VOLUME 11 NUMBER 3 • SEPTEMBER 2014
133
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Keep and Copy Series
PSYCHOLOGICAL CONSIDERATIONS IN
THE MANAGEMENT OF DIABETES
S Afr J Diabetes Vasc Dis
2014;
11
: 133–136
Ottilia Brown
Clinical Psychology Department,
Grey’s Hospital, Pietermaritzburg
e-mail:
Diabetes is a complex non-communicable disease requiring lifelong management and
personal responsibility of the patient for every aspect of treatment. Inadequate metabolic
control in diabetic patients is well documented. This article focuses on psychology and
diabetes in terms of examining the role of psychology in management of the illness
throughout its course, and the negative influence of psychological presentations on
diabetes management. The article also highlights the prevalence of these presentations
and emphasises the importance of identifying and treating these conditions, as this can
significantly improve adherence and glycaemic control. In closing, some thoughts on the
way forward are discussed.
Patient
information
leaflet
S
outh Africa faces a quadruple burden of dis-
eases consisting of HIV and AIDS, other com-
municable diseases, non-communicable dis-
eases, and violence and injuries. The consequence
of this is high levels of mortality.
1
Non-communicable
diseases (NCDs) are the leading cause of mortality
globally, causing more deaths than all other causes
combined. ���� ����������� �������� ��������� ������
The Negotiated Service Delivery Agree-
ment signed between the Minister of Health and the
President identified four strategic outputs for national
health, namely increasing life expectancy, decreas-
ing maternal and child mortality, combating HIV and
AIDS and decreasing the burden of diseases from
tuberculosis, and strengthening health system effec-
tiveness.
2
Reducing mortality from NCDs is critical to
increasing life expectancy. Diabetes is classified as a
non-communicable chronic disease.
According to the World Health Organisation
(WHO),
3
36 million people died globally from NCDs
in 2008, with 3% of these deaths being attributed
to diabetes. Premature deaths from NCDs are par-
ticularly high in poorer countries with around 80%
of such deaths occurring in low- and middle-income
countries. Globally, deaths due to NCDs are projected
to increase by 17% over the next 10 years, but the
greatest increase (24%) is expected in the African
region. By 2030 it is estimated that NCDs will con-
tribute to 75% of global deaths.
4
Accurate reporting on NCDs in South Africa is af-
fected by inadequate surveillance and research and
hence there is a lack of recent data on the prevalence
of diabetes in South Africa.
5
According to the WHO,
6
NCDs accounted for 29% of deaths in South Africa
in 2008, with 3% of these deaths being attributed
to diabetes. Statistics South Africa attributed 40% of
deaths to NCDs in 2008, with 2% being attributed to
diabetes. While this prevalence may seem small in
relation to other NCDs, cardiovascular morbidity and
mortality related to diabetes is well documented,
7
meaning that diabetes contributes to high NCD mor-
tality in other ways.
Diabetes is a complex disease requiring multiple
treatment modalities, the bulk of which are reliant
on the patient taking primary responsibility for the
day-to-day management of the illness. Diabetes has
been recognised as one of the most emotionally
and behaviourally challenging and demanding
chronic illnesses.
8
Both type 1 and type 2 diabetes
require treatment regimens that are complex,
including medication, self-monitoring and lifestyle
