SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 7 NUMBER 3 • SEPTEMBER 2010
91
Diabetes and the eye
FA MAHOMED
must reach all levels of healthcare. There is considerable interest in
receiving training in diabetes, especially among nursing staff. It is
time we provided a comprehensive programme to meet this need.
The use of HbA
1c
as a diagnostic test is discussed. This topic
has been debated for some time and its feasibility in South Africa
is still unclear. Some of the issues revolve around cost, access to
the test in clinics, standardisation of the test and variability of the
test between different population groups.
2
We await a consensus
statement from the Society of Endocrinology, Metabolism and
Diabetes of South Africa (SEMDSA).
The Skinners in Pietermaritzburg are featured in the community
personality section. We pay tribute to the countless dedicated
people like them who face an uphill battle trying to provide support
to the many patients with diabetes in South Africa.
It is hoped that diabetes care and management of complications
such as diabetic retinopathy will improve if we adopt a more
structured approach to diabetes healthcare in South Africa.
References
1.
Abu El-Asrar AM, Al-Mezaine HS, Ola MS. Pathophysiology and management
of diabetic retinopathy. Medscape CME. Released: 12/01/2009.
.
medscape.com/viewpublication/30067. Accessed 15/12/2009.
2.
Ziemer DC, Kolm P, Weintraub WS,
et al
. Glucose-independent, black–white
Differences in hemoglobin A1c levels: A cross-sectional analysis of 2 studies.
Ann
Intern Med
2010;
152
: 770–777.
FA Mahomed
D
iabetic retinopathy is an important microvascular compli-
cation of diabetes and remains one of the leading causes
of blindness worldwide among adults.
1
In relatively low-
resource countries such as South Africa, it is important to establish
a clear cost-effective strategy to tackle both preventative as well as
curative aspects of the management of diabetic eye disease.
Areas that are covered in this issue of the journal include the use
of the retinal camera in screening, a national diabetes information
service and structured education programmes. These are areas of
growth that deserve our full attention and effort to assist with the
improvement of our diabetes services.
The retinal camera, although initially an expensive option, would
allow a larger number of patients with diabetes to have access to
good-quality screening. The cost per patient would be low. One
could use technicians to operate the camera, and they could even
do the screening by following standard charts. Ophthalmologists
could oversee their work. The technology is mobile and could
therefore provide a service in both rural and urban settings. While
there are some retinal camera programmes operating in South
Africa, it would be worthwhile having a national programme. Dr
Ladner suggests starting with a pilot programme to consider the
best way to roll out a national programme.
A national diabetes information service is important. Knowing
the number of patients with diabetes, whether it is type 1 or 2,
their insulin usage, the burden of complications and geographical
differences would allow for planning the diabetes services, namely
the allocation of funds, staffing and resources. If we were to follow
clinical outcomes and how they change over time, it would give us
a measure of the quality of our care and whether we are making
progress or not. Working with accurate data is important. The main
challenges are upgrading computer infrastructure at all levels of
healthcare, the costs involved, co-ordination of data gathering,
statistical services and delivery of data to stakeholders for review
and action.
Structured education programmes would ensure us giving out a
uniform message about diabetes. These may have to be adapted
to local conditions depending on the predominant language of
an area and the available resources. These programmes need to
be part of a formal Department of Health diabetes strategy and
Correspondence to: FA Mahomed
Grey’s Hospital, Pietermaritzburg
Tel: +27 (0)33 897-3000
e-mail:
S Afr J Diabetes Vasc Dis
2010;
7
: 91
