International declarations

The St Vincent Declaration

Representatives of government health departments and patients’ organisations from all European countries met with diabetes experts under the aegis of WHO Regional Offices for Europe and the International Diabetes Federation (IDF), European region, in St Vincent, Italy on 10–12 October 1989. They unanimously agreed on the following recommendations and urged for their implementation in all countries throughout Europe.
“Diabetes mellitus is a major and growing European health problem, a problem at all ages and in all countries. It causes prolonged ill-health and early death. It currently threatens at least ten million European citizens.
It is within the power of national governments and health departments to create conditions in which a major reduction in this heavy burden of disease and death can be achieved. Countries should give formal recognition to the diabetes problem and deploy resources for its solution. Plans for the prevention, identification and treatment of diabetes and particularly its complications – blindness, renal failure, gangrene and amputation, aggravated heart disease and stroke – should be formulated at local, national and European regional levels. Investment now will earn great dividends in reduction of human misery and in massive savings of human and material resources.
General goals and five-year targets (listed below) can be achieved by the organised activities of the medical services in active partnership with diabetic citizens, their families, friends and workmates and their organisations in:

The management of their own diabetes and education for it.
The planning, provision and quality audit of health care.
National, regional and international organisations for disseminating information about health maintenance.
Promoting and applying research.

General Goals for Children and Adults with Diabetes

Sustained improvement in health experience and a life experience approaching normal expectation in quality and quantity.
Prevention and cure of diabetes and its complications by intensifying research effort.

Five-year Targets

Elaborate, initiate and evaluate comprehensive programmes for the detection and control of diabetes and its complications with self-care and community support as major components.
Raise awareness in the population and amongst health care professionals of the present opportunities and the future needs for the prevention of diabetes and its complications.
Organise training and teaching in diabetes management and care for people of all ages with diabetes, for their families, friends and working associates and for the health care team.
Ensure that care for children with diabetes is provided by individuals and teams specialised in the management of both diabetes and children, and that families with a diabetic child get the necessary social, economic and emotional support.
Reinforce existing centres of excellence in diabetes care, education and research.
Promote independence, equity and self-sufficiency for all people with diabetes, i.e. children, adolescents, those in the working years of life and the elderly.
Remove hindrances to the fullest possible integration of the diabetic citizen into society.

Implement effective measures for the prevention of costly complications:

a )	Reduce new blindness due to diabetes by one third or more.
b )	Reduce the number of people entering end-stage diabetic renal failure by at least one third.
c )	Reduce by one half the rate of limb amputations for diabetic gangrene.
d )	Cut morbidity and mortality from coronary heart disease in the diabetic by vigorous programmes of risk factor reduction.
e )	Achieve a pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman.

Establish monitoring and control systems, using state-of-the-art information technology for quality assurance of diabetes health care revision and for laboratory and technical procedures in diabetes diagnosis, treatment and self-management.
Promote European and international collaboration in programmes of diabetes research and development through national, regional and World Health Organisation (WHO) agencies and in active partnership with diabetes patients’ organisations.
Take urgent action in the spirit of the WHO programme ‘Health for All’ to establish joint machinery between the WHO and the International Diabetes Federation (European region) to initiate, accelerate and facilitate the implementation of these recommendations.”

At the conclusion of the St Vincent meeting, all those attending formally pledged themselves to strong and decisive action in seeking implementation of the recommendations on their return home.
Since 1989 further implementation and evaluation meetings have been held in Budapest (1992), Athens (1995), Lisbon (1997) and Istanbul (1999), where representatives of ISPAD have helped to formulate recommendations on behalf of children and adolescents.