Marina V., why are diabetics more vulnerable to coronavirus?

Marina Shestakova: This is true, first, they are generally more vulnerable to any infection because they have worse working immune system. Secondly, to trigger a “cytokine storm”, a virus needs energy, and it can be taken only from glucose. Therefore, the disease will be heavier in those patients who have high blood sugar levels. Third, diabetes often accompanies obesity, including internal organs. And loose adipose tissue itself creates the conditions for inflammation, so inflammatory reaction will proceed more rapidly. All three of these factors and ensure that patients with diabetes more likely to die.

How often? Do you have some statistics?

Marina Shestakova: as soon As the pandemic has crossed the borders of China, we in the Federal register of patients with diabetes introduced new fields. Doctors in all institutions that conduct a register was to indicate whether the patient underwent COVID infection or not moved, what analyses it is confirmed, what was the outcome.

Now in the database for more than 7 thousand patients. But according about the first four hundred patients, we saw that the mortality among them was 16 percent. While the General population is approximately 1.5%. Perhaps when the base is complete, our data on mortality of patients with diabetes will be adjusted, but I think it will remain at the level of 12-15 percent.

How organized assistance to these patients during a pandemic?

Marina Shestakova: first, we as a national center of endocrinology, immediately organized large-scale online consultations for the whole country. Sent out flyers to doctors what they should pay attention, how to adjust therapy. We insisted, first, longer periods of discharge prescriptions for the drug, the volunteers gave patients the test strips because they had to frequently check your sugar level. And if he was out of control, you could call us at the hotline. We contacted the attending physician, advised him, and he, in turn, could remotely help the patient.

Until 2012, we had Federal program “diabetes”. And as it is now structured system of prevention and treatment?

Marina Shestakova: the Program was very successful and increased the life expectancy of these patients, mortality has decreased, diabetic coma was minimized. Decreased kidney complications and high amputation of the feet.

For the duration of the program regions was supported by strong measurement of glycated hemoglobin were installed in provincial and regional hospitals. Was organized diabetic foot care offices, equipped by devices of laser photocoagulation eye care offices in the regions there appeared devices for hemodialysis patients who have lost kidney function. And all that remained for the balance of the regions. Now we, as the national center, received the right to monitor endocrinology services across the country and see where the structure was preserved and developed, and which regions we should help, because they stopped at 2012. In some regions, we propose to build branches of our multi-functional centre that there was an opportunity to provide specialized care to patients with any endocrine disease. These are now discussing pilot projects with the governors and the ministries in Astrakhan, Ivanovo, Irkutsk. The Ministry of health of the Russian Federation supports us in this.

If today is to talk about the resumption of the program “diabetes” what you need to focus?

Marina Shestakova: I think in the early diagnosis and prevention. Success in the fight against diabetes depends on it, and not on expensive high-tech care that we provide heavy running sick. The most important and economically viable – to prevent the development of diabetes. We have developed a new “indiancity” in which the answers to a few simple questions, evaluated in points, will allow the therapist to determine the patient’s risk of endocrine diseases. And if the risk is elevated, the physician can immediately send it to the special examination. Separately developed a questionnaire that allows us to detect not only diabetes, but also prediabetes and may be in time to take preventive measures.

how can you improve the results of treatment those who have diabetes already have?

Marina Shestakova: And the situation is not hopeless. There are groups of innovative products that are proven in long-term studies that their appointment, even in heavy patients with cardiovascular complications, reduces mortality over 3 years of 38 per cent. Each innovative product is more expensive than its predecessor. The state cannot get out of its banks and to please everyone. But drugs that decrease mortality from cardiovascular causes, should be available to all needy patients. But these among diabetics for at least 30 percent.

what else can you do to innovative drugs become more affordable?

Marina Shestakova: In the world solve this problem in different ways. One option is to completely all “hang” on the state, which is unrealistic. The second option is to completely replace all the original drugs to generics and biosimilars. This is not a solution, because the copy is not the same as the original drug. A sensible solution in my opinion, the model of co-financing. If a patient wants to receive free medicines, would give him a copy of the original product or original – according to individual indications. But if he in any case wants the original, more expensive drug, then he can pay the difference. We have Kirov oblast for several years pursued this experiment in patients with arterial hypertension. It worked well: quite sick and pulled a small fee, and the budget is not affected. I’m thinking I want this experience to spread to other regions may be of different economic level. And see if all is equally good catch on this model.

we Have the possibility of purchasing medicines by trade name for health reasons for a particular patient. But the mechanism is complex and in practice is almost never done. Whether such a possibility for patients with diabetes?

Marina Shestakova: I believe that brand names definitely need to buy drugs, which are produced by genetic engineering. As for diabetes, it is insulin. Technology of production of copies, including biosimilars may not be reproduced wholly. Therefore their properties cannot be identical. And patients are naturally worried when they are assigned biosimilar. Especially when it concerns children, because no studies, including biosimilars on the children has never conducted and will not conduct.

So, at least for children with diabetes, which in our country is now about 45 thousand, it is impossible to buy biosimilars. They from the very onset of the disease take the drug the original, because of including biosimilars did not yet exist. And if now we are being forced to translate from the original drug to biosimilars, it is risky, and families often played a real tragedy. Changing from one insulin to another in any person – and the child, and an adult – only possible for medical reasons. But in no way due to the economic. If the patient is well treated fact that it matched, no reason to change the therapy. In our country, more than 4.3 million patients with diabetes of the second type. About 40 percent of them need insulin, but it receives only 20 percent. In these patients it is possible to begin therapy with biosimilar insulins which have passed all rounds of testing, including in our center, and we confirmed the identity of their pharmacokinetics and pharmacodynamics. And if the patient is well on this drug, this is an argument for all the doctors, and for the Ministry of health, and manufacturers. But I am against chaotic change from one drug to another because it leads to the loss compensation of the disease and roSTU treatment costs.