Social Determinants of Health — Demystifying Type 2 Diabetes Mellitus

NOMSA (not her real name) is a 45-year-old obese lady. She had lived with Type 2 diabetes mellitus for more than five years. She however, has not been taking her medication regularly.

She does not drink or smoke. She has tried to seek treatment at different places but her Type 2 diabetes mellitus remained poorly controlled. She came with pain in the back which later settled to the upper part of the abdomen.

She said she felt stressed and irritated by her husband’s constant nagging about eating healthily and insistence on regular exercise. The husband would tell her that poor eating habits, sedentary lifestyle and taking medication irregularly was associated with complications and death. This negatively affected her health.

The husband would also tell her that patients living with HIV/Aids were faring much better than those with Type 2 diabetes mellitus. According to the husband, people living with HIV were more adherent to taking their medication while some of their diabetic counterparts were relaxed in adhering to a wide range of interventions like drug adherence, diet and exercise.

The doctor ran her regular tests. She was noted to be obese. Her cholesterol was very high. Her sugars were poorly controlled. She also had non-alcoholic fatty liver disease. She was also noted to be depressed.

As results were being read, she began to cry. This was so, especially when she was told that her liver had been infiltrated by fat. She cried because she thought she was going to die.

Her doctor emphasised the need for adherence to a recommended diet and the need to exercise regularly in order to control her sugar. She also needed to take her antidiabetes drugs regularly. She was counselled that adherence to her drugs, regular exercise and diet would assist with limiting or reversing the progression of the complications she was facing.

She was told that obesity is associated with increased risk of Type 2 diabetes mellitus, cardiovascular diseases and various types of cancers, for example breast, prostate and colon cancers. Other diseases related to obesity are gallbladder diseases, non-alcoholic fatty liver disease, dyslipidemia, glucose intolerance and insulin resistance, hypertension, gout, menstrual abnormalities, orthopeadic problems, reduction of cerebral blood flow and sleep apnea.

Having realised the gravity of her inconsistencies to her overall health, she noted that it was in her best interest to adhere to the interventions proposed with the support of her husband, rest of her family and the healthcare team.

Some patients believe that anti-diabetic drugs are harmful. They note that complications such as blindness, kidney failure, peripheral vascular diseases which results in amputations, sexual dysfunctions and general poor health are due to anti-diabetic drugs.

This belief has driven these patients to seek alternative treatments which range from herbal supplements, traditional and faith healer consultations and treatments. As Type 2 diabetes mellitus progresses, the complications also increases and this has buttressed the notion that the disease is associated with evil spirits or ‘‘generational curses’’ especially in families where the disease is hereditary. There is therefore, a growing belief that diabetes can be healed spiritually and most patients opt for faith healers especially those claiming ‘‘instant healing’’ for the disease.

It takes time for one to get to a stage where they are said to have Type 2 diabetes mellitus. It is therefore, expected that consistence in lifestyle changes as advised by the health care providers should be a lifelong obligation. It is therefore, expected that patience and perseverance will result in positive health benefits over time.

It is encouraged that we all understand the underlying causes of diabetes in order for us to come up with evidencebased solutions to Type 2 diabetes mellitus. Historically, a small proportion of our population suffered from the disease in the early 1980s but we have witnessed a sudden growth in the incidence of the disease in the last 38 years.

Obesity has been on the rise due to a number of factors. Improvements in technology has made life easier, simultaneously making us lazier. There has been a rise in high carbohydrate ( isitshwala) and fatty diets. Most people lack appropriate physical exercise. We have also witnessed an increasing number of fast food chains and proliferation of ‘‘comfort eating’’. The majority of our people lack basic understanding of good nutrition. On the other hand there are medical and genetic factors as well as a rise in high sugar diets.

The solution for this disease therefore, lies in the patient and the health care provider’s abilities to manage diet, physical activity and psychological measurers. On the other hand patients need to understand and appreciate the role of medication. There is a need for them to appreciate that drugs are more beneficial than harmful when used appropriately with appropriate monitoring and evaluation.

Type 2 diabetes mellitus is associated with increased risk of premature deaths in adults younger than 65 years and increased health care costs due to Type 2 diabetes mellitus related illnesses. Patients need to appreciate that this is a lifestyle disease.

On another note, Type 2 diabetes mellitus has come at a time when our health delivery system is barely coping with other chronic diseases. Policy makers need to come up with a more comprehensive approach to deal with this emerging epidemic. Nomsa was depressed. Faced with a progressive chronic disease such as Type 2 diabetes mellitus and its associated psychosocial challenges, health care providers should actively look for mental illness and come up with comprehensive management strategies.

Until we meet again may God bless you all.