Anne-Marie Felton, President of the Foundation of European Nurses in Diabetes tells HEQ about the importance of cohesive diabetes care.
More people than ever are living with diabetes. It is estimated that 415 million people around the world are living with the condition and 46% of them are undiagnosed. The more serious, type 1 diabetes means the body is unable to make a hormone called insulin which breaks down the glucose (sugar) in the bloodstream so it can be converted into energy. Managing the condition can be difficult and it can affect other parts of the body. In recent years, cases of type 2 diabetes have risen dramatically.
This type of diabetes, which can develop as a result of lifestyle choices, means the body is unable to produce sufficient amounts of insulin to break down glucose in the bloodstream. With an increasing number of people living with type 2 diabetes, the need for a coherent, interdisciplinary healthcare infrastructure to help people manage the disease has never been more vital.
Lorna Malkin, Junior Editor of HEQ speaks to the president of the Foundation of European Nurses in Diabetes (FEND) to find out why.
Can you start by telling me what led to the establishment of FEND and the founding ethos behind the organisation?
FEND is a not-for-profit, pan-European organisation established 25 years ago to ensure that its members working in the speciality of diabetes in Europe are appropriately equipped, not just from an experience point of view, but by undertaking structured academic, accredited training programmes. At the time, there were a number of nurses working in the speciality of diabetes but there was increasing evidence that they were coming from different areas of healthcare and delivering care at a local, regional and national level, without a national, unified framework in place to inform the delivery of that care. The acknowledgement of this need in the delivery of service as an interdisciplinary team was becoming increasingly important and recognised from published academic papers, through to relevant conferences addressing diabetes in terms of service delivery and evidence-based clinical practice. All these factors led to the emergence of a diabetes speciality in nursing.
Why is it so important to have an international voice to represent nurses working in the field of diabetes care?
While there are some international models already in place to support healthcare delivery, chronic diseases tend to have a lower public platform compared to acute diseases. This is understandably the case with COVID-19 because it is an acute, infectious disease and is very serious, but chronic diseases appear to have a degree of ‘second ranking’, rather than being an equal priority. Yet we know that in the context of chronic diseases, diabetes is one of the major contributors to ill health, both in a physical sense and in a psychological sense. Plus, the economic costs associated with diabetes are enormous due to the complications of the disease.
In 1989, the so-called St Vincent Declaration set out parameters for standards of care and how the complications of diabetes should be addressed in the context of an interdisciplinary team. This was signed by most European countries to ensure, on a political level, diabetes would be made a priority. While there was huge enthusiasm initially, it was slow to be formally enacted and slowly fell off the political agenda. As a result, voluntary organisations became increasingly concerned and a movement was established to try and ensure diabetes would become a major priority in health at a United Nations level. In 2006, the European Parliament adopted a Written Declaration on Diabetes and subsequently, the UN General Assembly passed a landmark Resolution 61/225. This movement led to an important milestone in the public health, political agenda. It was and still is the first non-communicable disease to have that status at the UN level.
More people than ever are suffering with diabetes, what do you think has driven this increase in recent years?
I do not think there’s any one cause, it is multifactorial. Undoubtedly, there is an environmental element and by that, there is almost a diabetogenic impact in relation to public health policies, how food is advertised, the way we live our lives (which is not necessarily structured) and the amount of physical activity we do. Governments can encourage people to eat healthily, exercise and not snack between meals but for those that live in uncertain economic environments it is not that simple. Within our societies, particularly those that are socially and economically deprived, there can be an emphasis on foods that are energy dense, as opposed to nutritious. Buying healthier foods can be expensive and there is a misconception that those people who are overweight, and could develop type 2 diabetes, are lazy. There is a stigma and basic ignorance about this in the public at large. While the social inequalities in health are recognised by practitioners in both primary and secondary care, there needs to be a better political response to ensure healthcare is available and easily accessible without unfeasible costs.
What do you feel are the major challenges in the management and treatment of diabetes today, particularly in light of the COVID-19 pandemic?
There is emerging evidence that people who have diabetes are at greater risk if they contract COVID. There are serious implications and higher rates of mortality, and likewise recovery is much slower compared to the non-diabetic population. The delivery of diabetes care has changed because of the pandemic, so it is really important to try and enable people with diabetes to take better care of themselves. It is important that they are given all of the necessary information and access to medications to enable them to do so. Ultimately, it is the people with diabetes who manage their condition and they manage their condition well if the infrastructure supporting them on a primary and secondary care level is intact. We know that across the world, healthcare delivery has been disrupted during this pandemic; we were not prepared for it and it is a virus that is new and very challenging. The situation is beginning to improve because of the increasing number of vaccines however the distribution leaves much to be desired, in particular low- and middle-income countries are grossly underserved.
Can you share any recent tools or developments that are helping people to manage diabetes and in which areas you would like to see more research?
Technology is contributing enormously in enabling people with diabetes to better self-manage their condition, particularly in relation to measuring their blood glucose levels and being empowered to make their own clinical decisions in relation to health management. This goes hand-in-hand with the efficiency of diabetes teams locally and regionally.
Continuing investment in diabetes research at a basic, science level and a clinical level is very important. For example, if we look at outcomes of pregnancy and diabetes, that has improved enormously in the last 30 years, because we have more sophisticated insulins and skilled inter-disciplinary, specialist teams. It is possible for women with diabetes to continuously manage their blood glucose levels. But we must remember that there is some cost to this, certainly in the provision of facilities, but there is also a cost to the individual themselves, both in terms of the time taken for them to manage their condition as well as the psychological cost. If diabetes is not well managed during pregnancy then the outcomes can be disastrous for both mother and child. Family planning also plays an important part to ensure women are well informed so that at the time of conception their diabetes control is absolutely optimum and will continue to be throughout the course of their pregnancy.
As professionals working in the speciality, the monitoring of outcomes is of utmost importance so that we can see where there is room for improvement and that has much to do with national registers and policy. Again, this goes back to the politics of healthcare and what investment there is in this chronic disease in terms of its understanding, particularly in relation to type 2 diabetes.
FEND looks forward to welcoming diabetes specialist nurses and other disciplines to the FEND Virtual Annual Conference on 24 September 2021. For information on the conference and also the MSc programme and PhD Fellowships see www.fend.org.
Foundation of European Nurses in Diabetes (FEND)