In Support of Pump Therapy for Diabetic Children in Our Country

The debate about the treatment of diabetic children by means of insulin pumps in our country is at its peak. Recently, at the request of the Ombudsman of the Republic of Bulgaria, a working group at the Ministry of Health has held a meeting, aimed at proposing action to resolve the problem of patients treated with insulin pumps in the country. And the problem is that Bulgaria still remains the only country in the European community which does not pay any part of the treatment, which is acknowledged as the best modern treatment of diabetes, and has been performed for more than 20 years in Europe and worldwide.

Four years ago the Varna Paediatric Endocrine Society came up with an opinion and a proposal for the solution to the problem, which was addressed to the then Minister of Health. There has been no government policy on this issue so far, but the support for the children for whom the only chance to live a normal and fulfilling life is the treatment with insulin pumps has been growing more and more.

A number of NGOs and patient organizations, individuals and even whole municipalities undertake various initiatives and fund-raising campaigns. At the end of the previous year endocrinologists from Varna and Varna Municipality launched a pilot project for training medical staff and teachers at nurseries and kindergartens to be able to take care of children with diabetes. "Together with the City Council, the Municipality of Varna provided financial assistance for the purchase of insulin pumps for the families of four children," said Nelly Valeva from Healthcare Directorate at the press conference, held today at St. Marina University Hospital. "Thanks to the proper dialogue between the Municipality of Shumen and the Patient Association "For Insulin Pumps", the Municipality of Shumen is about to vote on a budget for 2015 to provide funds for supplies for the children with insulin pumps on the territory of the Municipality," said Vanya Stoyanova, Chairperson of the national movement and a mother of a child with diabetes. The initiative is also supported by artists. The painter Yordanka Yanakieva and the National Endowment Fund “13 Centuries of Bulgaria” donated all the proceeds from the charity exhibition "Fairytale" for the purchase of an insulin pump for the 15-month-old Boryana from Varna - the youngest patient with diabetes mellitus in the country.

Boryana’s family found out about the child's disease three months ago - the diagnosis is type 1 diabetes (insulin-dependent diabetes mellitus). The team of Prof. Violeta Yotova, Head of "Pediatrics" at St. Marina University Hospital -Varna, placed an insulin pump into Boryana. Thanks to the modern treatment the parents spare the pain of daily pricking (4-6 times a day) for the child, which is caused while using conventional multiple insulin injections (MII). The insulin pump delivers the right amount of insulin, which entirely meets the individual needs of Boryana throughout the day. The child needs small doses of insulin that cannot be delivered by conventional means. Currently, the total daily dose of insulin of the child is under 4E for 24 hours, and throughout certain periods of the day she does not receive insulin at all.

 

The precise operation of the insulin pump is driven by a glucose sensor that makes hundreds of measurements of blood sugar per day, giving an accurate picture of the fluctuations in blood sugar levels. "The precise measurement of glucose is crucial for the improvement of the control and monitoring of the treatment. Precise dosing of insulin helps the body to begin to deal with the problem on its own and even to start producing the necessary insulin doses for a certain period of time," explained Prof. Yotova. "At present diabetes in all its forms cannot be cured, but with good conduct and a proper treatment a normal life of the patients without complications is absolutely possible. Frequent acute infections in the youngest children cause problems that could not be resolved without hospitalization. Boryanka has already been sick twice, and this has caused nether hospitalization, nor deterioration of the indicators of glucose metabolism."

This is one of the reasons why in many countries the treatment with an insulin pump has become the golden standard in the treatment of children with diabetes. In Slovenia, this type of treatment is started immediately after a type 1 diabetes diagnosis is established, and the pump and its supplies are entirely paid by the health insurance. Moreover, the provision of glucose sensors was also started in Slovenia 2 years ago. Thanks to the efforts of doctors and patient organizations in the countries of the former socialist camp in Europe, such as Hungary, Romania, Serbia, Macedonia, Croatia, insulin pumps and/or their supplies are paid fully or partially by the health funds or the health authorities. Regardless of the level of reimbursement, in all countries with the exception of our country, the treatment with a pump is obligatory for patients with diabetes, under 6 years of age.

"In our country a state policy on the treatment of children with diabetes with insulin pumps is to be established in the future. At the time we rely entirely on charity events, like the one held today, and initiatives of NGOs, municipalities, individuals, and I’d like to thank them all for their help and support. Pump therapy is an innovation, totally supported by Medical University – Varna and St. Marina University Hospital, because we believe that the development of science should be available to our patients. The team of Prof. Hristosov has begun to place pumps into adults as well. We are encouraged by the fact that the state institutions at various levels are aware of the problem now. All we specialists-endocrinologists have to do now is to put all our efforts into helping the state institutions with expertise, information and experience, so that the most optimal and proper decision is made for everyone,” said in conclusion Prof. Yotova.

"The care of chronically ill children, including children with diabetes, is among the priorities of the Municipality of Varna," said Nelly Valeva, Head of Healthcare Directorate at the Municipality of Varna. "We urge all municipalities to follow our example and we also appeal to the Health Insurance Fund."

The price of an insulin pump is 7500 lev and the monthly supplies amount to 300 lev. The number of children on pump therapy in Bulgaria is approximately 100. Provided their families could find funds for the purchase of the pump, the monthly payment of supplies turns out to be unaffordable for them. So if only this, partially or entirely,  was paid  by the Health Insurance Fund, our country would achieve a tremendous progress in the treatment of children with diabetes.