Diabetes mellitus management in the Greek financial crisis as an opportunity to steer recovery.

Sir,

Greece has recently been in the spotlight for its finances. Diabetes prevention and management could tip the scale toward success or disaster. A projection of the cost of diabetes management is approximately 2.3 billion Euros or 12% of the annual budget for health.[1] It is of the utmost importance, especially in the current context of the fiscal crisis, to develop solid, applicable and integrated policies that will facilitate a reduction in expenditures for diabetes.

Currently, there is lack of formal policies, guidelines and large scale trials on diabetes in Greece. Development of such tools is fundamental and the pertinent stake-holders should collaborate toward mapping the current status. However, given the burden of the disease and the time needed for such tools to be developed, it is reasonable that appropriate action is taken using existing resources.

The role of central Government is crucial. In the current climate of economic crisis and gargantuan unemployment rates, it is an opportunity to focus on promotion of healthier eating habits. The Mediterranean diet has been proven to be of value in diabetes prevention[2] and has been associated with reduced overall mortality. Greece could invest in “healthy lifestyle” tourism and exports of healthy food products as a means to exit the crisis (via reduction of unemployment, improvement in the balance of payments, reduction in health costs for diabetes).

Local communities can have a leading role in diabetes prevention. Raising awareness through campaigns in local settings, mass media and the dynamically spreading new media and social networks is but one option. It is vital that exercise is encouraged in the community either by urban planning, transportation policies or by promoting a “sports for the masses” culture. The Olympic heritage can be employed in this cause, as Greeks first identified the value of a healthy body and with the stadia infrastructure that was developed for the recent Olympic Games mostly abandoned it is a huge opportunity to engage the population in sports activities.

Risk assessment tools have been designed, shown to be able to detect high risk individuals for type 2 diabetes (T2DM) and validated for use in the Greek population.[3] Appropriate action should then be taken for those individuals or those diagnosed with T2DM. Large studies have proven that T2DM is preventable with sustainable results. Implementation of such interventions in Greece[4] has been successful and holds a promise for the future.

It is well-documented that a key factor in prevention programs is effective behavioural modification. The employment of lay health educators and peer led support[5] has been promising in that field and should be considered, especially in the current context of limited resources.

If appropriate action is not taken it is inevitable that Greek National Health System will face tremendous pressure from diabetes in the future. At the same time, the economic setting calls for limited, reasonable and cost-effective expenditures. This context asks for strategies that can facilitate a future where Greece will act as a paradigm in diabetes prevention, confirming that a crisis can be seen as an opportunity and steer development.