60% of rural patients with diabetes unscreened in EC
There has been a steep rise worldwide in the number of people living with diabetes –a chronic condition and serious public health concern.
Many developing countries like SA bear the greatest burden.
Diabetes refers to a high level of glucose in the blood.
Several factors contribute to diabetes, but obesity and unhealthy lifestyle behaviours are the major drivers.
It is a costly disease, and it reduces the quality of life and lifespan of patients, especially if not properly managed.
In SA, 11% of adults have diabetes, the highest prevalence in Africa.
Most have poorly controlled diabetes, and many others are yet to be diagnosed.
Many people develop complications as a result of poorly controlled diabetes. These include eye problems, kidney disease and cardiovascular diseases.
Some even develop wounds that don’t heal, resulting in limb amputation.
When people develop complications, they spend more money on health care, which places a greater burden on the already overstretched health system.
Some even lose their livelihood which, in turn, affects their families.
There have been some studies in SA looking at the level of screening for complications for people living with diabetes. But there’s very little focus at the primary health care level.
And some of these studies were conducted many years ago, so the data may no longer be valid.
It is imperative to determine the situation at present, especially at primary health care level.
Our recent study focused on the Eastern Cape, one of the poorest provinces with a high prevalence of poorly controlled diabetes.
We assessed the extent of screening for diabetes-related complications at primary healthcare clinics in the province.
We found that the rate of screening for these complications was very low.
Our findings are similar to research done in another rural province in the country.
This points to the need to promptly implement measures to improve screening coverage. Doing this will improve health outcomes and quality of life, and reduce the incidence of devastating diabetes complications.
To keep blood glucose levels under control and avoid complications, people with diabetes need to pay attention to their health.
They must be involved in their care, live a healthy life, and undergo important tests and examinations that help to quickly identify potential problems.
There are guidelines for diabetes management and complications screening in SA.
Healthcare providers also have a duty to check whether a patient’s blood glucose is under control, so they don’t develop complications that can cut their life short or disable them.
Primary healthcare clinics are the entry points into the healthcare system. Most people with diabetes are first managed at these facilities.
Here they receive medication and should have their blood glucose level checked at every visit.
In addition, primary healthcare providers must check patients’ eyes and kidney function – and annually thereafter.
Healthcare workers must also check patients’ feet at least once a year. Patients at higher risk of developing foot ulcers need more frequent check-ups to prevent complications like leg amputation.
In our study, we wanted to find out how people living with diabetes in some rural areas of the Eastern Cape are being managed.
We recruited participants with diabetes from six primary healthcare facilities.
By asking them questions and looking at their medical records, we determined whether these measures and examinations were in place at these primary healthcare clinics.
Our analysis showed that out of 372 people, only 71 (19%) had been checked for blood glucose control in the past year.
Sixty (16%) had been assessed for kidney function and 33 (8.9%) had been checked for blood cholesterol levels. Just 52 (14%) had undergone eye examinations in the past year.
Foot examinations, which helps prevent leg amputation, was done for only nine (2.3%) patients. More than half (60%) of these patients had not undergone any form of examination for these potential complications in the past year.
None had undergone all of these five important screenings.
Our study shows that without urgent intervention, many people with diabetes will soon develop complications that could be prevented through proper screenings.
This will affect the patients, their families, jobs, and the overburdened health system.
Prevention is cheaper than cure. Understanding the potential reasons for the gaps in diabetes management and finding effective solutions for improving screening coverage will cut health care costs, and prolong and improve patients’ lives.
There are a number of approaches that the country can take. For instance, mobile health technology can be used as a tool to facilitate screening.
A similar approach is being used in developed countries.
As a result, many of these countries have been able to cut down the number of diabetes-related complications.
Other countries have also embraced technology-based solutions to train community health workers to conduct some of these examinations under the guidance of experts.
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Our recent study focused on the Eastern Cape, one of the poorest provinces with a high prevalence of poorly controlled diabetes