The Spanish Diabetes Federation (FEDE) has issued a manifesto on the occasion of World Diabetes Day in which it calls for equitable healthcare across the country, with special emphasis on territorial equality, therapeutic education, and care quality for all people with diabetes. It also highlights the relevance of emotional support and that family members and caregivers should have a more active role in healthcare.
These priorities have been defined based on a survey carried out among more than 300 attendees at FEDE’s most recent annual congress, and therefore they reflect the common position of the 18 autonomous federations and of more than 120 local associations integrated into the organization.
"We need the reality of the condition to be known by society as a whole, so that we can reduce its impact and its progression through therapeutic education in diabetes, emotional support, early diagnosis and prevention," says Juantxo Remón, acting president of FEDE.
"Access to technology, to treatments, and to therapeutic education continues to depend on the autonomous community in which each patient resides, with added differences between urban and rural areas," he explains. From this situation, FEDE calls for a uniform portfolio of services across the national territory and effective access to continuous glucose monitoring, adjusted to clinical recommendations.
Therapeutic education is listed as one of the central pillars of the Manifesto and also constitutes a historical claim of the advocacy movement. Until now, to a large extent it has been the patients’ own associations that have taken on this task, training people with diabetes and their families in the day-to-day management of the disease. FEDE argues that this training should be incorporated as a real service provided by the public healthcare system and also requests an official and unified system to accredit diabetes-specific nursing training.
The document’s third major block focuses on the quality of care and health technology. Patient associations call for comprehensive, coordinated care across all care levels, with enough time in consultation to meet individual needs. This quality guarantee, they point out, must also extend to medical and technological devices, ensuring not only their reliability, but also stable long-term supply.
Early approach to diabetes and the role of patients
Early diagnosis and treatment of diabetes are also among the main priorities for the group. In the case of type 1 diabetes, the introduction of autoantibody screening makes it possible to detect the condition before symptoms appear, reducing episodes of ketoacidosis at the onset by up to 90%. In type 2 diabetes, prevention and early action on risk factors such as obesity or hypertension are key to slowing the progression of the disease.
In light of these data, FEDE calls for the rollout of type 1 diabetes screening programs in pediatric populations at a national scale, as well as an increase in resources allocated to the detection and management of type 2 diabetes and its risk factors.
On the other hand, the organization emphasizes that patient participation in health-care decisions will be increasingly decisive. FEDE already has representation at the patient associations’ table, in the Diabetes Expert Group of the Ministry of Health, and on the advisory committee of the National Strategic Plan for the Reduction of Childhood Obesity (PENROI), but it insists on making further progress to ensure the direct involvement of people with diabetes in the design of public policies, in the evaluation of health technology, and in research, including clinical trials.
The Manifesto also includes other requests considered essential by the group: the elimination of social, employment, and educational discrimination against people with diabetes; the implementation and normalization of the figure of school nursing; an increase in investment in research and technology; the integration of psychological care into the portfolio of services; and a health system truly oriented toward chronicity, able to accompany the patient throughout all stages of their life.