How South Africa is fighting its sugar-fueled diabetes epidemic
According to the World Health Organisation, four times as many people today have Type II diabetes as they did 36 years ago. In 1980, there were 108 million people diagnosed with diabetes in the world. In 2014, this figure had risen to 422 million.
7.5% of South African adults aged between 21 and 79, or 3.85 million people, have diabetes. Many of them remain undiagnosed.
Globally, the prevalence of adult diabetics has almost doubled. This is especially true in low- and middle-income countries. In 2012, diabetes was directly responsible for the deaths of 1.5 million people worldwide.
Diabetes is the leading cause of kidney failure, blindness, heart attacks, and strokes, as well as lower limb amputation. The strict control of glucose has helped to reduce some complications involving small vessels, such as kidney failure and blindness. However, the risk of heart attacks and strokes, as well as large-vessel complications, remains high.
Cause and Effect
Diabetes is primarily caused by excessive calorie intake and a sedentary lifestyle. High-risk individuals are those with a genetic predisposition, but the disease is preventable.
Diabetes rates have increased as South Africans urbanize and consume more high-calorie processed foods.
It is seen as a sign of success to be able to buy “food-like” processed products. Healthy eating is not given much attention. The problem is exacerbated by marketing campaigns run by the beverage and “food” industries.
An abundance of evidence links consumption of drinks high in sugar, such as soft drinks and energy beverages, to an increased risk of diabetes and obesity.
South Africans are unaware that the average can of a cold drink typically contains ten teaspoons of sugar. World Health Organisation recommends that people not consume more than 12 teaspoons of added sugar each day. The health benefits of keeping the daily sugar intake below six teaspoons are also significant.
The work environment is not conducive to exercise. Patients cite crime, concerns about road safety, and poorly maintained parks as reasons not to exercise outdoors.
South Africa’s government is very interested in non-communicable diseases. The focus of the budget is tuberculosis and HIV. Diabetes falls under the non-communicable diseases Budget. Non-government organizations receive very little funding to support diabetes prevention, education, or supplies.
Treatment challenges
The health system covers diabetes prevention and treatment. These services are not implemented everywhere, perhaps due to a lack of funding or bad administration.
The quality of the treatment suffers as a result. In the public sector, drug shortages are not uncommon. This sector has not yet adopted newer therapies that have fewer side effects.
The high costs of treatment in the public and private sectors are another problem. Healthcare systems cover 50% to 80%.
The role of diabetic nurse educators in self-management is not fully appreciated. There are no services tailored to vulnerable populations.
Modifying the Present to Change the Future
A multifaceted response is needed to address the complexity of this epidemic.
Diabetes patients need the best possible health care. This includes patient education on how to improve your lifestyle, such as eating healthy foods, exercising regularly, and not drinking or smoking.
It is important to increase screening rates to catch the undiagnosed. Multiple studies have shown that early diagnosis and treatment can improve the quality of life and reduce complications. Regular screening for diabetic eye diseases and other complications is recommended.
In light of new evidence, the government should also review the current dietary guidelines. In developed countries, low-carbohydrate diets have been introduced based on further proof. South Africa has yet to catch up.
Second, the healthcare facilities must be improved, and the medical professionals need to have the resources to perform the right assessments and treatments.
New treatments have made great strides. Two drugs, liraglutide, and empagliflozin, have demonstrated life-saving benefits, such as reduced cardiovascular risks and a favorable side-effect profile. These drugs (Incretins, SGLT2 Inhibitors) are effective in managing diabetes but do not yet show any cardiovascular benefits. These newer agents reduce weight as well as the risk of hypoglycemia.
Hypoglycemia is minimal or non-existent when new oral agents, such as DPP 4 Inhibitors, are combined with existing treatments like metformin. They are, therefore, ideal for nurses to prescribe as first- and second-line therapies in primary health clinics.
