Diabetes Educator’s Focus
114
VOLUME 7 NUMBER 3 • SEPTEMBER 2010
SOUTH AFRICAN APPROACHES TO
STRUCTURED EDUCATION IN TYPE 1
DIABETES
W
e as specialised diabetes nurse educators encounter many obstacles when educating pa-
tients on effective management of their condition. Often people with diabetes are confused
as a result of unstructured or incomplete education on their condition and therefore cannot
maintain optimal health and a good quality of life. There may be underlying emotional or stress-related
issues that should be addressed before patients can become self-motivated with regard to managing
their disease. Much needs to be done in South Africa to improve education and care of people with
diabetes.
Correspondence to:
Kamaretha Beckert
Centre for Diabetes and Endocrinology,
Paarl, Western Cape
Cell: 082 438 2747
e-mail:
Laurie van der Merwe
Centre for Diabetes and Endocrinology,
Richards Bay, KwaZulu-Natal
Cell: 078 802 7505
in Africa are impeded by inadequate healthcare infra-
structure, inadequate supply of medications, absence
of educational programs, and lack of available health-
care facilities and providers’.
5
Limitations of current treatment
programmes
About 47 million people live in South Africa. Approxi-
mately 80% of these receive government-sponsored
medical care and 20% receive medical care in the pri-
vate sector, paid for by either themselves or medical
insurance schemes. The costs of diabetes manage-
ment are considerable, both for the person with the
condition and the healthcare provider.
2
In a review of public-sector primary care of diabetics
in Cape Town,
6
it was found that care was inadequate,
and simple but appropriate protocols and education
were needed to improve the care and health outcomes
of these patients. A study of the diabetic population in
the public health sector in rural KwaZulu-Natal found
that only 15.7% had acceptable glycaemic control.
In fact the average HbA
1c
was 11.3% despite having
good rates of attendance at the health clinic and com-
pliance with medication. Again the care and control of
diabetes was found to be sub-optimal and the sugges-
tion was made that additional training for nursing staff
and education for patients is needed.
7,8
In the private healthcare sector, individuals with dia-
betes may be referred to a dietician or diabetes nurse
educator following diagnosis and may receive basic
Diabetes is an important cause of morbidity and mor-
tality in Africa and prevention and control programmes
are needed to stem the rising epidemic of diabetes
and its complications.
1
In Asia and Africa, the inci-
dence of diabetes has risen at an extreme rate and
the total number of people with diabetes was expected
to have reached 221 million by 2010. According to
the International Diabetes Federation (IDF), the esti-
mated number of people with diabetes in South Africa
is around 840 000. The World Health Organisation
(WHO) and International Diabetes Federation (IDF) pre-
dicts that in South Africa, the numbers will increase to
more than 1.3 million in the next 25 years. Although all
groups are affected, those most at risk are the black
community, who are undergoing rapid changes in life-
style and culture, and people of Indian descent, who
have a gene pool that makes them unusually suscep-
tible to diabetes.
2
The incidence of type 1 diabetes is rapidly increas-
ing in children and adolescents in many countries and
the global prevalence of type 1 diabetes in the child
population from birth to 14 years of age is assessed
to be 479 600.
3
The first long-term outcome study of
type 1 diabetes in sub-Saharan Africa, done in Soweto
and published in 2005, indicates that although the
mortality rate was substantial, it was similar to equiva-
lent studies in the United States of Afro-Americans
with type 1 diabetes. The outlook for individuals with
type 1 diabetes in Africa therefore remains poor,
4
as
‘efforts to prevent this disease and its complications
S Afr J Diabetes Vasc Dis 2010;
7
: 114–116
