SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 11 NUMBER 2 • JUNE 2014
51
The Internet is underutilised for diabetes education
LANDI LOMBARD
T
he USA has reached a diabetes prevalence
of 10% in the adult population and it is
increasing exponentially. If no changes are
made, it is feared the USA health system will be
bankrupt. In South Africa, we are in the top five
(currently number three) leading countries in the
obesity race and we will soon see a similar increase
in diabetes prevalence.
Type 2 diabetes mellitus is the biggest lifestyle-
related health challenge the world is facing
today. There is too much dependence on health-
care professionals and
the health system, which
cannot cope with the
volume of patients. We
can never train enough
doctors to deal with the
problem and we will be engulfed by the tsunami of diabetes
patients that will hit us soon.
Self-management of diabetes and transferring the responsibility
of care to the patient is essential. Training of large numbers of
patients in proper lifestyle adaptations and self care is critical.
This could be done via the Internet, by setting up websites where
newly diagnosed patients can educate themselves from a diabetes
website that is evidenced based and regularly updated. The
website could also have updates for the more experienced diabetic
patient. Patients should be required (by their medical aid or the
diabetes clinic) to register at these websites and then complete a
course on their disease, to arm them with the knowledge to help
themselves.
Self care is critical in the management of diabetes, but there is a
daily challenge related to diet and exercise, as well as compliance
with self-monitoring of blood glucose levels and blood pressure.
The healthcare practitioner should be involved only in checking
the success of the strategy (HbA
1c
level and other risk factors) and
adjusting therapy. On a daily basis, I find myself spending at least
half of my consultation time on lifestyle issues and advice. This
should be done through self-study, and we should be available to
answer appropriate questions.
By using the Internet and referring patients to the correct
websites, a huge burden could be carried by an unlimited, free
resource. Patients often don’t follow up regularly because of
financial or medical funder limitations. They often don’t understand
the importance of prevention of diabetes complications, and we
know that by the time complications start to occur, we have
probably already lost the battle. We should focus our resources
and efforts on the patients with no complications.
This is however not what is happening. General practitioners
and specialists dealing with diabetes are seeing the patients
with complications, where intervention will make only a small
difference, whereas we should be focusing on the huge number
of newly diagnosed patients without complications, in order to
prevent complications. Diabetes is a disease of prevention. We
cannot cure the complications and this is often poorly understood
by patients.
I believe we should challenge Government and the medical
aid industry to fund such a website that is unbiased, up to date,
easy to understand, and can be translated into all of our official
languages. If we don’t start thinking clearly about the challenges
in diabetes, this disease will engulf us and make healthcare
unaffordable. We need to act now.
The article by Onwudiwe
et al.
, ‘Barriers to self-management
of diabetes’ is important because we need to overcome many of
those same barriers and more, here in South Africa. Illiteracy is
a huge problem and access to the Internet is also problematic.
However, with smart phone use increasing exponentially,
these could be used to access the websites, which could be made
available as free downloads, sponsored by Vodacom, MTN, Cell C
and Government.
The pharmaceutical industry has responded to this huge
challenge of diabetes and is investing in research and development.
New drug options are discussed in an article by Ukrainski
et al
.,
focusing on novel oral therapies for type 2 diabetes.
This edition also has some excellent articles on cardiovascular
disease. These include a discussion on new cholesterol guidelines
from the USA, endothelial dysfunction, diastolic heart failure and
cardiovascular disease in type 1 diabetes.
Correspondence to: Dr Landi Lombard
Netcare Kuils River Hospital, Cape Town
Tel: +27 0(21) 906-1637
e-mail:
S Afr J Diabetes Vasc Dis
2014;
11
: 3
