“Advocating for Diabetes Care”

Presidents Blog - 2nd February 2013

Welcome to my first “Presidents Blog” posted on the new ISPAD website. A blog can be defined as “a Web page that serves as a publicly accessible personal journal for an individual, typically updated on a regular basis that often reflect the personality of the author”.  According to the Urban Dictionary a Blogger is “used to describe anyone with enough time or narcissism to document every tedious bit of minutia filling his or her uneventful lives. Possibly the most annoying thing about bloggers is the sense of self-importance they get after even the most modest of publicity”.

Gosh! Perhaps I should stop now. However, I hope I can control my ego and piousness (further criticisms from the Urban Dictionary aimed at the Blogger) and perhaps give some reflective thoughts on my role as President of ISPAD and my interactions with the world of Diabetes in the Young. A Blog only thrives on the responses it generates and that is down to you. Please comment, criticise, reject or even agree with my comments and ideas. If I can stimulate the ISPAD Community to interact then I will be delighted and perhaps add value to the Web site.
For this Blog I would draw your attention to the section on the web site on the “ISPAD Declaration of Kwa Zulu”. At recent meetings around the world the original ISPAD declaration was raised. I felt that in the twenty years since the original had been proposed, time had moved on and the aspirations of health professionals looking after young people with diabetes, even in resource poor countries, need to take account of these changes.

Perhaps the most controversial comments in the Declaration are: “all sick children need a blood glucose measurement” and “resource driven intensive therapy”. While in India recently, I heard the phenomenal success of the eradication of polio, with no cases in the last 2 years. Set against this, the lack of availability of blood glucose testing for all sick children is a disgrace. The improvements in the technology and ease of use of capillary blood glucose testing have been one of the tremendous successes in diabetes in recent years. Lack of availability in certain countries cannot be tolerated and we must advocate for its introduction into the health service programme of all countries as routine practice. In Africa, this should be routine practice as blood glucose testing is mandatory for the triage of all sick children, as recommended in the WHO ETAT+ programme. The reason is to monitor for hypoglycaemia in acute infection, but if performed routinely it will pick up the child with diabetes.

At the same time ISPAD has a duty to instruct and train health professionals in the use of capillary blood glucose testing. Only in this way will the “true” incidence and prevalence of Type 1 diabetes become know and encourage the development of epidemiological registers, the starting point for the development of good practice and the monitoring of outcome of care.

All management of diabetes of diabetes is intensive: that’s what the children and their families tell us repeatedly. We must recognise this even if access to certain diabetes technologies are not available in various parts of the world. While recognizing that we all wish to offer our patients the best treatment, ISPAD has to be conscious that Centres are performing as well as they can, and should be congratulated. Again advocacy of improved service resources is a major role for ISPAD. More on this in my future Blogs.

Again resorting to the dictionary, advocacy can be defined as a political process by an individual or group that aims to influence policy and resource allocation decisions within political, economic, and social systems and institutions. ISPAD needs to be at the forefront of the Advocacy for Diabetes in the Young. The “Declaration of Kwa Zulu” is a route map for that advocacy. However, I am sure there are many others tracks on this journey and it would be good to hear from the membership about their experiences, successes and failures in advocating service provision for young people and their families with diabetes.

Stephen Greene

Stephen Greene is the current President of ISPAD. He is a Professor of Child & Adolescent Health at the University of Dundee, Scotland and has been a member of ISPAD since 1990. He would be delighted for any engagement with his Blog but would ask you respect the normal and accepted rules of civilised debate and criticism. He will try to comment on all aspects of Diabetes in the Young, but cannot engage in specific discussion of clinical care or management.