Igea
The IGEA Project...
The IGEA Project
Contents
Some information on diabetes
Of those chronic diseases whose occurrence has been increasing, diabetes is one of the most diffuse, and the disease and its complications represent a health problem for persons of all ages in all parts of the world, though the impact is greater among disadvantaged socio-economic classes. In 2003, among persons between the ages of 20 and 79 years, the estimated prevalence was 5.1% worldwide, though this is expected to increase to 24% by the year 2025, with a prevalence of 6.3% and 333 million persons affected.
According to the World Health Organisation (WHO), in 2005 an estimated 2% of all deaths worldwide were attributable to diabetes (approximately 1,125,000 deaths). However, this figure probably constitutes an underestimate, given that deaths due to diabetes are usually attributed to complications (e.g., heart and kidney disease). In fact, in economically developed countries, cardiovascular disease is responsible for up to 65% of the deaths among persons with diabetes.
In Italy, according to the 2007 Report of the National Statistics Bureau (ISTAT), approximately 2,700,000 persons suffer from diabetes, constituting 4.6% of the population (4.9% of females and 4.4% of males). The prevalence increased from 4.2% in 2002 to 4.6% in 2007. The prevalence also increases with age, reaching 17.6% in persons older than 75 years. Regarding geographic distribution, the prevalence of diabetes is highest in southern Italy (5.6%), followed by central (4.4%) and northern (4%) areas of the country.
According to the QUADRI study (Quality of Care for Diabetics in Italian Regions), the quality of care for persons with diabetes in Italy is far from optimal. With regard to diabetes complications, most of the persons interviewed (76%) reported that they had at least 1 of the major risk factors (i.e., hypertension, hypercholesterolemia and obesity), and 42% reported at least 2 of these factors. Approximately 20% of the persons interviewed had been hospitalised in the year prior to the interview. Fifty-four percent were aware of having hypertension, yet 14% of them were not being treated; 44% reported that their cholesterol level was high, yet 26% of them were not undergoing specific treatment. Moreover, although nearly all of the obese persons had been advised to lose weight, little more than half of them were attempting to do so. Of the persons interviewed, 25% were smokers, which is surprisingly similar to the average percentage of smokers in Italy’s general population, and nearly one third of the persons interviewed had a sedentary lifestyle. In the 6 months prior to the interview, fewer than half of the persons had undergone a thorough examination by a general practitioner or diabetes specialist. Only two thirds of the persons had ever heard of glycosylated hemoglobin (HbA1c), and of these only 66% had undergone this test in the previous 4 months.
Diabetes is a paradigmatic example of a chronic disease that is correlated with lifestyle and is more widespread among socially disadvantaged groups. In a study that analysed data from national investigations conducted in 8 European countries, it was estimated that persons with a lower level of education have on average a 60% greater risk of diabetes than persons with a higher level of education, with the excess ranging from 16% in Denmark to 99% in Spain. This is also the case in Italy, where persons with a lower level of education (no formal education or an elementary school education) have an approximately 60% greater risk of diabetes.
The IGEA project arose out of the awareness that diabetes and its complications continue to represent a serious health problem for persons of all ages and geographic areas and that despite improvements the quality of the care that is actually provided is far from meeting the established standards. This awareness led the Ministry of Health, in its 2003-2005 National Health Plan, to make a serious commitment to fighting this disease through the activities of the National Health Service. In particular, the complications of diabetes were included among the priority areas of intervention in the 2004-2006 Prevention Plan and the 2005-2007 National Prevention Plan, which includes regional projects focussing on the prevention of diabetes complications through the adoption of “disease management” programs.
Moreover, in September 2006, Italy, together with the other countries of the Regional Office Europe of the World Health Organisation and the European Union, approved a comprehensive strategy for fighting non-communicable diseases known as “Gaining Health”. With regard to chronic diseases (including diabetes), this strategy focuses on reorienting healthcare services, relying on healthcare models that are suitable for preventing disabilities, for hospital discharges, for developing primary care, and for increasing the capacity for self-management of persons with chronic diseases.
Disease management is currently considered to be the most appropriate tool for improving the care of persons with chronic diseases. In fact, these persons require not only effective treatment but also continuity of care and adequate information and support, so that they can achieve self-management to the greatest extent possible. According to WHO, the following activities are necessary to develop disease-management interventions:
In 2006, Italy’s Centre for Disease Prevention and Control (CCM) and the Istituto Superiore di Sanità (ISS) began to develop the IGEA project, which defines a comprehensive strategy for implementing the disease-management intervention and coordinates and supports regional projects. The overall objective of IGEA is to improve diagnosis and therapy, placing the patient (and not the system) at the centre of the organisation of care, through the development of a model that:
A series of actions for improving the care provided to persons with diabetes are being realised as part of IGEA.
Definition of guidelines for managing type 2 diabetes mellitus in adults
The development and implementation of evidence-based decision support tools can improve
the delivery of effective care for chronic diseases.
A document containing recommendations has been developed which defines the minimum requirements for the management of diabetes mellitus, including a system of indicators.
Definition of the information needs for the management of type 2 diabetes mellitus in adults
Effective clinical information systems are an essential tool for providing the continuity of care necessary for chronic diseases and for encouraging communication between clinical team members and patients. In this document, the topics related to the information systems needed to sustain the management program of the IGEA project are described.
This document provides the basic language and defines the applicative domain of the information systems in this context. In this sense, the document can be considered as the reference for harmonising the diverse regional experiences and as the basis for future activities of the IGEA project.
Implementation of a structured diabetes education programme
Training health-care workers is a key element of chronic disease management and team building, and it is a necessary prerequisite for successfully applying a disease management model to healthcare activities. A training plan and training packages have been defined. The training plan is intended to allow Italy’s Regions to implement disease management by training health professionals from several different disciplines and focussing on the evaluation of new operative strategies.
The planning of an information and communication campaign on the management of diabetes and the prevention of complications
Finally, it should be stressed that a national program for the prevention of diabetes complications can contribute to reducing social inequalities. Like other chronic diseases, diabetes is perceived as a problem that mainly affects higher socioeconomic classes. However, it is actually the disadvantaged classes that are most affected. At-risk behaviour tends to be prevalent among these classes for various reasons: fewer years of education, greater psychosocial stress, limited choice in terms of consumption models, and inadequate access to care and health education. Moreover, these persons have less of a possibility to substitute at-risk behaviours with healthier habits, which are often more costly. As stressed by WHO, chronic disease and poverty exist in a vicious cycle: the poor are most affected by chronic disease, which in turn can represent an additional economic burden for individuals and families, thus making them more vulnerable to disease.
Last update Wednesday 24 June 2009
© Cnesps - Istituto Superiore di Sanità - 2009