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VOLUME 14 NUMBER 1 • JULY 2017
39
SA JOURNAL OF DIABETES & VASCULAR DISEASE
DIABETES NEWS
affair. Parents can play a substantial role
in how much anxiety is experienced by
the child with diabetes whether it be
specific fears related to diabetes or fears
that arise in their life context. All fears
have an impact on how well the child
will cope with having diabetes.
Anger: another deterrent to good
•
management is anger. Angry childrenmay
sabotage their diabetes management.
Even those children who have accepted
their diabetes and usually manage well,
sometimes become angry because of the
impact diabetes has on their lifestyle. It
is important to acknowledge this anger
and work with the child to enable them
to reduce their anger. ‘Anger gives rise
to a chemical response in the body and
unfortunately for the child with diabetes,
this response means that the child
develops high blood sugars’, she says.
Depression: another difficult emotion
•
is depression. Depression takes away
any motivation to succeed, so handling
depression and suicidal feelings is a
necessity for children with diabetes.
Three ways to help children become
more resistant to depression include
building their self-esteem, encouraging
physical activity, and finding a support
group. Support groups and camps for
children with diabetes provide a sense
of community, particularly when they
can see that other children handle their
diabetes well.
‘Children with diabetes have to learn to
live a lifestyle that promotes their health
and enables them to function in the best
way possible. This lifestyle includes eating
foods that are healthy, doing some exercise
and taking medication. However, despite all
good intentions, they may still falter. It is so
important for parents to provide guidance
on how to change, and encouragement to
sustain the positive changes they make’,
Flynn concludes.
T
here may be as many as 4.6 million
people in South Africa living with
diabetes, and possibly the same number at
risk of developing type 2 diabetes. Those
diagnosed face the risk of life-changing
and life-limiting complications unless they
receive the care and support they need to
manage their condition well.
Grant Newton, CEO of the Centre for
Diabetes and Endocrinology (CDE), says it
is critical that as a society we start working
together tomanage the current national crisis
posed by diabetes and related chronic health
conditions, all of which result in premature
and increased cardiovascular risk. ‘Not
everyone will develop this potentially life-
threatening health condition, but diabetes
will affect all of us. We are concerned that in
South Africa, 68% of people with diabetes
remain undiagnosed.’
Newton says that although diabetes is
a global problem, it has a local epicentre.
In the next 20 years, with 77% of people
with diabetes living in medium- and low-
economic countries, we expect that the
developing world will bear most of the
burden of the diabetes pandemic. ‘Africa will
be particularly hard hit’, says Newton, ‘with
76% of deaths from diabetes occurring in
people under 60.’
In South Africa, four out 10 men and
seven out of 10 women are overweight
or obese, which is a major risk factor for
the development of type 2 diabetes, a
largely silent, asymptomatic condition with
devastating cardiovascular outcomes. Figures
just released by StatsSA report that diabetes
Diabetes is the most potentially devastating and fastest-growing health
crisis of our time
became the biggest killer of South
African women in 2015, and the
second biggest killer overall, up
from fifth two years ago.
Newton say against the backdrop
of increasingly scarce and costly
healthcare resourcing, increasing but
preventable costs of admissions for
diabetes, and complications
of poor diabetes care, it is
imperative that the sector
urgently starts looking at
integrated approaches to
preventative, community-
based diabetes care.
‘We are clearly lacking critical research
funding and resources to improve healthcare
and treatment and there is an urgent need
for more education and a change in the
way diabetes is managed and funded in
South Africa’. Newton says while one can’t
move away from cost restrictions, the real
challenge is finding a way of reducing costs
without impacting on quality of care. ‘We
appreciate medical schemes are under
enormous pressure to manage their costs,
but it is concerning when the focus moves
to cost-saving rather than patient service
utilisation and improved clinical outcomes.
We need to start being far more proactive
in treating and promoting patient health,
particularly when one considers economic
studies from the US showing that in people
with diabetes, in-patient hospital care
accounts for 43% of the total medical
costs of diabetes and that poor long-term
clinical outcomes increase the cost burden
of managing diabetes by up to 250%.’
Over the last 20 years, Newton
says the CDE programmes have
seen a significant overall reduction
in all acute diabetes-related hospital
admissions. ‘We have seen a reduction
as high as 40% in all-cause hospital
admissions and a 20% reduction
in the length of hospital stay.
This can only be good for
funders.’
Newton admits the
challenge, however, is
that these programmes
are not universally accessible to everyone.
‘Programmes need to be revised to ensure
lower-income patients are not excluded and
education platforms need to be extended.’
He says that CDE is currently repositioning its
offerings to accommodate this need and will
be announcing some exciting new changes
next month. ‘We will also be focusing on
how we can partner better with the public
sector to extend our postgraduate diabetes
training and education.
Currently, CDE through its central
office in Houghton, Johannesburg, trains,
accredits, administers and audits the
biggest network of diabetes providers with
specialised postgraduate training in Africa.
With 25 endocrinologists, 216 CDE centres
of excellence and over 340 contracted
general practitioners, the CDE has a unique
ability to provide risk-stratified diabetes care
and cardiovascular risk management at
primary, secondary and tertiary levels of care
nationally.
Grant Newton