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Diabetes education research: July 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 July report. If you want to read the other months, scroll to the bottom of the page.

diabetes research

July focus:

The focus this month was on moving the diabetes app project forward with the National Dept of Health, finalising the food portion guide booklet and starting work on a diabetes registry proposal.

Diabetes app update:

Following our meetings in June, Itumeleng Setlhare from the NDoH confirmed that he had sent the proposal to the unit that is responsible for apps at NDoH, and was waiting for advice from them. 

The next update was that they had a discussion with their Health Information Unit and it was recommended that we submit a detailed costed plan for them to peruse and the NDoH principals to consider.

Praekelt then submitted a detailed proposal with high-level budget to NDoH: Digital support via WhatsApp for people living with diabetes in South Africa. This was less than 2 weeks ago, so we will follow up in the next few days.

Food portion guide booklet:

We are currently finalising the food portion guide booklet, a collaboration with Pick n Pay and supported by Sanofi. The idea with this booklet is to provide very simple, easy to understand advice on which food to choose and in what portion, for better blood glucose control. 

Portion control was one of the biggest problems identified when we asked diabetes doctors about essential diabetes information earlier this year. It’s the kind of thing that is more easily addressed in print format, because the booklet can live in the kitchen and become part of every meal – checking to see what portion to dish up. The booklet is extremely simple, with very few words, mostly illustrations. Any words used are as simple as possible.

This booklet builds on the idea of the ‘building blocks’ of diabetes. The goal is to have 5 basic facts that any patients diagnosed with diabetes, nurses working with people with diabetes, or doctors in clinics or hospitals will know and understand. We hope that this booklet will form one of these building blocks.

The booklet is currently being finalised, and we will print 15,000 copies in August. We will be testing what works and what doesn’t work in this first version by sharing it with diabetic employees at Pick n Pay, diabetic support groups and dieticians working at public clinics (the GREAT dieticians, for example). Once we have made any necessary changes, we will submit it to the National Dept of Health for approval in the hopes that it can be used in their diabetes clinics.

Diabetes registry:

With the increased need of NDoH to identify people with diabetes thanks to COVID-19, Dr Patrick Ngassa Piotie from the University of Pretoria suggested that now would be a good time to re-open the diabetes registry discussion. The idea is that Sweet Life, together with Dr Piotie, will work on a proposal with all the relevant information to be presented to the Diabetes Alliance. Once the Diabetes Alliance is happy with the proposal, Dr Piotie and the Diabetes Alliance board can present it to the NDoH. This seems like an appropriate way forward for requests / proposals from any members of the Diabetes Alliance. 

Relevant diabetes research:

Building a Computerized Disease Registry for Chronic Illness Management of Diabetes.

This article proposes a method for building a diabetes registry. It is helpful in some ways, but written in the US in 2000, so a bit outdated. Relevant excerpts:

  • Creation of a disease registry is crucial in the management of a population of patients with chronic illness.11
  • Research has identified four essential tasks that people with chronic illnesses must perform if they are to keep their risk of excess morbidity to a minimum.1 They must
  1. engage in activities that promote health and build physiological reserve, including exercise, nutrition, social activities, and sleep.
  2. interact with health care providers and systems and understand and adhere to recommended treatment protocols.
  3. monitor their own physical and emotional status and make appropriate management decisions on the basis of symptoms and signs.
  4. manage the impact of their illness on their own ability to function in important roles, on their emotions and self-esteem, and on their relationships with others.
  • Likewise, there are three essential activities that health care systems must carry out for patients with chronic illness. They must
  1. assure delivery of those interventions (evaluations and treatments, both medical and psychosocial) that have been shown by rigorous evidence to be effective.
  2. empower patients to take responsibility for the management of their conditions.
  3. provide information, support, and resources to assist patients in self-management tasks.
  • Following are reasons why this is the case, despite the fact that physicians and other members of the health care system strive to provide the best care possible.
  1. Chronic illness care involves tasks that must be repeated over long intervals of time.
  2. The amount of time primary care physicians are allotted per patient is usually 15–20 min, with pressures to see more patients, most of whom have either some acute problem or a mix of acute and chronic conditions.
  3. It is often difficult for physicians to identify which patients with chronic illness they are responsible for treating. Patients who fail to schedule follow-up appointments may be overlooked by even the most attentive physicians.
  4. Physicians are under tremendous pressure to not miss serious disease. As a result, visits are structured to specifically scan for symptoms, and it is easy for a busy physician to overlook routine monitoring tests such as HbA1c or screening for microalbumin. All clinicians struggle to balance the needs of the chronically ill with the fast pace of a busy office practice.

The diabetes registry proposal is in the process of being developed, and will be shared next month.

Next steps: August

  1. Follow up with Itumeleng and the NDoH about the diabetes app proposal.
  2. Print the food portion guide booklet and create a feedback form for anyone who would like to give input. 
  3. Continue developing the diabetes registry proposal.
  4. Organise a National Diabetes Month planning meeting for the Diabetes Alliance.

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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