Bushra Yunis

Diabetes mellitus is a chronic disease that impacts on the lives and well-being of individuals, families, and societies around the world. It is one of the chronic diseases with the greatest growth rates in the 21st century and it is one of the ten leading causes of death among adults in the world.¹ Type 2 diabetes mellitus accounts for approximately 90% of all diabetes cases.  

In 2009, it was estimated that 285 million people had diabetes (type 1 and 2 combined) increasing to 463 million people in 2019 – a global prevalence of 9.3%. It is estimated that the global prevalence of diabetes will increase to 10.2% (578 million people) by 2030 and will be 10.9% (700 million people) by 2045.¹ According to the National Diabetes Registry in Israel; in 2014 the estimated prevalence of individuals with diabetes over 18 years of age was 9.0%.²

The increased numbers of patients with diabetes leads to a corresponding increase in the economic burden of the disease on health services, the patients and those around them. Direct costs of diabetes are due to hospitalization, surgery, medication, auxiliary equipment and testing. Indirect costs of diabetes are due to illness, work disability, morbidity and mortality, as well as reduced quality of life of the patients and their families or carers. Costs incurred to the community due to diabetes include accessibility to treatment, cost of treatment, insurance costs and loss of labor force.³  

In 2019, the International Diabetes Federation estimated that total diabetes-related health expenditure will reach Euro 700 billion. The economic impact of diabetes is expected to continue to grow: It is projected that expenditure will reach Euro 765 billion by 2030 and Euro 780 billion by 2045.⁴ An evaluation performed in Israel, which estimated the cost of diabetes from a societal perspective – including direct medical care costs, productivity loss due to morbidity and mortality attributable to the disease, and expenses arising from the governmental welfare systems – revealed that out of a total expenditure of New Israeli Shekels (NIS) 25.3 billion on health care services for Clalit Healthcare Services (one of the four health funds in Israel) members over the age of 18 years, NIS 8.3 billion was spent on care for members with diabetes. Thus, about 33% of the expenditure was for members with diabetes, while their proportion of all members was only 13%. NIS 3.5 billion (14% of the total expenditure) constituted excessive expense compared to a reference group comprising members without diabetes. Furthermore, 42% of the overall burden of the disease was due to the indirect cost components of productivity loss.⁵ 

Treatment of diabetes is challenging. Both early and effective treatments are necessary to prevent or delay significant development of diabetes complications, to prevent diabetes mortality and to reduce the enormous economic burden of treating the disease and its complications.⁶ 

Patients with diabetes are usually treated in a primary care clinic by a family physician and other clinical staff (nurses, dieticians). The physician treats the patient’s existing symptoms simultaneously. As the treatment of diabetes is constantly evolving according to new research findings, the physician must stay updated and undergo relevant professional training to ensure the continuous provision of high quality and effective treatment. Experienced health professionals in the field of diabetes care and treatment are a resource of knowledge and support for patients and their families. An informed, up-to-date intervention by a multidisciplinary team including physicians, nurses, dieticians and other medical professionals is the preferred and recommended means for successful treatment of diabetes. The team participates in creating a self-care plan for patients with diabetes, providing consistent assessment and evaluation of patients' status and a quick response according to their specific situation and needs. As such, clinical staff is always in need for education and guidance to guarantee an efficient, personalized treatment path and prevent possible complications.⁷