Newspaper of the Lithuanian Diabetes Association
No 3 (47) August 2005

Lilly - the general sponsor.
Sponsors: Abbott Medisense representative UAB Abovita, Aconitum, Sanofi-Aventis Lietuva, Berlin Chemie Menarini Baltic, Convatec, Eksmos MTC, Interlux, Limeta, Novo Nordisk Pharma, Diagnostics branch of HOFFMAN - LA ROCHE Ltd. representative, Vitabalans OY representative, Wörwag Pharma GmbH & Co. KG..

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The 6th Lithuanian Diabetes Association Congress

The 6^th Lithuanian Diabetes Association Congress took place on the 10^th June, 2005. 130 delegates and more than 50 quests took part in it.

Honorary member of the Lithuanian Diabetes Association, consultant of World Bank, the Exs-expert of St. Vincent Declaration and DAWN study in World Health Organization Dr. Isuf Kalo stressed, that while Lithuanian Diabetes Association is going by recommendations of St. Vincent Declaration, it does a great job improving life quality of people with diabetes in Lithuania. The LDA is one of the best and the most actively working organization in Europe. The activity of the organization is evaluated highly and the president of LDA is elected to the members of Board of the International Diabetes Federation European region. The achievements in Lithuania while solving questions of diabetes treatment and prevention is the result of all members’ efforts. The world is on the way to reforms of health systems. Health reforms are very poor, as they are deaf to patients. There were investments only to medicine, not to human till now. But the question on patient as the partner in the centre of health system is rosed now. Medics are your friends and they must be your partners. Such a co-operation is the aim of health system.

The representative of World Health Organization in Lithuanian office Raimonda Sadauskiene thanked for the possibility to participate in the 6^th congress. She informed that the representatives of WHO in Lithuania values the activity of LDA in a very high level.

Deputy chairman of the Committee on Health Affairs of the Seimas of Lithuania  Antanas Matulas thanked for invitation to the Congress and expressed the joy such an organization to exist. He stressed that LDA got a great shock on budget distribution. The president of LDA defended interests of patients with strength and won the most she could in given situation. The quest presented congratulations from Committee on Health Affairs of Seimas of Lithuania, where the merits of the LDA were stressed in achieving results in diabetes treatment and prevention. He read the congratulation of chairman and deputy chairman of Homeland Union party. The quest was happy for ability to co-operate with LDA and its’ president Vida Augustiniene deciding problems of all Lithuanian patients as well as problems of people with diabetes.

Director of Social Integrity Department in Ministry of Social Security and Labour Alfredas Nazarovas participated in LDA meeting for the second time and knows LDA as important partner of Ministry. The Association with the help of it’s president defend its’ interests in a very professional way. He stated, that acts about payings to children with diabetes were corrected according to LDA offerings.

Director of State Patients’ Fund Algis Sasnauskas congratulated the LDA and stressed that LDA strongly represents interests of people with diabetes. He thanked to LDA and its’ president.

LDA was also congratulated by the deputy director of KMU Endocrinology institute Dr. Rytas Ostrauskas and the member of the Council of representatives of patients’ organizations of Lithuania and the chief of Lithuanian people with psychic disorders care community Danute Kasubiene.

Vice-president of LDA Genovaite Naidzinaviciene read congratulations and telegrams for LDA Congress. Congratulations were received from the president of International Diabetes Federation European region Dr. Wim Wintjiens, the president of Cyprus Association for People with Diabetes Dina Constantinides, the president of Latvian children and youth diabetes association Inara Puzule, the chief of German committee on supporting Lithuanian children with diabetes Lilly Karn, the honor member of LDA Irena Grakauskiene.

The honor member of LDA Dr. Antanas V.Stepanas and the chief of Varena diabetes club Petras Kontrimas were honored by minute of silence.

The president of Lithuanian Diabetes Association Vida Augustiniene presented a report on activity of LDA during 2002-2005.

Organizational questions

LDA moved to the new office on 2002. JSC Sanofi-Aventis Lietuva and Aconitum became the gold sponsors of LDA and Interlux and Gedeon Richter Ltd. became the silver sponsors of LDA. Pagegiai diabetes club “Rambynas” joined to LDA members. Vilnius diabetes club Dia was ejected from LDA. Urgent questions were discussed during tens of meetings by Council and Board of LDA.

Representing in various institutions

On 2002 Council of representatives of Patients’ Organizations of Lithuania was funded and the president of LDA was elected to be a chief of this Council. According to decision by Committee on Helth Affairs of the Seimas  of republic of Lithuania Vida Augustiniene was confirmed to be a supernumerary member of this Committee from 2003 as well as the member of Council of Obligatory Health Insurance according to the order of Minister of Health and the member of College of Ministry of Health from 2005. She is representing patients’ interests in different work groups formed by Minister of Health.

During 2000-2003 the president of LDA was the member of International Diabetes Federation Congress organizational committee. On 2003 she was elected to be the member of Board of  IDF European region and the chief of Committee of Diabetes Magazines of International Diabetes Federation (ICDM).

Events in diabetes clubs and communities

On 2002 the activity of Elektrenai and Kaisiadorys diabetes clubs was renewed. Klaipeda children club “Smalsuciai” celebrated it’s one-year birthday on 2002; Druskininkai and Kursenai clubs celebrated their 5 year jubilee on 2003; ten years of activity was stoned in Kelme and Jonava on 2002 and in Rokiskis, Raseiniai, Joniskis, Ukmerge and Pakruojis on 2003. 15 years jubilee was celebrated in Vilnius club “Dia” (2002), Panevezys (2004), Alytus and Lithuanian Diabetes Association (2005). An action “Limit <7” organized by LDA and JSC Sanofi-Aventis took place in Silute, Marijampole, Pasvalys, Vilkaviskis, Taurage, Pakruojis, Jonava, Kedainiai, Lazdijai, Plunge, Akmene, Elektrenai and Joniskis. HbA1c tests showed that more than 70 % of patients badly control their illness, that is, their HbA1c index exceeded 7 %. Diabetes club from Mariampole district (Mariampole, Vilkaviskis diabetes clubs) organized meetings every year as well as Plunge, Jonava and Taurage diabetes clubs. Events on World Diabetes Day took place in every district of Lithuania. The topics of World Diabetes Days: “Diabetes and eyes” on 2002, “Diabetes and kidney disorders” on 2003, “Diabetes and obesity” on 2004. Representatives of LDA took part in conferences and seminars organized by Kursenai, Raseiniai, Vilnius, Pasvalys, Panevezys, Taurage, Silute, Skuodas, Kaisiadorys, Rokiskis, Pakruojis, Kedainiai, Ukmerge, Mazeikiai, Kelme, Siauliai, Svencionys, Mariampole, Zarasai, Joniskis, Jonava, Elektrenai and Vilkaviskis diabetes clubs. Delegations from Silale, Elektrenai, Taurage, Varena, Radviliskis, Silute, Kaisiadorys and Anyksciai diabetes clubs visited LDA. A plenty of events, seminars and meetings took place in all diabetes clubs and communities.

Meeting society, government institutions, participating in conferences, sittings and actions

An activity of Lithuanian Diabetes Association was exposed during international BaltMedica expositions in exposition centre Litexpo, Lithuanian Opera and Ballet House, during Health feast in arena “Siemens”. Prophylactic tests of blood glucose were made for participants of events and visitors. The reports for nurses studying were made in Vilnius Centre University hospital and Vilnius Collegiums Health Care Faculty. The meetings with the President of Lithuania, representatives of Health Committee at LR Parliament, Health Ministry, State Patients’ Fund, political parties, pharmacy companies, media, patients’ organizations, society and patients took place in various events in the run-up to the elections to LR Parliament. LDA took part into the work groups of Health Ministry collegiums, Obligatory Health Insurance Council, National Health Council at LR Parliament, and Council of Invalids’ Affairs at LR Parliament. The questions of patients’ rights, compensating medicine, services quality and other urgent questions were discussed during these meetings. The protest action near the Government Office was organized on 2002 in order to prevent limits for compensated medicine. While fighting for compensation for diet, LDA invested many strengths and felt many offences from the side of Health Ministry and its’ officers. Still, Health Ministry obeyed LDA request and canceled paying it on 2005. Only with the efforts of LDA this money was devoted to additional amount of diagnostic sticks. An activity of Council of Patients’ Organizations’ of Lithuania was organized and appeals to government institutions were prepared on different urgent questions. A project “Strengthening patients’ organizations and their integration to European Union community” is on the way. Seminars “Effective communication with the press”, “Influencing and negotiating” and “Patients’ rights in Lithuania” was organized. On 9 May 2005 Council of Patients’ Organizations of Lithuania became the member of International alliance of patients’ organizations.

Conferences organized by LDA

3 conferences for collective members of LDA on the questions of diabetes took place in Palanga, Anyksciai and Plateliai. Press conference “Patients against medicine limits” took place in BNS on 2002, “Diabetes – the challenger for European Union and its’ members” in Health Ministry on 2003.the Vice-president of IDF Dr. Wim H.J.M.Wientjens took part in it. LDA organized th 4^th conference of Baltic States Diabetes Associations “We are stronger when together” on 2003. Republic conference “Diabetes and kidney disorders” took place in Vilnius on World Diabetes Day 2003 and the first republic conference for youth with diabetes in Druskininkai on 2004. 28 January 2005 conference “Strategy of diabetes; LDA role” was up to LDA 15 year jubilee. On 23 March LDA initiated the first discussion on diabetes questions by different health care institutions in Health Committee at LR Parliament. Committee made a decision according to reports by participants (Diabetes No. 2(46).

Diabetes school, encampments

Diabetes teaching takes place in the office of Lthuanian Diabetes Association 3 times per week constantly. Endocrinologist provides information freely. Every year 10 days long encampments for children and youth took place in Lazdijai, Silaine, Palanga, Druskininkai, Plunge, Plateliai (70 – 80 participants every year). 5 days long encampments for people with II type diabetes started at 2003. A few young people visited encampments in Latvia Finland and Russia. Quests form Latvia and Russia visited LDA encampments.

Publishing

Health passport “Diabetes”, calendar “Life and diabetes”, book “Eyes and diabetes; lets save life-light” were published on 2002, book “Healthy diet; Advices for people with diabetes” and the book “Diabetes and kidney disorders” on 2004. The newspaper “Diabetes” celebrated its’ 10 year jubilee. The folm “Prevention of diabetes and its’ complications” and the book “Diabetes and obesity” was prepared on 2004. Diabetes control diary and different booklets on urgent diabetes questions were published every year.

Articles in the press, participating in TV and radio broadcasts

Information on different urgent questions for society and patients was provided using different channels: newspapers “Lietuvos rytas”, “Valstietis”, “Kauno diena”, “Laikas”, “Paragaukite”, “Sveikatos ABC”, “Ukininko patarejas” and other district publications; Lithuanian National TV broadcasts “Spausos klubas”, “Kryzkele”, “Visuomenes interesas”, “SOS”, Baltic TV broadcast ”Pjuvis”, LNK TV broadcasts “Frontas”, “Zodzio laisve”; TV-3 broadcasts “Vienas pries viena”, “Nesutinku”; Vilnius TV broadcast “Pulsas”; Lithuanian National II TV news and other national and local means of radio and TV.

International activity

The representatives of LDA took part, reported and exposed stands during International Diabetes Federation congress in Paris (2002). Other places participated: IDF European Region General Assemblies and conferences “We are stronger being together” in Cyprus, France and Slovenia; European Diabetes Studies Association conferences in Hungary, France and Germany; European Health Forum in Austria; IDF European region board sitting in Belgium, Germany, Slovenia and Netherlands; IDF European Region, European Parliament and European Commission conference in Belgium; IDF European Region new members work groups in Belgium, Germany, Slovenia and Poland; European Patients’ Forum conferences in Belgium; IDF International Diabetes Journals’ Committee conference in France; European diabetes associations’ conferences in Russia, Latvia and Belorussia.

Chiefs of organizations, co-operators, members of patients’ families and permanent sponsors such as Eli Lilly Lithuania, Sanofi-Aventis Lithuania, Aconitum, Novo Nordisk Pharma, Abovita, Eksmos MTC, Interlux, Gedeon Richter Ltd., Council of Invalids’ Affairs at LR Government and Lithuanian Cooperatives’ Union was thanked. The most initiative co-operators of LDA were granted with thanks writings.

Aldona Danyliene presented a report by revision commission. 44 % of LDA budget was formed from pharmacy companies and other sponsors support for different projects and organizations’ activity, 40 % money was received from state budget for projects, 5 % of money was received from prescription newspaper “Diabetes”, 4 % was collected from members of LDA and 7 % was other type of income. 27 % of LDA budget was spent on coordination of different programs and organizing LDA activity, 21 % for teaching camps, 13 % for diabetes school, 12 % for publishing newspaper “Diabetes”, 10 % for other informational publications, 6 % for conferences and seminars, 6 % for events on World Diabetes Day and 5 % was other type outcomes.

The chief of Joniskis diabetes club “Viltis” Aldona Gostautiene stressed that LDA is a base we live on. People from districts are bothered by a plenty of problems: it is impossible to visit specialists; there are long rows near the cabinets of therapists; diagnostic blood glucose sticks are not prescribed; needed medicine and tests are hardly achievable; committals to health repairing treatment are not prescribed; there is no foot care cabinet.

A member of Lithuanian community of nurses-diabetologists, Plunge diabetes club nurse diabetologists Aldona Danyliene reviewed an activity by nurses-diabetologists in Lithuania. She stressed that teaching is recognized as important factor for a person with diabetes nowadays. The main aim of nurse-diabetologists work is to form a constant individual or group teaching program, based on practical usage of acquired knowledge. It is necessary to initiate an early responsibility of patient for his own daily diabetes care. Not only mistakes, but also improved results of self-control must be noticed. There is teaching program for nurses-diabetologists prepared in Lithuania and 396 nurses were specialized according to it and received certifications. Still, most of them do not have an ability to work as diabetologists. The main reason is that State Patients’ Fund does not pay for nurses’-diabetologists’ work and unplayable services can not guarantee a qualified diabetes teaching in Lithuania. In 224 medical institutions from 44 districts a poll was conducted for better understanding reasons interfering work as diabetes teacher. 95 % said there is no establishment for nurse-diabetologist and 5 % told there is reluctance by administration and bad work conditions. It appeared, no nurses-diabetologists are in Anyksciai, Jurbarkas, Kedainiai, Pakruojis, Pasvalys, Rokiskis, Skuodas, Sirvintos, Svencionys and Trakai. There is a different loading in different districts: 14 districts have 0.25 of establishment, 12 – 0.5 of establishment, 1 – 0.75 of establishement and 11 – 1 establishment. Patients’ teaching has a great economic value: outcome for diabetes complications and treatment are diminished with diminishing span of in-patient hospitalization per year, the number of hospitalization, risks of complications, improves management of existing complications. There are concrete economic values. Teaching people with diabetes is necessity, not luxury. World scientists proved that treating with insulin without knowledge and self-control is not effective! Complications are incurable, they must be avoided. Lack of knowledge cost more for the state and people. At instance, in Sweden private clinics activity of nurse-diabetologist is valued according to a decline of the number of complications and saved money of clinics. If we want to prevent diabetes complications and have a quality of patients’ life, a status of nurses-diabetologists must be recognized, establishments must be confirmed and work conditions must be provided. These actions would compensate outcomes as scientific studies proved diabetes teaching to be the way to successful treatment and qualified life. It is necessary to confirm tariffs for nurses-diabetologists and foot care specialists if we want to prevent amputations and other difficult complications. To renew old ones and to fund new diabetes teaching centers as well as diabetic foot care cabinets is necessary.

Larisa Rarovskaja from Kelme paid attention to the fact that therapeutists prescribe only 2 boxes of diagnostic blood glucose sticks instead of three. She offers to co-ordinate actions between Patients’ funds and therapeutists.

Activity and revision reports on LDA 2002 – 2005 year activity were confirmed unanimously.

Aldona Danyliene presented a new poetry book by prof. Juozas Steponas Danilevicius “Far away from the sun” and read poems. The author himself talked on his book and poetry. All delegates apploised standing and honoring the author for his work and creation.

Doctor endocrinologist from Kaunas “Orthopedics clinics” Vytautas Dargis reviewed a general patients’ health state, demonstrated film from operating-room with material about surgery treating ulcers and bandaging. He stated that nursing legalization is a great winning; still bandages compensations are strictly limited. There are many prosthesis companies, but they lack experience and their activity is not standardized and universally confirmed. Orthopedic Association prepared prosthesis standards and requirements for prosthesist qualification.

Doctor Orthopedist from “Kaunas Orthopedics Technique” Olga Pantelejeva invited all the chief of diabetes clubs to a seminar in “Kaunas Orthopedics Technique” on 17 June 2005 to get more information about companies’ activity, patients’ problems while prescribing health repairing treatment and prosthesis. She offered to enlist urgent questions for patients into a resolution by LDA and present them officially to Ministry.

Doctor endocrinologist Galina Apanel was pity for diminishing cabinets and specialists in districts, thus the treatment becomes problematic. She presented the results of a summer camp for people with II type diabetes.

The member of Community of nurses-diabetologists and nurse-diabetologist in “Palangos Zvorune” Aurelija Jakociuniene stressed that people do not pay enough attention to their self-education. 20 days are not enough for foot rehabilitation. She presented data about patients’ questions in diabetes school about feet injuries leading to rehabilitation.

All the question of participants’ was answered. Organizational questions were discussed during the congress, Governing organs were elected and the resolution was confirmed. A decision to leave LDA statute unchanged was confirmed unanimously. Vida Augustiniene was elected to be a president of Lithuanian Diabetes Association according to 129 voices.

Partners and sponsors of the congress: Abovita, Aconitum, Anyksciu vynas, Boehringer Ingelheim Pharma GmbH Wien representatives, Eksmos MTC, Eli Lilly Lithuania, Gedeon Richter Ltd., GlaxoSmithKline, Interlux, Lithuanian Diabetes Association, Lithuanian Cooperatives Union, Novartis Pharma Services Inc. representatives, Novo Nordisk Pharma, Oriola Vilnius, Roche Diagnostics, Ruta, Sanofi-Aventis Lithuania, Vilnius diabetes club “Beta”, Vilnius children and youth club “DiaBite Plius”, WORWAG Pharma GmbH&Co KG.

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Resolution of 6th Lithuanian Diabetes Association Congress (10^th June, 2005) “On the strategy of diabetes care and prophylactics”

The 6^th Lithuanian Diabetes Association Congress heard a thorough report by the president Vida Augustiniene about her work during 2002-2005 and all speeches about activity of Association by delegates and members of the Congress. According to remarks, wishes and offerings by the members of Association (people with diabetes, members of their families, medics and sponsors), the resolution was confirmed:

1. Lithuanian Diabetes Association is against hasty decision by Health Ministry canceling 20 % of MLL compensations for diet to people with diabetes. We must require  Seimas of Lithuania, Ministry of Health,  Ministry of  Social Security and Labour in the nearest future to decide the question of compensations for diet to socially supportable people and those with low superannuation or invalidity pensions.
2. We must require LR Government to keep on socially valid diabetes care politics, foreseen in Lithuanian Health Program for 1997-2010 and confirmed on 2^nd July, 1998 in decision No. VIII-833 by LR Parliament. Thus the Government must work actively and positively for the sake of patients and guarantee:

2.1.  Patients’ right to qualified and achievable health care as stated in the low;

2.2.  Diabetes prophylactics for state citizens;

2.3.  Co-operation of health care, social, educational, rightness and other sectors, coordinating diabetes prevention actions.

2.4.  Participation of Lithuanian Diabetes Association and other patients’ organization in health care decisions by LR Government; integration of such organizations’ services into the whole diabetes control system.

2.5.  Objective and public activity of diabetes care system.

3. Along with Council of Representatives of Patients’ Organizations we must require to enlist a representative of LPOC into National Council of Health at the Seimas of Republic of Lithuania..
4. We must achieve all the Executive Branch institutions co-operate with organizations representing people with diabetes actively, as activity and services of such organizations is valued as necessary part of state health and social politics in all progressive countries. These organizations must be valued as equal in deciding diabetes care politics questions as well as providing health services. Health care systems in all progressive countries are oriented into patient, who is in the centre of a system.
5. We must value diabetes spreading as epidemics in the entire world. According to WHO data, the number of people with diabetes will increase twice during the next 20 years, thus it will grow in Lithuania as well. We offer to co-operate money from Health Care, Social and Educational Ministries while supporting important innovative scientific projects of diabetes prevention. We must guarantee the continuity of such activity and spread these services in all country. The Government must plan growing budget for diabetes epidemics prevention.
6. We must initiate Health Care Ministry to renew an activity of National Diabetes Committee, which will achieve for the main aims more decisively while appealing to recommendations from St. Vincent declaration. The main aim is long-time improvement of peoples’ health and life quality.
7. It is necessary in the nearest future to prepare National Diabetes Program of complex medical and social help.
8. While seeking for proper medical care for people with diabetes according to recommendations from St Vincent declaration and evaluating qualification and experience of medics as insufficient, it is necessary to confirm obligatory consultations with endocrinologist at least one time per 3 months. At least 0.5 of establishment for endocrinologist must be funded in every district. All people with diabetes using insulin must be cared by endocrinologist, not by therapist.
9. We offer to Health Ministry and Obligatory Health Insurance Council to enlist insulin pump accessories for children, wide spectrum antibiotics, and bandages for diabetic foot, HbA1c tests, glucagons and medicine treating poly-neuropathies into the list of compensated medicine, illnesses and medical care services.
10. We must require Health Ministry to confirm establishments of nurses-diabetologists and foot care specialists in all medical institutions in districts. State Patients’ Fund must confirm the tariffs for them.
11. We must require Health Ministry and the chiefs of medical institutions at local governments to renew canceled and to fund new foot care cabinets and diabetes schools. It is very important means for people with diabetes care.
12. We must require Health Ministry to confirm diabetes passport. It is the document to mirror patients’ treatment, tests results and other important information. Passport is prepared by Lithuanian Diabetes Association according recommendations from St. Vincent declaration.
13. Indications confirmed by Health Ministry and State Patients’ Fund for rehabilitation and health returnable treatment to people with diabetes must be widened, as previous experience obviously showed excellent results of such treatment. These indications are too narrow at the moment. Rehabilitation must be possible without hospitalization. The help of qualified specialists and their base created and adopted to people with diabetes treatment is in hand.
14. The strategy of diabetes treatment, tests and prevention politics and budget must be discussed along with all institutions and health or social scientists interested in a question.
15. We must require the representative of local governments to take active responsibility for diabetes control strategy in districts.
16. We must recommend for State Society Health Care Institution to provide information about diabetes thread more actively and systematically.
17. We must offer for National Radio and TV Institution to mark the concrete time for propagation of diabetes prevention.

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The 6th Lithuanian Diabetes Association Congress

Continued from the page 1

Dear readership,

15 years ago our organization was very small. It is important and strong power at the moment. It happened because we burned the fire constantly. People are not shame to recognize to ill with diabetes any more; they understand it is not their fault. People are aware of being a part of the world and of necessity to talk and defend the rights of weak, as it is important for all searching for the light in the dark. The time will come and they will be such a light themselves.

Dear readership and the members of LDA, I am thankful for your support and trust for me. Let’s go together, as it was till now. The achievements must belong for us, not for parties, units, ministries and separate people, treating them as important and having good positions. They are human as well. The fire can be the killing force or creating and giving happiness.

Vida Augustiniene

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The 6th Lithuanian Diabetes Association Congress

Continued from the page 1

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LDA is the member of the International Diabetes Federation

The information about LDA is provided and the usefulness of being the member of LDA is stressed. Attention! Web-page address has changed! Web-page: www.dia.lt; e-mail: info@dia.lt

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Appeal

17 June 2005

To:

Chairperson of Committee on Health Affairs,  Seimas of Lithuania D.Mikutiene

Chairperson of Committee on Social Affairs and Labour, Seimas of Lithuania A.Sysas

Prime Minister M.A.Brazauskas

Minister of Health Z.Padaiga

Minister of Social Affairs and Labour Minister V.Blinkeviciute

Director of State Patients’ Fund A.Sasnauskas

During the seminar on 17 June 2005 organized by Lithuanian Diabetes Association, Orthopedic and rehabilitation services Association and AB “Orthopedic technique” next questions of supplying patients with orthopedic technique tools were discussed:

1. Register of amputations;
2. Quality of prosthesis;
3. New lists of compensated orthopedic technique tools;
4. Lack of money for orthopedic technique tools;
5. Financing of services of foot care rooms;
6. Legislation of tariffs for nurses-foot care specialists’ services.

As this year World Diabetes Day was nominated for solving diabetic foot and amputations problems by International Diabetes Federation, nowadays situation of amputations prophylactics (diabetic foot cabinets and tariffs for nurses-foot care specialists’ services) and problems in prosthesis in Lithuania was discussed. According to outgivings by patients’ organizations, doctors-rehabilitologists and other specialists it was stated:

1. Great amputations of lower limbs are not registered in Lithuania at the moment, thus we do not have an ability to have an exact register of amputations, which would help in planning budget for prosthesis and observe tendencies of amputations in Lithuania. According to AB “Ortopedijos technika” data, the number of patients coming to the company after amputation is increasing during 2003 – 2004, in spite of other prosthesis companies and rehabilitation institutions started providing services of prosthesis and rehabilitation.
2. Because of sending patient to institutions of prosthesis malapropos, prosthesis is done too late without health repairing treatment of too early along with health repairing treatment. In-time and qualified prosthesis warrants effectiveness of rehabilitation. Prosthesis can not be done in any prosthesis institution having license for providing services of moving steady apparatus but lacking experience in prosthesis after amputations. According to experience of West countries, patients after amputations must be treated concentrically, as experience of weird friends is very important.
3. According to analysis of prophylactic means done by AB “Ortopedijos technika” specialists, patients with amputations because of diabetes are under resourced with orthopedic footwear and podiatric services. Only 14 % of patients with diabetes wear orthopedic footwear before operation. Because of lack of money patients with diabetes can order orthopedic footwear only once a year.
4. Foot care services are not compensated from the budget of Obligatory Health Insurance Fund, tariff for nurses-foot care specialists’ services is not legislated, a big number of diabetic foot care cabinets was closed during health reform, thus a big part of patients has no ability to acquire knowledge and use services of podiatric cabinets and only a small number of them has ability to have prophylactics. Only 25 %of patients after amputations visiting AB “Ortopedijos technika” visited podiatric cabinets and only a half of them did it regularly.

In order to solve these problems we propose:

1. To register limb amputations in obligatory order (to construct a register of great amputations);
2. To class treating prosthesis to the third level of rehabilitation treatment;
3. Patients after amputations, especially after ones because of diabetes, must be sent to rehabilitation institutions having qualified specialists and conditions for prosthesis;
4. While changing the order of supplying with orthopedic means and lists of production, patients’ accessibility to services must not be worsened, the list of production must not be narrowed and necessary limbs’ prostheses must be not crossed for the reason it is expensive.
5. Money for compensations for orthopedic technique means must be increased.
6. Tariff for nurses-foot care specialists’ services must be legislated.
7. An activity of ambulatory diabetic foot care cabinets must be renewed.
8. Services of podiatric cabinets for people with diabetes must be paid from the budget of OHIF.

The president of Lithuanian Diabetes Association Vida Augustiniene

The president of Association of Orthopedic and Rehabilitation Services Providers Ruta Garsviene

The representative in Lithuania of International Working Group on the Diabetic Foot Olga Pantelejeva

Page 10

Glucardin 10 facilitate fight with diabetes

Prepared by Dr. Greta Parakeviciute

Pages 11 - 12

Chronicle of Lithuanian Diabetes Association

• On 10 May 2005 an action “Limit <7” was organized by Lithuanian Diabetes Association and JSC “Sanofi-Aventis Lietuva” in Joniskis club “Viltis”.
• On 12 May World Nurses’ Day was marked in Vilnius. The president of LDA Vida Augustinien4 took part in the event.
• On 13 May V.Augustiniene, E.Rudinskiene and J.Uleckiene met the representative of LifeScan Company Philippe Sakkalis from Finland.
• On 16 May the president of LDA talked on the urgent diabetes questions during the broadcast by Vilnius TV.
• On 17 May topicalities of buying medicine in hospitals were discussed during the broadcast of LNK TV. V.Augustiniene took part there.
• On 18 May the new edit of statute was confirmed during the meeting of Council of Lithuania Organizations of Patients (CLOP).
• On 18 May the representatives of CLOP V.Augustiniene and D.Kasubiene took part in conference on urgent psychiatric questions in Vilnius.
• On 19 May the president of LDA talked on rational diet for people with diabetes and canceled compensation for it during the broadcast by Cable radio.
• During 24 – 25 May V.Augustiniene shared her knowledge about diet and diabetes with students of diet specialty in Vilnius Collegiums Health Care Faculty.
• On 26 May V.Augustiniene and the chief of Jonava club “Ramune” J.Laiva talked on actual diabetes diet questions and canceled compensation during the broadcast of Jonava TV.
• On 27 May the chief of CLOP V.Augustiniene and the president of Lithuanian Asthma Association E.Kvedaraite with medics discussed on actual questions on compensating medicine for asthma treatment.
• On 30 May the chief of CLOP and specialists discussed on actual questions on compensating medicine for psychic illness and diabetes treatment.
• On 31 May the sitting of Obligatory Health Insurance Fund took place in State Patients’ Fund. The member of this council Vida Augustiniene took part in it.
• On 2 June CLOP project “Strengthening patients’ organizations while integrating to European Union” was discussed.
• On 4 June the member of IDF European Region board V.Augustiniene took part in a board meeting in Leusden. The topics of the meeting were next: preparation of National diabetes programs and their implementation, co-operation with European parliament and its’ influence on states members in recognizing diabetes as underlying area in health programs.
• On 7 June an interview with V.Augustiniene on the questions of medicine compensations was published in a newspaper “Ukininko patarejas”.
• On 8 June the question of canceling compensation for diet was discussed with lowers.
• On 10 June the 6^th Congress of LDA took part. The honor member of LDA, World Bank consultant, exs-expert of WHO St. Vincent declaration and DOWN study Prof. Isuf Kalo, the representative of WHO office in Lithuania Raimonda Sadauskiene, the deputy chairperson of Committee on Health Affairs in Seimas of Lithuania Antanas Matulas, the director of State Patients’ Fund Algis Sasnauskas, the director of Invalids’ integration department at Social Security and Labour ministry Alfredas Nazarovas, the deputy director of KMU Endocrinology institute Rytas Ostrauskas, the representatives of Council of Representatives of Patients’ Organizations Danute Kasubiene and Rimante Sakalauskiene, 150 delegates, 50 quests (medics, nurses, sponsors and representatives of other organizations) too part in it. Activity reports were confirmed; the further guidelines for activity were discussed; the resolution was declared; board organs were elected. Vida Augustiniene was elected as a president of LDA for the fifth cadency.
• On 17 June a seminar “Diabetes and feet” took place in Kaunas Company “Ortopedijos technika”. Actual questions of acquiring orthopedic footwear, caring for diabetic feet, rehabilitating patients were discussed and appeal to government institutions was prepared.
• On 20 June answers to newspaper “Lietuvos zinios” questions were declared by the chief of Council of Representatives of patients’ Organizations V.Augustiniene.
• During 22-23 June the president of LDA took part in a conference “Health teaching and understanding” by European Patients’ Forum group in Brussels.
• During 25 June – 4 July diabetes teaching camp for children and youth took place in Druskininkai. The chief of the camp was Jelena Simoniene, the doctor of the camp – Zita Zupkauskiene, student of VU Medicine Faculty Mindaugas Briedis was helping them. 27 children and youth from 15 Lithuanian districts and cities too part in it. The general sponsor was Council of Invalids’ Matters at LR Government, other sponsors – Lithuanian youth tourism centre, Abovita, Interlux, Mazeikiai, Raseiniai, Sakiai, Vilnius diabetes clubs and participants’ parents.
• On 27 June the president of LDA answered questions on supplying people with diabetes with compensated diagnostic self-control sticks, asked by newspapers “Kauno diena” and “Kurjer Vilenski”.
• On 1 July V.Augustiniene met the participants of teaching diabetes camp in Druskininkai.
• On 7 July V.Augustiniene took part in a presentation of European Health Insurance Card and publication “Patients’ Fund: 2004 activity review”.
• On 15 July the meeting–teaching seminar of the chiefs took part in Vilkaviskis district. The member of LR Parliament Algirdas Butkevicius, representatives Vilkaviskis government, medics, sponsors and quests. Vilkaviskis diabetes community “Insula” organized the meeting.
• On 15 June the sitting of CLOP took part. V.Augustiniene took part in it.
• During 23 – 31 July the chairperson of German Committee for sponsoring Lithuanian children with diabetes Lily Karn visited Lithuania. She met the participants of the LDA diabetes teaching camps and supported LDA with 10000 Euro for children.
• During 24 June – August the children and youth diabetes teaching camp took part. Jelena Simoniene, Egle Jakimaviciene, Dainara Kartheiser, Tomas Kaulakys, Darija Jarema worked on it. 28 children and youth from 10 Lithuanian districts and cities took part in it. The general sponsor – Lithuanian Council for Invalids’ matters at LR Government, other sponsors – Abovita, Interlux, Eksmos MTC, Taurage, Vilnius “DiaBite Plius” diabetes clubs, parents of participants, etc.
• During 26 July – 4 August the international diabetes teaching camp for children and youth took place in Plateliai. Aldona Danyliene, Vytautas Danyla, Agne Danylaite, Dorota Sutova and Jurate Krivickiene worked on it. 28 children and youth from 11 Lithuanian districts took part in it. The general sponsor – Lithuanian Council at LR Government, other sponsors – Audrius Klisonis’ Clinics “Inesa”, farmer \Morta Mikasauskiene, Abovita, Intelux, Eksmos MTC, Prienai, Kursenai, Plunge, Sakiai, Siauliai, Radviliskis and Taurage diabetes cloubs, parents of camps’ participants’ members.
• On 30 July the meeting of Plateliai diabetes teaching camp and Jonava, Plunge, Kelme and Plunge diabetes camps took place. Taurage diabetes club “Insula” organized an event.
• During 5 – 9 August the third and the first international diabetes teaching camp for people with II type diabetes took place in Plateliai. Aldona Danyliene, Agne Danylaite, Dorota Sutova, Juozas Danylevicius worked on it. 28 people with diabetes from 18 Lithuanian districts and Latvia took pat in it. The general sponsor – Lithuanian Council of Invalids’ matters at LR Government, other sponsors – Audrius Klisonis clinics “Inesa”, the farmer Morta Mikasauskiene, Abovita, Interlux, Eksmos MTC, Plunge and Radviliskis diabetes clubs, participants and etc.
• During 12 – 13 August the seminar “Diabetes and diabertic feet” is going to take place in Plateliai. LDA and Plunge diabetes club organizes an event. The general sponsor – Lithuanian Council of Invalids’ matters at LR Government, other sponsors – Audrius Klisonis clinics “Inesa”, Convatec, Abovita, Interlux, Eksmos MTC, Plunge diabetes club and etc.
• During 10 – 15 September the conference of European Diabetes Studies assoc ion.
• On 23 August the conference for children and youth with diabetes is going to take place in Antakalnis clinics. LDA and Vilius diabetes club “Dia Bite Plius” is organizing the meeting. The quest quest from German Prof. Halmut R.Heinrichs is going to take place and to read a report about actualities of treating by insulin pump.
• During 5 – 8 October European Health Forum is going to take place in Austria.
• During 10-12 October the conference of European patients’ forum takes place in Brussels.
• During 14-16 August the general assembly and conference “We are stronger together” is going to take place in German.
• On 14 November is the World Diabetes Day. The topic of the event is “ Diabeties and diabetic feet”.

An advertisement on self-control tools Glucocard by Interlux

Page 18

Fotoalbum of holidays

Page 19

An advertisement on Diabetiker-Vitamine by Worwag Pharma GmbH & Co. KG

Summer smiles

Vilnius children and youth diabetes club “DiaBite Plius” organized every-year sport trip for its’ members.

Page 20

The camp for children and youth with diabetes

Two diabetes teaching camps were organized this year. People who worked on it were Jelena Simoniene, Vita Zupkauskiene and Mindaugas Briedis. Dr. Egle Jakimaviciene, student of VU psychologist Darija Jarema, Dainara Kartheiser and Tomas Kaulakys worked on it. During 26 Luly – 4 August International Children and Youth diabetes teaching camp took place in Plateliai. During 5 – 9 August the 3^rd and the 1^st international diabetes teaching camp for people with II type diabetes took place at the same place. Aldona Danyliene, Agne Danylaite, Dorota Sutova,e Krivickiene and Vytautas Danyla are the chiefs and organizers. 83 people with I type and 28 people with II type diabetes took part in the camp. The general sponsor was Lithuanian Council of Invalids’ Matters at LR Government, other sponsors – Lithuanian Youth Tourism Centre, Abovita, Interlux, Eksmos MTC, Mazeikiai, Raseiniai, Sakiai, Vilnius “DiaBite Plius”, Prienai, Kursenai, Plunge, Sakiai, Siauliai, Radviliskis and Taurage diabetes clubs and other sponsors.

Every participant of a camp filled a questionnaire of knowledge, which was the source of teaching programs’ correction. Glucose tests were conducted before main meals, sleep and special cases. Participants of the camp swam, bicycled, sported and visited the most beautiful places in Plateliai. The evenings were wspent near the fire while speaking, singing and acting. The results from the 25 June – 4 July camp in Druskininkai camp are presented. Indexes are not joyful very much. Glucose was changing from 4.6 to 12.9 per day and glicate hemoglobin was changing from 4.5 to 10.8 %. Participant of the camp were using different insulin and insulin pumps. People controlling illness strongly or weekly were in all groups. No insulin or other means helps if patient can not use one or another advantage oftreatment or adopt them to their illness control. It is obvious, that the way of diabetes for children and youth is very label. The great efforts are needed to achieve good results of self – control. That’s why diabetes teaching camps are useful for new-comers as well as for old participants.

Page 21

An advertisement on AQUACEL by Conva Tec

Acknowledgement

The member of Joniskis diabetes club “Viltis” is thankful for a diabetes teaching camp.

Pages 22 - 23

Disorders of sleep - insomnia

Prepared by Dr. Egle Rudinskiene according to foreign press

An advertisement on SensoCard by Limeta

Page 24

“Beta” diabetes club invites

The new member of Vilnius diabetes club “Beta” shares her impression about the trip with all the members of the club.

Page 25

An advertisement on Accu-Chek by Roche Diagnostics

The new Accu-Chek Go already in Lithuania

Prepared by the representative of La Roche Ltd. in Lithuania

Pages 26 - 30

Diabetes, bicycle and me

Albinas Pilypas, having diabetes, shares his experience living with the illness.

Page 27

An advertisement on CareSens by Eksmos MTC

Page 29

An armlet for identification

LDA information

Page 31

Endocrinologists know the new medicine

An advertisement on FlexPen by Novo Nordisk

Page 32

An advertisement on Espumisan

An advertisement on Optium Xceed