November was International Diabetes Awareness Month. Much was written about the condition in the media. We need to be reminded of its devastation, as the incidence is rising worldwide and even faster in South Africa.
The prevalence of type 2 diabetes varies between 13% and 26%, depending on the population group, with an overall prevalence of 15,25% in people aged 25 and older. The prevalence of type 1 diabetes is much less, but is increasing at between 2–5% per year in this country.
Most of the articles I read in the public media are depressing. One in particular quoted a prominent endocrinologist in South Africa. She said diabetes care is facing multiple challenges, including funding deficiencies, shortages of medicines, especially the new, more expensive pharmaceuticals, an overburdened health-care system and a shortage of endocrinologists.
Deafeningly absent was the need to address the underlying causes of the rising incidence of type-2 diabetes or the role of behaviour change as foundation of management. National diabetes-management guidelines emphasise the starting point must be lifestyle behaviour change.
This addresses the importance of regular physical activity/exercise, a diet of predominantly whole plant foods and severe curtailment of processed foods, avoidance of smoking and alcohol consumption, adequate restorative sleep, good social-support systems and living with purpose.
It is unnecessary to have highly qualified endocrinologists to encourage these behaviour changes. Patients themselves can implement these changes with the assistance of nurses, physiotherapists, general practitioners, health coaches and other allied health professionals. We will not turn the tide of diabetes by training more endocrinologists, obtaining more expensive medicines, or building bigger hospitals, as important as these are for dealing with complications of this disease.
The good news is that diabetes is eminently amenable to lifestyle changes. There is now abundant scientific evidence that diabetes can be prevented, readily managed and, in many cases (especially in the early stages), even put into remission by intensive lifestyle behaviour changes. Patients can be empowered to actively participate in this rewarding process. People with pre-diabetes can be supported to prevent the onset of diabetes. Those who are diabetic usually can significantly reduce their medication as they adopt healthier behaviours, and many have been able to go off all medication under the direction of their doctors. This results in huge cost savings, both to patients and to the health-care fiscus. It improves outcomes and often prevents heart disease, dementia, chronic renal disease, neuropathy, blindness, gangrene and severe infections.
Even type-1 diabetes can be dramatically improved with intensive lifestyle interventions. Patients are often able to reduce their insulin dosages and their quality of life dramatically increases.
Next time you go to your doctor for a diabetes follow-up, insist on information on how to address the causes of your disease or request a referral to someone who can help.
V This health column is written by Dr Dave Glass, a retired obstetrician/gynaecologist living in Somerset West. He is also chairperson of the South African Lifestyle Medicine Association (Salma). Glass, with an MBChB, FCOG(SA) and DipIBLM, has a passion for preventing and addressing the root causes of chronic diseases.
