Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. In 2019, the International Diabetes Federation (IDF) reported a diabetes prevalence of 12.8% in South African adults (20-79 years), but cautioned that this estimate is less likely to be a true reflection of the reality because diabetes in Africa remains largely undiagnosed. The growing diabetes epidemic in South Africa, especially of type 2 diabetes, is related to an increasing urbanisation and rising behavioural risk factors such as unhealthy diet and physical inactivity. South Africa has the highest levels of diabetes-related mortality on the African continent. In 2019, 89 800 of the 366 200 diabetes-related deaths in Africa occurred in South Africa. Most of these deaths (73.1%) occurred in the economically productive age group, i.e. people under 60 years old.
World Diabetes Day (WDD) was created in 1991 by the IDF and the World Health Organization (WHO) in response to growing concerns about the escalating health threat posed by diabetes. In 2006, WDD became an official United Nations Day. It is marked every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. WDD is a large diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries. The campaign draws attention to issues of importance related to diabetes and keeps diabetes firmly in the public and political spotlight. The campaign is represented by a blue circle logo that was adopted in 2007.
Every year, the World Diabetes Day campaign focuses on a dedicated theme that runs for one or more years. The theme for World Diabetes Day 2020 is The Nurse and Diabetes. The aim of the campaign is to raise awareness around the crucial role that nurses play in supporting people living with diabetes. As the number of people with diabetes continues to rise globally, the role of nurses and other health professional support staff (such as community health workers and health promoters) becomes increasingly important in managing the impact of the condition.
Traditionally, nurses play a key role in (1) diagnosing diabetes early to ensure prompt treatment; (2) providing self-management training and psychological support for people with diabetes to help prevent complications; (3) tackling the risk factors for type 2 diabetes to help prevent the condition. The IDF argues that with the right expertise, nurses can make the difference for people affected with diabetes. In South Africa, the overwhelming majority of patients are seen by nurses, especially in primary care. Nurses are often the first and sometimes only health professional that a person living with diabetes interacts with.
At the University of Pretoria, the crucial role of nurses in combatting the diabetes epidemic is already acknowledged. In 2018, the Faculty of Health Sciences launched the Tshwane Insulin Project (TIP), a 5-year translational research programme sponsored by the Lilly Global Health Partnership that brought together the School of Medicine (Internal Medicine, Family Medicine, and Physiology), the School of Health Systems and Public Health (SHSPH), the Schools of Health Care Sciences (Nursing Science, Human Nutrition). UP researchers, led by Professor Paul Rheeder, developed and piloted a model of care adapted to the local environment to address the challenges of insulin initiation and titration in primary care for people with type 2 diabetes. Nurses were empowered to play a prominent role in identifying uncontrolled patients with type 2 diabetes who were already on maximum oral therapy; to counsel those patients for insulin therapy, to liaise with family physicians through a mobile app called Vula and to initiate those patients on insulin. In the pilot project, through mentoring, including simplified protocols and training, nurses in ten primary care facilities developed the skills and knowledge to identify patients with type 2 diabetes who need insulin, counsel those patients and initiate insulin therapy with the support of a doctor or family physician through a mobile app. The success of the pilot demonstrated that nurses in South Africa are ready, able and willing to once again make a difference in the lives of persons with diabetes under their care.
Two years into the implementation of TIP, UP researchers have identified various challenges in diabetes management as well as opportunities to improve the lives of people affected by diabetes in South Africa. Consequently, the University of Pretoria Diabetes Research Centre was created to find innovative solutions to those challenges through cutting-edge research, as well as transdisciplinary and interfaculty efforts. The vision of the Centre is to be a nationally and internationally recognised leader in diabetes translational research, ultimately aspiring to better the lives of people living with diabetes in South Africa and on the African continent.
Dr Patrick Ngassa Piotie is Project Manager of the Tshwane Insulin Project and PhD Candidate at the School of Health Systems and Public Health.
World Diabetes Day is observed annually on 14 November.