Koba Amirkhanashvili


                           Doctor of Chemical Sciences, Professor 
                Member of Parliament 1995-1999 and 1999-2004 years


World medicine is still unable to save people’s life from such diseases as malignant tumor and AIDS. Before applying the method of insulin injection therapy people with diabetes were predestined for death. Fortunately, this method enables diabetics to preserve their working ability to a venerable age and not defer from non-diabetics. Insulin is one of the greatest achievements of medicine of all times. At present, there is no deficit of it in the world and, it is shameful if even one diabetic person dies from insulin absence.

Diabetes is a chronic decease, complete convalescence from which is still impossible. Today’s level of insulin therapy gives a chance to save patients’ life and restore their working ability, but even solution of the above questions does not solve the problems in diabetic treatment. At times, patient’s condition may not be life threatening, have satisfactory working ability with high level of glucose in the blood, increasing risk of complications.

Due to the above, continuing medical control and care, greatly depending on patient’s psychological condition, are essential for them. Dramatization of this decease is inadmissible. The main things are self-control and adaptation to it, because diabetes is the specific and different lifestyle.

This problem is more severe for children because of its specific character, connected to the age factor and peculiarity of treatment.

From all the above considered, and also according to the international standards, a child with diabetes first of all needs insulin [human insulin], glucose control tools [glucometers, test-strips], ketone checking strips, special diet and corresponding education. Effective use of the above guaranties a normal development of a child with diabetes and his/her becoming an active member of society.

According to the above, the first diabetic charity organization (NGO) - “Diabetic Children’s Protection Association”, was established in Georgia, 1990. The aim of the organization has been to provide the diabetic children with insulin, glucose control tools, adequate diabetic education and their social rehabilitation.

The Association was established due to the difficult situation in Georgia. In 1990, the contours of the disintegration of USSR were clearly seen and it was evident that Georgian health care system would be in a very difficult position.

In view of this, for the transitional period, establishment of an organization, directly involved in providing diabetic children with insulin and at the same time protecting their rights, was of great importance.

As the subsequent developments showed, USSR collapsed and Georgia remained without medicines. To the above were added the processes taking place in Georgia (events in 1991-92, military operations in Samachablo and Abkhazia), significantly destroying the health care system and that putting disabled and invalids in the most difficult situation. Majority of such people, in Georgia, were insulin depended patients, about 40 thousand. The situation was especially difficult for the diabetic children (about 300 children, less than 14 years old), using U100 unit (penfill) human insulin, made by the company “NOVO-NORDISK’’ (Denmark).

Solving these problems the Association began it’s activity.

Yet in 1991 the association raised a question to the Government of that time, to approve a resolution about providing diabetic children of Georgia with insulin. Unfortunately, the Government couldn’t approve the above question and it was realize only in 1992. Though, due to the difficult economic conditions in Georgia, it was impossible to purchase insulin even for children, as well as for adults that meant death for many diabetic patients.

Here should be mentioned the role of Mr. E. Shevardnadze, who asked the USA Government and the State Secretary of USA J.Baiker, visiting Georgia, for providing Georgian people with insulin. Within this program, in 1992-93, Georgia got as donation from USA insulin “Humulin” to a total value of about 15 million dollars, saving the life of ten thousands of diabetic patients. But problem of penfill – insulin for children is still remained.

The problem was solved by the charity act, made in 1993 by Aslan Abashidze, the head of Adjarian Supreme Council, purchasing penfill insulin especially for the children at a value of 70 thousand dollars.

So, in the most difficult period (1990 – 1995), the Association was able to provide their members not only with insulin but also with humanitarian food products.

In 1995 in Georgia began the reform of the health care system. At the beginning, due to the financial difficulties, diabetic children program was not in the list of the State Budget Programs and was added only on initiative of Eduard Shevardnadze, and after that a new period for the diabetic children began.

Since 1997 the Association is the only NGO, fulfilling State Budget Program – the Diabetic Children Budget Program in Georgia.

In 1997, under the patronage of the Association, the first diabetic school for children in the Pediatric Clinic of Tbilisi State Medical University (TSMU) has been established.

In the same year, according to the agreement between the Association and the Georgian State Department of Disabled, the above mentioned Department purchased for the Association glucometers, strips for urine and blood testing and other laboratory tools.

In 1998, due to the Association’s suggestion the program participants age has been raised from 16 to 18.

Since 1999 the diabetic children’ state budget program that operates within the programs of State Company of Medical Insurance and Association took responsibility to purchase definite amount of glukometers and blood and urine test strips, besides insulin, enabling the children to test the blood at least once a day during a year.

Since 1996 has been created data base about diabetic children of Georgia – National Diabetes Register, giving a chance not only get the complete information about the patient’s condition but also it enables the Association to send the information to the leading clinics of the foreign countries for the consultation through the computerized network.
Diabetic children and their parents education is implemented at "Diabetic School" located at the Endocrinology Department of the Pediatric Clinic of TSMU. The curriculum of five-day seminar deals with diabetic mellitus, diet and insulin therapy, extreme conditions and a role of physical activities in case of diabetic mellitus.
Since 1997 up to 2002 the school was attended by approximately 800 participants, children and their parents. Finishing the school each participant gets handouts in Georgian and Russian languages, vital hypoglycemic agent – Glukagen and certificate. 
To solve a problem of diabetic retinopathy, the leading cause of blindness, the Association began cooperation with the Microsurgery Center. About 1000 Association members were examined and for more than 150 patients were performed lazier coagulation. It should be mentioned, that all the services in the center are free of charge for the Association members under 25.
"Diabetic Camp" has been held each summer, where under supervision of qualified medical team (doctors, nurses, diabetic adolescents) children get special diabetic education. Within 10 days period they adjust insulin injection by themselves, learn insulin dose correction and psychologically adapt to each other. The first such "Diabetic Camp" for Georgian children was held in 1995, (Hickory Hill, USA). Since 1996 up to nowadays the international camp were arranged once in year in Bakuriani, Hotel "Mtsvane Veli".
The association has its regional organizations in Kutaisi and Batumi. In regional office of Kutaisi operates the diabetic school and laboratory. In 1999, on the basis of the private medical firm “Paracelsi”, regional organization of Adjara has been opened in Batumi. The office is equipped with laboratory and testing instruments, operating a diabetic school.
At present, two State Budget Programs serve a treatment of diabetic children: the above mentioned program and free of charge medical treatment program for orphans, patients with low income and diabetic children. The latter program implies in-patient treatment.
High efficiency of the obtained results is clearly show by the several characteristics:
Annual use of insulin decreased by 40% per child, since 1995, that gave a chance to raise program participants age from 16 to 18.

Within the period of 1990-95, the number of patients with severe diabetic complications were higher than those since 1995.
Since 1997 none of the hypoglycemic coma and lethal cases was observed.
Since 1997 cases of angiopathy among children have fairly decreased.
In the recent years, the Association’s successful activity was mentioned on the international symposiums and conferences. For this the association cooperates with the Diabetic Federation of Georgia and on its initiative the Association became a member of International Federation of Diabetes and the European Diabetes Association.
The president of the International Federation of Diabetes Dr. Maria L de Alva, visiting Georgia by invitation of the chairmen of Georgian parliament Dr. Z. Zhvania, greatly appreciated the diabetic children’s treatment in Georgia. Since 1995 the Association is taking part in many scientific conferences and congresses.
Since the first years of the existence the Diabetic Children's Protection Association cooperates with the world famous insulin producer company "Novo Nordisk". The merit of this company is that fact, that during 1990 - 2000 children with diabetes of Georgia free-of-charge received the insulin of hundred thousand US dollars, technical means for the glucose analysis in blood and especially intramuscular medication Glukagen, owing which we have not during these years lethal cases caused by hypoglycemic comas.
Since 2000 the aid from the company "Novo Nordisk" to the diabetic population of Georgia has grown. This growth is connected and caused by the vice-president of the company, Mr. Harry Itameri. Mr. Harry Itameri has arrived to Georgia first time by the invitation of Association in March, 2000, in connection with the jointly humanitarian action. The children and teenagers with diabetes of Georgia have received insulin, means for the analysis glucose in blood and gifts for the total sum of hundred thousand US dollars during this action. The president of Georgia Mr. Eduard Shevardnadze has been presented at realization of the humanitarian action. Some humanitarian actions for the help of children with diabetes of Georgia were carried out after this action with active support of Mr. Harry Itameri.
The 2001 was very important for diabetic population of Georgia, when according to the joint decision of committee of parliament on public health services both social questions and state company of medical insurance was announced tender on state purchase insulin on 2001 - 2005. The company "Novo Nordisk" has won in the tender with the offer of delivery in Georgia human insulin, including free-of-charge insulin for the sum up to 10 million US dollars. By this decision Georgia became the fifth country in the world after Denmark, Norway, Sweden and Finland, which provides its population only with high-quality human insulin. The creation of such favorable conditions for Georgia first of all is connected to activity of Mr. Harry Itameri.
In 2001 the president of Georgia has appropriated to the citizen of USA, Mr. Harry Itameri, rank of the Honourable Citizen of Georgia for the large merits before diabetic population of Georgia. In the same year, per the tenth anniversary of independence of Georgia, the honorable citizen of Georgia has visited the North Pole, where has set up state flags of USA and Georgia.
Since 2002 the position of vice-president of the company "Novo Nordisk" is occupied by Mr. Sergei Smirnov. He, together with the manager in the Caucasian region Mr. Victor Vlasov plays the important role in the subsequent strengthening and expansion of cooperation between the company and association. It is especially necessary to note, that sirs Smirnov and Vlasov successfully continue tradition of the company "Novo Nordisk" in the sphere of the humanitarian aid to children with diabetes of Georgia.

The president of Georgia, Eduard Shevardnadze highly has estimated activity of association and for the large contribution in business of treatment of diabetes children and adult and for fruitful charitable and public activity in 2001 has awarded with awards and medals of Georgia of the following members of Association:
By award of honour:
Koba Amirkhanashvili - President of the Association, a member of IDF and EASD, Doctor of chemical sciences, professor. 
By medal of honour:
Teimuraz Vardosanidze - Vice-President of the Association
• Zurab Sekhniashvili - Candidate of Medical Sciences, Director of Republican Centre of Children's Endocrinology, Professor. 
Has announced gratitude:
• Tinatin Chantladze, MD.
• Marina Gordeladze, MD, Candidate of Medical Sciences, Senior Lecturer.
• Lamzira Komshiashvili, MD.
• Tamila Lapanashvili, MD.
• Eka Tckhadadze, MD.
• Svetlana Kargieva - Biologist. 


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