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Vol. 30. Núm. 4.
Páginas 118-119 (Julio - Agosto 2014)
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Vol. 30. Núm. 4.
Páginas 118-119 (Julio - Agosto 2014)
Letter to the Editor
DOI: 10.1016/j.avdiab.2014.06.001
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European Policy Action Network on Diabetes (ExPAND)
Red de Acción Política Europea sobre la Diabetes (ExPAND)
Maite Valverdea,
Autor para correspondencia

Corresponding author.
, Margarida Jansaa, Edward Hardingb, Suzanne Waitb
a Sociedad Española de Diabetes, Spain
b ExPAND Secretariat, SHW Health Ltd, United Kingdom
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Dear Editor,

I am writing with news of a valuable new resource in diabetes policy and to ask for your help in bringing this important work to the attention of clinicians, healthcare providers and diabetes advocates in Spain.

The ExPAND Policy Toolkit on Diabetes is a practical guide to help national and regional governments to raise the profile of diabetes in our healthcare systems. It provides a single comprehensive resource summarising the leading evidence of effectiveness across the key pillars of diabetes care, provides short case studies of leading examples of implementation in Europe, and gives advice to help health policy makers consider the political challenge of implementing clinical best practice.

The toolkit is an urgent contribution to a pressing problem for healthcare systems across Europe. Diabetes is recognised by leading commentators as an ‘epidemic’ of the 21st Century1 and a major issue for social and economic sustainability,2 reflecting the international consensus for chronic disease overall. Diabetes is estimated to affect 56 million people in Europe in 2013 and cost €109 billion in direct healthcare costs, and numbers will rise significantly, reaching 70 million people by 2035.3 In Spain, the prevalence of type 2 diabetes is 13.8%,4 the incidence of type 1 diabetes is 10–12/100,000 inhabitants. The direct cost related to diabetes is 8.2% of total health budget in Spain.5

Yet leadership from national governments is woefully lacking across the continent – as evidenced by the poor adoption of national strategies for diabetes, and continued poor performance of healthcare systems on the continent across prevention, care and management of diabetes.1,6 Up to 50% of cases of diabetes in Europe are thought to remain undiagnosed,7 and of those known to have diabetes, only 50% achieve effective blood glucose control.8 Even in countries with comprehensive strategies and or care frameworks for diabetes, progress is slow in delivering the truly integrated and comprehensive care and management so crucial to reducing the burden of ill health, and access to even basic treatments remains a major concern.1,6

The ExPAND toolkit has sought to sensitise national politicians to this pressing issue and empower diabetes champions within national governments to lead the case for change. Content is organised around the topics of prevention, self-management and person-centred care (see Fig. 1, below). There are also dedicated chapters to innovation and the care and treatment of children and older people. It is our aim that in providing accurate and accessible information in a format intended to closely meet the needs of politicians operating in a challenging and competitive policy environment, we will help to increase the adoption of clinical best practice in diabetes.

Figure 1.

Diagram of key content in ExPAND policy toolkit on diabetes.


The Toolkit has been developed by an alliance of national members of Parliament (MPs) and Members of the European Parliament (MEPs) from Belgium, The Czech Republic, Greece, Poland, Portugal and the United Kingdom, working with patient representatives and scientific societies from Spain, Italy, and Romania. The International Diabetes Federation Europe, an umbrella organisation representing 70 patient organisations in 47 countries across Europe, is also a member. We are delighted that the Foundation of European Nurses in Diabetes (FEND) and the Primary Care Diabetes Europe (PCDE) has seen fit to endorse and promote the toolkit to their members.

As a trusted source of information in the international diabetes community, we would be grateful if you help us to share news of the Toolkit with your readership by reprinting this letter in your journal.

The ExPAND secretariat SHW Health will be delighted from any readers who wish to know more. Please contact them via expand@shwhealth.co.uk.

Federation of European Nurses in Diabetes, Euradia, Primary Care Diabetes Europe, International Diabetes Federation Europe.
The policy puzzle – is Europe making progress?.
3rd ed., International Diabetes Federation Europe, (2012),
D.E. Bloom, E.T. Cafiero, E. Jane-Llopis, S. Abrahams-Gessel, L.R. Bloom, S. Fathima, et al.
The global economic burden of noncommunicable diseases.
World Economic Forum, (2011),
International Diabetes Federation.
IDF diabetes atlas.
6th ed., (2013),
F. Soriguer, A. Bosch-Comas, E. Bordiú.
Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study.
Diabetologia, 55 (2012), pp. 88-93
C. Crespo, M. Brosa, A. Soria-Juan, A. López-Alba, N. López-Martínez, B. Soria.
Costes directos de la diabetes y sus complicaciones en España (Estudio SECCAID): Spain estimated cost Ciberdem-Cabimer in diabetes.
Av Diabetol, 29 (2014), pp. 182-189
International Diabetes Federation Europe.
Access to quality medicines and medical devices for diabetes care in Europe.
Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts.
Diabetes Care, 26 (2003), pp. 61-69
World Health Organisation Europe.
Gaining health: the European strategy for the prevention and control of noncommunicable diseases.

The ExPAND Policy Toolkit on Diabetes is the result of discussions between the ExPAND members that occurred over the course of 2012–2013. The development of this Toolkit was overseen by SHW Health Ltd, an independent heath policy consultancy acting as secretariat for ExPAND. The contents of the Toolkit are fully endorsed by, and are the ownership of, the members of the network. Acknowledgements to Bristol-Myers Squibb, AstraZeneca and Roche Diagnostics for providing support to facilitate the regular meetings of the ExPAND network and for funding the development of this Toolkit.

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