Silesian Center for Heart Diseases
Krzysztof Strojek, MD is a specialist in internal medicine, diabetology and hypertensiology, and a National Consultant in Diabetology..
Academia: How is diabetes diagnosed and treated in today’s unfavorable state of the Polish healthcare system?
Krzysztof Strojek: The problem with diagnosing this condition stems from the fact that at first it appears as slight hyperglycemia, which is characteristic of type 2 diabetes, and does not cause any alarming effects. Thus the patient isn’t aware of the dangers, or ignores them. This is why routine checkups are necessary, even if we’re feeling fine. It’s ironic that we take our cars for inspection every year, but we are not as diligent when it comes to our own health. The aim of modern medicine, including diabetology, is to diagnose diseases very early on, before they are even clinically perceptible. It is based on routine checkups of apparently healthy people. In its recommendations, the Polish Diabetes Association includes the requirement to test blood glucose levels, which enables early detection of diabetes, every three years in persons over 45 years of age, and once a year in those at a higher risk of contracting diabetes. The data from our report shows that for every three people diagnosed with diabetes one person is not aware they have the condition.
That’s quite a lot.
Yes, but we can see progress. A few years ago, for every patient diagnosed with diabetes there were two undiagnosed cases. Besides, these figures do not deviate from the European average. But the shortage of specialists certainly presents a problem. According to my calculations we need 1500 diabetes specialists, but Today have 1100, which is about 30% fewer than needed. In addition, they are unevenly spread out. There are regions where 85% of the demand for them is covered, but then there are those areas where that number doesn’t exceed 40%. Of course not all diabetics need to be treated by a specialist. Insulin-dependent diabetics and those with complications should be treated at a Diabetes Clinic. But patients who take oral medications may remain in the care of a family doctor, and only annually consult a specialist to evaluate their clinical state and determine further treatment.
What is used to treat diabetics in Poland today? The newest medications available to diabetics in Western Europe?
All diabetes medications available world-wide are licensed in Poland. This means all types of therapy are accessible, but only in theory. It’s an illusion, because for the past ten years newer therapies have not been reimbursed. They cost 100‒200 PLN per month, which significantly restricts access to them for most patients.
Are the numbers of newly diagnosed diabetics in Poland increasing as fast as in other countries?
We don’t have complete data on this. Our report reflects the current situation, and doesn’t enable us to assess trends. However, in the future it will be the starting point for further estimates. Indirect data suggest an upward trend, as in other countries in our latitude and similar stage of development. It is mainly based on growing obesity and overweight issues.
There were plans to establish a National Program for Prevention of Diabetes and related complications. Was such a program created?
That program was indeed established several years ago, but the funds allocated for its implementation amounted to 2 million PLN, which comes out to less than one zloty per patient. The Polish Diabetes Association is strongly urging the Ministry of Health to launch another program.
In January, David Ludwig, an American endocrinologist and Professor of Pediatrics at Harvard Medical School, published a book entitled Always Hungry, in which he writes about the insulin-carbohydrate model of obesity, where excess refined sugar interferes with the self-regulating balance of the metabolic system. What are your thoughts on the impact of sugar on our bodies?
Sugar is not a problem in itself. The notion that consuming large amounts of sugar can lead to diabetes is untrue. However, excessive consumption of food, including carbohydrates, may cause the condition through the induction of obesity. Professor Ludwig suggests that high intake of carbohydrates increases the appetite due to release of insulin and thereby contributes to obesity through unnecessary consumption of excess food, causing diabetes in the process.
In order to digest sugar, the body uses many valuable components, such as B vitamins, chromium and zinc, which is essential in fighting depression. Is sugar addictive as well?
It is not a classic addictive drug, but for some people, because of its taste, or simply because it’s “delicious,” it seems essential for normal functioning.
How can such a person survive on a low-sugar diet?
They have to realize that this is not something essential to survival. It also helps to find other pleasures in life aside from food, and sweets in particular.
Statistically, each person consumes 25 kg of sugar per year (previously 2.5 kg), which adds an extra 260 calories per day. Should we avoid products to which sugar was added, such as bread, which did not need extra sugar in the first place?
I very much urge everyone to carefully read food labels and avoid those products which are high in carbohydrates. In some countries, including the UK, there is an ongoing legislative process aimed at increasing the excise tax on sugar, so as to reduce its consumption, and thus halt the plague of obesity and diabetes.
Sugar causes the deposition of cholesterol. 61% of Poles have elevated cholesterol. How does this number compare to other countries in the world?
It seems to me that in this respect we are no different from other societies in developed countries.
At the end of your report there is a chart showing that the world’s top ten countries in terms of numbers of diabetics include the highly evolved and health conscious Germans and also the slim Japanese. That’s a big surprise. What could be causing the high incidence of diabetes in those countries?
Germans gain weight similarly to us Poles, while in the case of the Japanese the problem is genetic predisposition. A growing number of patients with type 2 diabetes in this country are people who are not overweight. Intensive research is underway to explain this phenomenon.
Interviews by Anna Kilian
Photographs by Jakub Ostałowski
© Academia 2 (50) 2016