July is chronic disease awareness month. Diabetes mellitus (DM) is no exception to the challenges of managing a chronic disease, as it continues to affect millions of people around the world.

>60% of patients cited lack of diabetes education and support as a leading factor in their lack of HbA1c goal attainment

By 2045 it is expected to rise by 143% on the African continent, a continent that has the least number of resources to manage such a dynamic disease. In South Africa, the number of people living with diabetes has risen from 1.9 million in 2011 to 4.2 million people in 2021.1

The International Diabetes Management Practices Study showed that despite all the efforts implored in the management of diabetes, South African patients are still not reaching target HbA1c.  The study, which focused on the patient management of physicians (general practitioners, diabetologists, specialists’ physicians and endocrinologists) in low- and middle-income countries including South Africa, showed that >60% of patients cited lack of diabetes education and support as a leading factor in their lack of HbA1c goal attainment.2-3

There are several reasons why many diabetics feel overwhelmed in managing their condition. Multiple daily tasks include taking their chronic medication appropriately, managing their diet, physical activity, monitoring blood glucose levels, developing good problem solving skills, coping skills, and risk reduction behaviour.4 In order to support patients, studies have shown that diabetes management should focus on several aspects, namely; education, lifestyle changes, meal planning, physical activity and daily habits.5 Diabetes education and support can empower patients to make self-management decisions to ensure a better quality of life while living with diabetes.

Studies have shown that Diabetes Self-Management Education/Support (DSME/S) remains a significant contributor to attaining glycaemic control and preventing associated complications. DSME/S has been shown to consistently decrease HbA1c by as much as 1% in type 2 diabetes and further prevent the onset and advancement of diabetes associated complications.6-7 Furthermore, a study published in the Diabetes Care Journal has shown that people living with diabetes who participated in diabetes education or those who consulted a dietician, had been found to have one third the hospitalisation rate as compared to patients who did not receive DSME/S. Lifetime hospitalisation costs were similarly lower in those patients who received diabetes education. Further benefits such as psychosocial and behavioural aspects of diabetes have been recognised, as well as decreasing diabetes related mental health conditions such as diabetes distress and depression.7-8

With the complexities of running a medical practice in South Africa and considering the length of a typical medical consult, DSME/S is not always adequality administered by a single healthcare practitioner. The American Diabetes Association have taken a position that all diabetics receive DSME/S at diagnosis and thereafter. It is essential for health care providers to emphasise the importance of diabetes self-management, education and support to all diabetic patients.8-9 Regrettably, DSME/S remains an optional resource with many barriers such as poor structure, finances, lack of time, space and language barriers, preventing its initiation and continued use. Dube et al reported that within sub-Saharan Africa there remains a limited scope, content and consistency of DSME/S. Furthermore, the continued upskilling of the providers of DSME/S in sub-Saharan Africa was found to be minimal according to audit data.10

With the estimated rise in diabetes in the years to come, DSME/S is a resource that needs more focus in diabetes care in South Africa. This Chronic Disease Awareness month, healthcare professionals should advocate for DSME/S as well as make patients aware of organisations and societies, that enable patients to manage their diabetes holistically.

MAT-ZA-2200550-0.4-062022


REFERENCES:

  1. International Diabetes Federation. IDF Diabetes Atlas, 10th edition. Brussels, Belgium: 2021
  2. H Kaplan, A Amod, A Chadli, JC Mbanya, A McMaster, K Naidoo & MG Musa (2021): IDMPS Wave 7 Africa, Journal of Endocrinology, Metabolism and Diabetes of South Africa, DOI: 10.1080/16089677.2021.1897230
  3. Kaplan H, Amod A, van Zyl FH, et al. Incidence
    of hypoglycaemia in the South African population with diabetes: results from the IDMPS Wave 7 study. J Endocrinol Metab Diabet South Africa. 2019;24 (2):58–64.
  4. Lee SK, Shin DH, Kim YH, et al. Effect of diabetes education through pattern management on self-care and self-efficacy in patients with type 2 diabetes. Int J Environ Res Public Health 2019; 16:3323.
  5. SteinsbekkA, RyggLO, LisuloM, RiseMB, FretheimA. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res2012; 12:213
  6. Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of public health research, 10(2), 2240. https://doi.org/10.4081/jphr.2021.2240
  7. SteinsbekkA, RyggLO, LisuloM, RiseMB, FretheimA. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res2012; 12:213
  8. HealySJ, BlackD, HarrisC, LorenzA, DunganKM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycaemic control. Diabetes Care2013; 36:2960–2967
  9. American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care2015;38(Suppl. 1): S5–S87
  10. Dube L, Van den Broucke S, Dhoore W, Kalweit K, Housiaux M. An audit of diabetes self-management education programs in South Africa. J Public Health Research. 2015;4(3). pmid:26753160