PEN: A real shot at addressing the diabetes epidemic, now!

27 August 2012

I just spent a fascinating week in China.

It started at a WHO meeting with 14 countries from the Western Pacific Region discussing the big question: Now that the UN Summit on NCDs is over, how can governments committed to addressing NCDs and diabetes do so in resource poor settings?

Now that the UN Summit on NCDs is over, how can governments committed to addressing NCDs and diabetes do so in resource poor settings?

In countries and areas where everything is scarce - money, medicines, trained health workers and patient records how can governments make these commitments more than paperwork.

Where health systems are designed to treat one off episodes of infectious illness and not designed for chronic diseases like diabetes, how can governments reshape these systems to tackle the diabetes epidemic.

I ended the week with very hospitable diabetes colleagues in Qingdao, the team led by the amazing Professor Dong who spotted diabetes as an issue decades before others had spotted China's current epidemic.   

The hospital he established now sees 50,000 outpatients a year. Demand is so great that they are building a second hospital in an effort to cope. His very able colleague Dr Zhang told me that many of those with type 2 diabetes have never been obese and a high percentage have to be swiftly moved on to insulin.

We have to prevent and delay as much as we can, but we must also take action to cope with the 366 million people with diabetes who are with us now, 92 million of them in China.

That's where the WHO meeting I attended last week comes in. Five years ago IDF experts were involved in developing a WHO protocol for identifying and treating NCDs at the primary care level in low income settings. The PEN (Package of Essential NCD Disease Interventions) got off to a slow start. It appears that new focus on diabetes and the NCDs following last year's Summit has prompted WHO to brush off the PEN package and see how it can be updated and evolved to answer that big question of 'what should we do?'

Primary health care workers must be equipped and trained to recognise and treat diabetes and its complications as far as possible.

And we should applaud WHO for doing this and for rightly focusing on primary health care. Primary health care workers must be equipped and trained to recognise and treat diabetes and its complications as far as possible. The numbers are now too great to think that the tertiary level can cope. Primary care workers need to be trained to know when they should refer a case on and then, have somewhere to refer it to.

The challenges are immense. Primary health care workers are already scarce and overloaded. But ignoring diabetes is not an option.  And as we know, real people come with multiple conditions. It is illogical to treat someone for TB only to let them die from diabetes complications. Diabetes is with us, governments have committed to act and so they must.  

The PEN package is not perfect. It misses out diabetes in pregnancy, it has no strategy for dealing with traditional and 'quack' medicine which targets NCDs far more than infectious, it needs to develop health worker training to fit the real world and promote the all essential empowerment of patients. And it must recognise the role that NGOs like IDF and its member associations have to play. We have expertise, experience and people power to assist governments in a job they will not be able to do alone.

Nothing in PEN is new but it presents an opportunity to make primary healthcare more effective for chronic diseases and all other conditions

We will work with WHO and give our feedback on all these issues, to improve what is basically a very sound approach. Nothing in PEN is new but it presents an opportunity to make primary healthcare more effective for chronic diseases and all other conditions. If WHO and governments get PEN right it will save lives and money through early detection of diabetes, early treatment and making the most of inexpensive and effective medicines. This could be a very big step forward for millions of people now struggling with diabetes in poorly resourced health services.

We are here to help.