The war in Ukraine has resulted in a catastrophe on all levels.

Access to medical care for the population has become increasingly difficult, particularly at the primary care level. The capabilities for diagnosis and timely treatment of diabetes, especially Type 2 diabetes, is significantly reduced. The low socio-economic status is associated with an elevated risk of mortality, both among individuals diagnosed with diabetes and those whose diabetes has not been detected during their lifetime.

In the structure of mortality, 86% of deaths of Ukrainian citizens are accounted for:
- cardiovascular diseases
- oncological diseases
- respiratory diseases
- diabetes

THIS IS WHAT THE PROJECT "BEWARE! DIABETES IS NEAR: Disaster Can Be Averted!? Call to Action"

While the effectiveness of type 2 diabetes prevention is clear, implementing these findings into national policies remains a challenge. We focus on primary prevention.

PROJECT OBJECTIVES
1. Informational: reach out to everyone
2. Social: prevent deaths
3. Economic: save funds to improve care for those currently living with diabetes

TERM
14.08-14.11.2023 - 3 months and permanently

A year after the signing of the agreement between Ukraine and the European Union on Ukraine's participation in the EU4Health program, the Ministry of Health submitted applications for participation in 9 projects.

The European Union, within the framework of the EU4Health program, allocates more than
€4.6 million for healthcare projects.

The European Commission has approved Ukraine's participation in them and confirmed more than €4.6 million in total funding for their implementation. More about the projects:
https://moz.gov.ua/article/news/evrosojuz-vidiljae-ukraini-ponad-46-mln-evro-na-proekti-u-sferi-ohoroni-zdorov%e2%80%99ja-v-ramkah-programi-eu4health?fbclid=IwAR17GZS92tcYcrzKun-smrevK9ZKOggwxwGdQX4wBRF3b7yoprVdcyC8_ko

During a joint meeting of the Ministry of Health of Ukraine, the Public Health Center of Ukraine, regional Centers for Disease Control and Prevention and World Health Organization Ukraine, Ihor Kuzin said:

"Implementation of disease prevention projects in communities is a priority for the Centers for Disease Control and Prevention (CDCP)."

By the end of the year, the heads of regional centers for disease control and prevention have set key goals:

· implement projects to prevent noncommunicable diseases, such as strokes and diabetes."

But without active cooperation, motivation and stimulation of the family doctor, who is offered to engage in prevention, it is impossible to really change the situation.

How to include prevention in the package of guaranteed services

The medical guarantee program includes 42 packages of medical services. Each of them has a clearly defined list of services that the state guarantees to the patient free of charge. There are packages for such areas of medical care.

· Diagnosis and treatment of oncological diseases.
· Treatment of strokes and heart attacks.
· Palliative care.

Is such a package planned for medical guarantees of free services for patients with diabetes?

APPLY TO THE NHSU WITH A PROPOSAL TO INCLUDE PREVENTION IN THE PACKAGE OF GUARANTEED SERVICES

NCDs (non-communicable chronic diseases) are known to kill 41 million annually.
77% of these deaths occur in low- and middle-income countries.

Is such a package planned for medical guarantees of free services for patients with diabetes?

OBESITY

is a major risk factor for NCDs, one of the biggest health crises facing the world today, Nearly 1 billion people are living with the disease. We need to change that.

According to the criteria of the International Diabetes Federation (IDF), central obesity is diagnosed in adult Europeans based on a waist circumference of ≥ 80 cm and ≥ 94 cm in women and men, respectively. A significantly increased risk of metabolic complications is found in women with a waist circumference ≥ 88 cm and in men with a waist circumference ≥ 102 cm.

According to the World Obesity Federation, Ukraine has a high national obesity risk of 7.5/10 and an extremely low chance of achieving the targets set by the UN to end obesity (2030), especially for men.

Diabetes, Hypertension, Coronary heart disease are diseases that are preceded by obesity, and for which obesity is the most common risk factor.

This is how the "Beware! Diabetes is near" project was born as part of the Type 2 Diabetes Prevention Action Plan

Publication plan: Develop and implement:

1. Recommendations for the Average Population: Prevention of Type 2 Diabetes

People who are overweight or obese have an increased risk of developing type 2 diabetes, and should aim to lose weight by at least 5% by adopting an intense lifestyle intervention that includes an energy-restricted diet and increased physical activity.

Energy intake and physical activity according to individual needs are recommended to ensure long-term maintenance of a healthy weight.

Achieving a low-risk lifestyle mix through measures such as maintaining a healthy diet (e.g., Mediterranean, Nordic, vegetarian diets), regular physical activity, avoiding overweight and obesity, and smoking cessation is recommended.

2. UDF youth - for the older generation. Guidance for you who is willing and able to help a neighbor who is left alone with diabetes, or a family with a child or family member with newly diagnosed diabetes, or someone who has no one to help but you.

3. HANDBOOK "Diabetes: Modern Technologies as a Factor in the Prevention of Complications".

To hold events for World Diabetes Day 2023 focused on diabetes prevention.

Propose to post information on the need for diabetes prevention on government Internet publications on the model of the government website of Canada: https://www.canada.ca/en.html

II. SOCIAL: PREVENT DEATHS

In matters such as health, the main focus should be on helping people learn to help themselves:

1. Engaging the healthcare system

2. Reaching Out to Everyone in the Most Remote Corners

3. Keeping communities engaged

4. Accustoming from childhood to a healthy lifestyle

5. Living up to expectations

WHAT TO DO?

• Empower people who want to prevent diabetes through the Enlightenment and with the help of new technologies.

• Focus on the fight against DiaObesity, especially in the school environment.

• Evaluate "How our actions contribute to the desired outcomes"

TASKS

1. Pay due attention to educating the population about the need and possibility of preventing DiaObesity, Prediabetes and Type 2 Diabetes

To translate, adapt to current circumstances and bring to stakeholders the recommendations of the IDF "RECOMMENDATION TO STAKEHOLDERS: prevention of obesity and type 2 diabetes in the school environment"

PROVEN Diabetes Intervention in Schools Produces Really Positive Outcomes
(systematic review of the literature
https://www.jphres.org/index.php/jphres/article/view/467)

2. Approve a system of early diagnosis of diabetes and its complications: conduct screenings and provide an operational Register to record the results and analyze the situation.

- General screening for type 1 diabetes is not recommended.

- Introduce screenings for early detection of diabetes complications (Diabetic Retinopathy, Diabetic Foot, Nephropathy)

- Screen every 3 years:
In the population aged ≥40 years or those at high risk, so as not to miss those with undiagnosed dysglycemia.

Evaluate and screen more frequently in people with additional risk factors. See "Screening algorithm for type 2 diabetes in adults" (in 2021, the United States Preventive Services Task Force (USPSTF)):https://jamanetwork.com/journals/jama/fullarticle/2783414

- Issue recommendations for targeted screening for type 2 diabetes in overweight or obese adults aged 35 to 70 years.

- Adapt the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) https://www.healthycanadians.gc.ca/en/canrisk – which is a statistically significant risk assessment tool that is suitable as an educational tool for patients to self-assess risk. The questionnaire is available on the government website of CANADA!

3. Implement a publicly accessible therapeutic education system for diabetes patients

Therapeutic education has become a universally recognized integral component of diabetes treatment and an effective mechanism for preventing severe complications.

In the country, the network of Diabetes Self-Management Schools has been devastated, despite demonstrating their utility and effectiveness. It is necessary to introduce training and certification of instructors for these schools under uniform programs approved by relevant authorities.

III. ECONOMIC: SAVING COSTS FOR IMPROVING DIABETES CARE

1. Restore the collection of statistical data on diabetes type 1 and type 2.

There are no current statistical data. Data for 2021 are provided in the "Atlas: Diabetes in Ukraine," published by the Ukrainian Diabetes Federation (UDF) https://diabetesatlas.com.ua/ua.

Statistics are crucial for decision-makers and future planning.

2. Review and finally approve the "Protocols for Providing Care for Type 2 Diabetes."

The absence of protocols hinders the quality control and effectiveness of medical care for people with diabetes.

3. Address the National Health Service of Ukraine (NHSU) with a proposal to include prevention in the package of guaranteed services.

4. Adopt and implement the "Type 2 Diabetes Prevention Plan."

Most countries around the world have such programs, and they have proven to be effective.
See the overview at [link]: https://diabetesatlas.com.ua/ua/pro-diabet/tpost/0ijp3xxil1-proflaktina-dabetu-2-tipu

APPENDIX

NATIONAL DIABETES PREVENTION PROGRAM IN THE USA

The growing burden of diabetes on health and the economy has made preventing this disease a priority in public healthcare.

However, investing in chronic disease prevention programs requires a long-term horizon, as it may take many years for the subsequent savings to fully offset the initial intervention costs.

Using a simulation model, the costs and benefits of a nationwide community-level lifestyle change program for the prevention of Type 2 diabetes were projected.

Taking into account all healthcare system costs in the USA, the results show that the program will pay for itself in just fourteen years. Over twenty-five years, the program will prevent or delay about 885,000 cases of Type 2 diabetes in the United States and save $5.7 billion nationwide. If the program targets people aged 65-84, it will save $2.4 billion.

Thus, implementing such a nationwide program would be an efficient use of healthcare resources, although it may be necessary for all health insurance companies to participate in the distribution of prevention expenses. Our results also show that while the prevention program will lead to cost savings in both young and old people, it will bring more health and economic benefits if it targets people under 65 years old.