The program is not in the money – Newspaper Kommersant No. 235 (7436) of 12/19/2022

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. In the next year’s budget, 10 billion rubles have been allocated for diabetes. But experts note that 7.5 billion rubles may be needed to provide children with continuous glucose monitoring systems alone. And the implementation of such a program will require more than 238 billion rubles. in year.

Russian President Vladimir Putin spoke about the problem of diabetes at a meeting of the Council for Strategic Development and National Projects on December 15. In Russia, there are officially more than 5 million people with such a diagnosis, but “in fact, there are probably more,” he admitted. Vladimir Putin referred to the results of state programs to combat cardiovascular and oncological diseases and instructed the government to launch a similar program to combat diabetes from 2023. According to the president, this work should include early diagnosis of the disease, guaranteed provision of citizens with medical products (including consumables) and medicines, as well as preventive work – “that is, the whole range of measures that determines the quality and life expectancy of patients with diabetes.” At the beginning of this year, the president already gave the government a number of instructions that should improve the quality of care for patients with diabetes. In particular, it was supposed to implement additional measures for the timely diagnosis of this disease and allocate funds for the training of endocrinologists.

The diabetes program has been discussed for the past few years. In fact, it already exists – the document has not yet been published, but this year it was actively developed and discussed by the expert community.

According to the federal curator of the All-Russian Organization of Parents of Disabled Children, Yulia Pankova, the program will include precisely those areas that the president indicated at the meeting.

Ms. Pankova believes that these are “important and necessary” aspects that will improve the diagnosis and treatment of diabetes in Russia.

It should be noted that the previous similar state project – the federal target program “Diabetes Mellitus” was adopted in 1996 and worked until 2012. General Director of Geropharm (engaged in the production of full-cycle insulin) Petr Rodionov in a conversation with Kommersant pointed outthat the situation has deteriorated significantly since then. He cited statistics according to which the absolute number of patients diagnosed with diabetes mellitus (DM) has increased from 3.78 million in 2012 to almost 4.9 million in 2022.

The prevalence of heart failure from 2012 to 2020 increased by more than 4.5 times in patients with type 1 diabetes, and by almost 6 times in patients with type 2 diabetes.

At the same time, the number of diabetes schools has decreased: by 2014, more than 1.5 thousand schools of diabetes were created in the Russian Federation, by 2020 there are less than 900. there are classes that are not held there at all, another 20% are unofficial, with irregular classes.

Anton Danilov-Danilyan, co-chairman of Delovaya Rossiya, co-chairman of the working group on the development of the federal project “Fight against Diabetes Mellitus”, also cited data that diabetological dispensaries have been abolished in 34 subjects of the Russian Federation for ten years, the number of diabetic foot rooms has decreased by 50%, it is observed the low level of provision of patients with test strips, there is an outflow of doctors from the primary link of care. Thus, according to Natalya Mokrysheva, director of the National Research Center for Endocrinology, almost 2,000 endocrine specialists are needed to treat adults, and another 600 are needed to treat children.

“We need endocrinologists, diabetes schools, we need state provision with medicines and medical devices,” sums up Yulia Pankova.

At the same time, only 10 billion rubles are allocated for diabetes in the budget for 2023. Ms. Pankova believes that this is the amount that, under the new law, will be collected as an excise tax on sugar-containing drinks.

But the amendments to the Tax Code will come into effect only on July 1, 2023, therefore, she notes, it is not clear how the program will function until then. According to her, just to provide children with continuous glucose monitoring systems, 7.5 billion rubles will be required. “And there are still adults, among whom, according to the standard, 30% should be provided with these systems. And there are many more important points that these 10 billion will not fit,” says Yulia Pankova.

As previously told “Kommersant”, according to a preliminary estimate of the Center for Expertise and Quality Control of Medical Care (CEKKMP), the implementation of the entire program will require 238.8 billion rubles. in year. According to TsEKKMP, out of the estimated amount of 139.9 billion rubles. will be needed to provide patients with test strips to determine the level of glucose in the blood, 32.6 billion rubles – for the purchase of continuous glucose monitoring systems, 9.8 billion rubles – for the purchase of insulin pumps, 4.1 billion rubles – to finance schools for patients with diabetes. The cost of purchasing hypoglycemic (non-insulin) drugs was estimated at 52.4 billion rubles. Kommersant sent a request to the Ministry of Health of the Russian Federation with a request to indicate the sources of funding for the program, but did not receive a response to the request.

“Patients with diabetes who do not have disabilities are provided at the expense of the state. Possibilities of diagnostics and maintenance of the inhabitants of the regions differ. Meanwhile, there are effective methods of control and treatment that help maintain health and protect against serious complications, such as blindness, kidney failure, heart attacks, strokes, gangrene of the extremities, ”says Yury Zhulev, co-chairman of the All-Russian Union of Patients. According to him, the program should provide access to these methods for 5 million patients.

The real number of patients, Mr. Zhulev notes, is twice as much – about 10 million people.

Asked why the program has been discussed for so long and still hasn’t worked, he replies that “it turned out to be difficult to integrate it into the tight budgetary framework.”

Natalya Kostarnova