To the President of Ukraine Sir Petro Poroshenko

APPEAL on the need to implement the "National policy on diabetes prevention and providing care to patients with diabetes for the period until 2025."

Recognizing the threat of an epidemic of diabetes for all mankind, on the 20th of December 2006 the General Assembly of the United Nations adopted Resolution 61/25 on World Diabetes Day, which calls on governments of all UN member states to develop national policies for the prevention and treatment of diabetes. This put diabetes in first chronic disease status, which should be a global problem of humanity. For the first time all governments have recognized that non-communicable diseases for the world is not lesser threat than AIDS or tuberculosis.

There are 415 million people with diabetes in the world. The prevalence of diabetes in Europe is high and growing rapidly over the past ten years. About 627,000 people aged 20 - 79 years died of diabetes during 2015 in Europe. Quarter (26.3%) of these deaths are under the age of 60 years. WHO prognoses that mortality from diabetes will increase by half between 2005 and 2030. According to the "Global Report on Diabetes WHO, 2016" Diabetes is the cause of 1.5 million deaths in 2012. Above optimal blood glucose was responsible for an additional 2.2 million deaths from cardiovascular disease, chronic kidney disease, and tuberculosis. Overall, worldwide 3.7 million deaths associated with elevated glucose levels in 2012.

Ukraine is no exception. According to official data critical situation in Ukraine We have a 1, 38 mln. People with diabetes (plus 5.7% per year) and prevalence of 2.9% (01.01.2015). Experts estimate that the real figure is at least twice as higher. Today in Ukraine there is a steady increase in mortality, and diabetes makes a significant contribution to this process. Link this situation only to the economic crisis impossible. Analysis of demographic and economic development of Ukraine in view of the cross-national perspective shows that there are many countries with lower GDP per capita, but with a more positive situation relative mortality and life expectancy of people with diabetes. This is because in these countries due attention to timely diagnosis and monitoring of diabetes disease introduced through the NDP. Eighty-eight percent of the governments of the world (156 countries) reported the presence of national policy, program or strategy for diabetes.

Implementation of a comprehensive program "Diabetes" 1999-2007 and 2009-2013 allowed Ukraine to achieve important results. The main one is 100% guaranteed to ensure insulin insulin-dependent people - the most vulnerable parts of diabetics. It is a balanced approach to providing insulin to prevent social unrest because of the unavailability of insulin to everyone who needs it is the only right way. However, the issue of effective care for patients with diabetes is more complex than providing minimum requirements for survival. Effective assistance is a set of measures that aims at achieving the targets of treatment and improve the quality of life of people with diabetes, reduce the incidence of disability, reduce the development and progression of diabetes complications, reducing mortality from problems related to diabetes. It is this measured economic efficiency of a program. The situation that now exists in Ukraine is dangerous. Lack of current program, that would ensure efficient system and accurate economically justified mechanism of diabetic care and coordination on the central and regional levels, is a prerequisite for the extremely negative consequences. Numbers of unresolved problems accumulate.

Adjusting practical activities in the segment of care for people with diabetes is in accordance to the reckless legislative initiatives. Underestimate the value and economic feasibility of early diagnosis of diabetes and its complications (diabetic retinopathy, diabetic foot, etc.). TB and diabetes is a combination of two terrible epidemics (more than common comorbidity TB and HIV) and is a real threat to our population. But there is no action plan to solve this problem in Ukraine. Although we have two academic institutions working on the Endocrinology themes (Kyiv, Kharkiv) but scientific support of a diabetic care system is not provided. This is due to the lack of a centralized national policy on diabetes. As a result, a condition for ineffective use of funds to help people with diabetes has been created. The major mistake in preparing the majority of the steps was the complete lack of evaluation of results of implementation measures and its economic effect. There are lacks of pragmatism in the process of developing concepts, policy documents, and mathematical modeling is absent.

The main goal of the National Policy on Diabetes (NDP) should be: • to reduce mortality and morbidity from diabetes and its complications (mainly cardiovascular diseases, renal failure and tuberculosis); • to provide guaranteed public access to diabetic care; • to provide scientifically based calculations to maximize an effectiveness of the funds.

To prevent emergencies in the future and to reduce the threat of human and material resources offer:  to actualize, taking into account the current recommendations IDF and the real economic situation;  to organize public discussion of "National policy providing care to patients with diabetes mellitus for the period up to 2025";  to adopt a realistic action plan for implementation of the NDP, which is based on system analysis using current technologies of mathematical modeling.

In connection with the above, we consider it appropriate to include diabetes as the priorities of Public Health of Ukraine and encourage you to provide official order relative to the development and implementation of the "National policy on diabetes prevention and ensuring the current level of diabetes care diabetes for the period up to 2025".

Signatures Name Place of residence Signature