Building European Partnerships in Diabetes Conference

I. INTRODUCTION

The conference-debate was organized in the preamble of the most important Eastern European manifestation focused on diabetes, held in 2023 in Romania, The Congress of the Central European Diabetes Association (CEDA).

The objective of the event was to emphasize the importance of collaboration for the prevention and control of diabetes, but also to develop the exchange of scientific experience to build strong partnerships in diabetology at the central European level. Lecturers, opinion leaders in the field of diabetes, from national and international level, attended the debate.

• Assoc. Univ. Dr. Anca Pantea Stoian, CEDA 2023 local scientific coordinator
• Local scientific organizer of the CEDA 2023 Congress: "Carol Davila" University of Medicine and Pharmacy Bucharest

II. SPEAKERS

• MD. Assoc. Prof. Anca Pantea Stoian, elected Vice President of CEDA/FID
• MD. PhD. Prof. Viorel Jinga, Rector "Carol Davila" University of Medicine and Pharmacy, Bucharest
• MD. PhD. Prof. Peter Kempler, President of CEDA/FID
• MD. Assoc. Prof. Diana Loreta Păun, Presidential Advisor, Department of Public Health
• MD. PhD. Prof. Alexandru Rafila, Minister of Health
• MD. Assoc. Prof. Adela Cojan, President of the National Health Insurance House
• MD. PhD. Prof. Chantal Mathieu, EASD President
• Bart Torbeyns, Executive Director European Diabetes Forum
• Dan Nica, Member of The European Parliament
• MD. PhD. Prof. Cătălina Poiană, President of the College of Doctors from the Municipality of Bucharest
• MD. PhD. Prof. Manfredi Rizzo, University of Palermo, Italy, and Rector’s Delegate for International Cooperation
• MD. PhD. Prof. Bogdan Timar, Dean of the Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Vice President of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases
• MD. PhD. Prof. Thomas Stulnig, Former President of CEDA/FID
• MD. PhD. Prof. Maria Moța, Former President of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases
• MD. PhD. Prof. Cornelia Bala, Member of the Board of Directors of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases
• PhD. Prof. Mihnea Costoiu, Rector of the Polytechnic University of Bucharest
• MD. PhD. Prof. Dan Ionuț Gheonea, Rector University of Medicine and Pharmacy in Craiova
• MD. PhD. Prof. Andreea Didilescu, Dean of the University of Medicine and Pharmacy Bucharest, Faculty of Dentistry
• MD. PhD. Prof. Francesco Giorgiono, EASD Ambassador
• MD. Beatrice Mahler, Manager of Nasta Institute
• MD. Ștefan Busnatu, cardiologist, Vice Dean "Carol Davila" University of Medicine and Pharmacy, Bucharest
• Rodica Molnar, The Association of Diabetic Children and Young People from Mureş (Ascotid)
• MD. PhD. Prof. Nebojsa Lalic, IDF Europe Regional Chair
• Cristina Petruț, Psychologist, Vice-president of the Federation of Diabetic Associations in Romania (FADR)
• MD. Assoc. Prof. Bogdan Mihai
• MD. Delia Reurean Pintilei
• MD. PhD. Prof. Dario Rahelic, President of Croatian Society for Diabetes
• MD. Cristina Lăcătușu
• MD. Zinaida Alexe, President of the Society of Endocrinologists from The Republic of Moldova

III. Main statements

MD. Assoc. Prof. Anca Pantea Stoian, Vice-president CEDA

I am extremely honored that Romania hosts one of the largest annual European scientific events in the field of diabetes, as well as this conference-debate, organized in the preamble of the 54th Central European Diabetes Association Congress (CEDA). Why a meeting at the Palace of the Parliament in the preamble of the CEDA Congress, 2023 edition?

We considered that it is extremely important to provide the framework to implement and develop scientific collaborations in diabetology at European level. For five days, some of the most important leaders in diabetology at European level are present in Romania and, together with colleagues from Romania, I am convinced we can identify perspectives for collaboration in diabetes.

Romania has a strong tradition in diabetes, so we can lend a hand and be part of building strong bridges of collaboration at European level in the field of diabetes. Science, exchange of experience and interaction are fundamental directions for this year‘s edition of the CEDA Congress.

Today‘s conference is held under the concept: Building Partnerships in Diabetes at European level. Much more than before, especially during the pandemic, as well as presently, we observe a heightened dynamism in the scientific field. We see how the data changes from day to day and I am convinced that we all understand how important research or the exchange of experience and information between specialists is.

I am confident that we will lay the foundations and build together a solid platform for discussions – a scientific summit – and I am honored that CEDA 2023 is being held in Romania under the auspices and with the University of Medicine and Pharmacy Carol Davila from Bucharest as the local scientific organizer, one of the traditional Universities of Medicine and Pharmacy in Europe. Prevention of diabetes is essential to reduce the impact of this condition on health and quality of life. A multidisciplinary approach, involving different medical specialties as well as patient cooperation, can have a significant impact on diabetes management. The multidisciplinary approach to diabetes prevention requires the involvement of a wide spectrum of health professionals. Through collaboration between these specialties, better outcomes can be achieved in early identification and management of diabetes risk. Exchange of experience and collaboration between health professionals are also key factors in diabetes prevention. Through this scientific exchange of information, specialists can learn from each other, keep up-to-date with the latest developments in the field, and develop innovative approaches to diabetes prevention. Collaboration with patients is also an important aspect in preventing diabetes complications. Educating people with diabetes can encourage personal responsibility and action regarding their lifestyle and health. Also, by creating a discussion platform like a European scientific summit in diabetes with the involvement of all factors, from doctors, to decision-makers in the field of diabetes and patients, I am convinced that we can identify solutions in the most effective management of diabetes.

MD. PhD. Prof. Viorel Jinga, Rector of UMF "Carol Davila"

Building partnerships in diabetes at EU level can be a great opportunity. Prevention campaigns & medical prevention should remain amongst the priorities of medical professionals.

MD. PhD. Prof. Peter Kempler, President of CEDA/FID

Romania is fully reintegrated into CEDA after 13 years. The mission of CEDA is to integrate more countries – therefore, next year Italy will be integrated into CEDA.

MD. Assoc. Prof. Diana Loreta Păun, Presidential Advisor, Department of Public Health

The number of cases of diabetes and the prevalence of diabetes has been increasing globally. Diabetes is one of the most challenging health problems of our century. Strong partnerships in medicine support the global health knowledge and promote health equity.

MD. PhD. Prof. Alexandru Rafila, Minister of Health

This event brings to the fore the recognition of the Romanian school of diabetes, nutrition, and metabolic diseases. Diabetes affects a large percentage of the European population and is a multifactorial disease with potentially serious complications. The Ministry of Health has a very good partnership with the National Health Insurance House. Recently, the two institutions have worked to integrate into the framework contract a package of preventive services for citizens that makes early diagnosis of diabetes possible and facilitates patients’ access to medical services.

MD. Assoc. Prof. Adela Cojan, President of the National Health Insurance House

There are 15 curative national health programs financed by the National Health Insurance House with the help of the Ministry of Health. Starting from this year there are important changes to the legislative framework and a consistent financial effort (over 1 million patients).

The National Health Insurance House is very involved in prevention activities. With the entry into force of the new framework contract, patients will be able to access a series of prevention services, with the help of family doctors. They will be directly involved in the process through financial incentives given to them for early detection of diabetes or providing nutritional advice. With the help of these new tools, we believe that we will be able to change the behaviour of patients, especially regarding the early detection of diabetes.

Together with the Ministry of Health, we run the Monitor 7 program and patients no longer have to wait a long time (maximum 5 days) for investigations. Access to specialized services has also been widened (expansion from 7 to 36 centers that can offer specific investigations).

MD. PhD. Prof. Chantal Mathieu, President of EASD

EASD underlines the importance of collaboration in dedicated research – thus, EASD wants to collaborate with all researchers, but mostly from eastern EU Countries. Europe has different initiatives regarding type-1- and type-2-diabetes.

There is a gap between specific literature and the implementation of the findings – EASD and ADA will collaborate on finding the best instruments to implement the academic findings (such as access to different medicine/technology and therapy).

With regards to type-1-diabetes, we have now the proper instruments for early detection. A big new project – "Identify" – different strategies to help people detect type-1-diabetes – will be implemented in Poland, Czech Republic and Italy.

Bart Torbeyns, Executive Director of The European Diabetes Forum

The European Diabetes Forum brings together all STKs from across Europe working on the policy agenda. The Romanian Diabetes Forum is the most active organization at national level.

Underlines the importance of an EU joint project on diabetes and cardiovascular diseases, which Romania is part of.

Dan Nica, member of The European Parliament

The message for researchers is to be active and involved, even if they sometimes run into red tape, even at European level.

Mr. Nica is responsible for The Horizon Europe Program (the diabetes financing exceeds 800 million euros), a very important program.

He promotes the introduction of mandatory minimum standards for prevention, screening, continuous monitoring. The participation of Romanian hospitals in clinical trials is an extraordinary thing, with numerous benefits.

MD. PhD. Prof. Cătălina Poiană, President of the Romanian College of Physicians

The most effective way to tackle a disease is prevention. There are over 760 million patients with obesity (it is a chronic disease with alarmingly increasing numbers). In 2030, the figure worldwide is 1 billion adults with obesity. In Romania, the prevalence of obesity for adults is 22-23% adults and by 2035 it is estimated to grow up to 35%, and in children an increase in annual incidence by 5.6%.

MD. PhD. Prof. Adrian Streinu-Cercel, President of the Health Committee of the Romanian Senate

It remains to be seen to what extent artificial intelligence will help in the fight against diabetes. Until then, we have prevention, to which we must pay more attention. If there is a need for legislative improvements, especially related to prevention, the health commission is at the disposal of all interested parties.

MD. PhD. Prof. Manfretti Rizzo, Delegated Rector for International Cooperation of the University of Palermo

We have to ensure patients the best treatment and a long healthy life. The most important thing, but a weak point in most EU countries, is the early diagnosis event though it’s not that difficult to put into practice. We have the responsibility to offer them a better and longer life through early diagnosis.

MD. PhD. Prof. Bogdan Timar, Dean of the Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Vice President of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases

Telemedicine in diabetes has had a rapid growth over the years, its rate being major impacted by the COVID-19 pandemic. Still, telemedicine can be used nowadays with great results, to enhance and optimize the patient healthcare provided interaction.

We now have both the infrastructure and the legislative framework for implementing telemedicine solutions for patients with diabetes. Telemedicine will not replace classic on-site consultation but will be of very much use for both patients and medical specialists.

MD. PhD. Prof. Thomas Stulning, former president of CEDA/FID

Early detection & early treatment mean extending the life of a patient.

MD. PhD. Prof. Maria Moța, Former President of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases

The prevention of gestational diabetes by educational programs & screening in weeks 24-28 for all women no matter the risk. Therapeutic education of patient with gestational diabetes, regarding diet, performing blood glycemia, recognizing the symptoms etc. was included in the National Health Programs by the Ministry of Health and The National Health Insurance House.

MD. PhD. Prof. Cornelia Bala, Member of the Board of Directors of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases

Therapeutic education has been recognized as a method in the complex, comprehensive care of people with diabetes.

Unfortunately care systems are not sized to meet the needs of a growing number of people with diabetes. Directions of action were mentioned:

• the creation of specific partnerships dedicated to therapeutic education requires an adaptation to socio-cultural particularities;
• crafting structured programs of therapeutic education, professionalization, and research in the field of therapeutic education.

The Diabetes Education Study Group, carried out at regional level, it’s an important and useful experience for creating new opportunities for collaboration leading to a better quality of life for people with diabetes.

MD. Assoc. Prof. Florin Buicu, Vice-president of the Family and Health Commission of the Chamber of Deputies

Regarding The Law on the prevention and early detection of diabetes, it is the role of professionals and patient organizations to send proposals when the law/ the rules need to be improved.

There is a real opening of the Health Commission in the Chamber of Deputies regarding the debate of diabetes issues.

PhD. Prof. Mihnea Costoiu, Rector of the Polytechnic University of Bucharest

Today’s medicine cannot exist, cannot be conceived without technology, in the broadest sense of the term. The Polytechnic University of Bucharest is particularly involved in collaboration with medical universities in the country in research projects.

There are 3 important themes: the acceptance of technology by physicians (currently it is not used to its maximum capacity), the integration of artificial intelligence (the development of applications including in diabetes, invitation to test the projects submitted during this period to the physicians’ board) and access to data, big data (global analysis).

Regarding the ethics of using technology in medicine, beyond ethics in medicine - a debate is desired with all those who use and will use technology in medicine.

MD. PhD. Prof. Dan Ionuț Gheonea, Rector University of Medicine and Pharmacy in Craiova

The G6 UMF concept started 3 years ago as a necessity regarding the unity of decisions in medical education. The Innovation Hub is a country project in the field of health research and innovation, a partnership between the Ministry of Health, the G6 UMF University Alliance and the Local American Working Group.

In April 2023, on World Health Day, a conference, Craiova Conect, was built around 3 specialties: gastro-enterology, obstetrics-gynecology and diabetes and nutritional diseases, with over 650 physical participants – debating the efficiency of personalized therapies following a management of appropriate case.

IV. CALL TO ACTION IN DIABETES

MD. PhD. Prof. Andreea Didilescu, Dean of the University of Medicine and Pharmacy Bucharest, Faculty of Dentistry

Underlines the importance of collaboration between diabetes and dentistry. Diabetes can lead to multiple complications in the case of dental conditions. Dentists can be involved in early detection. There is already a partnership between the specialists of the two specializations.

MD. PhD. Prof. Francesco Giorgiono, EASD Ambassador

There is a great need to try to transfer the knowledge into initiatives that could help patients in a broad context (Europe and beyond) and this is a major priority for EASD.

EASD will initiate a new program - International Council - which will gather representatives from EU and other countries with the purpose of finding out how to translate the knowledge into practice and implement more effective treatment programs, especially regarding type 2 diabetes and what are the individual challenges of each country in terms of implementation of protocols and early prevention. EASD will invite CEDA to be part of this project.

MD. Beatrice Mahler, Manager of Nasta Institute

Diabetologist-pulmonologist collaboration is very important and must be developed, for the benefit of patients.

MD. Ștefan Busnatu, cardiologist, Vice Dean at the Faculty of Medicine Carol Davila U.M.F

It is very good that there are common tools for the management of the patient with cardiac conditions and diabetes, which must be used according to their specifics.

Rodica Molnar, The Association of Diabetic Children and Young People from Mureş - Ascotid

The proposed partnerships must support patients. Patient associations can get involved in the process.

MD. PhD. Prof. Nebojsa Lalic, IDF Europe Regional Chair

Speaks about the EU Parliament’s adopted resolution on prevention, management, and better care of diabetes in the EU on the occasion of World Diabetes Day. He is working for a high-level event under the umbrella of WHO Europe (invitation sent to all attendees at this event).

Cristina Petruț, Psychologist, Vicepresident of the Federation of Diabetic Associations in Romania (FADR)

The fact that diabetes remains high on the agenda is a gratifying thing. We need early detection, we need prevention and education and support for patients.

MD. Assoc. Prof. Bogdan Mihai

Systematic intervention involves very well synchronized human and financial resources. Medical efforts should be directed towards identifying patients with prediabetes.

MD. Delia Reurean Pintilei

Progress has been made in Romania in terms of patient access to different devices such as Insulin pumps and glucose sensors, but we still have a lot of work to do.

MD. PhD. Prof. Dario Rahelic, President of Croatian Society for Diabetes

It‘s crucial to have good collaboration with other countries and even smaller countries can contribute to the bigger picture.

MD. Cristina Lăcătușu

The number of doctors in this specialty has increased, so we can better cover the therapeutic area.

MD. Zinaida Alexe, President of the Society of Endocrinologists from The Republic of Moldova

We must emphasize building partnerships including in everyday medical practice, for the benefit of patients.

V. CONCLUSIONS

Diabetes prevention & early detection

Prevention of diabetes is essential to reduce the impact of the condition on health and improve the quality of life. There is a need to emphasize prevention activities, especially at primary health care level & introduce packages of preventive services that make early diagnosis of diabetes possible. Prevention campaigns & medical prevention should also remain amongst the priorities of the medical professionals. At the same time, medical efforts should be directed towards identifying patients with prediabetes.

Comprehensive care of people with diabetes

We have to ensure patients the best treatment and a long healthy life – said MD. PhD. Prof. Manfretti Rizzo in his address at the event.

The introduction of mandatory minimum standards for prevention, screening & continuous monitoring is a starting point. To integrate therapeutic education into the healthcare system, to make use of the benefits of telemedicine are also solutions for better care of people with diabetes.

Cooperation in every day medical practice

Experts highlighted the importance of a close collaboration between the team of specialists involved in diabetes management and care. Exchange of experience and collaboration between health professionals is a key factor in diabetes prevention & management.

Building partnerships & transfer of knowledge

There is a great need to transfer the knowledge into initiatives that could help patients in a broad context (Europe and beyond) – said MD. PhD. Prof. Francesco Giorgiono.

Strong partnerships in medicine support the global health knowledge and promote health equity – said MD. Assoc. Prof. Diana Loreta Păun in her address at the conference.

Ongoing & forecasted joint initiatives mentioned by participants at the conference:

• Collaboration between EASD and ADA on finding the best instruments to implement the academic findings (such as access to different medicine/technology and therapy)
• "Identify" project that will be implemented in Poland, Czech Republic and Italy and refers to different strategies to help people detect type 1 diabetes
• The Horizon Europe program is the EU’s key funding programme for research and innovation
• EU Parliament’s Resolution on prevention, management and better care of diabetes in the EU adopted last year on the occasion of World Diabetes Day
• International Council program, initiated by EASD, which will gather representatives from EU and other countries with the purpose of finding out how to translate the knowledge into practice and implement more effective treatment programs, especially regarding type 2 diabetes and what are the individual challenges of each country in terms of implementation of protocols and early prevention
• EU joint project on diabetes and cardiovascular diseases
• programs & specific partnerships on thematic areas, such as therapeutic education
• national collaboration platforms, like the Romanian Diabetes Forum that bring together STKs from the diabetes landscape
• Collaboration between medical universities and technology universities on research projects on topics such as: the acceptance of technology by physicians, the integration of artificial intelligence and access to data
• country projects bringing together institutions, universities and other STKS focused on health research and innovation.

Erschienen in: Diabetes, Stoffwechsel und Herz, 2023; 32 (5) Seite 263-268