Free RBS checking campaign on the occasion of observing World Diabetes Day at the Sylhet Diabetic Hospital premises. Sylhet, Bangladesh. Photo: Getty Images
November is Diabetes Awareness Month with World Diabetes Day being celebrated on 14 November. The theme for 2022 is “Education to protect tomorrow”. This year is significant because it marks the 100th anniversary of the first use of insulin as a treatment in humans.
Advances in the past century include the introduction of “designer” insulins — molecules structured to mimic the physiology of the human protein and offering patients the freedom to tailor the use of medication to improve their glucose control.
In addition, monitoring devices are becoming more sophisticated. Thanks to technological advances like smartphone apps, some devices are even able to continuously monitor the blood glucose levels of people with diabetes and warn them when these values are too high or too low.
The landscape of other treatment options has changed significantly in recent years. If one thinks that we only had a handful of drugs, both oral and injectable, available for the first 50 years since the introduction of insulin, we have had an explosion of new molecules and drugs in recent years, many of which have fantastic trial data on their benefit in altering the course of the disease by preventing complications, especially cardiovascular complications.
But can we pat ourselves on the back?
The world is still recovering from the effects of the Covid-19 pandemic. But outcomes of patients with diabetes highlighted the fact that the true pandemic of non-communicable diseases (NDCs) that we have neglected for far too long, needs attention urgently. The International Diabetes Federation 2021 Report estimates that 563 million adults are living with diabetes globally.
This number is expected to increase by 46% to 783 million in 2045. The prevalence reported for South African adults is 12.8%, but this is an underestimate because 60% remain undiagnosed. Unsurprisingly, it has been described as one of the fastest growing global (including South Africa) health emergencies of the 21st century.
The theme for this year’s Diabetes Awareness Month and World Diabetes Day is, therefore, particularly relevant as it emphasises the importance of diabetes education in the management of the condition in South Africa.
First, we need to step up the education of every single person about the effect of this condition on our daily lives. Awareness campaigns should not be limited to a certain time of the year; efforts should be continuous to improve knowledge around prevention, timely diagnosis and health care.
For example, we must increase awareness of the effect of diabetes on women planning a pregnancy, and the far-reaching consequences this can have for both mother and child. Educating the public on the prevention of diabetes and other NDCs lends itself to the World Health Organisation’s philosophy that it is not only the absence of disease that constitutes health, but a complete state of wellness — physically, mentally and socially.
Second, education of the person diagnosed with diabetes, or identified as high-risk, has been shown to be a great contributor to achieving management goals. Aspects such as lifestyle modification, adherence to medication, self-monitoring of glucose levels with the ability to respond appropriately and the prevention of both acute and chronic complications, need to be addressed in structured education programmes for individuals and groups. Technology and community interventions can also be part of diabetes education.
In South Africa, diabetes education and the recognition and registration of diabetes educators remain suboptimal. At numerous healthcare facilities, people do not have continuous access to a dedicated diabetes educator, culminating in an escalation of risk and cost which could have been prevented. We need to address this as a matter of urgency.
Third, the education of healthcare workers (starting at a community level but including all tiers) is of paramount importance if we want to improve care for those living with diabetes or who are at high risk of developing it.
This includes promoting lifestyle choices to prevent the onset of the condition, improving the rate of diagnosis by screening people at risk, advising on the appropriate management options and timeous screening for complications. Guidelines exist regarding treatment choices, but unless all aspects of management are addressed, the script of medications will not lead to an improvement in outcomes.
We have learnt many valuable lessons during the Covid-19 pandemic, many of which we will hopefully use when faced with future pandemics. In addition, we continue to address other diseases such as tuberculosis, HIV and malaria that cause large-scale problems in low- and middle-income countries.
It is now time that we learn that education is a key factor in the management of the ongoing diabetes pandemic.
The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.