In June 2024, the International Blindness Prevention Agency (IAPB) and Abbvie launched the Diabetic Eye Conditions (DEC) Union. A major initiative of the DEC Union, a group of regional and global partners concentrated in Europe, is to engage European policymakers in the prevention of diabetes and associated eye complications. Dec Coalition shared five calls to action last summer, hoping to trigger the action led by the IAPB Global Eye Health Summit 2026.1.
For more information about Dec Coalition and its instructions, the Ophthalmology Times Europe spoke with Francesco Bandello of Febo, the head of the ophthalmology at IRCCS Ospedale San Rafaele in Milan, Italy. Professor Bandello was a key participant in the launch of The Dec Coalition. In this interview he contextualized the group's five-point call to action.
Five actions that will allow you to rebuild DEC in Europe
“With the global rise in diabetes and aging population, the incidence of diabetic eye condition is expected to grow,” reads a statement from the DEC Coalition at the time of launch. “Despite advances in diagnosis and treatment, many people remain undiagnosed and untreated, missing out on opportunities to prevent obstacles that have serious consequences for individuals and society.”1
Professor Bandello described these five calls to action that are essential to the management of the DEC, as patients can empower and inform them. “It's very easy to motivate patients when the wider culture is one of education and information,” he said.
Dec Coalition calls policymakers to:
Integrate eye health into European diabetes policy, national health strategic plan, primary care model, integrate DEC screening protocols, ensure consistent high quality care through European comprehensive patient education program, ensure comprehensive patient education program across the environment and age group, strengthen self-management of ordinary dissemination and support for European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support of European dissemination and support for the dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination and support of European dissemination And national policy aimed at improving care for people living in December
“It's very important to build a culture of consciousness from a very early stage,” Professor Bandero said. “The level of knowledge and the accessibility of information within a national or regional culture makes all the difference.”
Courtesy of the IAPB/DEC Coalition.
The changing focus of December
As the population of patients with diabetes and DEC grows, patient education opportunities become more important. “I've seen a huge increase in diabetes patients in my country,” Professor Bandello said. “The number of diabetes patients in Italy is on the rise, but looking at the levels of diabetic retinopathy, we've seen some improvement over the last few years.”
Professor Bandello said that in his practice in Italy and Europe, the most advanced form of diabetic retinopathy is a regression in commonality. “We don't see the most advanced form of proliferative diabetic retinopathy, just like in the past, that was very common,” Professor Bandello said. “And the obvious reason is that the quality of diabetes treatment has improved. These patients have improved metabolic control, and generally speaking, patients are empowered to treat diabetes more effectively.”
Now he said that most clinicians are working to manage non-maturistic forms of retinopathy, or other ocular complications of diabetes. One such DEC is diabetic macular edema (DMO), which is rapidly increasing within many patient groups, said Professor Bandello. “Maybe this is because optical coherence tomography (OCT) can be used to get a more accurate diagnosis of DMO,” Professor Bandello said. “In any case, DMO is the most pressing eye condition among diabetics.”
In the near future, Professor Bandello predicted that clinicians and industry partners will make DMO a major focus for eye care. He said that its changing focus on macular edema is already ongoing, as demonstrated by the increased availability and accessibility of treatments for DMO. “Previously not possible with DMO patients today. There was no endovitreal therapy,” he said. “In the past, treatments available to DMOs, like laser treatments, have never been comparable to today's endovitreal therapy. As DMOs continue to be a major topic in ophthalmic care for diabetes, those treatments can improve.”
Global leaders, clinical perspective
The main goal of the DEC Union is to “integrate eye health into European diabetes policy, national health strategic plan and primary care model.” Professor Bandello said this is a simple yet strategy that has the greatest impact on patients across Europe.
“Follow-up is one of the most important things about chronic diseases like diabetes,” emphasized Professor Bandero. “For follow-up, good compliance is required for advanced treatments. For that, education is required. Knowledge is required.” Clinicians need to ensure that patients are both their illness, their current condition and management options, and that their future outlook is for progression and vision, Professor Bandello said.
He continues, “It's important that we should push as clinicians.” [policymakers] Establishing certain types of diabetes education from elementary schools. We need to teach very young people how to improve their quality of life, exercise, and how to eat the best. And all of this has to be started in elementary school. ”
He said DEC management has improved, but the results are often too little and too late. “What's happening now is that we always arrive late,” Professor Bandero said. “The most important thing is first-line prevention of diabetes, primary prevention. Secondary prevention, diabetic eye condition or other complications are already too late for diabetic patients. Diabetes prevention is much better.”
Here, Professor Bandello said it would become clear that patient education is not sufficient. European policymakers also need to receive education. Clinician researchers can inform policy makers of what is possible in diabetes management, the benefits of prevention, and the economic factors associated with DEC treatment and prevention.
“The truth is [many policymakers] Professor Bandello said “the clinicians' interest in education and screening is not important.” For many in the government, Professor Bandello said 15 years was “a whole political life.”
“In these cases, policymakers are only sensitive to what is happening in a year in the 18 months when the next election took place,” he continued. “So they prioritize something that delivers visible results in very short time,” Professor Bandero said. Some people in the government may not be “sensitive” to the urgency of preventive care, but “when you explain it to them, they understand.”
“They understand the problem. They are smart people and we can see why preventive education is so important to reduce the impact of diabetes,” Professor Bandello said. “But, at least in my experience, policymakers aren't as motivated as clinicians who make that change, so we need groups like the DEC Union.”
reference
1. Eye Conditions of Diabetes (DEC): An International Call for Action. press release. International organization for blind prevention. Published on November 12th, 2024. Accessed February 21, 2025. https://www.iapb.org/news/diabetic-eeye-conditions-dec-a-call-for-international-action/