Konstantina Boumaki is a Greek medical student. A board member of the European Patient Forum and the Hellenic Diabetes Federation, she is an active member of the International Diabetes Federation.
Konstantina can remember her diagnosis clearly. “I was 9. I had been feeling awful for some time. My general practitioner detected that smell on my breath, that fruity smell that indicates a dangerous level of ketones in the blood: it’s called ketoacidosis. He sent me straight to hospital. It was scary. But he was calm and positive, so I felt positive too. I remember I had been looking forward to eating my weekly treat that I had chosen with my mum from the supermarket. So, my first question was, will I still be able to eat my treat? And his answer was yes!”
Konstantina’s paediatric specialist in diabetes also helped her to accept and embrace her condition. “He not only helped me and my parents to understand diabetes but also gave us hope that things would get easier – which eventually they did, with new technologies we couldn’t imagine then.”
She adds, “When you have a little hope of an easier and better reality in a few years, you hold on and keep going on tough days. He knew this. He also knew that psychological support during the first days of the diagnosis was very important, so he often asked me and my mother to meet another family and their newly diagnosed child. They could then voice all the thoughts and fears that my doctor knew they wouldn’t tell him. I remember the mothers always cried to let all their feelings out.”
Konstantina emphasizes, “This doctor is the reason I started advocacy, and the reason I started medical school.”
Creating a bond
“My advice for all doctors, as a future doctor and as a patient, is to see their patient as a human being and not as a number,” Konstantina explains.
“As long as my doctor could see a good HbA1c [glycated haemoglobin] value and good blood glucose levels, he didn’t focus on numbers – he cared about how I was and how I was doing with my life in school with my friends, how I was accepting diabetes and if I was leaving other things behind to control it. These questions weren’t random; he created a safe space, a great bond between us. Every 3 months I went to Heraklion Hospital for my check with him and his nurse, who had diabetes herself. I had a great team around me.”
Konstantina also experienced the opposite approach. “Early on, I had a dietitian who didn’t see me as a person, but just a patient that she told what to do. I was in the mixed insulin system with syringes and a rigid food programme involving exact measurements and times. Her cold attitude meant that I didn’t want to go back to her – or any dietitian – again.”
Recalling this experience, Konstantina states, “You should listen to your patient and their needs so they know you will help them in achieving glycaemic control. It is a sensitive area: there is a lot of research showing that people with diabetes, especially type 1, often develop eating disorders. I had a huge issue with an eating disorder myself, which I still fight, but now it’s not as severe as it was. The approach of this dietitian didn’t help.”
Technology
People with diabetes are often reliant on technology. When Konstantina arrived in Athens as a student, she was determined to try the pump known as the artificial pancreas. However, the instruction she was given was so poor that her efforts to operate it turned into a 3-month nightmare.
“New technologies are great and we need them, but if we don’t have a great system to teach us how to use them, it’s worse than not having them! Diabetes is a full-time job as it is.”
Psychological support
Konstantina believes that a psychologist is a great addition to a diabetes team. “People with diabetes can often keep their feelings locked up: we feel alone, obliged to prove ourselves and hyper-aware of stigma. If you have a bad day, you always think it is your fault, you are not doing a good job. I used to hide my feelings, but being open is so important – otherwise, your friendships are not as deep as they should be, you put up a wall. Some days are hard, but you accept it and deal with it. Now, I am open and calmer, but I am stubborn!”
She is concerned that for many young people in poorer countries, the supply of insulin is erratic or hard to access. Good friends have died because of this. “In some places, there are people with diabetes who are living in the shadows with stigma, discrimination, no access to insulin and little patient education. This needs to change. I was lucky.”
Person-centred care, which Konstantina so values, is the approach taken by WHO/Europe’s recent publication, “Therapeutic patient education: an introductory guide”. It aims to help policy-makers and health professionals provide effective therapeutic patient education for all people living with chronic conditions. The goal is to improve decision-making about clinical care by involving the patient through education, empowerment and support, but also to help them live more meaningful lives.
Background on diabetes: what are WHO Member States committed to?
In 2022 WHO Member States first supported the creation of global targets for diabetes as part of recommendations to strengthen and monitor diabetes responses within national noncommunicable disease programmes.
WHO/Europe and the International Diabetes Federation Europe have agreed to accelerate progress to meet or exceed these global diabetes targets for 2030:
- 80% of people living with diabetes to be properly diagnosed
- 80% of them to have good control of glycaemia and blood pressure
- 60% of people over the age of 40 with diabetes to receive statins
- 100% of people with type 1 diabetes to have access to affordable insulin and blood glucose self-monitoring.