Diabetes in Europe

 

There are many differences in diabetes care for children

 and adolescents throughout Europe


..............
"Access to treatment that allows more flexibility can really change your life"
(Christiane Bartos, mother of child with diabetes)
 
 
 

Estimation of Incidence & Prevalence

  • The Europe Region [1] currently has the highest number of T1DM in children of any region. In 2011, there were about 115,700 children (0-14 years) with T1DM in Europe. The region also has one of the highest incidence rates of T1DM in children, with 17,800 new cases in 2011.1
  • In European children younger than 5 years old, a doubling of new cases of T1DM is predicted by 2020. Prevalent cases younger than 15 years will rise by 70% between 2005 and 2020 if current trends persist.2

Differences in Care

  • Treatment strategies differ considerably across the EU and even in countries with excellent medical infrastructure particular inefficient strategies may remain present, e.g. identical care and education programmes which are used both for children and adults.
  • Not only treatment but also daily management strategies vary across the EU: Due to ignorance and fear of possible incidents, children with diabetes are in certain countries often not allowed to participate in school trips or sporting events. On the contrary, a corresponding medically oriented training for teachers and educators is mandatory in other countries, so that children with diabetes can be assisted in the classroom as well as in leisure events. 3
  • Unfortunately, treatment outcomes also vary greatly across the EU: Analysis of HbA1c values from 21 centres in 17 different countries, revealed a 7.6 to 10.1% variation between centres (with an average HbA1c value of 8.6). Whereas some centres had better values compared to this average, other centres unfortunately had significantly higher HbA1c values. 4

Burden

When calculating the cost of T1DM, not only financial burden, but also disability burden, mortality and quality of life factors including possible social burden should be taken into account.

Financial burden:

  • Most cost of illness studies so far do not clearly differentiate between the costs associated with T1DM and T2DM. Evidence suggests however that while fewer in number (adult population), T1DM patients incur higher mean treatment costs compared with T2DM patients.5
  • Especially severe hypoglycemic events are associated with significant treatment costs.5-7 In addition, a recent Scottish study reveals that of all modifiable risk factors (such as serum creatinine, HbA1c, BMI) HbA1c is the most important driver of cost in T1DM.8

Disability burden and mortality:

  • Despite mod­ern treatment options, more than 50% of children with diabetes develop complications 12 years after diagnosis.9
  • Several studies, both in T1DM10 and T2DM11 patients, have shown that HbA1c levels determine the occurrence and progression of microvascular complications. Small, persistent elevations in HbA1c significantly increase the risk of major complications of diabetes, such as cardiovascular disease.10 Every 1.0% decrease in HbA1c can reduce the risk of microvascular complications by 40%. 12 As such, intensive glycaemic control substantially lowers the incidence of diabetes-related complications and extends life expectancy.13-15
  • A French study indicated that only 1 in 7 children with T1DM were found to reach target HbA1c < 7%. In addition, 14% had blood pres­sure levels above 130/85 mmHg.16
  • The results of modelled survey data have shown that the life expectancy for children diagnosed by age 10 is reduced by nearly 19 years.17
  • Better glycaemic control is also associated with better quality of life.18,19

Quality of life factors:

In a survey20 of 580 German families, 31% of the mothers reduced their working time or stopped working when the child was diagnosed with diabetes. 33% of the mothers reported handicaps in their professional career development. Negative financial consequences were present in 44% of the families.

A youth study indicated that: 21

  • 35% of young adults with diabetes have poor psychological well-being. High levels of anxiety (26%) and depression (13%) have been reported by healthcare providers in this context.
  • 20-39% of young adults experienced a significant effect on their school or work performance due to diabetes.
  • Approximately 25% found that diabetes regularly causes them embarrassment and 12% even experiences discrimination.

Research and Databases

  • The European region has by far the most complete and reliable data for T1DM in children.1 However, a quite substantial proportion of the countries still do not have nationwide registries.
  • The EURADIA-DIAMAP project examined diabetes funding practices in EU Member States between 2005-2008 and concluded that in almost all cases funding for T2DM research was considerably greater than funding allocated to T1DM.22
 

[1] The wider European region as defined by the WHO, including The Russian Federation.