The St. Vincent declaration on the treatment of diabetes
From 10-12 october, 1989, a group of patient representatives, governmental representatives and diabetes experts met in St. Vincent, Italy, to discuss the growing problem of diabetes across Europe. The meeting, which was organised under the auspices of the World Health Organisation and the International Diabetes Federation resulted in the St. Vincent Decaration, which identified some fundamental goals and tasks necessary to reduce the individual and societal burden of diabetes. The fact that all stakeholders were represented created momentum for major improvements in many countries across Europe in the way diabetes was perceived and treated. However, full implementation has not been achieved. Many countries are lagging behind in their efforts to improve diabetes care and follow-up meetings in Istabul in 1999 and in Glasgow in 2009 have tried to reinforce the original message. At the same time it must be acknowledged that diabetes landscape is continually changing, and to preserve the spirit of the declaration, healthcare systems will constantly need to adjust.
The St. Vincent declaration was the first result of increased cooperation between the WHO and the IDF. After Europe, similar initiatives such as the Diabetes Declaration of the Americas (DOTA) have aimed to spark momentum to improve diabetes care in other continents. While some of these intitiatives have been dicsontinued, the rising prevalence of diabetes has put diabetes firmly on the healthcare agenda in most countries, as evidenced by the UN resolution 61/225 of 2006 and the official designation by the UN of November 14 as World Diabetes Day.
Diabetes mellitus is a major and growing European health problem, a problem at all ages and in all countries. It causes prolonged ill-health and early death. It threatens at least ten million European citizens. It is within the power of national Governments and Health Departments to create conditions in which a major reduction in this heavy burden of disease and death can be achieved. Countries should give formal recognition to the diabetes problem and deploy resources for its solution. Plans for the prevention, identification and treatment of diabetes and particularly its complications - blindness, renal failure, gangrene and amputation, aggravated coronary heart disease and stroke - should be formulated at local, national and European regional levels. Investment now will earn great dividends in reduction of human misery and in massive savings of human and material resources. General goals and five-year targets listed below can be achieved by the organised activities of the medical services in active partnership with diabetic citizens, their families, friends and workmates and their organisations; in the management of their own diabetes and the education for it; in the planning, provision and quality audit of health care; in national, regional and international organisations for disseminating information about health maintenance; in promoting and applying research.
General goals for people - children and adults - with diabetes
Sustained improvement in health experience and a life approaching normal expectation in quality and quantity.
Prevention and cure of diabetes and of its complications by intensifying research effort.
Elaborate, initiate and evaluate comprehensive programmes for detection and control of diabetes and of its complications with self-care and community support as major components.
Raise awareness in the population and among health care professionals of the present opportunities and the future needs for prevention of the complications of diabetes and of diabetes itself.
Organise training and teaching in diabetes management and care for people of all ages with diabetes for their families, friends and working associates and for the health care team.
Ensure that care for children with diabetes is provided by individuals and teams specialised both in the management of diabetes and of children, and that families with a diabetic child get a necessary social, economic and emotional support.
Reinforce existing centres of excellence in diabetes care, education and research.
Create new centres where the need and potential exist.
Remove hindrances to the fullest possible integration of the diabetic citizen into society.
Implement effective measures for the prevention of costly complications.
- Reduce new blindness due to diabetes by one third or more.
- Reduce numbers of people entering end-stage diabetic renal failure by at least one third.
- Reduce by one half the rate of limb amputations for diabetic gangrene.
- Cut morbidity and mortality from coronary heart disease in the diabetic by vigorous programmes of risk factor reduction.
- Achieve pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman.
Establish monitoring and control systems using state of the art information technology for quality assurance of diabetes health care provision and for laboratory and technical procedures in diabetes diagnosis, treatment and self-management.
Promote European and international collaboration in programmes of diabetes research and development through national, regional and WHO agencies and in active partnership with diabetes patients organisations.
Take urgent action in the spirit of the WHO programme, “Health for All” to establish joint machinery between WHO and IDF, European Region, to initiate, accelerate and facilitate the implementation of these recommendations.