Diabetes prescribed the school curriculum

The Ministry of Health proposes to update the procedure for providing medical care in the profile “Endocrinology”. For the first time, the document will outline the organization of the “School for Patients with Diabetes” and “Diabetic Foot” classrooms. At the same time, it is assumed that each endocrinologist will be able to manage two groups of diabetic patients instead of one, and the number of nurses with him, on the contrary, will be reduced from two to one. Experts note that this will significantly increase the burden on specialists, who are already “not enough in the field”.

The draft order of the Ministry of Health on the new procedure for providing medical care to the adult population in the field of Endocrinology has been published on the regulation.gov.ru portal. In comparison with the current edition, it has the opportunity to conduct telemedicine consultations, as well as palliative and pre-medical health care (it can be provided by health workers with secondary education). In addition, the document significantly expands the standard of equipping an endocrinologist’s office. Patient reception rooms should now have hydraulically operated examination and therapy tables, as well as an air decontamination and purification unit (or air and surface cleaning). Staffing standards have also been changed: instead of two nurses, one endocrinologist now relies on one.

For the first time, the document outlines the procedure for organizing medical offices “School for Patients with Diabetes” and “Diabetic Foot”. For the first, the duration of the program is 15–25 hours (depending on the type of diabetes and the method of treatment). Norms for the school “Diabetic foot” are not given. Also, compared to the current order for schools, the staff of doctors was reduced: now each endocrinologist will manage two groups of diabetic patients instead of one. In the case of the “Diabetic Foot” rooms, one specialist is assigned to 250,000 adults.

In 2023, a state program to combat diabetes mellitus should appear in Russia – such an instruction was given by President Vladimir Putin. The program should include early diagnosis of the disease, guaranteed provision of citizens with medical devices and medicines, as well as preventive work. The budget for 2023 includes 10 billion rubles for its implementation. The president of the Russian Diabetes Association (RDA), psychoendocrinologist Mikhail Bogomolov, believes that this amount is not enough to fulfill all the provisions of the program and, as a result, it will be possible to organize schools only for new patients. The general director of the Geropharm company (engaged in the production of full-cycle insulin) Petr Rodionov notes that today there are about 800 schools of diabetes operating throughout the country on the basis of polyclinics, hospitals and consultative and diagnostic centers, but the need is much higher: according to experts, about 2 thousand. In addition, they are unevenly distributed across regions. And the main burden of patient education falls on endocrinologists, who “are not enough locally in Russia.”

It should be noted that according to Mikhail Bogomolov, there are now approximately 4,000 endocrinologists in the country for every 10–15 million diabetic patients. Director of the National Research Center for Endocrinology, Corresponding Member of the Russian Academy of Sciences Natalya Mokrysheva said that almost 2,000 endocrine specialists are missing for the treatment of adults, and another 600 for the treatment of children. Rosstat cited data according to which the shortage of endocrinologists is more than 20%, children’s specialists – more than 30%. “This staffing problem has persisted for years, but the situation worsened after the COVID-19 pandemic, during which many narrow specialists retrained to fight the infection and its consequences,” says Mr. Rodionov. “Many specialized specialists taught diabetes schools after the main appointment without additional payment. In this regard, it is important to change the approach to the organization of therapeutic education.” In his opinion, it is impossible to improve the situation simply by increasing the workload on doctors and without providing mechanisms for additional support for medical institutions and their employees.

Mikhail Bogomolov draws attention to the fact that in most countries, paramedical personnel are engaged in teaching patients with diabetes. In Russia, such rates are not yet officially provided. RDA, according to him, “at one time” trained about 400 nurses in Moscow and is now training “a group of three to five nurses” in Stary Oskol. Against the backdrop of a shortage of doctors, the Tyumen State Medical University also launched the training of nurse teachers to conduct diabetes schools.

Yan Vlasov, co-chairman of the All-Russian Union of Patients, emphasizes that the professional community has been talking about the shortage and quality of training for endocrinologists for several years in a row. “There are high risks that the additional load may affect the treatment process in terms of the availability of an appointment with a specialist and further work with the patient,” points out Mr. Vlasov. In his opinion, the “optimal” development of the work of schools could be the allocation of specialized medical care on the basis of existing diabetes centers. In this case, the sources of funding, the formation of a personnel standard will be clear, and it will also become possible to standardize the work of schools throughout the country and fill them with the necessary technologies.

The medical director of IPharma, endocrinologist Yulia Trakhtenberg, commenting on the new procedure, notes that the burden on doctors “seems to be adequate.” According to her, the school of diabetes is an integral part of the treatment of patients with this disease, which is necessary to achieve a long-term result. Patient education improves adherence to therapy, which, Ms. Trachtenberg points out, reduces the burden on the attending physician. Mikhail Bogomolov, in turn, talks about an ingrained practice: for a fee, patients agree in advance with endocrinologists on telephone consultations once a month or less, and such “diabetes schools,” according to him, are effective. The official diabetes schools, according to Mr. Bogomolov, actually did not fulfill their functions, and doctors will hardly notice that instead of one group, two should now be taught.

“Kommersant” turned to the Ministry of Health for comments on the project, but at the time of publication did not receive a response.

Natalya Kostarnova