Table 4.
Self-Monitoring of Blood Glucose and Diabetes Burden in Central and Eastern Europe
| Country | Population and GDP per capita (PPP) (2012 estimate)a,b | Number of patients with DM (IDF 2012 estimate)c | Adult DM prevalence (2012 estimate)c,d | Cost of DMe | Local SMBG reimbursement | Local SMBG guidelines |
|---|---|---|---|---|---|---|
| Bulgaria | 7,254,000 (total) 5,703,000 (adult) $14,312 GDP per capita |
530,500 DM (adult), including 190,000 undiagnosed DM Local estimate: 420,000 T2DM (including 55,000 on insulin) |
9.3% (national) 6.7% (comparative) |
10.2% of total health budget (2011); $532 per person with DM per year (2012) | Glucose meters fully reimbursed for all insulin-treated patients Children/adolescents/during pregnancy: 1,100 test strips/year fully reimbursed Insulin-treated (>18 years of age): 150 test strips/year fully reimbursed |
No special guidelines on SMBG Some SMBG recommendations included in the National Guidelines on Good Clinical Practice in Diabetes, developed by the Bulgarian Society of Endocrinology |
| Croatia | 4,402,000 (total) 3,307,000 (adult) $17,810 GDP per capita (PPP) |
225,400 DM (adult), including 93,700 undiagnosed DM Local estimate: 230,084 registered DM, including 90% with T2DM (26% on insulin alone, 19% on OAs+insulin; 53% on OAs alone) |
7.9% (national) 5.3% (comparative) |
7.8% of total health budget (2011); $1,441 per person with DM per year (2012) | Glucose meters fully reimbursed for all insulin-treated patients OA-treated: 100 test strips/year fully reimbursed Insulin-treated (once daily): 360 strips/year fully reimbursed Insulin-treated (twice daily): 720 strips/year fully reimbursed Insulin-treated (3 times daily): 1,100 strips/year fully reimbursed Insulin-treated (>3 times daily): maximum 1,500/year fully reimbursed |
Croatian National Guidelines for treatment of DM regulate SMBG use |
| Czech Republic | 10,553,000 (total) 8,083,000 (adult) $27,191 GDP per capita (PPP) |
605,900 DM (adult), including 251,900 undiagnosed DM Local estimate (2011): 825,382 registered DM, including 55,542 T1DM, 758,719 T2DM, 205,049 on insulin |
7.5% (national) 5.6% (comparative) | 8.0% of total health budget (2011); $1,677 per person with DM per year (2012) | Glucose meters fully reimbursed for all insulin-treated patients; frequently distributed by manufacturers free of charge Lifestyle intervention only: 50 strips/year fully reimbursed OA-treated: 100 strips/year fully reimbursed Insulin-treated (≥3 times daily): 400 strips/year fully reimbursed (with up to extra 600 upon request by diabetologist [up to extra 1,400 for children under 18 years of age]). There are no limits for strips during pregnancy. | No specific local SMBG guidelines are available, but general recommendations are ≥3 daily measurements for T1DM and T2DM treated with 3 or more insulin injection per day or with insulin pump. |
| Hungary | 9,962,000 (total) 7,519,000 (adult) $19,638 GDP per capita (PPP) |
578,100 DM (adult), including 240,300 undiagnosed DM Local estimate: 850,000 T2DM, 15% on insulin |
7.7% (national) 6.1% (comparative) |
8.6% of total health budget (2011); $1,272 per person with DM per year (2012) | Glucose meters 50% reimbursed for patients on insulin ≥2 times daily; frequently distributed by manufacturers free of charge Children/adolescents: 1,800 test strips/year 80% reimbursed Insulin-treated (twice daily): 400 strips/year 80% reimbursed Insulin-treated (3 times daily): 1,200 strips/year 80% reimbursed Insulin-treated (≥4 times daily): 1,800 strips/year 80% reimbursed |
Local guidelines for SMBG use have been formulated by the Hungarian Diabetes Association, most recently in 2011. |
| Poland | 38,896,000 (total) 28,997,000 (adult) $20,592 GDP per capita (PPP) |
3,082,800 DM (adult), including 1,105,900 undiagnosed DM Local estimate (2011): 2,500,000 DM (90% T2DM) Data (2011) from National Health Fund (universal public payer): 1,996,996 treated pharmacologically (including 627,971 on insulin) |
10.6% (national) 9.0% (comparative) |
12.4% of total health budget (2011); $1,145 per person with DM per year (2012) | Glucose meters are not reimbursed; distributed by manufacturers free of charge OA-treated: strips 70% reimbursed Insulin-treated (≤2 times daily): strips 70% reimbursed Insulin-treated (≥3 times daily): small flat fee (<1€) for 50 strips In all cases, the number of strips provided is up to the prescribing physician. Up until 2011, test strips were virtually free and unlimited. |
Well-defined local SBMG guidelines are published and updated yearly by Diabetes Poland. |
| Romania | 21,347,000 (total) 16,312,000 (adult) $12,808 GDP per capita (PPP) |
Local estimate: •810,134 DM •674,383 on OA •135,751 insulin-treated |
9.3% (national) 7.7% (comparative) |
10.8% of total health budget (2011); $607 per person with DM per year (2012) | Glucose meters fully reimbursed for all insulin-treated patients Insulin-treated (<18 years of age): 600 strips/year fully reimbursed Insulin-treated (≥18 years of age): 400 strips/year fully reimbursed |
No specific local SMBG guidelines are available, but general recommendations are ≥3 daily measurements for T12DM and 1–3 daily measurements for insulin-treated T2DM. |
| Serbia | 7, 566,000 (total) 7,183,000 (adult) $10,405 GDP per capita (PPP) |
673,800 DM (adult), including 241,700 undiagnosed DM 70,000–80,000 patients on insulin |
9.4% (national) 7.7% (comparative) |
11.0% of total health budget (2011); $586 per person with DM per year (2012) | Glucose meters and test strips fully reimbursed for patients <18 years of age, those on multiple dailyinsulin injections/insulin pump therapy, and during pregnancy Patients on intensive insulin therapy are reimbursed: 50 strips/month Pregnant patients and children reimbursed for 150 strips/month |
Local guidelines for SMBG have been in place since 2002 as part of the National Guidelines on Diabetes (updated in 2012). |
| Slovakia | 5,439,000 (total) 4,170,000 (adult) $24,249 GDP per capita (PPP) |
279,500 DM (adult), including 116,200 undiagnosed DM Local estimate (2010): 336,552 registered DM patients; 87,983 on insulin |
6.7% (national) 5.7% (comparative) |
8.4% of total health budget (2011); $1,744 per person with DM per year (2012) | Glucose meters fully reimbursed for all insulin-treated patients T1DM/insulin-treated T2DM (≥3 times daily): 900 strips/year (adults), 1,200 strips/year (children/students <25 years of age) fully reimbursed During pregnancy: 1,200 strips/year fully reimbursed Insulin-treated T2DM (≤2 times daily): 300 strips/year fully reimbursed OA-treated/lifestyle intervention only: 150 strips/year fully reimbursed |
SMBG recommendations are included in the National Guidelines on Diabetes and in the official textbook on diabetes, developed by the Slovakian Diabetes Society. |
| Slovenia | 2,055,000 (total) 1,565,000 (adult) $28,195 GDP per capita (PPP) |
174,800 DM (adult), including 72,700 undiagnosed DM Local estimate (2012): 135,000 DM; 16,000 on insulin only, 10,500 on OAs+insulin, 53,000 on OAs only |
11.2% (national) 8.1% (comparative) | 11.3% of total health budget (2011); $2,436 per person with DM per year (2012) | Glucose meters fully reimbursed for all insulin-treated patients Insulin-treated, once, twice, three times, and (>3 times daily: 200, 250, 550, and maximum of 700, respectively/3 months fully reimbursed During pregnancy and insulin pump therapy: 900 strips/3 months fully reimbursed |
Slovenian National Guidelines for treatment of T2DM includes also SMBG, last updated 2011 |
| Ukraine | 45,453,000 (total) 34,432,000 (adult) $7,374 GDP per capita (PPP) | 1,311,335 DM (officially registered), estimated undiagnosed DM 1,099,201 No figures for number of patients on insulin |
3.5% (national) 2.9% (comparative) | 4.3% of total health budget (2011); $332 per person with DM per year (2012) | Glucose meters fully reimbursed for children/adolescents and during pregnancy Children/adolescents/during pregnancy: 200 strips/year fully reimbursed |
In 2012, leading specialists in endocrinology and health authorities developed a standardized clinical protocol of medical care for patients with T2DM, but this is not yet fully approved; however, it does include some SMBG recommendations. |
Adult data are for the 20–79 year age range.
a
Source for total population and GDP data was the IMF World Economic and Financial Surveys.91 Source for adult population data was the IDF Diabetes Atlas, 5th ed.99
b
Gross domestic product (GDP) based on purchasing-power-parity (PPP) per capita GDP (PPP takes into account differences in the cost of living between countries).
c
Source for IDF estimates was IDF Diabetes Atlas, 5th ed.99
d
National prevalence provides a measure of actual DM burden with a country. Comparative prevalence adjusts for age and allows between country comparisons independently of population age distribution.
e
Sources were Diabetes. The Policy Puzzle: Is Europe Making Progress?, 3rd ed.100 and IDF Diabetes Atlas, 5th ed.99
DM, diabetes mellitus; IDF, International Diabetes Federation; OA, oral (glucose-lowering) agent; SMBG, self-monitoring of blood glucose; T1DM/T2DM, type 1/type 2 diabetes mellitus.