Many years ago when I was in medical school, HIV and Aids was a fairly new thing. Another topic in my internal medicine class while experts were still figuring out what it was and how to deal with it. ARVs were expensive and not readily available. When they finally became available, only a select few could access them due to cost constraints. Years later as an intern, I saw body after body falling in our internal medicine wards as they succumbed to Aids.
It was this high mortality rate, and drastic reduction in life expectancy, that called for government to declare HIV and Aids a national emergency. We saw government mobilise all sectors of society around the pandemic. We also saw sectors of government begin to collaborate around how to change this narrative.
Today we boast improvements in life expectancy, infant and under-five mortality, as well as maternal mortality rates – largely as a result of a concerted effort by government to preserve its most valued assets – the people of this nation.
But we dare not celebrate too soon. Because another threat is busy rearing its head and it’s moving in on us at a faster pace than most of us realise. Diabetes – a chronic disorder of glucose metabolism – has thrived at the hands of ignorance and myths that have led many to a place of complacency, while they ignore the very things it feeds on – unhealthy eating habits, physical inactivity, and of course, excess body weight.
Though the cause of type 1 diabetes, otherwise known as childhood onset diabetes, remains unknown, and though experts agree that in the current scheme of things it cannot be prevented, type 2 or adult onset diabetes is preventable 90% of the time. Yet in spite of this we are seeing a rapid rise in the prevalence of type 2 diabetes, particularly in low and middle income countries.
A Stats SA report of mortality data in 2017 named diabetes as the second leading cause of death in South Africa, and the leading cause of death among women in South Africa, surpassing TB and HIV.
Every eight seconds someone dies from diabetes.
Every 30 seconds someone loses a limb from diabetes.
65% of people will die from some form of heart disease or stroke.
Five out of a hundred adults in South Africa had diabetes in 2017.
There are more than 1.8 million people diagnosed with diabetes in South Africa.
About 1.5 million people in South Africa are living with diabetes, but are not aware.
It is not just a little bit of a sugar problem. It is a metabolic disorder characterised by high glucose levels because of insufficient insulin, defects in insulin usage or both.
Indeed the wave of diabetes is sweeping over South Africa like a tsunami.
The City of Johannesburg became part of the Novo Nordisk, Cities Changing Diabetes initiative six years ago, and it is one of 10 cities around the world that are part of this network, working together on a winning formula to beat this tsunami.
This partnership resulted in a survey in 14 clinics that revealed an 11% prevalence of diabetes in Johannesburg, and a strong association between diabetes and excess body weight. Of the 2,427 participants 29% were overweight, and 37% were obese. (Overweight: BMI 25 to less than 30; Obese: BMI 30 and above) Following the survey, the city engaged with the other cities at a global summit last year, to share best practice around diabetes control at a city level. Projections were made for each of the cities, to look at what would need to happen to bend the diabetes curve, and Johannesburg was given a target of 25% reduction in obesity by the year 2045 to ensure the diabetes prevalence does not increase beyond 12%, failing which the diabetes prevalence in 2045 will be 16.2% — that’s 16 in every 100 people living with this completely preventable, life-threatening condition.
So what is diabetes? It is a chronic condition that occurs either when the pancreas cannot produce enough insulin (type 1), or when it cannot effectively use its insulin (type 2). Insulin is a hormone that regulates blood sugar. Symptoms of diabetes include frequent or recurring infections, cuts and bruises that heal slowly, itching skin and boils, unusual weight loss, unusual thirst, excessive urination, extreme fatigue or lack of energy, blurred vision, or tingling and numbness in the hands or feet.
The onset of type 2 diabetes can be prevented or delayed by maintaining a healthy body weight, being physically active, and eating a healthy diet. Regular screening is advised and diagnosis is made through blood sugar testing. If diagnosed it can be treated using a multimodal approach including a healthy diet, physical activity, insulin administration in type 1 diabetes, and oral medication with or without insulin in type 2 diabetes.
If undiagnosed and untreated it can lead to heart attacks, strokes, blindness, kidney failure and even limb amputation.
These are the truths that society deserves to know, and through a series of interventions we will make it known. The Johannesburg Student Council, another partner in this initiative, has to date managed to reach more than 2,000 learners in Region D and F of the city with awareness campaigns.
Our health promoters are out in communities raising awareness and doing screening. Our nurse clinicians have been trained to conduct nutrition assessments, nutrition counselling and nutrition support. Our clinics have started doing routine BMI monitoring on all patients, and not just babies.
These are just some of the many ongoing initiatives within the city as we forge ahead towards bending the curve. We did it for HIV, we can certainly do it for diabetes.
Someone dies from diabetes every eight seconds.
And each time you see the blue circle, let it serve as a reminder of this silent killer lurking in our midst, but let it also serve as a reminder of the power you have to beat it. Get tested, eat healthily, exercise. It can save your life. DM
Mpho Phalatse is MMC for Health and Social Development, City of Johannesburg.