SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 10 NUMBER 2 • JUNE 2013
47
Correspondence to: Dr Landi Lombard
Netcare Kuils River Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2013;
10
: 47
Non-communicable diseases: an ongoing challenge
LANDI LOMBARD
T
he global burden of cardiovascular disease and diabetes
presents a major challenge to health systems and human
development. A series of five papers on non-communicable
diseases (NCDs), recently published in Lancet, presents the latest
results and ideas from some of the world’s most eminent scientists.
In the first Series paper, Sir George Alleyne and fellow researchers
highlight the fundamental link between health and development
and the disproportionate effect that NCDs have on poor people.
According to Alleyne, “Health is essential to the ability of people
to contribute to sustainable development, productivity, economic
growth; and to adapt to environmental change. Since NCDs are
a major contributor to ill health… any realistic attempt to make
human development sustainable must take NCDs into account.”
This is of particular concern in South Africa where we face dual
epidemics of NCDs and infectious disease (HIV and TB), in hand with
the demographic transition of an ageing population. Impoverished
and marginalised populations are more likely to be exposed to risk
factors for NCDs such as smoking, alcohol abuse, obesity and high
blood pressure. Consequently, a higher burden of disease is found
in low- to middle-income countries, yet there are fewer resources
to deal with them.
People with low socioeconomic status have worse access to
health care for timely diagnosis and treatment of NCDs. The need
for chronic care and the consequent burden imposed on families
can contribute to social disruption. Chronic caregivers are usually
women and girls, who may forego education or employment
opportunities to meet this need. People with NCDs are likely to be
less productive at work, lose their employment or retire early; thereby
decreasing household earnings and increasing the risks of poverty.
Long periods of ill health are costly to family finances; with hidden
costs of care imposing catastrophic expenditure that impoverishes
many households. Spending on chronic care for NCDs (and money
spent on consumption of products causing NCDs) displaces funds
that may otherwise have been used for education and food.
Our ageing population is also at higher risk for NCDs. An ageing
society has greater levels of multimorbidity and health systems
have to manage patients with new comorbid disease patterns. This
highlights the need of health systems to provide person-centred
care with improved outreach and self-management of risk factors,
illness episodes and multimorbidity over many years. In order to
deliver preventive interventions and to enable early detection and
treatment of NCDs, universal high-quality primary care should be
financially and physically accessible. The economic implications of
NCD are a challenge for all health budgets and first world countries
(USA and UK) also struggle to fund optimal management of NCDs.
In South Africa, a rapidly growing population where the vast
majority do not have access to health care, funding optimal care for
NCDs will probably not be achievable in the near future. Prevention
however, can be achieved with considerably fewer funds and
legislative changes; regulation of the food and beverage industries
and advertising campaigns can make a big difference. Education
of the public on NCD risk factors and the implications of poor diet
and obesity can have a huge impact on prevalence.
Cardiovascular disease (CVD) is the most common cause of
mortality in those with type 2 diabetes. Knowledge gained from
CVD risk evaluation may motivate patients to adopt healthy lifestyle
measures and/or observe prescribed risk modifying treatments. In
this issue, existing approaches to CVD risk evaluation in diabetes
are critically examined by Dr Andre Kengne. CVD risk models
developed from the Framingham Heart Study, the UKPDS study
and the ADVANCE cohort are discussed. Evidence suggests that
existing popular models derived from older cohorts were less
accurate for CVD risk evaluation in contemporary populations with
diabetes. New CVD risk models, including the ADVANCE model,
show improved predictive accuracy for people with diabetes. The
growing diabetes epidemic in South Africa will surely impact on the
prevalence of CVD. Accurate CVD risk prediction is very important
in order to spend our limited health Rands on those most at risk.
Little attention has been focused on hypertension in the elderly
in Africa. Older adults in South Africa face a disproportionate rate
of hypertension, with an increased risk of CVD. In this issue, a paper
from Dr’s Karl Peltzer and Nancy Phasawana-Mafuya indicates that
the percentages of older hypertensive subjects who were aware,
treated and controlled were very low, underscoring the urgent need
to strengthen public health education and improve blood pressure
monitoring systems. Hypertension is a very serious modifiable CVD
risk factor and treatment is cost-effective and can prevent many
complications down the line. Access to health care and both the
limitation of health care professionals and funding is, however,
restrictive.
Dyslipidaemia is an important atherosclerotic risk factor that is
very common in type 2 diabetes. Dr Dirk Blom reviews dyslipidaemia,
atherosclerosis and type 2 diabetes in this issue; discussing the
clinical concerns of prevention and treatment. The skin may
provide vital clues in the diagnosis of diabetes and may portend
advanced disease. Recognising various skin signs is therefore critical
in the management of patients with diabetes. A review from Drs
Kannenberg and Visser on diabetes mellitus and the skin considers
the diagnosis and management of some skin conditions.
Included amongst recommended effective actions to reduce
NCD inequalities are childhood education programmes. Youth with
Diabetes is a non-profit organisation registered with the South
African Department of Social Welfare, largely run by young people,
mostly with diabetes themselves. Being diagnosed with diabetes
at a young age can be devastating and having the support of this
wonderful group of young people can make a big difference in
the lives of many. This organisation has been established with the
express purpose of saving lives of young people in South Africa
who have diabetes. In this issue, read about their weekend camps
that take place in major centres throughout the country; and to
find out more about their school awareness campaign see www.
youthwithdiabetes.com
