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Empowering Patients to Make Better Informed Decisions

Gisela Ayala Téllez - Mexican Diabetes Federation
Executive Director

STORY INLINE POST

Wed, 09/09/2015 - 13:18

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Q: The complications associated with diabetes are one of Mexico’s main causes of death. What factors have caused this epidemic?

A: Late diagnosis is a feature of doctor-patient relationships in Mexico. Studies have shown that patients are diagnosed 10 years after they have contracted the condition. Diabetes has no painful symptoms, and so in a culture which does not encourage check-ups, the outlook tends to be worse for patients who only go to the doctor when they feel ill. In fact, if a person suffering from diabetes feels ill, it is an indicator that the condition is very advanced. If the disease is caught early and controlled in an appropriate manner, life expectancy is not affected. Without early intervention, however, life expectancy can be reduced by up to ten years. Another issue about the culture is the failure of patients to stick with a treatment program. Less than half of patients abandon these programs for reasons including the complexity of therapies, given that the treatment involves taking medicines through different means at different times of day. Access to health services and medication is another major issue, since health centers do not often stock the required medicine. Without medication, treatment becomes more complicated, with patients and their families paying out of pocket to cover costs. The issue is worse for economically disadvantaged societies. The treatment programs for chronic illnesses last a lifetime, and must be adjusted based on a range of factors, including age, weight, severity of the condition, and the person’s level of physical activity. All the same, some patients follow the same treatment program using the same medical regime for 20 years or more, when the treatment must be adjusted to prevent complications. Lifestyle, long working hours, and low incomes aggravate the fact that Mexicans have a genetic propensity towards contracting diabetes.

Q: How does the Mexican Diabetes Federation (FMD) help to educate people?

A: We want people to know what diabetes is and what they can do to manage the condition. Many of the habits we recommend developing involve basic self-checking, such as healthy eating, exercise, and following medical instructions. We try to help incoporate theese practices in the everyday experience, so that patients can monitor glucose levels in the blood, as well as minor health complaints such as flus. The idea is to prevent or reverse complications, and also to promote positive mental attitudes. Common sense has a role to play in changing the perception of health in Mexico, since there is so much contradictory health information surrounding diabetes. One myth we must discard is that heathy food is always more expensive. We need to upskill patients to enable them to follow the right recommendations for treatment.

Q: What role does the FMD have in coordinating efforts within the field of diabetes care?

A: We try to join together the large number of organizations that are working on the issue. At first, since there were no organizations of this kind in Mexico, we learned a lot from the International Diabetes Association, along with other such groups in the US. We launched the FMD in Monterrey, before replicating the model in a number of other cities nationwide. Later, there was a need to unite all organizations of our kind. For the moment, we have 19 member associations, and we hope to end the current year with 22. Civil society has an enormous responsibility in this regard. A number of major challenges are required to keep these associations alive, since their strength depends on those volunteers who dedicate their time to this work without pay. We want all of our member associations to provide the same level of care, wherever they are located.

Q: An estimated 60% of patients do not follow doctors’ instructions, with 35% of these seeking cheaper alternatives for their prescriptions. How does FMD intervene in seeing that doctors’ orders are followed?

A: The best way to do this is to help patients to understand why doctors have prescribed them particular medicines. It is better for patients to know what is happening in their own bodies, rather than simply taking medicine without understanding what it does. This is a primary reason for patients abandoning medical treatment. As such, we believe it is necessary to issue patients with the challenge of living better, so as to motivate them to continue with treatment. Informed patients make better decisions. Education must start with basic information, such as the fact that there is no such thing as healthy foods –only healthy portions. While health spending represents a large-scale outlay, it must be looked at as an investment.

Q: Estimates indicate that treating diabetes is 30 times more expensive than treating prediabetes. What is necessary to promote timely diagnosis?

A: Treating prediabetes is about supplementing lifestyle changes with improvements to diet, increased physical activity, and a reduction of belt-size paramount, supported by some kind of medication to control blood sugar levels. Every year that diabetes can be avoided represents a large saving in treatment. The government program Chécate, Mídete, Muévete has proven useful for the promotion of diagnostics and healthy lifestyles, though it could do with putting greater emphasis on selfmonitoring, since knowing how to measure food portions and to choose the right exercise habits are crucial here. Promoting cultural change means encouraging younger and older people to go for regular check-ups to detect medical conditions early. Empowering patients through education is necessary, since Mexico’s treatment offer is of an extremely high standard.

Q: What is the main target audience for the online educational programs offered by the FMD?

A: Organizations such as ours cannot simply focus on patient care without scientific backing, so the advice we offer is backed up by both patients and medical professionals. All patients need a multidisciplinary team behind them. We publish one magazine for patients, and another for doctors. We also organize congresses divided according to the same structure, inviting doctors, nutritionists, nurses, psychologists to one, and bringing patients to another. The idea is to phrase the same information in language which each separate group will be comfortable with. The congresses are successful, and bring in around 2,000 attendees each. We want doctors to have the most up-to-date tools for diabetes, helping them to communicate the right message to their patients. This is the objective of our online course. Since 80% of patients with diabetes are attended by a primary healthcare provider, this sector must be highly trained, knowledgeable, and give the most up-to-date health recommendations. This necessity extends to nurses, whose role is important, since they must supplement a 15-minute doctor’s consultation.

Q: What has your involvement been with the government schemes such as the tax on sugary drinks and the regulations on food advertising?

A: We have participated in outlining government regulations on prevention, treatment and control of diabetes mellitus. Our collaboration extends to work regulating cholesterol and lipid consumption, which is relevant to hypertension. We are also part of a monitoring group on non-transmittable chronic diseases, which is charged with evaluating the government’s strategies. Since medical professionals require a great deal of training in order to boost efficiency, our role is to contribute on questions concerning education.

Q: How does the FMD decide what foods to recommend to people living with diabetes? What criteria lie behind these recommendations?

A: This initiative was created to offer patients support in purchasing products. Our seal guarantees that contents indicated on the label are suitable for a diabetes patient’s diet –as well as for a healthy lifestyle in general. The process involves laboratory testing, verified by third parties. Our criteria relate to the amounts of salt, carbohydrates, and fat in a given product. We assist in the labelling of products, as well as contributing to the communications strategies of food companies. In this way, we meet the needs of our patients. We believe that no foods should be prohibited, since this makes these same products more desirable. The central pillar of this aspect of our work is a healthy diet based on healthy portions of different foods.

Q: What are the FMD’s plans for this year?

A: We want to strengthen ties between the 19 organizations that comprise our federation. We also hope to contact other groups so as to spread our influence throughout the country. We also run camps for children with Type 1 diabetes, which we hope to expand with the help of more volunteers. We also have a program for some 200 children in marginalized conditions who are living with this illness. Our relationship with the pharmaceutical industry is strong, and we intend to use this as an asset in assuring that more patients follow through on their treatment plans.

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