Europeans in the ‘twilight zone’ of type 2 diabetes care are living under a false sense of security and set to suffer avoidable long-term consequences

IDF Europe, Brussels, April 17th 2007, 12.01AM: The results of an in-depth survey of over 750 patients across Europe launched today points to a crisis in the management of the rising numbers of people living in the ‘twilight zone’ of type 2 diabetes care. They are inadequately controlled on oral antidiabetics but under a false sense of security about the severity of their disease.¹ The survey revealed that over three-quarters of patients across Europe wrongly believe their poorly controlled condition is well managed and almost half believe that they have ‘mild’ diabetes.¹ The Choose Control report identifies a number of serious mis-matches between how patients perceive the severity of their condition and the reality of their plight.¹ “The consequences of uncontrolled diabetes are devastating for patients; they include eye problems and blindness, kidney failure, nerve problems, heart attack and premature death. The medical response to date has included increased efforts to attain a life-long optimum control of blood glucose levels. However, as this report shows, this clearly isn’t working. New and flexible approaches are urgently required across Europe” commented Dr Tony O’Sullivan, IDF Europe President. For the first time, answers were sought to explain why people in the ‘twilight zone’ of diabetes care, cannot, or will not, gain control of their condition. Central to the report’s conclusions are a number of findings that point to the scale of the problem:

• Almost half of people wrongly believe that they have ‘mild’ diabetes, despite the duration and seriousness of their condition¹
• 3 out of 4 people believe they have good control of their diabetes, despite their doctor recognising their condition is poorly controlled¹
• Most patients do not fully understand HbA1c targets and their importance even though these targets are a recognised Governmental and HCP priority¹
• 80% of people would like to be in control of their diabetes, but are failing to do so, with weight control highlighted as their key struggle¹
• Many patients are concerned about insulin – viewing it as the ‘last resort’ despite the proven health benefits it may bring¹

Diabetes is a serious condition, poor control of which is linked to long-term complications and death.² All of the patients interviewed in ‘Choose Control’ have poor control of their condition. Yet, it is clear from the majority of patients interviewed:

• Many patients do not understand the seriousness of diabetes, wrongly believing it to be ‘mild’, and that they were at a low risk of complications¹
• Healthcare professionals do not appear to be effectively communicating to people with Type 2 diabetes about the seriousness of their condition, the impact in the long-run, and the need to meet HbA1c targets¹

Over 53 million people in Europe suffer from diabetes and this is soon expected to reach epidemic proportions.³The burden on healthcare systems is vast, with 5% of healthcare budgets across Europe spent on diabetes.^4,5,6Much of the current media and governmental concern has focussed “almost exclusively on our growing understanding of the potential to delay or prevent diabetes; in fact many politicians and administrators have reached a convenient conclusion that all Type 2 diabetes can be prevented by implementing healthy lifestyle advice and promoting health food choices. Sadly, this is not the case”commented Dr Tony O’Sullivan. What can be done? Choose Control & Take Control Commenting on the results, Dr Tony O’Sullivan noted “the time for action is now if we really want to help change the future for people with Type 2 diabetes – this study joins a growing body of evidence favouring education and empowerment approaches and a sense of partnership, in contrast to a traditional medical model”. Type 2 diabetes clearly has a negative impact on the lives of people with the condition, both physically and psychologically - many find tackling their diabetes difficult. To help people with Type 2 diabetes, the IDF Europe conclude it will be key to:

• Provide practical intervention strategies which enable them to change behaviour – for example, losing weight can be a positive motivating factor
• Increase awareness and understanding about the importance of meeting HbA1c targets
Patient education, information and awareness must go hand-in-hand with strategies for healthcare professionals. Recommendations from the IDF Europe include:
• Increasing awareness about Hba1c – value and utility – empowering then to take appropriate action when patients are uncontrolled
• Educating people with Type 2 diabetes about insulin – reduce their fears and not use it as a threat in the early stages of diabetes Providing them with improved disease management strategies that can help them gain effective control of their diabetes

IDF Europe believe that for the sake of people with Type 2 diabetes, better education and implementation of treatment strategies are clearly required now and in the future. Click here to view a printable pdf of the choose control survey (315KB)

1. Choose Control Survey Data, 2006
2. United Kingdom Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphoylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837–53.
3. International Diabetes Federation (IDF) Diabetes Atlas, 3rd Edition
4. Williams R, van Gaal L, Lucioni C. Assessing the impact of complications on the costs of type 2 diabetes. Diabetologia 2002a;45:S13-7.
5. Jonsson B. Revealing the cost of Type II diabetes in Europe. Diabetologia 2002;45:S5-S12.
6. Lucioni C, Garancini MP, Massi-Benedetti M et al. The Costs of Type 2 Diabetes Mellitus in Italy: A CODE-2 Sub-Study Treat Endocrinol 2003;2:121-33.
7. International Diabetes Federation (IDF) Prevalence. URL:http://www.eatlas.idf.org/ [Accessed January 2007]
8. Diabetes UK. Diabetes in the UK 2004. October 2004 Click here to view site
9. World Health Organisation (WHO). Diabetes – Global Strategy on diet, physical activity and health. Click here to access site[Accessed January 2007]