with
proper treatment and access to continuous education.

“Good health and high quality healthcare are essential for economic and social
development. European governments need to ensure that health systems are more efficient
and sustainable, while ensuring access to quality care for all people living with diabetes
in the region. After all, we are talking about giving people with diabetes the right to be
treated well,” concludes Joao Nabais.

Country Highlights


Access to diabetes treatment is seriously challenged by several issues in Azerbaijan.
First, there is overall lack of transparency and publicly available information about what
people with diabetes are actually entitled to and how medicines and devices provided by
the healthcare system are selected.

In addition, insufficient or inadequate supply of diabetes medicines and devices is a
recurring issue in the country. Also, a majority of people with diabetes simply cannot
afford to cover the full costs of their treatment.

“According to the National Diabetes Programme, people with diabetes who register in
policlinics or in national healthcare centres are provided with insulin and oral
medication free of charge. However, this is often not the case in practice,” says Mominat
Omarova, President of the Diabetes Association of Azerbaijan. “The supply of insulin and
oral medication has improved this past year. However, the problem is that the majority of
resources are allocated to people living in Baku, our capital. It is very difficult for
people with diabetes living outside Baku to get access to their treatment.”


Even if the government has recently shown more willingness to increase public help,
unaffordable diabetes treatment is a major issue in Georgia. Prices for diabetes and
devices are not regulated and are reportedly quite high. Also, oral medication for people
with type 2 diabetes is not covered. In general, people with diabetes have to pay for most
of their medicines and devices, making it very difficult for them to follow regular and
continuous treatment.

In addition, low awareness of diabetes amongst the public and politicians make change
difficult to achieve.


In Italy, access to diabetes treatment is challenged because of the country’s highly
regionalised healthcare system. This translates into inequalities between regions and
sometimes even between cities because prescription criteria for diabetes medicines and
devices are different.

Most importantly, regionalisation of healthcare in the country strongly impacts the
capacity of regions to cover the costs of diabetes treatment. As a direct consequence of
the crisis, healthcare budgets in some parts of the country run out prematurely and
healthcare authorities can no longer provide free supplies for people with diabetes.

In light of all these issues, diabetes associations advocating for the rights of
people with diabetes play more than ever a crucial role. “Because of the crisis, our
government wants to rationalise costs on health, and therefore on diabetes. Recently a
draft bill was proposed to provide all people with diabetes in Italy with the same
medicines and devices. Thanks to intense lobbying, diabetes associations limited the
damage and obtained that people with diabetes get the most suitable treatment on doctor’s
prescription,” commented Michele Sette, 21, living with type 1 diabetes.


The economic situation in Poland makes it very difficult for people with diabetes to
get the treatment they need. Not a single medicine or devices, including insulin, is
entirely covered by the country’s healthcare system. Whether or not people get some level
of reimbursement for their treatment is also highly conditioned. For example only
children, pregnant women and young people under 26 get reimbursed for newer generations of
insulin. “This is really sad. Every person with diabetes should have the right to get the
best treatment there is,” says Martyna Neumman, a 22-year-old student who has type 1
diabetes. “I’m lucky because my parents help me buy my medicines and devices, but I know
many people just can’t afford it.”

People with diabetes also find it very difficult to get an appointment with a
healthcare professional, sometimes having to wait for months. “Sometimes I feel like I’m
my own doctor,” adds Martyna. “When I feel bad, I count on the support and advice of other
people with diabetes and my family. However, there is a lot of people who don’t have that
kind of support; especially older people. They just don’t know what to do, what to eat,
what type of treatment to use and start having serious health problems because of this
lack of support.”


Access to diabetes treatment in Portugal has been affected by austerity measures.
Local healthcare centres have had to reduced their staff or have simply closed down. This
makes it harder for people living outside big cities to access the treatment and
information they need.

Another issue in the country concerns insulin pumps, a device that plays a central
role in the treatment of certain people with diabetes. Portugal currently has national
quotas on insulin pumps, leading to waiting lists of sometimes up to 2 years for people
who are eligible to get the device.

Miguel Gaspar, 25, a personal trainer living in Lisbon, was diagnosed with type 1
diabetes four years ago. “Up to now I never had issues to get treatment. We have many
associations for people with diabetes here, which also makes it easy to get information
and support,” he says. “However, support and proper treatment is more difficult to get
outside big cities. The crisis is also making it more and more difficult for people to pay
for the part of their treatment that is not reimbursed.”


In Romania, access to diabetes care is primarily challenged by very tight control over
prescription, used as a way to contain public spending on diabetes treatment. “In general,
all diabetes medication is given free of charge. However, access to new or more modern
treatment is only given after a case-by-case approval by a special diabetes medical
committee,” says Maria Mota, President of the Romanian Society of Diabetes Nutrition and
Metabolic Diseases. “In practice, this means that very few people with diabetes have
access to insulin pumps for example.”

In addition, people with diabetes -either type 1 or type 2- in Romania are treated by
diabetologists, i.e. specialised healthcare professionals. Usually these healthcare
professionals are based in larger a city. This makes consultation harder for people living
further away from urban areas.


Shortages and unaffordable treatment are the two main barriers for people with
diabetes to access their treatment in Serbia. Very limited public health spending on
diabetes means that prescription and reimbursement for diabetes medicines and devices are
tightly controlled and highly conditioned.

“It’s hard for us to accept that healthcare authorities get to decide what type of
treatment we get,” says Stela Prgomelja, Vice President of the Serbian Diabetes
Association. “A significant number of people with diabetes cannot self-monitor because
they don’t get enough test strips or simply can’t afford medicines that are not
reimbursed,” she adds. “Children and young people up to 26 with type 1 diabetes have
higher reimbursement rates for their treatment. So when you turn 26, in the eyes of the
healthcare system, it’s like you don’t have the same condition anymore.”


Regionalisation is the main challenge to equal access to diabetes treatment in Sweden.
Regional or local authorities are responsible for the implementation of prescription
criteria and for financing certain medical devices. This inevitably leads to inequalities
in access to diabetes treatment.

In this respect, a recent decision by Swedish authorities to transfer responsibility
for financing insulin pumps and continuous glucose monitoring devices (CGM – devices to
monitor blood-glucose levels at any time) to regions is making people with diabetes and
diabetes association anxious. Right now these two devices are still free of charge if
prescribed by a doctor but the diabetes community fears that once regions will have to
decide on their financial coverage, fewer people will be able to receive insulin pumps and

“The cost of using a CGM is as high as 3,100 euros per year,” says Josefin Palmen,
professional athlete living with type 1 diabetes. “This is something very few people can
afford. However, our healthcare system now seems to think that I somehow don’t need it
because my blood glucose levels are good. I couldn’t imagine doing sports competitions
without continuous glucose monitoring. But what’s more important, I need it to just be
able to live my life.”

United Kingdom

In the United Kingdom, one of the main barriers for access to diabetes treatment comes
from the uneven implementation of national treatment guidelines at local level.

Even if prescription guidelines are defined at national level, implementation and
resources do not always follow locally. This leads to inequalities as to the type and
quantity of medicines and devices a person with diabetes can get, depending on where they
live. In a recent study carried out by Diabetes UK, 39% of both people with type 1 and
type 2 diabetes using self-monitoring devices reported being refused a prescription for
blood glucose test strips or having their prescription restricted. In such cases, people
with diabetes have either to accept what they have been prescribed or buy the missing
supplies out of their own pockets.

Simon O’Neill, Director of Health Intelligence and Professional Liaison at Diabetes
UK, said: “There is still a very long way to go to improve levels of care for people with
diabetes, both Type 1 and Type 2, in the UK. We know that our 15 Healthcare Essentials
campaign, which sets out the checks and services people with diabetes should receive, has
had a huge impact on people with diabetes and healthcare professionals, but the evidence
shows that many people with diabetes in the UK are still not getting the care they

“In a recent survey, time and again people told us they felt ‘isolated’, ‘abandoned’
and ‘alone’ with their diabetes and we need to do more to support them.”


IDF Europe Study on Access to Quality Medicines and Medical Devices in Europe

The IDF Europe study on Access to Quality Medicines and Medical Devices for Diabetes
Care in Europe highlights disparities in access to quality medicines and medical devices
for diabetes care in the 47 countries of the IDF Europe Region. Articulated around three
key dimensions of access to healthcare (availability, accessibility and affordability),
the study aims to provide evidence to policy makers and stakeholders on the current
challenges faced by people living with diabetes in terms of access to the treatment they

The study is based on a total of 1150 answers to a survey questionnaire sent out to
the 47 countries of the IDF Europe Region, interviews and desk research. Respondents are
people with diabetes, healthcare professionals, diabetes advocates, academics and public
and private stakeholders.

The executive summary of the study is now available for download at


The full study will be available online and for download as from 28 November 2013 at


About the International Diabetes Federation European Region – IDF Europe

IDF Europe is the European Region of the International Diabetes Federation. We are an
umbrella organisation uniting 66 diabetes associations in 47 countries. We represent
people with diabetes and their families, as well as health professionals working in
diabetes. Through our work, we aim to influence policy, increase public awareness and
encourage health improvement, promote the exchange of best practice and high-quality
information about diabetes in all countries throughout the Region.

For more information, visit http://www.idf-europe.org.

SOURCE International Diabetes Federation European Region (IDF Europe)

Source: PR Newswire