On the 100th anniversary of the discovery of insulin by Frederick Banting and Charles Best, 10 November 2021, academics, doctors, educators, psychologists and people living with diabetes joined hands in a virtual presentation and panel discussion to commemorate South Africa’s firs Diabetes Summit as an initiative of the Diabetes Alliance and the University of Pretoria (UP).
Professor Tawana Kupe, Vice Chancellor of UP set the scene for the discussions contextualising diabetes in a South African scenario. Most profound was the fact that diabetes is the number one cause of death in women in the country and number two among men. “South Africa also faces an extremely high obesity rate with 68% of women and 31% of men overweight or obese.” He said the direct medical costs associated with Type 2 diabetes, which accounts for 90% of diabetes cases, are significant with a 2018 public sector figure for diagnosed Type 2 diabetics at R2.7 billion. The projected costs for 2030 for all treatment of Type 2 diabetes is estimated at R35.1 billion, 51% attributable to the treatment of the disease and 41% to complications.
Dr Kibachio Mwangi of the World Health Organisation (WHO) told participants that 420 million people live with diabetes worldwide and 4.6 million in South Africa, half of whom are undiagnosed. “The cost of inaction far outweighs the cost of action,” he said. Dr Mwangi emphasised that the WHO looks at diabetes as a barometer of national governments’ responses to other non-communicable diseases (NCDs). The WHO has set a target of 80% of those living with diabetes worldwide to be diagnosed and under treatment and, as part of the centenary of the discovery of insulin, has launched the Diabetes Compact – a five-tiered approach to diabetes prevention and management at a primary healthcare level.
Dr Yogan Pillay of the Clinton Health Access Initiative and former Deputy Director General within the Department of Health equated the response needed for diabetes in South Africa to that of COVID-19 and climate change and said it could only be achieved through a multi-sectoral and interdisciplinary approach. “What’s needed is a life-course, whole-of-society and inter-generational approach that tackles the multiple drivers of diabetes at the same time”, as was initiated in Singapore in 2016 in its “War on Diabetes” aimed at reducing the prevalence of modifiable diabetes risks – overweight, obesity, physical inactivity and unhealthy diet in the general population. It also meant addressing the commercial impacts on health through harmful products and the marketing of those products. Dr Pillay said there’s so much more that needs to be done at an individual level, at the health sector level and at a societal level and hoped that the Summit kicks off a national campaign against diabetes with a great sense of urgency.
Modifiable diabetes risks were identified in the early 90s in a survey done within the Western Cape urban communities, where obesity and lifestyle alterations through urbanisation saw 6% of the surveyed population having diabetes, half of whom were undiagnosed and only 65% of diagnosed people living with diabetes were receiving treatment. Professor Naomi Levitt, Director of the Chronic Disease Initiative for Africa (CDIA), who conducted the research, said an audit of healthcare services revealed alarming statistics in diabetes control. The mean HbA1c, was 10.5%, only a third of patients had controlled blood pressure and three quarters of examined patients attending healthcare services had at least one complication, of which eye complications were prevalent in 60%, and foot and renal complications in 30%. And very little has changed with Prof Levitt saying that the prevalence of diabetes has increased to 15% of urban populations, that there’s continued suboptimal control and monitoring, and poor diagnosis of complications within the primary health care sector. As an example, there is not one podiatrist represented in the public sector healthcare system in certain provinces.
During the panel discussion that followed the formal presentations, Dr Joel Dave, Head of Endocrinology at UCT and Groote Schuur Hospital, told attendees that we had a collision of pandemics between COVID-19 and diabetes and that people living with diabetes were not at greater risk of infection, but were at greater risk of developing more sever disease – at least 45% needing admission, of which 50% succumbed to the virus.
In response to the facts presented by panellists, the Diabetes Charter, prepared by the Diabetes Alliance was unveiled as an initiative to unite the disparate voices working with diabetes in South Africa and aligned with the WHO Diabetes Compact and the South African National Department of Health, National Strategic Plan for Non-Communicable Diseases, briefly touched upon in a presentation to the Summit by Deputy Minister of Health Dr Sibongiseni Dhlomo.
Chairperson of the Diabetes Alliance Bridget McNulty introduced the Charter as a “menu” presenting comprehensive analysis of the various challenges we are facing with diabetes across the five themes with proposed evidence based solutions to the challenges.
The work streams mirror those of the WHO Diabetes Compact:
- Awareness and Prevention
- Management and Access to Care
- Research and Innovation
McNulty said the Diabetes Summit would be held every two years and the Charter would be revised over the same period. “We want it to be an alive, working document. We have included contact details in the Charter if anyone has suggestions. This is something that’s collaborative and co-created and we want it to be a living document,” she told the over 200 attendees. She said all the words being used around diabetes are of a car crash mentality and that we can change that and alter the trajectory of diabetes in South Africa through participation in the ideals of the Charter.
Find out more at www.diabetesalliance.org.za/diabetes-summit