134
VOLUME 10 NUMBER 4 • NOVEMBER 2013
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Diabetes Educator’s Focus
EXCELLENCE IN DIABETES: MISSED
OPPORTUNITIES FOR OPTIMAL CARE
S Afr J Diabetes Vasc Dis
2013;
10
: 134–138
T
he exponential increase in incidence of dia-
betes and other non-communicable diseases,
such as cardiovascular diseases, hyperten-
sion, stroke, hyperlipidaemias and certain cancers
are associated to a large extent with a growing epi-
demic of obesity, and lifestyle issues, mainly as a re-
sult of lack of exercise, dietary indiscretion, smoking
and excessive alcohol consumption.
1
Most people with these diseases and other chron-
ic non-communicable diseases in South Africa are
treated in public-sector clinics, where both acute
and chronic conditions are managed together. This
situation rarely provides adequate care for those with
chronic conditions or attempts to address their risk
factors, nor is it organised to detect early complica-
tions and generally lacks patient-centred initiatives
to enable patients to become active partners in their
own care.
Planning to improve the organisation of how pri-
mary healthcare services deal with chronic non-com-
municable diseases is lacking. This is in vast contrast
to how some communicable diseases, such as tuber-
culosis (TB) and human immunodeficiency virus (HIV),
are currently organised and managed. The reality in
South Africa is that non-communicable diseases are
far more common and have a greater impact than
communicable diseases with regard to morbidity and
mortality rates if not adequately assessed, managed
and funded at the primary level of care.
As a result of this, there are deficiencies in the
levels and standards of care, with a high prevalence
of unrecorded diabetic, hypertensive and cardiovas-
cular complications and sub-optimal glycaemic and
blood pressure control, as well as an almost total
absence of essential laboratory tests to manage
Dr N Naidoo
Specialist family physician and district medical
officer, New Hanover,
KwaZulu-Natal.
e-mail:
progress of the disease or detect early complications
at the primary level. The result often is polypharmacy
and a repetition of the same medications without
an attempt to treat to target or change treatments
if contraindicated, either as result of side effects or
renal or hepatic impairments. A major problem that
is often encountered is failure to refer to a higher
level of care when indicated.
2
Despite improvements in measurement of blood
pressure and blood glucose levels, current guide-
lines are often not followed, with the result that over
60% of diabetics and 50% of hypertensive patients
and those with cardiovascular disease are sub-opti-
mally managed.
3,4
It is surprising that despite these
findings, the trend recently has been to close well-
functioning chronic non-communicable disease clin-
ics or not to establish these where the need exists,
even though the National Department of Health has
made policy progress and established chronic dis-
ease care on the health agenda, such as the South
African Declaration for Prevention and Control of
Non-Communicable Diseases 2020 targets.
Diabetes and other chronic non-communicable
diseases require not only continuing medical care
but also planning and organisation with regard to
continuing patient self-management skills, patient
education, health professional education, nutritional
education and on-going evaluation of lifestyle modi-
fication, to ensure optimal care. A comprehensive
approach that extends beyond glycaemic control
(Steno 2 study) showed that intensive multifactorial
interventions, which included cardiovascular risk-
factor assessments, hypertension and dyslipidaemia
management and attention to lifestyle matters was
more cost-effective than conventional treatment.
5
