This article is part of our special report Diabetes care in Europe: The path forward.
Cardiovascular disease related to diabetes is wrecking Europe’s public health budgets at an astonishing rate. Patients with diabetes are up to three times more likely to develop cardiovascular disease, while one in three will experience some form of vision loss.
According to the European Society of Cardiology, cardiovascular diseases are the leading cause of death in the EU, and the International Diabetes Federation reports that every 30 seconds, a lower limb is lost to diabetes somewhere in the world.
Growing clinical, psychosocial, and socioeconomic burdens
Francesco Cosentino, a Senior Physician and a Professor of Clinical Cardiovascular Research at the Swedish Karolinska Institutet, specialises in the molecular mechanisms behind the increased risk of cardiovascular disease linked to diabetes, overweight, and ageing.
In a recent paper by Cosentino et al, it’s argued that there is a mounting clinical, psychosocial, and socioeconomic burden worldwide as the prevalence of diabetes, CVD and chronic kidney disease continues to rise.
They report that “despite the introduction of therapeutic interventions with demonstrated efficacy to prevent the development or progression of these common chronic diseases, many individuals have limited access to these innovations due to their race, ethnicity, and/or socioeconomic status.”
Diabetes remains a global health concern. It’s associated with a myriad of complications affecting various organs and in high-income countries it is a leading cause of CVD, blindness, kidney failure, and lower limb amputation.
Type 2 diabetes increasingly represents a significant public health problem due to its alarming prevalence and associated complications including CVD, and these are closely interconnected and can constitute the main causes of morbidity and mortality in people with type 2 diabetes.
Regular monitoring of blood glucose, blood pressure, and cholesterol levels is essential to delay or prevent these complications.
CVD and healthcare budgets swell
In 2020, diseases of the circulatory system were responsible for almost one-third (32.7%) of all deaths. Germany had the highest level of current healthcare expenditure among the EU Member States, valued at €432 billion in 2023.
The World Bank predicts that public expenditure on healthcare in the EU could jump from 8% of GDP in 2000 to 14% in 2030 – a significant financial burden on healthcare systems and government budgets.
The substantial burden of cardiac and renal damage can also contribute to the increased risk of mortality in people in the early stages of type 2 diabetes.
Heart failure and chronic kidney disease are the first and most frequent manifestations of CVD in people with type 2 diabetes and are associated with increased morbidity and mortality risk. While CVD, affecting the heart and blood vessels, is the most common cause of death in people with diabetes.
High blood pressure, high cholesterol, and high blood glucose are risk factors that increase the likelihood of cardiovascular complications.
Optimal CVD / diabetes management
Though efforts for optimal management of CVD risk factors in people with type 2 diabetes have had an impact on atherosclerotic outcomes, there has been no significant impact on heart failure and chronic kidney disease. Studies have shown these to be more common complications in people with type 2 diabetes than stroke, heart attack, and peripheral artery disease.
They account for the highest proportion of hospital healthcare costs and are associated with increased mortality risks.
Diabetes and the politics of inequality
In the EU, approximately one in six adults live with CVD, and the number of people with diabetes mellitus has almost doubled in the last decade, affecting nearly one in ten adults.
The Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) emerged from this growing need to help European countries reduce the burden of chronic diseases.
JACARDI a project which is part of the European Commission’s Healthier Together EU Non-Communicable Diseases Initiative and is scientifically supported by the WHO runs from November 2023 to October 2027 and involves partners from 21 European countries. It aims to enhance the quality of care for people affected by CVD and diabetes in Europe.
In part, the project seeks to reduce the significant differences in the prevalence and mortality of CVD and diabetes between social groups, regions, and countries, pointing to large inequalities across Europe.
EPP’s manifesto CVD pledge
To address this multifaceted and seemingly intractable healthcare puzzle, the European People’s Party (EPP) has included a ‘European Cardiovascular Health Plan’ in their 2024 electoral manifesto.
This plan was a direct response to the recognition that cardiovascular disease is the leading cause of death in the EU.
The plan proposes the establishment of a European Knowledge Centre and the promotion of a joint cardiovascular and diabetes health check. Its inclusion in the EPP manifesto was viewed as a historic step in addressing the urgent need for comprehensive action to tackle Europe’s health crisis.
The initiative was welcomed by the European Alliance for Cardiovascular Health (EACH), a coalition created in 2021 comprising patients, healthcare professionals, researchers, and health industry representatives.
In its manifesto, the EPP argues that considering “our ageing society, investment in healthy longevity is the best way to alleviate the burden of ageing on budgets and to make our longer lives also healthier.” The focus is therefore not just lifespan, but ‘healthspan’ – the opportunity we possess to live a functional, healthy life for longer.
Counting the real cost of diabetes
Peter Attia, a prominent figure in the field of health and longevity, has said: “Patients with T2D have a significantly elevated risk of cardiovascular disease, cancer, and Alzheimer’s disease relative to those without T2D, yet deaths from those respective diseases count as their own categories.”
Attia argues that the real cost of diabetes in lives and Euros is likely to be significantly higher than health institutes report, because we often count causes and outcomes in isolation, necessarily so. Of T2D Attia says “We must bear in mind that a much larger impact on mortality lies hidden.”
Without a holistic, urgent, well-funded and communicated approach to diabetes, Europe is not only diminishing the quality of life for its citizens but emptying its wallet unnecessarily.
At a time when the European Union is struggling to pay for munitions in Ukraine, it should deploy its frontline healthcare practitioners in the war on diabetes.