Rome – Among the 3,5 million people with diabetes in Italy, one in six is hospitalized at least once a year, often remaining under observation in the emergency room for periods of up to 36 hours.
This data, highlighted by a recent survey, highlights a significant criticality: the impact of complications related to this chronic disease on the healthcare system, already burdened by overcrowding in emergency facilities.
These complications are frequently attributable to inadequate management of drug therapy, insufficient monitoring of blood glucose, poor therapeutic adherence and, more generally, the limited diffusion of preventive and proactive medicine models. The result is a considerable increase in costs for the National Health Service.
To address this issue, the health policy journal Italian Health Policy Brief (IHPB) organized a Dialogue Meeting today in Rome, at the Sturzo Institute. Promoted under the aegis of the Parliamentary Intergroup Diabetes, Obesity and Lifestyles, the event saw the participation of scientific societies and patient associations.
The objective is to define the basis for a diagnostic-therapeutic-assistance pathway (Pdta) dedicated to the management of people with diabetes in emergency rooms, developing a proposal document that can guide future interventions.
"Within the context of a more efficient management of diabetic pathology - stated in her message of adhesion to the initiative Senator Daniela Sbrollini, vice president of the 10th permanent commission of the Senate and president of the Parliamentary Intergroup for obesity, diabetes and chronic non-communicable diseases - I believe it is absolutely useful to have a working and guiding tool containing indications to overcome the lack of real continuity of care between hospital and territory in the management of the relationship between chronicity and acuteness. Local medicine and future community homes will have to create the conditions to free emergency rooms from non-urgent cases that could be managed outside of hospital facilities".
The result of the contributions of a high-profile scientific and institutional committee, the document not only emphasizes the lack of a structured continuity of care between hospital and territory, but also recommends implementing an integrated management of clinical data that can be available to the various health workers who gravitate around the person with diabetes, still lamenting an inadequate use of technological innovation that today would allow easier management of the pathology.
In this regard, Dr. Federico Serra, Head of the Technical Secretariat of the Parliamentary Intergroup on Obesity and Diabetes, stressed that "strengthening an organic management of chronic and diabetic patients in the territory contributes to easing the pressure on emergency rooms, which are a central cornerstone of our health system in which operators must provide their services with a lower level of difficulty".
“Furthermore,” he continued, “it should be remembered that access to emergency rooms in marginal internal areas is particularly difficult and that the aid of technological innovation could offer valid support for the prevention of acute episodes.”
However, the national health system is showing limits of efficiency because, despite the fact that there are now several Pdta (regional and/or company) for diabetes that identify the procedure, sequence and times of the care process that should ensure appropriateness and effectiveness, people with diabetes continue to access emergency rooms due to lack of glycemic control and it frequently happens that the emergency services themselves are the first to diagnose diabetes.
“There is therefore a need - intervened Professor Paola Pisanti, coordinator of the committee that created the document-proposal - to develop a new specific Pdta that starts from adequate training of hospital/territorial staff, and that provides, before his discharge, an organic information action on the patient as well as on the possible caregiver and that leads to a real and subsequent taking charge of the person with diabetes both in adulthood and in developmental age, in particular type 1 diabetes, in all phases of necessary assistance.
A set of information elements that must convey greater awareness of the disease, adequate focus on the importance of therapeutic adherence that today can be made more efficient also with the use of self-managed continuous blood glucose monitoring devices”.
The emergency room is therefore, in fact, a strategic hub in the management of diabetic pathology and a hub for the acquisition of data and information capable of offering important evaluation elements: from the absolute number of patients who access it due to the lack of care by the territorial diabetes network to the evaluation of the repetitiveness of prescriptions by general practitioners/pediatricians of free choice or their level of updating on the subject or, again, their lack of engagement with the patient; from the visits determined by the diabetic foot, to be considered as an indirect indicator of inadequacy of the Pdta adopted and of the poor diffusion of proactive medicine, to the percentage of use of continuous monitoring devices for glycemic levels, from the state of updating of general medicine as a reference for specialists to its ability to be the first step capable of evaluating the patient's ability to understand and use new technologies for measuring glycemic levels.
The works were chaired by Professor Andrea Lenzi, Emeritus of Endocrinology at La Sapienza University of Rome and president of the Committee on Biosafety, Biotechnology and Life Sciences of the Presidency of the Council.
“If we consider that the annual healthcare expenditure for diabetes, and we are only talking about direct costs, is around 10 billion euros, 53% of which is absorbed by hospital expenditure,” Lenzi highlighted during his Lectio magistralis, “we can clearly understand how essential it is to have a more effective and efficient organizational approach that moves from a still prevalent logic of waiting healthcare to a more incisive logic of initiative healthcare, also characterized by prevention and training activities for patients and caregivers.”
A first session of the Dialogue Meeting focused on the management aspects of chronicity in emergency situations, with particular reference to the need for new health policy tools between clinical effectiveness and organizational efficiency, entrusted to the moderation of Dr. Federico Serra, Head of the technical secretariat of the Parliamentary Intergroup Obesity and Diabetes.
The second, moderated by Professor Francesco Pugliese, representing the Italian Society of Emergency Medicine (Simeu), turned the spotlight on the topics of self-monitoring of blood sugar, telemedicine and the efficiency of diabetes pathways.
Article published on 28 January 2025 - 21:26
Video Chronicles
