South Africa has the highest ratio of obese or overweight adults in Africa: about seven out of 10 women and four out of 10 men are either overweight or obese. This makes them especially vulnerable to developing diabetes. In fact, after tuberculosis, diabetes is the second-highest underlying cause of natural death in South Africa.
With the world’s spotlight having been fixed on the Covid-19 pandemic, World Diabetes Day on 14 November is a critical opportunity for us to do an urgent inventory of our lifestyles.
Far too many people are not diagnosed with diabetes until many years later, by which time, significant damage has often occurred. Without treatment or sufficient support, those with the condition are at risk of developing a range of serious, life-threatening health complications such as blindness, leg amputation, heart attacks, stroke or kidney failure.
Diabetes is the result of our bodies not being able to break down sugar effectively. Our body’s cells need energy; we get this when glucose (sugars) is broken down by the insulin hormone, which is produced naturally by the pancreas. When people develop diabetes, the pancreas has begun to deteriorate and is unable to produce or use insulin well, resulting in high blood sugar levels that can cause irreparable damage to organs, nerves and body tissue if left untreated.
There are two main types of diabetes: type 1, where the body does not make any insulin at all, and type 2, where the body does not produce enough insulin or cannot use it effectively. Both types come with serious symptoms that have to be managed carefully and diagnosed at an early stage, especially at a time when the incidence of diabetes is projected to increase by an astonishing 250% within the next 10 years.
More recently, the focus on the Covid-19 pandemic has shifted public awareness and some resources away from the diabetes epidemic, even though people living with the disease are disproportionately affected by the virus and often require ventilation or admission to ICU wards.
There are several reasons for this growing epidemic of obesity and diabetes in South Africa. While in some cases there are genetic factors, many of us are living sedentary lives, sitting behind office desks for much of our working day instead of exercising our muscles doing manual work in the open air. Rather than walking to work, we drive cars or catch buses and taxis to the office.
And, very often, we eat badly. Many find it easier to grab low-cost, high-energy take-away meals and sugary drinks instead of buying healthier foods to prepare at home.
Our children are also leading more unhealthy lifestyles. It is not uncommon to see visibly obese parents at shopping malls accompanied by their equally obese or overweight children eating fatty, sugar-rich ice cream or deep-fried snacks at 9am on a Saturday morning. Apart from looking after our own health, we also have to take responsibility for the diet and lifestyle choices of our children.
Living healthily is a challenge for many of us in these fast-paced times, but we have to take time out to properly evaluate whether we are leading healthy lifestyles or not: what are we eating; can we cut out junk food; are we getting enough exercise and sleep; and are we nurturing meaningful relationships?
Families also need to determine whether they are encouraging their children to develop bad habits. This is especially important in communities that have a higher prevalence of the disease.
At a national level, the prevalence varies between 6% to 8%, and research indicates that it can be as high as 25% in the Indian community and mixed-race communities in the Western Cape. While a genetic component is suspected, lifestyle and nutrition appear to be the more significant factors, such as the way food is prepared.
This year, the International Diabetes Federation has adopted the theme Access to Diabetes Care: If Not Now, When? for World Diabetes Day. We believe that ensuring early access to diabetes care is critical, because it is a progressive disease that, without substantial weight loss, cannot be cured. So the earlier it is controlled, the better.
Unfortunately, diagnosis is made after only eight to 12 years in countries with an efficient healthcare system. In South Africa, it could be even longer.
Unlike tuberculosis, for example, where patients start to cough incessantly, diabetes is not a bothersome disease in the early stages. Someone may have the beginnings of high sugar levels, yet might not feel unwell. But then they generally start to develop excessive thirst, urinate more frequently or eat and drink more than usual.
That is why we advocate regular health checks to detect diabetes among at-risk individuals, such as people over the age of 40, those who are obese or overweight, who have hypertension or heart disease, and those who have a family history of the disease.
The good news is that in South Africa, there is much better access to free or affordable treatment than in most other countries on the continent; this includes access to world-class medication at primary healthcare level.
Those living with diabetes also need to take charge of their condition and demand good care from their GP, clinic, hospital or specialist, and insist that their healthcare providers do the regular checks that we refer to as the 4Bs and 4Cs.
The 4Bs are the things that need to be controlled as well as possible:
- Blood pressure
- Blood glucose (sugar)
- Blood cholesterol
- Breathe fresh air (don’t smoke)
The 4Cs are complications that should be assessed for at least annually:
- Poor dental hygiene, which may worsen glucose control
- Poor kidney function - early treatment can prevent or delay kidney failure
- Eyes problems that are amenable to treatment and to prevent blindness
- Loss of feeling in the feet, which means they are at risk of ulcers and amputation
*Professor Paul Rheeder, Senior Specialist Physician at the Steve Biko Academic Hospital’s Department of Internal Medicine and Director of the University of Pretoria (UP) Diabetes Research Centre, and Dr Patrick Ngassa Piotie, Project Manager of the Tshwane Insulin Project at the UP Diabetes Research Centre.