The Tshwane Insulin Project has been underway at the University of Pretoria since 2019, with researchers contributing to the effort. The project will involve the delivery of workshops and seminars on the thorough management of diabetes and high blood pressure in primary care. Additionally, the researchers offer clinical guidance and support to healthcare professionals to enhance diabetes care. The Conversation Africa had a discussion with project manager Dr. Patrick Ngassa Piotie about diabetes and how it is so difficult to control.
What Exactly is This Diabetes?
Diabetes mellitus, more commonly referred to simply as diabetes, is a group of diseases that affect how the body uses blood glucose (sugar). Diabetes is characterized by either the inability of the pancreas to produce insulin or an inability on the part of the body to make effective utilization of the insulin that is produced. Because of this, the glucose level in the blood becomes elevated. The damage done to the body and the malfunction of various organs by high blood sugar levels is cumulative and occurs over time.
Diabetes Comes in a Variety of Different Forms
The second type is the most typical. It is responsible for ninety percent of all cases. In people with type 2 diabetes, the body is still capable of producing insulin but is unable to make proper use of it. The majority of people who develop type 2 diabetes are adults of a specific age who are obese, don’t get enough exercise, and have a diabetes-related family history.
Diabetes type 1 can form at any age, but the majority of cases are seen in children and teenagers. When a person has diabetes type 1, their pancreas releases minimal to no insulin at all. This indicates that people who have type 1 diabetes require insulin daily to maintain normal levels of glucose in their blood.
Last but not least, there is a form of diabetes known as gestational diabetes that manifests itself during a woman’s pregnancy. It affects the mother as well as the child, but it typically goes away after pregnancy.
The Condition Known as Pre-diabetes Can Be Reversed
It takes place when the levels of glucose in the blood are higher than normal but are not high sufficient to be classified as diabetes. If measures to prevent it, such as making changes to one’s lifestyle, are not taken, then it can lead to diabetes.
The elevated levels of sugar in the blood are connected to the symptoms that are associated with diabetes. Some of these symptoms include urinating frequently, feeling more dehydrated than usual, feeling exhausted and weak, and weight loss without making an effort to do so. Other symptoms, such as vision issues, repeated infections, or sores that heal more slowly than normal, are signs that the disease has progressed to a more advanced stage.
How Is It Handled in Practice?
The answer to this question is condition-specific. People who have diabetes type 1 require insulin injections daily, for instance. Adopting a healthy lifestyle, which includes increased levels of physical activity and a healthy diet, is required to successfully manage type 2 diabetes. On the other hand, diabetes type 2 is a condition that worsens over time. Because of this, people who have type 2 diabetes will eventually require oral medications and/or insulin injections to maintain control of their blood glucose levels as the condition worsens.
Diabetes management is not as simple as ensuring that the patient’s blood glucose levels remain within acceptable ranges. People who have diabetes and health professionals frequently have the additional responsibility of controlling their cholesterol levels and blood pressure. In addition, one of the most important aspects of diabetes management is reducing the risk of complications by taking precautions to safeguard target organs like the kidneys, the heart, and the feet.
The Diabetes Research Centre at the University of Pretoria has come up with an acronym that encapsulates its methodology for providing quality diabetes care. This acronym is known as the four “Bs” and four “Cs,” and it is abbreviated as “4Bs 4Cs.”
Important factors in the management of diabetes include the following 4Bs:
- Blood pressure control
- Blood glucose control
- Regulation of blood cholesterol levels
- Take deep breaths and don’t light up!
People who have diabetes should get annual screenings for the following four conditions:
- Examine the eyes with a diabetic eye screening, which is a specialized test designed to check for eye problems brought on by diabetes.
- Visit the dentist to have your mouth checked out.
- Examine in the lab on the kidneys.
- Examine the feet by performing a straightforward and easy-to-understand foot exam.
To effectively manage diabetes, medical professionals require the full involvement of individuals living with the condition and the members of their families. Because of this, it is essential for people who have diabetes as well as their families to receive education regarding diabetes. People who have diabetes need to have the skills necessary to make decisions and participate in activities related to self-management.
What Are the Primary Obstacles That Must Be Overcome When Treating the Condition?
The majority of diabetic patients in South Africa receive their medical care through the country’s public health system. This system is overworked, overstretched, and lacking in resources all at the same time. Even though diabetes medication, including insulin, can be obtained at no cost from primary care clinics, these structural obstacles still affect the delivery of diabetes care.
As a result of lengthy wait times and overcrowded medical facilities, healthcare professionals frequently lack the time necessary to educate patients about diabetes. As a direct consequence of this, people who have diabetes do not get the education they require. This, in turn, means that people don’t have a clear understanding of their condition, which in turn impacts their capacity to adopt the needs-based approach and to adhere to their medication. This is a vicious cycle that hinders people’s ability to effectively manage their condition.
Research that has been carried out in South Africa has repeatedly shown that healthcare professionals do not comply with the guidelines for the management of diabetes. In addition to this, they do not carry out the recommended procedures for care, such as taking measurements of the patient’s weight, waist size, or body mass index.
An additional barrier is presented by the fact that paper-based medical records are used rather than electronic medical records. The patient’s medical records are frequently misplaced or lost. When medical personnel frequently move between different departments, it is challenging to maintain a patient’s medical history and to provide care that is consistent from one visit to the next. When dealing with diabetes, it is challenging to implement structured care when using a system that relies on paper.
Studies conducted in South Africa have revealed that there is a lack of screening for complications related to diabetes. A good illustration of this would be the inability of medical professionals to monitor patients for eye problems brought on by diabetes. Screening for diabetic eye disease requires a specialized camera, which the vast majority of medical clinics and community hospitals do not have.
What Solutions Are There to These Problems?
Care for diabetes should be organized, conducted based on evidence, and helped facilitated by an interdisciplinary team that is trained in the management of diabetes.
It is important to improve the healthcare system in South Africa. To make necessary improvements in diabetes care delivery, investments are required. It is of the utmost importance to provide healthcare professionals with ongoing education and training in the treatment of diabetes. Allied health professionals, community health workers, and health promoters must be equipped to carry out non-clinical duties such as diabetes education and support due to the heavy workload placed on primary healthcare nurses and doctors.
It should be a top priority to prioritize the recognition and incorporation of diabetes educators into the public healthcare system. Education about diabetes will consequently become more methodical and consistent as a result of this. It ought to be carried out at consistent time intervals. Families of people who are currently living with diabetes ought to be involved in the diabetes education process as well because the support they provide is essential.
Telemedicine, digital health solutions, and other technological advances have the potential to make diabetes care more effective. The use of clinical information systems like digital medical records and computerized patient registries can have a beneficial effect on the provision of diabetes care that is supported by empirical evidence. These systems must be put into place as soon as possible.
What Are Some of the Most Important Things You’ve Learned So Far From Working on the Tshwane Insulin Project?
One of the innovations that were introduced was the utilization of digital health, which also included the enhancement of the part played by community health professionals and the proactive monitoring of patients. The vast majority of those working in healthcare are enthusiastic about embracing change and gaining new knowledge. The education that people living with diabetes and their family members were getting was being gratefully received by all parties involved. They described it as having a profound impact on their lives.
To improve diabetes care and results in South Africa, there will need to be a powerful will and unconditional support from the leaders in charge of health care, as well as the implementation of medical information systems, the utilization of technology and digital solutions, advocacy, and responsibility.
