Sugar Dagger and Educate to Protect the Future

I wrote the following almost 20 years ago in my newspaper column: “The golden age of hominids is over. We are the only ´Homo´ that exist after a long period of evolution. But where is Homo sapiens heading, perhaps towards Homo diabeticus? Today I confirm that yes.

There have been many diseases whose natural history has changed with civilization. The improvement of hygienic conditions and advances in the management of many acute diseases have allowed the population pyramid to change, increasing life expectancy, also called survival by the famous Spanish filmmaker Luis Buñuel, who died in our country at the age of 83. years. The Life Expectancy at Birth (LEB) in Mexico in 1940 was an average of 37 years and went to 75 years in 2020. There are calculations that in 2022 the LEB will register a decrease to 71 years, due to the associated excess mortality to Covid-19 and the poor planning of the hospital “conversion”.

However, even in the face of all the technological progress and success in health, chronic adult diseases such as Diabetes Mellitus (DM) -taking the literary license of calling it “Sugar Dagger”- are claiming the greatest number of victims, already by premature death or already due to disability, turning DM into a public health problem of epidemic proportions, which requires the collaboration of all to prevent and control it.

DM in 2019 was the cause of 8.24% of Healthy Years of Life Lost, with a growth trend of 2.4% in the last decade. The INEGI has just reported the definitive 2021 mortality: 140,729 deaths from DM as the main cause, to which should be added the fraction of deaths where DM is a triggering factor, such as 225,729 from heart disease and more than 12 thousand for kidney failure.

Speaking in economic terms, the DM in Mexico -based on 2019 but converted to 2022 pesos- had a “direct cost” of 38 thousand 331 million pesos for ambulatory medical care (12.5%) and 267 thousand 540 million pesos for the medical attention of its complications (87.5%). The indirect cost of DM that same year was 236,850 million pesos due to premature death; 29,831 million due to lower productivity; 29,512 million for disability and 29,138 million for incapacity for work. In total 631,202 million pesos, that is, 70% of the public budget dedicated to health. To measure it, it is six times the budget that will be allocated to Insabi during 2023 or 73% of all the remittances of dollars sent by our countrymen from January to September of this year.

Next Monday “World Diabetes Day” will be celebrated -yet another…- with the motto “Educate to protect the future”, which always has diabetes training and education as its central axis, as it is the key tool for people living with the disease can avoid and reduce future complications to enjoy a good quality of life. And it is that diabetes education is part of essential care and, therefore, it is a right that must be guaranteed to patients, through a health system focused on chronicity and health professionals trained specifically in diabetes.

A successful example of “educating to protect the future” and not falling under the sugar dagger has been the “Diploma in Therapeutic Education in Diabetes DETD-Gto” of the University of Guanajuato, with funds originating from Innovation of the Government of Guanajuato and the communion virtuous with the Mexican Association of Diabetes in Guanajuato so that the graduates acquire their knowledge, abilities and skills with people who live with DM.

The DETD-Gto began in 2011 with the objective of training health professionals, mainly from public health institutions, to educate people with diabetes in their own management, as a cost-effective strategy to reduce the social and human costs of diabetes. the disease in Guanajuato and the country.

The health professionals who graduated from this continuing education program, trained as diabetes educators, explain the theoretical and methodological bases for educating people living with diabetes in their self-care; They work in interdisciplinary teams applying a preventive and comprehensive approach, having a significant impact on the person with diabetes, their family and community.

To date, 577 diabetes educators have graduated, each one in his generation planning an education and research project on DM within his professional setting, his community or working with his own family, an average of 80 people living with or at risk to develop responses.

At the beginning of this year, within the follow-up of DETD-Gto graduates, a survey was applied to 140 of them, answering that the most valuable thing they learned was active listening, empathy and insulin treatment. They also referred as a satisfactory result, the gratitude of their patients for improving their diabetes management and their quality of life. One of the comments was: “I had done other courses and this was definitely the most complete. My relationship with patients has improved remarkably, their results are much better, their mood in the consultation. And my insulin management is, without exaggeration, abysmally better.”

I want to recognize from this column the rectors José Luis Lucio Martínez and Carlos Hidalgo Valadez; doctors Rosa María Aguilar Tlapale, Sergio Márquez Gamiño and Elvia Rodríguez Villalobos; and hundreds of national and international professors who altruistically have made DETD-Gto a global example to follow. Congratulations! And to give it that it is pot mole, because the task is still immense.

I conclude, dear readers, by telling you that in the last ten years Guanajuato has obtained first place in the diabetes care quality index, rated by the Federal Ministry of Health and, I am certain, that the DETD-Gto students have been An important part of this achievement, undoubtedly driven by the dedication to health of the thousands of health workers in Guanajuato, its Secretary of Health, Dr. Daniel Díaz Martínez, and Governor Diego Sinhue Rodríguez Vallejo, who has had the support of your Congress to invest like never before in people’s quality of life.

*Éctor Jaime Ramírez Barba is a surgeon, specializing in public health, with a doctorate in health sciences and public administration, and is a re-elected deputy of the PAN parliamentary group in the LXV Legislature.