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VOLUME 7 NUMBER 2 • JUNE 2010
Diabetes Personality
DIABETIC DIETS NEED TO BE
REALISTIC, BALANCING NUTRITIONAL
AND ECONOMIC CONCERNS
A
multidisciplinary approach is key to the man-
agement of diabetes – and physicians, coun-
sellors, biokineticists, dieticians and educators
all have important roles to play. This is the view of
clinical dietician, Marlene Gilfillan, who is based at
Kalafong Hospital in Pretoria. She has high praise for
the ‘closely networked’ team in which she works, and
feels that the successful interdisciplinary co-operation
at Kalafong more than compensates for the resource
shortages that are par for the course in the public sec-
tor.
A lack of diabetes educators at Kalafong, however,
sees Marlene taking on that role herself in addition to
her primary focus on patients’ dietary management.
Like so many other healthcare workers, she finds that
her principal difficulties lie in getting patients to accept
and understand the implications of the diagnosis and
then comply with the prescribed treatment strategies.
‘Diabetes is an extremely complex and labour-inten-
sive illness’, she says. ‘When patients are first referred
to me I spend an hour to 90 minutes with them, to as-
sess them and individualise a treatment strategy. The
challenges are many, especially when you’re working
with children, which is a particular speciality of mine.
It’s very difficult to make them understand the disease,
which is why it’s critical to involve parents and caregiv-
ers in the process. I also treat a lot of poor patients,
who have many more pressing concerns in their lives
than diabetes. The fact that they’re often not in pain, or
experiencing any symptoms, means that they tend not
to take the condition seriously, despite my best efforts
to make them aware of its gravity, even to the point
of showing them graphic illustrations of the complica-
tions of uncontrolled diabetes.’
Managing the diets of diabetics is very important,
as even when patients are compliant in respect of
their medication, it is often not sufficient to achieve
good glycaemic control. ‘It’s so much easier to pop a
pill than make fundamental changes to an unhealthy
lifestyle’, Marlene says. ‘Most type 2 diabetics are
overweight, and in addition to the difficulty in trying
to change their diet and exercise habits, one also en-
counters cultural challenges. For many patients, being
overweight is seen as something positive, indicative
that one is financially well off and/or HIV-free.’
She admits frankly that it can be disheartening
when one doesn’t see results. ‘And yet, often when
we test patients’ knowledge, we find that they might
indeed understand what we’ve told them, but it still
doesn’t translate into compliance. I feel, too, that we
Correspondence to:
Marlene Gilfillan
Department of Human Nutrition,
Kalafong Hospital, Pretoria
Tel: (0)12 318-6412
e-mail:
S Afr J Diabetes Vasc Dis 2010;
7
: 37–38
Photos by GG Photography
Providing appropriate nutritional information to clients for varying socio-economic
backgrounds is vital in diabetes care.
