A week after the World Diabetes Day celebration, messages from professional groups and representatives of patients around this year's main motto "educate to protect the future."Diabetes education remains the key, the need not resolved in diabetes and the margin of improvement that is requested year after year.More education professionals are necessary in diabetes, a greater investment in personnel and a reform of some educational materials that have become obsolete due to the advancement of technology and the arrival of new drugs.

Diabetes research and unstoppable introduction of diagnostic and therapeutic improvements, as well as innovative technologies to facilitate glucose control in people with diabetes, is allowing substantial progress in the management of this disease and its complications, as well as aImportant improvement in the quality of life of patients and their relatives.However, ‘chronic’ deficits are still identified and new challenges that threaten advances in this area also arise.

This is confirmed from the Spanish Diabetes Society (SED) and its Foundation (FSED), and also from the Spanish Diabetes Federation (Fede), which take advantage of the next celebration of World Diabetes Day (November 14) to exposeboth the improvements achieved and to underline the important margin of improvement that exists in the attention of people with diabetes in Spain, mainly focusing on access to care and diabetes education

As Dr. Sonia Gaztambide, president of FSED, is highlighted, “it is clear that diabetes education, as part of the diabetes treatment, becomes more strength every day.Now it is necessary that the authorities in Spain put the means to do so, with the creation of a profile of professionals to educate in diabetes and the possibility of having time to do so, that allows to program and structure education ”.

Diabetes education: lack of professionals and training

Therapeutic education in diabetes has gone from being a necessity to erect in a priority and urgency.The unstoppable increase in cases and the appearance of important novelties in the control and management of precise disease, more than ever, formative efforts, accompanied by the indispensable equity measures to facilitate the access of all people with diabetes to these new resources.

The DMD, which annually summons the International Diabetes Federation (IDF), and which supports from our country the Spanish Diabetes Society (SED) and its Foundation (FSED), is celebrated this year under the slogan "educate to protect the future",putting above all in value the role that nursing plays.And, as Carmen Yoldi stands out, of the therapeutic and vocal education group of thirst, "therapeutic education is leaded by diabetes expert nurses", a fact that is important but not exempt from problematic, especially because "some nursesDiabetes educators have reached their retirement age, or are ready to reach it, and the forecast that is made to cover their place leaves much to be desired. ”

This implies, among other consequences, that the attention and education of people with diabetes can fall on professionals not properly trained and, in this way, it would be directly and negatively impacted on the quality of the care that these people receive.

These deficits are also reproduced in regard to the use and optimization of the technological resources indicated in diabetes, with the constant incorporation of novelties that, in many cases, are not accompanied by the means and the appropriate training for their correct and full implementation.“Technology alone does not work: educational sessions are required so that patients can obtain theMaximum benefit with the use of technology, ”says Yoldi, who recalls that“ nurses demand the recognition of the accreditation of an advanced practice nurse in diabetes to ensure that professionals who teach therapeutic education have acquired the necessary competences ”, an accreditationthat has been recognized in some hospitals in isolation but that remains a need to solve nationwide.

significant inequalities

The importance of education in diabetes is valued from thirst/f."Education consists in accompanying the patient in his learning process and helping him integrate the treatment into his daily life, motivating him for it, trying to maintain his quality of life," says Dr. Antonio Pérez Pérez, president of SED, who clarifiesthat "this education in diabetes should be taught through structured programs, planning over time the contents that will be taught and adapting them to the needs of patients."

"Many people with diabetes, mainly with type 2 diabetes, have never accessed an educational session," says Carmen Yoldi.However, there are studies that show that imparting education in diabetes to people with type 2 diabetes can reduce a point the glyd hemoglobin values, a much greater reduction than that sought by pharmacological treatments for diabetes.In short, it summarizes, "we demand that there are greater access of people with diabetes to therapeutic education and that this is more equitable."

And it is that an aspect that worries especially is the existence of inequalities in the access of the population to diabetes care.According to Dr. Gaztambide, "depending on where you can have more or less access to education in diabetes";Specifically, "the access of people with diabetes to therapeutic education continues to depend on the zip code in which they live, with a lack of worrying equity," says Carmen Yoldi, which she exercises as an advanced practice nurse in the Diabetes Unit of the Diabetes of theEndocrinology service of the Sant Joan de Déu Hospital (Barcelona).

Patient representatives themselves warn these inequities."From Fede we work to reduce this gap, but the transfer of health competencies causes there to continue access differences both in treatments and material and in the time that passes to access to them," says the president of the Spanish Federationof diabetes, Juan Francisco Perán

In general, it is noted that "the Administration invests very little in expanding technical and human resources for diabetes attention," according to Sonia Gaztambide.In the specific case of nurses, the ratio in Spain is 5 nurses per 1000 inhabitants, well below the European average (which amounts to more than 9);These ratios can be extrapolated to the attention of diabetes.In any case, as the president of the FSED admits, “some light is seen at the end of the tunnel, especially after the recent approval in the Senate of competencies in education and the creation of new nursing accreditation diplomas for care and care ofPeople with diabetes, although this must be ratified by the Congress and Ministry of Health. ”

advances

As for technology, the Covid19 pandemic accelerated the implementation of the Telesalud.However, "the resources that are invested are insufficient," says the president of the thirst.In many centers, a computer and camera computer is not usually available to be ablePatient (guaranteeing quality in communication and confidentiality), telephones do not usually have wireless supplementary so that the professional can work having both hands free, ...

However, from thirst/FSED, the important progress that has been achieved in recent months in the approach of diabetes, especially with technological advances, also recognizes.This year, for example, the financing of Flash systems for people with type 2 diabetes (DM2) has been approved in treatment with Bolo-Basal insulin guideline;However, as indicated by Carmen Yoldi, "as happened when public financing was approved for use in people with type 1 diabetes, no resources or training have been facilitated for its implementation."In this sense, thirst has developed unified support materials that facilitate professionals to implement the use of these devices in people with DM2.