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Diabetes education research: April 2020

Sweet Life is South Africa’s diabetes community: a space to share information and advice about living well with diabetes, both here on the website and on Diabetic South Africans. But we’re also involved in diabetes education research – a big focus for 2020. Each month, we’ll be sharing the research we’ve done into diabetes education in public clinics, in the hopes that it helps someone else looking for answers to diabetic questions! This is the April report, be sure to scroll to the bottom of the page for the other months.

April focus:

With COVID-19 taking up all the NDoH’s attention (and rightly so), we have had to pause on the bigger diabetes education project. But this has provided space for the development of a tool that could work alongside it: a ‘food education for diabetes’ print product. 

Food education for diabetes

The original idea:

One of the things that struck me in the (excellent) community diabetes education session organised by GREAT was that many people find it difficult to classify foods (into starch/protein/fat etc). I thought it would be helpful to create a poster or booklet with illustrations of all the various foods in their correct categories, to assist with making healthy food choices. 

As we discussed the idea with Prof Bob Mash and Dr Joleen Cairncross (from GREAT) as well as Juliet Fearnhead from Pick n Pay (our partner on this project), we realised that what was necessary was not so much a classification booklet as something to help make the correct portion decisions of the right kinds of food. It’s no good understanding what a carb is if you’re still eating 5 slices of white bread at a time. This education booklet could be one step along the path of making it clear which food options to choose (and which to avoid) and in what portions to eat these foods.

The issue of food in diabetes education is a complex one, and we are very aware that we can’t try to solve too many problems at once. For example, weight loss is always helpful to include but as it’s not the focus of this booklet we have left it out. The idea is to form basic building blocks of diabetes education that we can build on later.

This booklet will be distributed as a trial to Pick n Pay’s diabetic employees (in July) and thereafter we will have an iterated version ready to distribute in November in time for National Diabetes Month. We are happy to collaborate and share this information and booklet with anyone who is interested, and hope to have it as part of the NDoH diabetes education in the future. 

Helpful perspectives on food education for diabetes:

Prof Bob Mash:

It is quite difficult to come up with a way of categorising foods that makes sense for Type 2 diabetes education. How to make the complex, simpler. Happy to share our approach which aligns with NDOH also.

Our thinking is:

  • Starchy food (carbohydrates) – these break down into sugar so need to watch portion size, too much may also increase weight.
  • Vegetables (not the starchy ones) – can be eaten freely.
  • Fruit – break down into sugar so need to watch portion size
  • Protein – animal protein is often fatty, which increases weight, so lean meat. Plant protein is also a good choice here, less fatty.
  • Fats and oils – may increase weight, so also watch portion size.

Simple message is: eating food that breaks down to sugar increases your blood sugar, eating food that increases your weight may make it harder to control the sugar (insulin resistance). Choice, portion size, cooking method, meal planning all important.

Dr Joleen Cairncross (GREAT):

I’ve contacted Joy and the other Trainer Megan, both are brilliant dieticians and conducting diabetes group education. It would be helpful to involve them. They work with and understand financially constrained patients. In addition they would know what patients can realistically afford to buy. A team effort from all our perspectives would be great.

Clients (patients) and healthcare workers (non-dieticians) struggle with putting foods into the correct categories.

What I would like to add from my perspective as a Dr, researcher and trainer… different hats on my head. I believe we should be doing this with the clients. “Doing with them and not to them.” We don’t understand the context of the clients. Once we know their context, we can help them better. Even with something as simple as food groups.

Lourentia van Wyk, registered dietician working with Dr Ankia Coetzee (Tygerberg)

2020 Education tool on blocks (adults & children)

PDF that explains the concept of ‘blocks’ as portion sizes for carbs (foods that raise blood sugar) with the idea being that you get a certain number of blocks to eat in a day.

Juliet Fearnhead, PnP dietician

These are the basic concepts that I think need to be covered:

  • The healthy foods that lead to increases in blood sugar (high fibre starches, legumes, fruit and dairy products)
  • The healthy foods that don’t affect blood sugar (lean proteins, oil, avocado, free vegetables)
  • Education about portion sizes in the most practical way – a fistful of pap, a thumb of cheese, a palm size piece of protein etc.
  • The need to cut out sugar, sweetened drinks and processed foods (illustrations of slap chips, burgers, donuts, muffins and biscuits with a big red cross over them?) Teaching moderation to this group of people is not likely to have the same effect as with more educated groups. The message has to be direct.
  • The benefits of weight loss in reducing health risks
  • A simple meal plan with serving sizes of basic foods for a day. (I think that this is really important for effective nutrition education – it may not be individualised but it goes a long way to helping someone understand what the meals should be made up of)

Accessing our staff with diabetes is something I will look into as I think their feedback on the first draft of the leaflet will be invaluable. 

The aim is to produce a simple booklet (using illustrations as you suggest) that can be distributed for use in clinics for the basic education of a person who is newly diagnosed or needs help with diet planning. Having posters would be great too as this would reinforce the information, but we could look into this as a second phase if the leaflets hit the mark and we get the right level of understanding. Not the easiest task especially with so many languages in SA – hence the need for as little writing as practically possible.

Thoughts (from Sweet Life):

  • Food education for diabetes is the goal. Portion sizes are so important: I like the idea of using the hand for everything and I also like the idea of separating the booklet into things that raise blood sugar, healthy things that don’t, and things to avoid. Super simple. Whether or not people entirely avoid the ‘forbidden foods’ isn’t the point – that’s a nuanced understanding that we can build on in future. For now we simply need to lay out the ground rules.
  • This isn’t the space to talk about weight loss, it’s a reference guide for what food is. I love the idea of a meal plan at the end, it’s something people are always asking for on Diabetic South Africans.
  • The first step is putting together the most comprehensive food list we can, with community input. We have gone through 3 rounds of this (compiled from Diabetic South Africans suggestions and looking at the basic food parcels being sent out). We have asked for community dietician feedback and will soon begin illustrating it so that we can put together a basic V1 to get further feedback.


Next steps: May

  1. Continue developing the ‘food education for diabetes’ print product.
  2. Reach out to Praekelt to get further details on how the app could be developed given the broader scope outlined last month. Still very exploratory but it would be good to have a clearer picture of what is needed.
  3. Read the WHO Be He@lthy Be Mobile handbook for diabetes.

This handbook has been prepared by an international group of experts in mDiabetes for WHO and ITU, to be used by governments, ministries and other relevant national organizations. The main objective of this handbook is to provide evidence-based and operational guidance and resources to assist countries and governments in putting together a detailed work plan for the development and deployment of a national level mDiabetes programme to prevent or control diabetes through healthy living.

The 2020 Diabetes Education Project by Sweet Life is supported by Pick n Pay and BD.

Read the whole diabetes education research series:

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Sweet Life is a registered NPO/PBO (220-984) with a single goal: to improve diabetes in South Africa. We are funded by sponsorships and donations from aligned companies and organisations who believe in our work. We only share information that we believe benefits our community. While some of this information is linked to specific brands, it is not an official endorsement of that brand. We believe in empowering people with diabetes to make the best decisions they can, to live a healthy, happy life with diabetes.