Treating diabetes is possible, yet not nearly enough is being done in South Africa and around the world to win the war on a disease that directly impacts millions of families in the country and globally, said the University of Cape Town’s (UCT) Professor Naomi Levitt.
Professor Levitt is a senior scholar at UCT and the director of the Chronic Diseases Initiative for Africa (CDIA). She is also the former head of the Division of Diabetes and Endocrinology at UCT’s Department of Medicine and Groote Schuur Hospital.
Speaking to UCT News ahead of World Diabetes Day on Saturday, 14 November, Levitt described the disease as an “enormous problem that is inadequately tackled” in society.
World Diabetes Day is an initiative of the International Diabetes Federation and is the annual primary global awareness campaign that focuses on the disease. More than 463 million people around the world are living with diabetes, and this year’s campaign highlights the role nurses play in preventing and managing the disease.
“These figures are quite stark, but [type 2] diabetes is preventable, and [both types are] treatable – we shouldn’t forget that.”
In South Africa alone, more than four million people are living with diabetes, and more than half of those cases remain undiagnosed.
“These figures are quite stark, but [type 2] diabetes is preventable, and [both types are] treatable – we shouldn’t forget that,” Levitt said.
Facts about diabetes
Diabetes is characterised by high blood sugar levels over a prolonged period of time. This hyperglycaemia, as itʼs known, occurs when the body fails to produce enough or any insulin (type 1 diabetes mellitus) or is unable to make effective use of the insulin it produces (type 2).
Insulin, she explained, is produced by the pancreas and transfers sugar from the bloodstream into the body’s cells. There, the sugar is either used for energy or it is reserved. Typically, symptoms of diabetes include frequent urination, increased thirst and an increased appetite.
What can go wrong
Diabetes is associated with a number of long-term complications, due to damage to the small and large blood vessels. Diabetes also doubles the risk of cardiovascular disease and is a leading cause of foot problems, such as diabetic foot ulcers, which, if left untreated, could result in amputation.
“Examining the feet every day for swellings, redness or wounds and wearing comfortable shoes that are not tight are important to prevent ulcers. If ulcers do occur, visit a doctor immediately,” Levitt said.
Good eye care is essential too, and Levitt encouraged people living with diabetes to insist that their healthcare provider checks their eyes regularly to prevent blindness from diabetic retinopathy (damage to the retina of the eye caused by visual impairment or abnormal blood flow).
“It’s all part of the [management] process,” she added.
Levitt reiterated that diabetes is one of the leading comorbidities of COVID-19 (the presence of one or more conditions occurring with a primary medical condition). And people living with diabetes are at greater risk of contracting severe COVID-19 if their blood sugar levels are out of control.
“In this regard, it’s important to control blood sugar levels, maintain a healthy diet and keep the lines of communication open with your healthcare provider. Flag anything out of the ordinary,” she said.
Diabetes is influenced by inequality
Levitt said global research reveals that obesity is one of the major risk factors for type 2 diabetes. South Africa continues to face a growing obesity problem. According to the South African Demographic and Health Survey 2016, 68% of women, 31% of men and 13% of children are overweight, making South Africa the country with the highest obesity rate in sub-Saharan Africa.
She described processed meats and foods high in starch, sodium and added sugar as “definite no-no’s” for people living with diabetes. However, because of the high levels of poverty and inequality in the country, she said it’s often too expensive for these people to maintain a healthy diet.
“A change in lifestyle is hard for our people. A bag of mealie meal is far cheaper and goes further than a chicken, or fish. Food choices are also dependent on what’s available in the community and how many mouths people need to feed,” she said.
Further, she said, despite free healthcare, the employment and income status of people in under-resourced communities also influences whether they choose to seek care for their diabetes or not.
“The cost of transport to get to a clinic and losing a full day’s wages mean that it’s easier to just not go at all.”
“The cost of transport to get a clinic and losing a full day’s wages mean that it’s easier to just not go at all. There’s no money to do so. It’s for this reason that I believe that diabetes is influenced by inequality in our country.”
She suggested that government and the private sector join hands to reverse the tax on healthy food items to ensure they become more affordable and accessible for everyone in the country. She said the Health Promotion Levy (sugar tax) introduced in 2018 to support the Department of Health’s strategic plan for prevention and control of obesity is a step in the right direction. But it’s not enough.
“We need all sectors of society to come together to promote diabetes prevention, early diagnosis, education and continuity of care. This will improve the outcome for people living with diabetes and those at risk of diabetes,” she said.
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