Schwarz Peter E H, Müller Uta, Schulz Martin, Hauner Hans, Landgraf Rüdiger
Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden.
Med Monatsschr Pharm. 2007 Aug;30(8):289-96.
The most efficient way to manage diabetes and its complications is to prevent diabetes. Recent studies have convincingly demonstrated that prevention of diabetes and its complications are possible and cost effective. Life-style interventions and also early pharmacological preventive strategies have yielded a 25-75% diabetes risk reduction and an even more promising reduction in cardiovascular risks. These findings offer the evidence-base for diabetes prevention, but essential is the delivery of intervention into our societies. The challenge, therefore, is the management of prevention and intervention programs considering scientific aspects and practical requirements during implementation. This can only be addressed in a coordinated interdisciplinary setting and across sectors which requires the development of a comprehensive, integrated prevention management program also on an European level. Pharmacies have to play an important role in this concept because of their widespread distribution and the frequency of pharmacy visits of the general population. They should be established as places where patients can continuously offer risk assessment including recommendations on how to prevent the disease. Developing the role of the prevention manager and continuous evaluation and quality control are key factors in performing high quality intervention and care. Community pharmacies could take an active part in this prevention program, its evaluation, and quality assurance. Implementing structured prevention programs will enable nationwide prevention of diabetes mellitus without consuming large resources from health care insurances. This process will be challenging and time consuming, requiring many partners but resulting in a profitable "health" investment.
管理糖尿病及其并发症最有效的方法是预防糖尿病。最近的研究令人信服地表明,预防糖尿病及其并发症是可行的且具有成本效益。生活方式干预以及早期药物预防策略已使糖尿病风险降低了25%至75%,心血管风险降低的前景更为可观。这些发现为糖尿病预防提供了证据基础,但关键是要将干预措施推广到我们的社会中。因此,挑战在于在实施过程中考虑科学方面和实际需求来管理预防和干预项目。这只能在跨学科协调的环境中并跨部门加以解决,这需要在欧洲层面也制定一个全面、综合的预防管理项目。由于药店分布广泛且普通民众光顾药店的频率高,药店必须在这一理念中发挥重要作用。药店应成为患者能够持续进行风险评估的场所,包括提供有关如何预防疾病的建议。培养预防管理人员的角色以及持续评估和质量控制是提供高质量干预和护理的关键因素。社区药店可以积极参与这一预防项目、其评估以及质量保证工作。实施结构化的预防项目将能够在全国范围内预防糖尿病,而无需消耗医疗保险的大量资源。这一过程将具有挑战性且耗时,需要众多合作伙伴,但会带来有益的“健康”投资。