Improving access to diabetes care for people of the Western Cape

On World Diabetes Day, 14 November, the Western Cape Department of Health and Wellness encourages residents to know their risk of type 2 diabetes and to take proactive steps to help delay or prevent this chronic disease. When not detected and treated early, diabetes can lead to serious and potentially life-threatening complications. Under the theme, ‘Access to Diabetes Care’, healthcare workers across the province regularly engage in raising awareness with community members and patients. Their efforts include topics on how to prevent diabetes, screen for early detection, know the signs and symptoms and available treatment to manage the disease at all levels of care. 

Western Cape Minister of Health and Wellness, Dr Nomafrench Mbombo, shares: “As we observe World Diabetes Day today, it is crucial that we all raise awareness about the global health challenge that diabetes still poses to residents across the world. This is why the Department has continued with its Western Cape on Wellness (WOW) Healthy Lifestyle initiative in order foster better understandings of diabetes and other chronic illnesses in our communities. It is important that we continue to advocate for healthy lifestyles in order to prevent, reduce and manage one’s chances of developing chronic lifestyle diseases.”

“As a diabetic, I appreciate the critical importance of managing the condition. This involves regular exercise, sticking to a diet, and getting medical check-ups as often as possible. It is possible to manage diabetes, but we must take personal responsibility and adopt a healthier lifestyle. So many of our residents who live with the condition are able to lead healthy, active, fulfilling lives. Let us beat diabetes together,” says Alan Winde, Premier of the Western Cape.

Globally, diabetes caused 6.7 million deaths in 2021, that is 1 death every 5 seconds. It is estimated that 44% of adults living with diabetes have not been diagnosed and therefore not receiving treatment or managing the condition. Diabetes is also the leading cause of blindness, amputations, and end-stage kidney disease. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or does not make enough insulin. In the past three decades, the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. More than 95% of people with diabetes have type 2 diabetes, and close to half are not yet diagnosed. This type of diabetes is largely the result of excess body weight and physical inactivity.  

In the Western Cape, diabetes is one of the leading causes of early death and affects women more than men.

• In 2021, more women (63.1%) than men (36.9%) were living with diagnosed diabetes. 
• Diabetes was most prevalent in the age group 40-64 years old (51.65%), followed by the 65+ years age group (38.8%), the 20-39 years old age group (8.9%) and the 0-19 years old age group (0.6%).

Type 2 diabetes and its complications can be delayed or prevented by adopting and maintaining healthy habits. “Type 2 is a preventable and treatable disease and its prevalence within the Western Cape is of concern. We encourage persons affected by diabetes to understand diabetes, obesity, and the associated risks.  In terms of prevention, we understand this is a shared responsibility, with all of us prioritising a healthy, active lifestyle”, says Dr Hilary Goeiman, Director of Service Priorities Coordination at the Department.

The Department encourages everyone, 35 years or older who experiences any of the risk factions to be screened at our clinics every year. This especially includes men, who are often hesitant to access health care. A simple finger-prick test can diagnose the strong likelihood that you may have diabetes within a minute.  

David Solomons (72) was diagnosed with diabetes about 20 years ago. “I did not know I had it. I remember while at Vanguard Clinic for a check-up and when they pricked my finger, the nurse asked me if was diabetic, ‘I told her no, that is for older people’. When they checked the reading, it was 17. I was quite surprised. From there I had to attend the clinic regularly to get my medication.” 

Solomons, a self-taught musician, and singer, admits that he lived a very busy lifestyle and health was not necessarily a high priority. “Music is my life. I have had various opportunities to sing. At first after being diagnosed, I stopped taking my medication.” This led to further complications when he lost sight in his one eye.  “I was told by the doctors that they could not save the eye.  I had to go through an intense three-hour operation to save my left eye. It was at Groote Schuur Hospital, where I received great care regarding the complications with my eye.  The doctors sat with me and explained the whole process. The fears I had regarding taking my medication did not matter when I could see how not adhering to treatment was having a negative impact on my body.” He has since adopted, maintained healthy habits, and accessed tools available to him to support self-care in order to delay or prevent further complications.  

The Department seeks to provide access for patients at all levels of care. Central hospitals, such as Tygerberg Hospital, play a role in treating complex diabetic conditions as a referral centre.  

Dr Marli Conradie-Smit, Head of Endocrinology at Tygerberg Hospital, highlights that late diagnosis of patients is a global problem. “This is concerning as patients present with complications for example cardiovascular disease (myocardial infarctions or strokes). The diagnosis of all cardiovascular risk factors, including diabetes, is important to manage the conditions effectively and decrease the risk of complications. In the case of diabetes this also includes microvascular disease like retinopathy and kidney disease.”  

This Diabetes Day, residents are reminded to make sure that they have access to a screening tool, which is freely available at clinics. This is especially important if someone in their family has diabetes that they should visit their clinic for regular screening. The message of adhering to a healthy lifestyle, diet and regular exercise, cannot be over-emphasised.

Living with diabetes can take its toll on our mental health. In reflecting how he has managed to maintain his health, including mental wellness, through these many years, Solomons had to prioritise his health. “You need to do something to keep your mind focused and that helps give you purpose in life.  If I did not take care of my health, I would not have been able to do music. I have seen people lose their legs or their arms.  It is important to prevent or delay diabetes with achievable lifestyle changes which have assisted me in treating my condition.”  

Solomons encourages anyone living with diabetes, to recognise their value especially to those around them. “Are you going to pick up your tablets and taking it? Or do you tell yourself, you do not feel like it?  If you want to live a long healthy life, please take your medication. I have been married for 52 years; I know my wife for 55 for years.  My granddaughter got married on Saturday. I have four kids, the eldest is 53. I have six grandchildren and six great grandchildren. I love them to bits! They give me the inspiration to ‘keep on keeping on’.”