A collaborative project launched by the University of Pretoria (UP) in 2018 to manage diabetes in community settings – the Faculty of Health Sciences’ Tshwane Insulin Project – has received a significant boost with the development of a digital solution to improve the lives of people living with type 2 diabetes. It will also assist primary healthcare nurses and community healthcare workers to deliver better diabetes care.

Diabetes is a growing epidemic. It is the second biggest cause of death in South Africa, behind tuberculosis (TB). In Africa, it is responsible for more deaths than malaria, HIV and TB combined. It is a cause of concern globally, and targets for its prevention and control have been put in place by the World Health Organisation (WHO). In accordance with these targets, the South African Department of Health drafted the National Strategic Plan for the Prevention and Control of Non-communicable Diseases, in which it published its 90-60-50 target for the management of diabetes by 2027. With this target, it aims to increase to 90% the percentage of all people over 15 who will know whether they have hypertension and/or raised blood glucose; to 60% the percentage of people with raised blood pressure or blood glucose who are receiving intervention; and to 50% the percentage of people receiving interventions who are controlled.

One of the biggest challenges in controlling this epidemic in South Africa, according to Dr Patrick Ngassa Piotie, Project Manager of the Tshwane Insulin Project, is the initiation of insulin and increasing insulin doses to achieve glycaemic control at primary healthcare level. Although diabetes management guidelines recommend that insulin be initiated by a doctor, dedicated medical staff are not always available in primary care settings to prescribe insulin. This led to the appointment of full-time fieldworkers, who are nurses or clinical associates, as part of the Tshwane Insulin Project. This contributes to the success of diabetes management strategies, as these healthcare workers work with the staff at the clinics, including doctors, nurses and community healthcare workers, and coordinate visits to patients in their homes to ensure that they adhere to their treatment regimens by injecting insulin and using their glucose meters correctly.

Members of the Department of Health Sciences and Aviro Health celebrate the launch of the diabetes app on World Diabetes Day.

The development of the digital tool by Aviro Health and UP represents a significant contribution towards reaching the targets of the WHO and the Department of Health. The solution takes the form of a mobile application (app) that is integrated into an existing digital health platform, called Pocket Clinic. Developed with input from members of the Tshwane Insulin Project, the app is the result of seed funding obtained from the University’s business incubator, TuksNovation, which challenged Aviro Health to develop a digital solution for diabetes. The app will allow community healthcare workers and nurses to collect vital information during clinic and home visits, and facilitate the management of patients with type 2 diabetes who are on insulin.

During home and clinic visits by field workers, the glucose values of patients who are using insulin can be uploaded to the app, which has a digital insulin calculator to advise healthcare workers on how to adjust patients’ doses, explains Dr Piotie. “For example, if a patient is injecting 10 units of insulin a day to control their blood glucose levels, the app will indicate whether they should increase, decrease or maintain the insulin dose based on the blood glucose values.” Healthcare workers can then remotely pass the changes recommended by the app on to the patient’s doctor, who may approve the recommendation and adjust the patient’s treatment.

Aviro Health’s mission with the app, according to its CEO, Dr Musaed Abrahams, is to help medical practitioners focus on more complicated cases by providing technology-enabled services that automate workflows, improve access to quality medical information, and provide digitally enabled counselling services.

Prior to the development of the app, field workers were collecting data on diabetes patients during home and clinic visits using a paper-based system. “This digital solution has many benefits,” explains Dr Piotie. It eliminates the possibility of human error, renders results much quicker than would be obtained when performing the process manually, and medical practitioners are able to maintain the quality of care as they have an algorithm calculating the results for them.

According to Dr Piotie, the counselling and education of people living with diabetes is an important element of the treatment regimen. The app not only enables home and clinic visits to be managed through automated flows, but makes diabetes education content available at the right time.

The soft launch of the app took place at the Faculty of Health Sciences’ Diabetes Research Centre on World Diabetes Day on 14 November 2022. The app will now be piloted at six facilities in Tshwane to determine its usability and identify any aspects that would need to be improved for the final iteration.

The successful roll-out of the app will enable the Tshwane Insulin Project to expand its footprint to other areas beyond Tshwane, and upscale the management of this life-threatening condition. However, this depends on the support of funding partners in the public and private sector who can ensure that the tool can be implemented in vulnerable communities with limited access to primary healthcare providers.

A further benefit of the app is that it will enable the collection of data that can be used to measure the country’s progress towards achieving the Department of Health’s target by 2027.