Portugal: Coordinated efforts on prevention, diagnosis and care
Portugal has a long history of fighting diabetes. The Associação Protectora dos Diabéticos de Portugal (APDP) is the oldest diabetes association in the world, having just celebrated its 90th anniversary in 2016. The Programa Nacional da Diabetes (National Programme for Diabetes) dates back to the 1970s. The two have worked closely together for decades, and in recent years, they have implemented innovative approaches that have had a significant impact on diabetes prevention, diagnosis and treatment.
The national programme has focused for years on primary prevention of diabetes, as well as the education of people living with diabetes and training for healthcare providers. But in 2007, the programme underwent a major review, which resulted in a new emphasis on involving the entire community in prevention efforts, including local authorities, schools and employers. To this end, each municipality now has a trained primary prevention manager for diabetes – generally from the local authority, rather than from a health unit – whose task is to raise awareness about diabetes and to promote specific campaigns and activities.
One specific effort is Portugal's application of the FINDRISC diabetes risk assessment calculator, a tool that was pioneered by the Finnish Department of Health. The national programme has set a goal to apply FINDRISC to at least 25% of the adult population, recognizing that there is a need to reach those individuals who don't generally access primary health care services. The online FINDRISC assessment has been promoted in Portugal across many channels to reach a wide audience, and the resulting data is then shared with the health system. People whose results show moderate to high risk are invited to a follow-up appointment at a health facility and to take part in a lifestyle and behavior programme called "Gosto" (I Like It), which encourages them to make positive health and lifestyle changes to reduce the risk of diabetes.
The primary goal of the FINDRISC diabetes assessment is to help prevent diabetes, and a goal has been set to prevent 50,000 new cases over five years from 2016 to 2021. However, it also plays a useful role in early diagnosis of the disease. An estimated 40% of all diabetes cases in Portugal are undiagnosed, providing a compelling reason for the national programme to focus efforts on identifying both those at risk and also people who already have the disease.
Another important effort undertaken by the national programme, in cooperation with the APDP, is the publication of a yearly report on diabetes – Factos e Números. This annual report, first published in 2009, aims to raise social awareness about diabetes, specifically targeting health professionals, students and researchers, the media and the general public. The data presented in the report provides powerful insights into the impact of health efforts to fight diabetes and also helps to identify areas where increased efforts or a strong focus may be needed.
High-quality data plays a vital role in enabling the health system to identify both positive and negative trends in diabetes and successfully address them. In one instance, the large number of amputations taking place due to complications from diabetes led the national programme and APDP to implement a course for health workers about foot care, as it relates to diabetes. This course provided nurses with training on how to detect early complications from diabetes and gave them the skills needed to perform consultations about foot care with diabetes patients. Nearly 90% of nurses in the country received this training, and the resulting benefits were significant. During the period 2005 to 2014, total amputations fell from 1782 to 1385, with the number of major amputations (versus minor) falling most sharply from 958 to 560.
Portugal still faces many challenges in the areas of diabetes prevention and care. But the coordinated efforts of the national programme and the APDP illustrate the potential to make real progress in fighting the disease.