Preventing and Managing Diabetes in Romania: Strategies for Individuals and Systemic Solutions

-You recently talked about a diabetes curve in Romania and a national emergency in terms of addressing this disease in Romania. What are the main measures you see for flattening this curve?

-The main measure is prevention. Prevention of diabetes, especially type 2, involves intervention on specific risk factors for diabetes.

There are treatment strategies, pharmacological options, and resources that can be used for all age groups. The overall goal of people with risk factors for diabetes is to learn to live as full and healthy a life as possible, an awareness of lifestyle modification as a whole. Strategies to achieve the overall goal focus on glycemic control by improving healthy lifestyle behaviors. Combating sedentarism, balanced nutrition, limiting alcohol and tobacco consumption, respecting the work-rest rhythm and maintaining a healthy body weight are the main elements of diabetes prevention strategies.

However, a strategy to prevent the complications of diabetes can also be discussed, if part of the population is already diagnosed with diabetes. The strategies for the prevention of complications of diabetes aim at other objectives, more precisely they include the ones mentioned above, but the main focus is maintaining blood pressure within normal limits, cholesterol, triglycerides and weight as close as possible to physiological limits and, obviously, obtaining and maintaining normal glycemic values, through therapeutic and nutritional means.

Diabetes care begins with a basic medical evaluation. Assess the patient’s current degree of glycemic control, document the presence and status of any diabetes complications, and assess for any aggravating conditions such as obesity or physical inactivity. Diabetes is a chronic disease, and people need a lifelong diabetes self-management plan. It is essential that the patient be part of the plan to achieve the goals and not be subjected to isolated doctor’s notes.

-What are the systemic solutions, but also at the individual level in our country, to prevent the spread of the condition?

-Type 2 diabetes and other non-communicable diseases are a growing public health challenge globally. A relatively small percentage globally of those with diabetes or prediabetes are diagnosed with the potential to develop chronic complications. To address this epidemic, governments, in concert with the private sector, must establish policies that promote healthy nutritional and agricultural policies, foster environmental changes that encourage more vigorous physical activity, and make prevention accessible to all at-risk citizens picked up. The public health sector has the task of translating scientific evidence into practical, accessible and easily assimilated programs and monitoring the process of continuous improvement of prevention initiatives. The clinical sector faces the challenge of screening and identifying those at high risk and referring them to accredited intervention programs.

There is a need to explore additional cost-effective interventions that are tailored to meet individual needs that can be delivered at the community and clinical level. Thus, all three sectors, government, public health and clinical, each have a critical role in this process and, working in partnership, should create the necessary synergies essential to make substantial inroads in the prevention of type 2 diabetes. Dysglycemia characterized by glucose levels that do not meet the conventional criteria for diabetes, but are still higher than normal, constitute the prediabetes population. Prediabetes is a condition that can set in many years before the onset of type 2 diabetes. A substantial number of individuals (up to 70%) with prediabetes may develop diabetes in later years. In addition, prediabetes is associated with a 10-40% increased risk of cardiovascular complications, as well as stroke and microvascular disease. Early recognition of prediabetes in high-risk individuals is therefore essential, as lifestyle modification in particular, as well as medication, have been shown to be effective in reducing progression to diabetes in pivotal studies in various cultures. In other words, screening is essential. In Romania, starting in 2022, prediabetes can be diagnosed and treated by both diabetologists and family doctors.

-From what age do you recommend monitoring and caution regarding risk factors for diabetes?

-The American Diabetes Association (ADA) recommends that screening for most adults begin at age 35. The ADA recommends screening before age 35 if patients are overweight and have additional risk factors for prediabetes or type 2 diabetes.

If patients have a history of gestational diabetes, the doctor should probably check the blood glucose level at least once every three years.

-Can we live a life that includes the little pleasures or cravings, without the worry or burden of diabetes?

-Diabetes does not mean restriction from food, but rather moderation and strictness of the diet in the first place. There are countless strategies that can be applied in such a way that the patient with diabetes leads a normal, social life. Alcohol, for example, or the consumption of coffee are not prohibited, but recommended in moderation, limited in quantity. A more delicate and hard-to-fight topic is the abandonment of traditional cigarette consumption. Smoking has a negative impact on patients with prediabetes and diabetes in particular, and therefore every effort is worth and must be made to stop this addiction. There are strategies that recommend psychological support, dedicated therapies, but also replacing the consumption of conventional cigarettes with modern versions of heated tobacco. Recently in Sweden a group of public health policy experts released a report* outlining this country’s approach to reducing smoking: combining smoking control measures with risk reduction strategies, which include the use of new categories of nicotine products which does not involve burning tobacco. This can be a worthy example for other countries to follow, especially since Sweden is approaching the low threshold of 5% of smoking incidence, which qualifies it as a “smoke-free country”.

*Sweden’s Stunning Smoke Free Success Provides a Road Map That Could Save Lives of Millions – Major New

Report,