LEADER

Stockholm 1995: personal reflections on an international meeting

e 31st annual meeting of the European Associ- ation for the Study of Diabetes (EASD) was held

Seepage286 ence, and what prerequisites for such learning are needed. Thus the Datient’s own blood glucose

this year in my home town, Stockholm. What messages would the participants bring home this year and what effects on their research and treatment would result? I often bring very personal memories from these meetings. This year I noticed a new strong presence of people from Russia and the Baltic states. The pharmaceutical companies have entered these new markets, and brisk competition is evident. To me, this signals a new era for the many millions of patients with diabetes who have suffered from restricted supplies and inadequate products. Now these people should gradually get access to better diabetes care and health. Economic barriers may still block many from obtaining essential drugs and accessing tools to learn how to understand their diabetes in a proper way. Nor will they be untouched by the sluggish translation of medical research into clinical practice.

Professor Michael Berger, President of the EASD, pointed out that a major future task ahead will be to bridge science and patient care. In his flamboyant Claude Bernard Lecture, Professor Berger gave many examples of how much is needed in order to practice sound evidence-based diabetes care. He critically examined the lack of data on long-term outcomes and the need for effective teaching methods in diabetes education.

The Diabetes Education Study group of EASD demon- strated what this entails in their workshop ‘New trends in diabetes education - a hands-on experience’. The purpose of the workshop was to show how a tutor can elicit meaningful learning in the patient, based on his own experi-

- monitoring can become a learning tool with which to understand how the body reacts to food, exercise and medication. The patient will gradually learn from experience that which is not easily obtained from textbook manuals - that to balance glucose levels is a skill that must be acquired by practice and reflection.

The EASD meeting attracted a large number of researchers, and they listened to some very informative ‘state-of-the-art’ lectures. 1 updated myself on the mechanisms that trigger insulin release from the beta cells and learned about the intricate molecular machinery that translates the glucose signal into insulin release. I obtained a comprehensive picture of how intracellular metabolism is adapted to sense glucose and control the release of insulin via regulation of ATP and intracellular calcium. It seems that, from this new knowledge, new drugs and better treatment for NIDDM patients should emerge. When you sit in the darkness of the conference room and think you comprehend it all, you wish that you could rapidly translate this under- standing into clinical practice. Yet we know how tedious that procedure can be. In a meeting like this with more than 5000 participants, there are opportunities for creative jumps in understanding; but until they materialise, we can achieve a considerable amount from present-day knowledge of how to treat our patients, even if we cannot cure them as yet.

Professor Urban Rosenqvist MD PbD Akademiska Sjukhusol, Uppsala Universitat, Sweden

War, diabetes and humanitarian aid umanitarian aid in disasters has generally con- Seepage 276 problems for an agency in entering a commitment to H centrated upon the plight of those with acute - supply a drug that will be needed for life; many

problems, infection, injury and starvation. Recent conflicts humanitarian aid agencies are not equipped to enter into this have meant that populations with an ‘Westerdaffluent’ type of relationship. pattern of disease have become in need of humanitarian aid. People with maturity-onset (non-insulin-dependent) Furthermore, it has meant that those previously in receipt of diabetes pose a different problem. In some cases their treat- treatment of chronic conditions have found their access to ment may appear inappropriate to an aid agency, with treatment threatened. The provision of humanitarian aid for insulin being used and demanded by healthcare facilities chronic conditions, especially in the circumstances of a where an agency might reasonably feel that these patients chronic ongoing disaster, has created new dilemmas and could be managed better on diet and/or oral agents. problems for those responsible for delivering humanitarian Agencies might find themselves in conflict with local medical aid. The conflict in the former Yugoslavia and the difficulty authorities as they try to introduce other methods of manage- of ensuring appropriate treatment for people with diabetes ment. It may well be that, under the dietary regimen im- epitomises many of these problems. posed by war, patients with non-insulin-dependent diabetes

The epidemiology of Type 1 (insulin-dependent) diabetes may have improved glycaemic control. in a population means that a reasonable estimate can be Many of the problems described in the article in this issue, made of the number of people with Type 1 diabetes likely to ‘Diabetes control in war conditions’, have been seen during be present within a population. However, this figure may be the conflict in the former Yugoslavia. This has been exacer- greatly distorted by influx of refugees or changes in the bated by the deliberate destruction of healthcare facilities as population age structure. The major problem lies in the pro- ‘legitimate’ targets. Agencies have found themselves entering curement, delivery and storage of adequate supplies of insulin into a commitment which has proved to be longer-term than within an area beset by conflict. Furthermore, there may be originally thought. Having started to supply insulin or

Practical Diabetes International Nou/Dec 1995 Vol. 12 No. 6 251