It’s time to take diabetes seriously in South Africa – The Mail & Guardian

One in four people over the age of 45 has diabetes, and one in two people may have or be at risk of diabetes.

Most people in South Africa know someone with diabetes, and the disease is now ubiquitous. One in four people over the age of 45 has diabetes, and one in two people may have or be at risk of diabetes. It has surpassed HIV to become the leading cause of death and has numerous complications that often require hospitalization.

The main pathway for complications is damage to blood vessels anywhere in the body. This leads to problems such as stroke, kidney failure, heart failure, blindness and amputation. This damage is often compounded by high blood pressure and tobacco use. These complications are increasingly occurring among young and working-age adults.

Being aware of this, people observe. World Diabetes Day On November 14th. Theme for 2024-26 Diabetes and Health.

Health services remain inadequate due to the needs of people with diabetes. I recently spoke to a doctor at the Mitchells Plain community health center in Cape Town who said they currently treat 6,000 people with diabetes at that facility.

One of our national goals is for 90% of people to know if their blood sugar is high, but currently we can only detect half of people with diabetes. Our teams of community health workers can help with this.

Another goal is for at least 50% of people with diabetes to be able to control their sugar well, but currently only 25% of people achieve this.

If we are to turn the tables on diabetes, we must take the problem as seriously as we do with HIV and commit to resources and innovation.

Diabetes runs in families, and although this may reflect a genetic predisposition, it also reflects a lifestyle shared in families. Type 2 diabetes is associated with overweight and obesity. Healthy nutrition is the key to preventing and controlling this condition. Our diet often contains large amounts of sugar, cheap starchy foods and fats, which increase weight and lead to the development of diabetes. Physical activity is important.

To prevent diabetes, we need to not only motivate people to make healthy choices, but also place them in an environment where they are at lower risk of developing diabetes. We need to make healthier choices easier. The government and the food industry must work together to ensure people can get more vegetables and plant protein in their diets. Similarly, we need to make physical activity attractive and safe in our societies.

We must educate our children about healthy nutrition and physical activity. Children are often effective advocates for behavior change with their parents and families. Legislation such as a sugar tax can help, but transformation is also needed at the community level. The government and civil society must solve the problems that health services alone cannot solve.

Health services also need to be prepared for the diabetes problem. Most people with diabetes receive treatment in public sector primary care facilities, where they meet with nurse practitioners. We need to ensure that our nurse practitioners are experts in diabetes and lifestyle changes, and that our primary care teams have access to GPs to help more complex patients.

Although the range of medicines in the public sector is limited, the medicines are effective and accessible. Although clinical inertia is a problem, we have evidence-based guidelines.

People with diabetes need to be empowered not only to take medication but also to change their lifestyle. A person cannot simply swallow tablets or inject insulin. Healthcare often focuses on prescribing medications in brief mechanical consultations. Efforts need to be made to empower people through interventions that are possible in our context. Options include group reinforcement by trained facilitators, digital solutions, and telehealth. Group empowerment and education for diabetes (BIG) It was developed locally and proved to be cost-effective.

Many people with diabetes will eventually need insulin as their pancreas produces less and less of its own insulin. Starting insulin is another hurdle on the road to good control. People are afraid of injections and how it will affect their lifestyle. Recently, Novo Nordisk withdrew its insulin pens from the South African market to prioritize profits elsewhere. This has made it more difficult for older adults and people with visual impairments to use insulin.

Patient organisations, e.g. Diabetes SAMore attention and resources are needed to speak on behalf of people with diabetes. Health care must also do a better job of empowering people when starting insulin. Again, group empowerment, digital solutions and telehealth can help in this regard.

When people go to the clinic, healthcare professionals need to check their sugar control and look for early signs of complications. Currently a blood test (called HbA1c) is usually done once a year to check control. Unfortunately, the results may not be available until the next visit, which may be weeks or months later. Point-of-care testing is now readily available and will allow people to know immediately whether their diabetes is under control. This should become the standard of care.

Healthcare workers are supposed to check their eyes once a year, but the use of the handheld device is fraught with problems and is rarely used successfully or on a large scale. New technology to photograph the back of the eye (retina) is readily available and mobile fundal cameras should be standard.

We also check our kidneys once a year with a blood test and looking for protein in the urine. When these tests come back positive, there is already serious kidney disease and the moment to intervene successfully has been lost. Urine tests are available to detect and intervene in kidney disease early.

Therefore, we need to work better in every aspect in the fight against diabetes. We need upstream interventions to create environments that do not increase the risk of developing diabetes. We need healthcare that doesn’t just dispense drugs. We need specialized healthcare professionals at the primary care level who have the technology and innovations to strengthen people’s self-management, who can identify and take action, and who can screen for complications at a time when treatment is still possible.

Professor Bob Mash is executive and department head of the Department of Family and Emergency Medicine at Stellenbosch University.