2.3. Metabolic diseases

Of the various metabolic diseases, that of greatest interest for public health, given its frequency and related load of disease, complications and disabilities, is undoubtedly diabetes mellitus. Data provided by the National Statistics Institute (Istat) indicates that the prevalence of diabetes has continued to increase over the past decade. In 2010, 4.9% of the Italian population (5.2% of women, 4.5% of men), equal to 3,000,000 people were diabetic. The prevalence of diabetes increases with age to reach 19.8% in people aged 75 or above. In the 18-64 years age group, prevalence is highest amongst men, whereas over 65 years it is higher amongst women. As regards geographic distribution, the prevalence is highest in the South and Islands, with a value of 5.6%, followed by Central Italy with 4.8% and the North with 4.4%.

Given the direct relationship between obesity/overweightness and type-2 diabetes, the data concerning the spread of these conditions amongst the Italian population should be a cause for concern. According to Istat data, in 2009, 36.6% (45.6% amongst males; 28.1% amongst females) of the adult population in Italy was overweight and 10.6% (11.6% of males and 9.5% of females) were obese. The highest percentage of obese and overweight people (11.8% and 39.8%, respectively) was recorded in Southern Italy and the islands. It has therefore been estimated that there are approximately 6 million obese adults in Italy. It is also estimated that 1 million Italian children aged between 6 and 11 are overweight or obese, with significant differences between Regions.

Primary prevention of diabetes is connected to the prevention of overweightness. The obesity epidemic can be kept under control and the pattern inverted by means of structured initiatives that involve social, economic and environmental lifestyle determinants, taking into account a number of fundamental elements:

• the prevention of obesity cannot be the exclusive competence of the Health Service;
• the schemes to be implemented must be aimed at a sociocultural change intended to alter individual behaviour regarding diet and exercise and to develop policies that allow healthier personal choices by means of a series of environmental, structural and sociocultural changes;
• programmes of documented efficacy must be developed, involving all the subjects of civil society (public institutions, citizens and consumers associations, manufacturers, distributors and dealers, the sport world, advertisers, etc.) within a process of change.

Diabetic patients must be managed by means of continuous healthcare that can be achieved through the use of new care models such as disease management, case management and the chronic care model, which can be termed organised, integrated, proactive, population-centred “integrated management” practices, focussing on an informed patient trained to play an active role in the management of his/her disease. Through common care pathways, Integrated Management currently acts as a prototype organisational model, aimed at improving healthcare and preventing complications. The National Centre for the Prevention and Control of Disease (CCM) IGEA (Management and Healthcare Integration) project, run jointly by the National Institute for Health (ISS) and the National Centre for Epidemiology, Surveillance and the Promotion of Health (CNESPS), has taken on the role of developing instruments that are useful for the implementation of the Integrated Management of the diabetic patient, by performing initiatives and actions aimed at promoting improvements in the care provided to people with diabetes and the prevention of the disease’s complications.