The number of diabetic patients, as well as the number of men and women defined as pre-diabetic, is increasing in the world and in Israel. In the periphery the situation is particularly serious and an intervention is required to prevent complications among the patients and curb the number of new entrants to the circle of diabetes patients. The "Sferat HaGalil" initiative, which grew out of the Faculty of Medicine of Bar-Ilan University in the Galilee and is partnered by many members of the medical system, government ministries, local government and academia, was established with the aim of addressing and improving the situation.
How do the people of Galilee literature intend to realize this goal? Prof. Naim Shahada of the Rambam Medical College, one of the top endocrinologists in Israel and the chairman of the project, talks about the vision of the project and its tasks.
There are 460 million diabetics in the world today, and it is expected that this number will reach over 600 million in 20 years. "This is a very large epidemic that is intensifying, says Prof. Shahadah. The reasons for the increase in the number of patients include negative factors, but also positive ones. On the one hand, we are witnessing an increase in the population, and more risk factors such as obesity, a shift from an active to a sedentary lifestyle and a change in diet from natural food rich in fiber to processed food; On the other hand, the increase in general life expectancy and the increase in the life expectancy of diabetics specifically contribute to the prevalence of the disease in the population.
And what is the situation in Israel? About 600 diabetics live in Israel, and another 900 to a million men and women diagnosed as pre-diabetic. According to Prof. Shahada, the rate is similar to the one in the US or Europe. The pre-diabetic are an important and interesting group because every year up to 8% of them will become diabetic, they are in a gray area between diabetes and health. "If we really want to reduce the number of diabetics, this is the most important risk group, which we will treat and intervene in the Galilee literature through a change in lifestyle and the addition of simple and cheap drugs," He says. "With the help of such interventions, the passing rate can be lowered by 50%"
Prof. Shahada points out that reports and studies have been published in the world about intervention in the pre-diabetic population, and they confirm that with the right emphasis on a healthy lifestyle - exercise, nutrition and weight loss - the risk of deterioration from pre-diabetes to diabetes can be greatly reduced. One of the most famous studies in this field was done in Finland, published in 2006, and showed that a change in lifestyle could reduce morbidity by 43%. It was found that the positive changes in health, achieved during a four-year intervention, were also maintained after it for at least seven years. The healthy change in lifestyle and weight loss has a positive effect not only on diabetes, but also on the heart, blood vessels, blood lipid level and the risk of developing cancer caused by obesity, Prof. Shahada notes. "We influence the main causes of death in the world and in Israel. Although the title is diabetes, it is a healthy intervention in other serious diseases."
While the general picture of diabetes in Israel is similar to that seen in other developed countries, the situation in the Galilee is more serious. "The Galilee is a periphery," Secretary Prof. Shahada. "Periphery both geographically and socio-economically, unfortunately. There are publications of indicators carried out by the national program for quality indicators for community medicine in Israel, which presents things according to the socio-economic situation. For example, in terms of diabetics defined as balanced, we stand at 68%. But if we look at those with a high socioeconomic status, it seems that among them the good balance reaches 80%, while for those with a low socioeconomic status, the balance rate drops to 58%." This is a huge gap, which exists according to Prof. Shahada, since many of the diabetic patients in the Galilee are welfare recipients (in the five cities where Seferat HaGilil operates today, about half of the type 2 diabetes patients are welfare recipients). "This is due to difficulty in accessibility and the ability to obtain healthy food and appropriate medicines. Although Israel has one of the best medicines in the world, there are still segments of the population that have difficulty obtaining medicines even at the low price." He points out. "Sometimes a patient asks the pharmacist which drug is more important because he cannot afford to buy all the drugs he needs. Education and awareness of a healthy lifestyle and physical activity are also lower in the weaker populations."
The socioeconomic status is also a risk factor for obesity, which in turn is the most significant factor in the development of diabetes. "100 years ago obesity was a disease of the rich, but it has become a disease of the poor," says Prof. Shahada. "Although we are a country with a recommended Mediterranean diet, unfortunately the healthier food is more expensive and the poor cannot always get it." It is evident that one of the root causes of the high rates of diabetes and pre-diabetes in the Israeli periphery is poverty, and this the Galilee numbers will not be able to solve. Therefore, the strategy is to provide available and applicable tools for people living in poverty. A byproduct of success in this area will be the prevention of the burden that diabetes creates on families who are already facing financial difficulties.
According to the data, there is no doubt that there is more diabetes in the north and that it is less balanced there. "Balance is the most important factor, unequivocally, for preventing diabetes complications or at least delaying them," says Prof. Shahada. The most significant complications he points out are blindness that occurs at the age of 60-20 due to damage to the retina and blood vessels in the eye, extreme kidney failure requiring dialysis (45-50% of dialysis patients are diabetic), limb amputations, nerve damage, heart disease and stroke - All of these are more common in diabetics. A good metabolic balance reduces the risk of developing these complications.
Prof. Shahada explains that the intervention within the Galilee Literature project is divided into four arms:
Prevention - in this arm, the local authority is the central entity through which the intervention is carried out. The partners are the health funds, social organizations, government ministries and welfare services. In each settlement, the strengths and weaknesses are mapped, and accordingly interventions are carried out in the field of education, the offering of the services of health instructors, the cultivation of health-seeking schools, the introduction of Ministry of Health programs such as "Healthy Possible" and the construction of walking routes, later projects of overall situation assessment will be carried out.
Control and balance - here it is a direct intervention in everything related to the quality of the direct treatment of the diabetic patients to ensure a better metabolic balance that will prevent complications. The intervention includes educating the patient and providing appropriate treatment, and trying to understand why compliance with treatment is low. "This was done thanks to full cooperation that we were able to build with the health insurance funds and intervention with the help of family doctors for a better balance," Prof. Shahada says. "The doctors who work with us go through a course in diabetes education. They receive a certificate recognized by the state doctors' organization for diabetes doctors to improve the knowledge and service they provide to patients."
treatment (which) - here the focus is on ancillary services, making treatments and tests accessible, among other things with the help of a mobile that will allow all the tests that diabetic patients are supposed to do every year, such as blood tests, urine tests, blood vessel tests, eye tests, etc. - in one appointment within an hour. The mobiles will reach the hot spots, usually weak neighborhoods, and the patients will undergo all the tests on the spot and thus will not have to waste work days, travel and money. The arrival of the mobile will be determined according to the mapping of neighborhoods where there are more people who need the service. Prof. Shahada points out that there is experience in the world with similar mobility for the treatment of various diseases. In addition to making treatment more accessible, the mobile will make it possible to get an overall picture of the diabetes situation in the population, and it will be possible to learn from it about using similar mobiles to treat other conditions such as geriatric diseases.
Research - "We have a lot of research in the pipeline that relates to personalized medicine for the patient," Prof. Shahada notes. "Personalized-social medicine refers to all kinds of factors such as genetics that influence the response to treatment or explain why certain families have more cases of diabetes. Research is also carried out in the field of the microbiome (the population of intestinal bacteria), which is known to have an effect on morbidity and balance. In the social aspect, aspects such as the availability of healthy food, education, cultural and linguistic adaptation of the health services to the population, and responsiveness to treatment will be examined. In addition, engineers will check the urban plans, and the level of walkability (walkability) in the settlement" (as mentioned, the intervention includes the services of walking guides as part of the encouragement for physical activity).
The studies will of course also deal with the drug treatment. One of the serious revolutions in this field is diabetes drugs that not only balance the sugar, but also protect the target organs that are at risk such as the heart and kidneys. Prof. Shahada points out that such drugs are known in the medicine basket for a large part of patients. "We will improve the use of these drugs and increase the percentage of adequate treatment. In my estimation, this reduces damage to the heart or kidneys by almost 30%, which is a tremendous thing."
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