It is unusual for patients to be consulted about a national policy and then to see the results. However, when Slovenia decided to develop its second 10-year programme for diabetes in 2021, this was one of its goals. The Ministry of Health and the National Institute of Public Health wanted to hear from those affected by or involved with diabetes, whether as professionals, patients or family members. They partnered with a range of sectors and levels from across the country, reflecting the fact that diabetes is not only a health challenge but also a wider social, societal and economic challenge due to its high prevalence and severe consequences.
The development of the comprehensive programme for 2020–2030 included patients and their organizations, nurses, clinicians, university departments, medical and nursing schools, professional organizations in areas such as pharmacology and ophthalmology, and the National Health Insurance Agency. This ambitious process of meaningful engagement was overseen by a steering group of up to 40 professionals to raise awareness in every quarter.
Diabetes in Slovenia
Like many countries in the WHO European Region, Slovenia has an ageing population. In 2022 it was estimated that around 145 000 people in Slovenia have diabetes, and around 10 000 new cases are diagnosed every year. Cases of type 1 diabetes in children and adolescents have stabilized in recent years, but the number of people with, or with risk factors for, type 2 diabetes is rising.
A recent national study showed that 3 out of 4 patients with diabetes are over 60 years of age and have a body mass index of over 30. Understanding these characteristics could help to identify others with undiagnosed type 2 diabetes.
How was the diabetes programme developed?
The steering group met 9 times. People were interviewed, emails exchanged and workshops held. Discussions and debates raised awareness among health professionals of all kinds, and also involved the public.
The first draft of the programme ran to 150 pages and was deemed too long. The process continued, and it grew to 180 pages as efforts were made to balance public health and medical details. Finally, it was cut to a manageable size. It was considered important that the public could understand and engage with the programme, so the vocabulary had to be non-technical and messages needed to be clear. Work was also done with an agency to develop a logo and visuals for a campaign, based on a blackbird.
Objectives
The programme’s objectives are familiar – to strengthen population health, delay or prevent type 2 diabetes, reduce complications and mortality from diabetes, and improve quality of life. Continuous professional development for staff is also a key element.
During the engagement process, consensus also formed around 3 principles that reflect the importance of putting the patient first:
- empowering people with diabetes to be involved in managing their condition through training, support and general health literacy;
- tackling inequality and improving the social determinants of health; and
- fully embracing a community-focused approach to achieving evidence-based and integrated care that ensures quality and safety and can adapt to the changing needs of people with diabetes.
What happened next
Since 2021, rapid progress has already been made across the country:
- Systematic training, tools and materials are now provided for health-care professionals on new national diabetes dietary guidelines, and on a harmonized pathway for women with gestational diabetes including care after birth.
- Patient education and empowerment have increased; since 2022 all patients in primary care throughout Slovenia are entitled to educational group workshops if they are at risk of developing diabetes.
- People who already have type 2 diabetes can attend targeted group workshops, and a 5-session group programme.
- Structured educational programmes have been developed and evaluated on type 2 diabetes with digital support.
- The national diabetes guidelines have been refreshed.
Every 2 years, an action plan will be updated to monitor implementation and list specific points for improvement. This pragmatic approach to evaluation uses available sources of routine data and convenes relevant stakeholders regularly to review progress. It builds on successful ways of working developed over the previous decade.
“This is how we like to develop a policy or programme in Slovenia – evidence-based, intersectoral, inclusive, including meaningful engagement with people with diabetes, and based on our values and principles of reducing inequalities in health and addressing determinants of health,” explains Vesna Kerstin Petrič, Director-General of the Public Health Directorate at the Ministry of Health. “The overall aim is, of course, to improve quality of life for people with chronic conditions.”