Dr J.L.
Gorriz Teruel, Dr A. Martinez Castelao and Dr F. de Alvaro Moreno
Spanish Study Group of Diabetic Nephropathy
GEENDIAB
Spain
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Dr J.L.
Gorriz Teruel, Dr A. Martinez Castelao and Dr F. de Alvaro Moreno |
Prof Zoccali: Could tell us how the idea of GEENDIAB was generated within the Spanish Society of Nephrology?
Geendiab: Diabetes, and especially diabetic nephropathy, has been a goal of interest for Spanish nephrologists for years now. In January 1995, a small group of 25 nephrologists from the various Spanish communities, who had been previously working in the DN field as a goal, met for the first time in Madrid, to create a group that was totally dedicated to Diabetes and the problems of diabetic patients, but from a nephrological point of view. Thus, the GEENDIAB was born. Under the auspicious of SEN, we set down the rules for the functional activity of the group, and promoted the first Spanish Consensus document on the detection, prevention and treatment of DN, which was published in 1997. The CALVIDIA study was initiated with other studies following afterwards.
Prof Zoccali: Do you believe that in the future concerted efforts of enthusiastic investigators will be the highway for successful clinical studies on this issue?
Geendiab: Our thought is that the “calamity” of diabetes can only be stopped through the coordinated effort of the many people involved in the care of diabetic patients. The solution is to act as early as possible. Only if doctors, nurses and the diabetic patient him/herself become aware of the necessity for an integrated education, can this plague be stopped. Under these conditions, the efforts of young investigators, guided by the experience of “not so young” investigators, may be mandatory to decrease this terrible illness and its complications.
Prof Zoccali: Which obstacles did you have to overcome in the early phases of your initiative?
Geendiab: At the outset, we needed to define the rules to activate the group in the general context of our own society and to open the activities to the members of the other Spanish societies involved in the management of diabetic patients. The moments of great difficulty were, first of all, to get the other three Societies for the Consensus together in 1997 and, especially, to overcome the problems by obtaining a consensus among seven societies for the 2002 document. On the other hand, members of the GEENDIAB are enthusiastic to support the group, with ideas, suggestions and extremely qualified work.
Prof Zoccali: What is currently the main problem for the growth of the GEENDIAB group?
Geendiab: The group currently has 80 members, distributed throughout the autonomous communities of Spain. This growth renders management difficult as regards meetings and financial support. Nevertheless, we are usually in close contact and communicate via e-mail. We are functioning in small groups for each project or clinical trial in course, and Fernando, José Luis and myself act as group coordinators . We have held 17 national meetings, usually taking advantage of the annual SEN Congress and two international meetings. On these two occasions, we have had all the support of the Pharmaceutical Industry.
Prof Zoccali: Do you believe that GEENDIAB has the potential to converge in wider (international) scientific enterprises or do you consider it a purely Spanish collaboration?
Geendiab: We are very close to other international organizations on DN, for example, the European Diabetic Nephropathy Study Group and many of us are members of this group and attend the meetings organized each year. We held the EDNSG meeting in Barcelona in May 2003. International collaboration in this field would be of vital importance with a view to combining efforts on DN. I think that the complications in the organization of international groups could be overcome if we combine our efforts and work together.
Prof Zoccali: You put a great deal of emphasis on collaboration between specialities (nephrology, cardiology, internal medicine, etc). Yet this is difficult to realise. Frankly speaking what progress have you made in this direction?
Geendiab: We are convinced that a close collaboration among the different specialities involved with diabetic patients is needed. If you take into account that diabetic patients may visit an endocrinologist or diabetologist, a cardiologist, a podologist, etc, it is obvious that we need to integrate all the concepts and to educate our patient in a well-coordinated manner. This is not easy. But, when you organise a meeting such as our last GEENDIAB international meeting, you can see the great interest manifested by the specialists. In our meeting in Madrid, on January 20-21, 2005. We had the assistance of more than 300 Spanish endocrinologists, diabetologists, nephrologists, cardiologists and general practitioners. That is the idea of our Group, to integrate the actions of one and all, pooling our experiences on evidence-based Medicine.
Prof Zoccali: Although integrated, multilevel intervention is necessary for effectively combating diabetic nephropathy, to what type of intervention would you give priority at the present moment?
Geendiab: Firstly, to stop the increased incidence of one's own diabetes, that is, education on life-style as well as the prevention of new-onset diabetes through drugs or treatments. Secondly, we are convinced that systematic detection of microalbuminuria is still a “pending matter" in many Primary Care settings. And today we have certain drugs available such as ACEI, ARA II, statins, which are essential in order to prevent DN, but they need to be administered as soon as possible. Early intervention is crucial for this purpose.
Prof Zoccali: Which paper most influenced your scientific interests?
Geendiab: There have been many good papers over the last few years that have had a decisive influence on our thoughts when taking care of diabetic nephropathy patients. The simultaneous publication of IRMA II, IDNT and RENAAL was a very important moment for DN around the world. But recently an estimation of Wild et al (Diabetes Care 2004;27(5):1047-1053), on the global prevalence of diabetes for the year 2000 and projections for 2030 has encouraged us to work more closely to stop this authentic “plague”.
Prof Zoccali: What is the best Spanish wine?
Geendiab: José Luis is right when saying that Vega Sicilia is probably the best Spanish (Ribera de Duero) wine. Especially the “Unico” reserve. But don't forget other like Contino (Rioja), Mauro (Ribera de Duero without designation of origin), Pingus (the most expensive Ribera de Duero), Val de Vos o Enate (Somontano), and the new Priorato wines, which are considered among the best emerging red wines in the world.
Prof Zoccali: Is paella a Catalan or a Valencia specialty?
Geendiab: Definitely, paella is a Valencia invention and is really very good. The best way is to eat it in the Valencia region, of course.
