[Diabetes care pathways and the diabetic convention in 2017]

Diabetes is a chronic, pandemic disorder which has a growing impact on healthcare costs and leads to severe micro- and macro-vascular complications. In 2009, Belgium introduced " care trajectories " (CT), a program which allows multidisciplinary management of this disease. CT is built on a partnership between three parties: the patient (central to the concept), the general practitioner (GP) and the diabetologist. The GP is responsible for the medical management according to an individualized care plan. The specialist's task is to update the GPs' knowledge and to coach them. Only those patients receiving a parenteral treatment with insulin or GLP-1 (Glucose Like peptide-1) analogues and those patients whose HbA1c target is not achieved with oral glucose lowering treatment and for whom parenteral treatments taken into consideration can enroll in a CT. This model was implemented in other countries to increase the quality of diabetes care, to provide continuity of care, and to reduce the occurrence of diabetes complications. In February 2016, the pre CT replaced the diabetic passport. It concerns patients with dietary or oral antidiabetic treatment and provides reimbursement of dietary and podological visits. Since July 2016, a new diabetes convention has been established. The novelty is that it allows the financing of a new continuous glucose measurement equipment for patients with type 1 diabetes or total loss of endocrine function of the pancreas.