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L-ERBATAX-IL LEĠIŻLATURA P.L.

1266 Dokument imqiegħed fuq il-Mejda tal-Kamra tad-Deputati fis-Seduta Numru 81 tal-25 ta’ Jannar 2023 mill-Onor.

Claudette Buttigieg, MP.
___________________________ Raymond Scicluna Skrivan tal-Kamra European Parliament 2019-2024 TEXTS ADOPTED P9 _ T A(2022)0409 Prevention, management and better care of diabetes in the EU on the occasion of World Diabetes Day European Parliament r esolution of23 November 2022 on prevention, management and better care of diabetes in the EU on the occasion of World Diabetes Day (2022/2901(RSP)) The European Parliament, having regard to the Treaty on the Functioning of the Emopean Union, in particular Article 168 thereof, having regard to the 2030 Agenda for Sustainable Development, in particular Sustainable Development Goal (SDG) 3 target 4, to reduce by one third premature mmtality from non-communicable diseases through prevention and treatment and promote mental health and well-being, and SDG 3 target 8, to achieve un iversal health coverage, including financial risk protection, access to quality essential health-care serv ices and access to safe, effective, quality and affo rdable essential medicines and vaccines for all1, having regard to the Global Monitoring Framework for the prevention and control of non-communicable diseases (NCDs), in particular the priority to halt the rise in diabetes and obesity2, having regar-d to the outcome report from the World Health Organization (WHO) European high-level confe rence on non-conummicable diseases held in Ashgabal, Turkmenistan, on 9-10 April2019, entitled ' Time to Deliver in Europe: meeting non communicable disease targets to achieve the Sustainable Development Goals' 3, having regard to the WHO Global Diabetes Compact'\ having regard to its resolution of 14 March 2012 on addressing the EU diabetes epidemic5, 2 4 5 https://sdgs.un.org/goals N CD Global Monitming Framework (World Health Organization) https:/ /apps.who.intliris/handle/ 10665/34 738 1 https://www.who.in t/initiatives/the-who-global-diabetes-compact OJ C 251 E, 31.8.2013, p. 47. having regard to the Commission communication of 11 December 2019 on the European Green Deal (COM(20 19)0640) and Parliament's
 resolution of 15 January 2020 thereon 1, having regard to the Commission communication of 20 May 2020 on a Farm to Fork Strategy for a fair, healthy and env ironmentally-friendly food system (COM(2020)0381) and Parliament's resolution of20 October 2021 thereon2, havi ng regard to the Commission communication of 25 November 2020 on a Pha1maceutical Strategy for Europe (COM(2020)076 1) and Parliament's resolution of 24 November 2021 thereon3, having regard to the Commission communication of3 Febmary 2021 on Europe 's Beating Cancer Plan (COM(2021)0044), and Parliament's resolution of 16 Febmaty 2022 on strengthening Europe in the fight against cancer - towards a comprehensive and coordinated strategy\ having regard to Regulation (EU) 2021/522 of the European Parliament and of the Council of24 March 2021 establishing a Programme for the Union's action in the field ofhealth ('EU4Health Programme') for the pe1iod 2021-20275, having regard to the Commission's proposal for a regulation on the European health data space (COM(2022)0197), having regard to Regulation (EU) 202112282 of the European Parliament and of the Counci l of 15 December 2021 on health technology assessment\ having regard the Commission's Healthier Together EU Non-Communicable D iseases Initiative of20 June 20227, having regard to the World Health Assembly resolution of28 May 2019 on improving the transparency of markets for medicines, vaccines, and other health products, having regard to the European Pillar of Social Rights Action Plan8, having regard to Rule 132(2) of its Rules of Procedure, A. whereas diabetes is one of the most common non-communicable diseases; whereas there are more than 33 million people in tbe EU living with diabetes; whereas the OJ C 270, 7.7.2021, p. 2.
OJ C 184, 5.5.2022, p. 2.

OJ C 224, 8.6.2022, p. 47.

OJ C 342, 6.9.2022, p. 109.

OJL 107, 26.3.2021 , p. 1.
OJ L 458,22.12.2021, p. 1. https ://health.ec.europa.eu/publications/eu-non-comm unicable-diseases-ncds-initiative guidance-docwuent en https :/ /op.emopa.eu/webpub/emp 1/emopean- p illar-of-social-ri gbts/en/ number of people li ving with diabetes in the EU is predi cted to rise to 38 million in 2030 1; whereas app rox imately half of people living with di abetes are not ach ieving or maintaining optimal blood g lucose targets2 , leading to an increased risk of diabetes related compl ications resulting in deterioration of well-being and other consequences including productivity loss and costs for society; whereas Europe is the region wi th the highest number of chil dren and youths living with type l diabetes in the world3 ; whereas more than 95 % of people w ith diabetes have type 2 diabetes, with risk factors including weight above a healthy range, tobacco use, lack of exercise and tmhealthy diet; whereas type 2 diabetes is becoming increasingly prevalent among children and young adults4 ; whereas type 1 and type 2 diabetes have been shown to have negative impacts on life expectancy5 ; whereas diabetes has been estimated to be the fomth leading cause of death in Europe6 ; whereas no cures are cmTently available for diabetes; whereas people of all ages and walks of life can be afflicted by di abetes; whereas diabetes affects different socio-economic groups unequally, and socio econom ic factors determ ine its impl ications for people's lives; whereas all patients have the right to optimal h·eatment, regardless of their fi nancia l means, gende r, age or nationality, whereas there is an urgent need to ensure equal access to safe, effective and affordable treatments within the EU; whereas EU citizens are still facing inequities in terms of prevention, and are unequall y protected against risk factors, Lillequally educated in tetms of healthy behaviours and unequally equ ipped against misinformation; whereas EU citizens are unequal in terms of timely access to affordable and high quality treatment and care from Member State to Member State and from region to region in any given cmmtry; whereas diabetes is a cause of many health complications, with one third of peop le living with diabetes developing diabetic retinopathy 7 and one third developing cardio vascu lar diseases (CVDs)8; whereas four fifths of end-stage renal diseases occur in people living with type 2 diabetes and/or hypertension9; whereas diabetes is a cause of early mo1tality and disability (bli ndness, amputations, healt failure); https:l/research-and-innovation.ec.europa.eu/research-arealhealth/diabetes en https://journals.sagepub.com/doi/ full/ 1 0.1 177/ 1479 1641 16679775 https://diabetesatlas.org/atlas/tenth-ed.ition/ https:/ /www.
who .

inllnews-room/fact -sheets/detai I/ diabetes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673790/ https://www .euro.who.intl data/assets/pdf fi le/0003/9839 1/E93348.pdf https :1 /pubmed.ncbi.nlm .nih.

gov /266053 70/ https://www.ncbi.n lm.nih.gov/pmc/atticles/PMC5994068/ https://idf.org/our-activities/care-prevention/diabetes-aud-the-kidney.html B. c. D. E. F. G. H. T. J.

3 4 5 6 9 K. L. M. N. 0.
P. whereas some fonns of type 2 diabetes, diabetes in pregnancy, diabetes-related complications and other consequences of diabetes may be prevented tlu·ough policies addressing the condition's modifiable risk factors, such as promoting active and tobacco-free living and access to healthy foods as well as policies tackling the environmental, cultural and socio-economic determinants of health an d the promotion of early diagnosis and action; whereas, however, diabetes is frequently diagnosed too late, and up to one third of all people living with diabetes in the EU are cmrently unaware of their condition 1 ; whereas front-of-pack nutritional labelling supports citizens in making healthier food choices and thereby preventing unhealthy consumption of food high in salt, fat and sugar and preventing obesity which is one of the major detennining risk factors for developing type 2 diabetes; whereas people living with diabetes are among the most severely affected by COVID- 19, not only relating to their risk of developing severe f01ms of the disease but also relating to their risk of later-life complications resulting from the disruption of care during the pandemic2; whereas diabetes is a complex and multifactorial disease owing to its interplay w ith other conditions and with all levels of care; whereas prevention, treatment and management of the disease can be indicative of a health system's quality, effectiveness, performance and resilience; whereas effective diabetes management and care also leads to better outcomes for other NCDs and other diseases; whereas 100 years after the breakthrough discove1y of insulin, many inequalities still exist globally and among and within Member States regarding access to care, education, autonomy, medicines, tools to monitor blood sugar levels, supplies and technologies and health outcomes\ whereas research is still needed to clearly identify personalised risk factors for type 1 diabetes, to help determine how best to enable earlier diagnosis of type I di abetes and to identify patients that are candidates for an immunological treatment approach in the future; whereas further research, including behavioural research, is also required to improve and further determine the most impactful interventions for the prevention and management of type 2 diabetes; whereas across all Member States, diabetes is responsible for about 9 % ofhealthcare expenditure\ and whereas up to 75% of those costs could be related to potentially preventable complications5; whereas prevention is more effective than any cure in reducing the incidence, prevalence and complications of some types of diabetes, as well as being the most cost-effective long-term diabetes control strategy; Q. whereas people living with diabetes must self-manage their conditions, with sporadic input or support from their healthcare professionals, a few times a year; whereas the 2 3 4 5 h ttps :/I diabetesatlas.
org/atlas/tenth-edi tionl https :1 /idf.org/our-network/regio ns-members/euro pe/covid-1 9 .html https://www.mepinterestgroupdiabetes.eu/wp-contentluploads/2021/03/MMD BLUEPRINT-FOR-ACTION -ON -DIABETES.
pdf https://www.idf.org/our-network/regions-members/euro pe/europe-news/487:idf-europe statement-on-the-eu-ncd-initiative-%E2%80%93-healthier-together%C2% AO.htm l bttps://pubmed.ncbi.nlm .nih.go v/ 17853332/ burden of diabetes on individuals and the ir fam il ies is not only financial, but also involves huge psycho-social issues and reduced quality of life; whereas innovations in the fi eld of self-measurement of blood sugar levels faci litate the easier and better regulation of blood sugar levels; whereas supporting the swift availability for diabetes patients of such innovations is beneficial, as they improve successful diabetes management, thereby preventing health complications and subsequent health costs; R. whereas there is no EU legal framework against discrimination towards people living with diabetes or other chronic diseases, and prejudice against those people living with the condition is still widespread in schools, job recruitment, work places, insurance policies and assessment for d1iving licenses throughout the EU; whereas developments in knowledge of diabetes as well as in treatment and teclmology in recent years mean that people living with diabetes can be in much more precise and continuous con trol of their blood sugar, enabling them to overcome previously perceived risks in daily activities; S. whereas people living with diabetes and other NCDs have been shown to be at great risk of discontinuing care and of developing more serious symptoms and complications during humanitarian emergencies; T. whereas several EU actions have addressed diabetes, including the 2006 Council conclusions on the promotion of healthy lifestyles and prevention of diabetes, and Parliament's resolution of 14 March 2012 on addressing the EU diabetes epidemic; whereas there is a strong rationale for increasing these efforts in response to the increasing burden of diabetes and the mgent need for Member States to take strong action, particularly in the light of the added value of concerted efforts at EU level; whereas the Healthier Together - EU Non-Comrmmicable Diseases lnitiative addresses some ofthe Member States' needs and requests raised in Parliament's 2012 resolution, but lacks a clear framework for action in the Member States and does not have concrete objectives and targets which would allow for the setting of goals and the measuri ng of progress; 1.
2.
Deeply regrets the fact that a growing number of people are living with diabetes and expresses solidarity with the patients of this dismptive disease and their families; RecaUs the global coverage targets for 2030 for diabetes adopted at the 75th World Health Assembly, including the targets of 80 % of people living with diabetes being diagnosed; 80 % having good control of glycaemia; 80% of people with diagnosed diabetes having good control of blood pressure; 60 % of people with diabetes aged 40 years or older receiving statins; and 100 % of people with type 1 diabetes having access to affordable quality-assured insulin and blood glucose self-monitoring; stresses that the EU coverage targets for 2030 should be even more ambitious; 3.
Welcomes the joint statement issued by the Commission and the WHO Regional Office for Europe at the 70th session of the WHO Regional Committee for Europe in 2020, in which they promised to boost their already strong partnership and adapt it to new health primities including a comprehensive response to non-communicable diseases 1; https://health.ec.europa.eu/system/files/2020-11 /2020 who euro cooperation en O.pdf 4.
Welcomes the development of the Healthier Together - EU Non-Communicable Disease Initiative and calls on the Member States to avail themselves of the best practices outlined in the document and of the funding made available through various EU programmes; 5.

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Calls on the Commission and the Member States to demonstrate pol itical commitment and set ambitious targets fo r reversing the rising trend in numbers of Europeans with diabetes, to reduce inequalities between EU citizens and improve the care and qu ality of life of people living with diabetes; Underlines in this regard that the Commission should follow through with the Healthier Together- EU Non-Communicable Disease Initiative, inter alia by collaborating with Member States in developing and implementing common, standardised criteria and methods for data collection on diabetes, and in collecting, registermg, monitoring and managing comprehensive epidemiological data on diabetes, as well as economic data on the cost of diabetes prevention and management in the EU, including patient preferences and patient-generated data; stresses that fostering and leveraging best practices and supporting research into the effectiveness of clinical interventions and prevention programmes will lead to better outcomes not just for diabetes but also for all other complications and co-morbidities of diabetes; Calls on the Member States to develop, implement and monitor national diabetes plans and stTategies with comparable milestones and targets, including a risk-reduction and screening/early action component to target, among other things, the socio-economic determinants of health, the promotion of health-enabling environments and health and digital literacy, education and awareness rising aimed at both the population at large and high-risk groups in pmticular (such as people with prediabetes), and which is designed to reduce inequalities and optimise healthcare resources; Calls on the Commission to ensure that all EU actions and documents across all work areas reflect the most up-to-date evidence, especially with regard to modifiable risk factors and risk reduction measures, and present an accmate picture of diabetes to combat stigma and discrimination; Underlines that more attention should be paid to the prevention of all non communicable diseases, and asks the Commission and the Member States to reinforce, implement and evaluate properly ftrnded prevention plans; 10.
Deplores the significant health inequalities in the EU, including in NCD prevention; insists on the need to identify and pay special attention to vulnerable, marginali sed, socially excluded populations and people livi ng in remote areas (such as in rural, isolated or outermost regions far fro m medical centres), in order to ensure they have access to prevention services; considers in this regard that prevention also needs to be framed in the context of social justice, entailing the need for systemic changes through population-wide public policies beyond changes in individual behaviour; 11 .
Calls on the Member States to ensure continued patient access to primaty and secondaty care, and diabetes treatments and technologies, including e-health technologies such as continuous glucose monitoring systems and new insulin delivety systems, and to support patients in obtaining and sustaining the skills and tmderstanding needed to enable competent life-long self-management; 12.

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Stresses the impmtance of viewing NCDs from a position that acknowledges that human, animal and environmental health are intrinsically linked and that therefore all actions to combat NCDs should be firmly rooted in the One Health approach; Emphasises the impmtance ofEU health legislation and actions, including the Directive on patients' rights in cross-border healthcare 1, the revised mandates for EU public health agencies, the proposed serious cross-border health threats regulation (COM(2020)0727), the Tobacco Products Directive2 the phannaceutical strategy, in preventing chronic diseases and addressing hea lth risks; , the EU4Health programme, and Underscores the essential role of a healthy food enviromnent in preventing NCDs and asks the Member States and the Cmmnission to step up their actions to ensure that the most healthy and sustainable food is also the most affordable; Underlines the need to address the modifiable Jisk factors ofNCDs with policies that promote active and tobacco-free living, access to healthy foods and physical activity, and which tackle the environmental, cultural and socio-economic detenninants of poor health; Acknowledges that obesity is considered a primary risk factor for type 2 diabetes; emphasises the role of a healthy diet in preventing and managing type 2 diabetes; stresses that individual d iabetes risk can be reduced by increasi ng consumptio n of sustainably-produced plants and plant-based foods, such as fresh fruits and vegetables, whole g rains and legumes3; emphasises, fi.uthermore, the need to address the overconsumption of meat and ultra-processed products, and products high in sugars, salt and fats; welcomes the revision of the EU school fmi t, vegetables and m.ilk scheme and of the EU 's policy on the promotion of agricultural products; Asks the Commission and the Member States to encourage and help consumers to make informed, healthy and sustainable choices about food products by m eans of the adopti on of a mandatmy and harmonised EU front-of-pack nutritional label
 that is developed based on robust and independent scientifi c evidence; welcomes the focus on healthy nutTi tion in the EU Child Guarantee and calls for a new EU action plan on childl10od obesity; supports fi scal measures to make fresh foods (such as fruits and vegetables, pulses, legumes and wholegi·ains) more affordable and accessible at national level, especially for people on low incomes; encourages M ember States to use pricing policies such as value added tax differentiation, and marketing controls to influence demand for, access to, and the affordability of food and drinks that are low in saturated fats, trans fats, salt and sugar; supports the Member States in revising the relevant provisions for restricting the advettising of sweetened beverages and processed food products high in fats, salt and sugar, including advertising on social media, and eagerly awaits the annmmced legislative proposals in this regard under the fatm to fork strategy; 18.
Underlines that tobacco, harmful alcohol consumption and environmental pollution are r isk factors common to other chronic diseases; reiterates its call for an integrated Directive 2011/24/EU of the E uropean Parliament and of the Council of 9 March 201 1 on the application of patients' rights in cross-border health care (OJ L 88, 4.4.201 1, p. 45).

OJ L 127, 29.4.20 14, p. 1. bttps:/ /www .ncbi .nlm.nih.
gov /pmc/articles/PMC5466941 2 chronic disease prevention program me, to be developed in close cooperation with the Steering Group on Health Promotion, Disease Prevention and Management of Non Communicable D iseases; 19.
Reiterates the importance of the European Green Deal as a significan t contributing factor to disease prevention in Europe, by means of reducing air, food, water and soi l pollution and chemical exposure and ensuring access to and infotmation on healthy foods; calls for an evaluation of Lhe impact of policies on NCD incidence to be integrated into the farm to fork strategy, the chemicals strategy for sustainability, the zero pollution and the non-toxic enviromnent strategies; 20.
Calls on the Commission and the Member States to support the digitalisation of national heaJth services and the adoption of new tools and technologies, allowing for more effective data collection, monitoring and action to improve self-management, reduce the risk of diabetes-related complications and other consequences of diabetes and improve quality of life; stresses that any digital transition in healthcare should go hand in hand with enhanced digital health literacy, be user-friendly and patient-centred, and promote tmst by ensuring high standards on data privacy and cybersecurity; stresses in thi s regard the potential of the European Health Data Space for NCDs including diabetes; 21.
Call s o n the Commission to engage w ith patient organisations and people living wi th diabetes and other chronic diseases in a structmed way and encourage the development of a common set of outcome measures that matter most to people living with diabetes, to be used for regulatory assessment and decision-making on pricing and reimbursement, as well as throughout the development and implementation of relevant policies, including national diabetes plans and awareness programmes; 22.
Calls on the Commission to continue providing financial support, in a transparent manner, to key non-governmental organisations, including those that advocate for and represent patients, consumers and healthcare professionals; 23.
Calls on the Member States to review and as approp1iate advance their national models of care with a focus on deploying person-centred and fully integrated care across the entire care pathway, particularly including disease prevention, prevention of diabetes complications and mental health suppoti; 24.

Cal ls on the Commission and the Member States to map out and address barriers to both human and analogue insulin, and to ensm e affordability for both users and national health systems; 25.
Calls on the Commission to provide concrete guidance to Member States for ensuring the unintenupted treatment of people living with diabetes dming humanitarian emergencies and highlights the need to provide diabetes care within humanitarian responses; 26.

Calls on the Commission to support the upskilling of primary and proximity care across the Member States, ensuring integration and continuity of care with a focus on collaboration between professionals wi thin multi-disciplinary care teams; 27.
Calls on the Commission and the Member States to improve the coordination of E uropean and inter-Member State diabetes research; 28.
Calls on the Commission and Member States to suppmi research into unmet clinical needs for diabetes and its many co-morbidities and complications, taking into account the need to improve the quality of life of people living w ith diabetes and other chronic diseases; calls on the Conm1ission and the Member States to supp01t production capacities for quality-assured affordable insulin, injection devices and glucose monitoring tools to improve competition, national supply and patient access; 29.
Stresses the importance of excellence in medical research and imwvation in the Union and calls on the Commission to build on the work of Europe 's Beating Cancer Plan in this regard; reiterates its call in its resolution of 24 November 2021 to support additional research in undeuepresented populations, such as the elderly, children, women and patients with comorbidities, including obesity as a primary morbidity as well as where it exists as a gateway chronic disease lo other non-communicable diseases such as diabetes; 30.
Ts concerned that the accessibility and affordability of medicines remain a challenge for national health systems, and that innovative medicines are expensive or in certain Member States are not even brought to market for commercial reasons; 31.
Reiterates its calls on the Commission to ensure that EU nmding for biomedical research and development is made conditional on the full transparency and traceability of investments, on ensuring supply in all Member States and on facilitating the best outcomes for patients, including in terms of the accessibility and affordability of manufactured medicines; 32.
Calis on the Commission to periodically evaluate and review the incentive system, increase price tTansparency and highlight the factors limiting affordabilily and patient access to medicinal products; fmther calls on the Commission to address the root causes of shmtages of pharmaceuticals and propose sustainable solutions that also promote on and off-patent competition and the timely ent1y into the market of generic and b iosimilar medici nes; 33.
Reiterates its call to guarantee that research priorities are driven by patient and public health needs and that public funds are invested in a transparent manner, ensuring the availability and affordability of products resulting from these partnerships and public funds; 34.

Calls on the Commission to review the relevant occupational health and safety legal framework and road safety legislation to avoid further discrimination against people living with diabetes; 35.
Calls on the Commission and the Member States to ensure continued suppor t for diabetes funding under the cUtTent and future EU fi:amework programmes for research, including research on integrated care models, effective interventions in diabetes prevention and management, and the impact of digital technologies on diabetes self management and behavioural changes; 36.

Instructs its President to forward this resolution to the Council, the Commission and the governments and parliaments of the Member States.