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affair. Parents can play a substantial role

in how much anxiety is experienced by

the child with diabetes whether it be

specific fears related to diabetes or fears

that arise in their life context. All fears

have an impact on how well the child

will cope with having diabetes.

Anger: another deterrent to good

management is anger. Angry childrenmay

sabotage their diabetes management.

Even those children who have accepted

their diabetes and usually manage well,

sometimes become angry because of the

impact diabetes has on their lifestyle. It

is important to acknowledge this anger

and work with the child to enable them

to reduce their anger. ‘Anger gives rise

to a chemical response in the body and

unfortunately for the child with diabetes,

this response means that the child

develops high blood sugars’, she says.

Depression: another difficult emotion

is depression. Depression takes away

any motivation to succeed, so handling

depression and suicidal feelings is a

necessity for children with diabetes.

Three ways to help children become

more resistant to depression include

building their self-esteem, encouraging

physical activity, and finding a support

group. Support groups and camps for

children with diabetes provide a sense

of community, particularly when they

can see that other children handle their

diabetes well.

‘Children with diabetes have to learn to

live a lifestyle that promotes their health

and enables them to function in the best

way possible. This lifestyle includes eating

foods that are healthy, doing some exercise

and taking medication. However, despite all

good intentions, they may still falter. It is so

important for parents to provide guidance

on how to change, and encouragement to

sustain the positive changes they make’,

Flynn concludes.


here may be as many as 4.6 million

people in South Africa living with

diabetes, and possibly the same number at

risk of developing type 2 diabetes. Those

diagnosed face the risk of life-changing

and life-limiting complications unless they

receive the care and support they need to

manage their condition well.

Grant Newton, CEO of the Centre for

Diabetes and Endocrinology (CDE), says it

is critical that as a society we start working

together tomanage the current national crisis

posed by diabetes and related chronic health

conditions, all of which result in premature

and increased cardiovascular risk. ‘Not

everyone will develop this potentially life-

threatening health condition, but diabetes

will affect all of us. We are concerned that in

South Africa, 68% of people with diabetes

remain undiagnosed.’

Newton says that although diabetes is

a global problem, it has a local epicentre.

In the next 20 years, with 77% of people

with diabetes living in medium- and low-

economic countries, we expect that the

developing world will bear most of the

burden of the diabetes pandemic. ‘Africa will

be particularly hard hit’, says Newton, ‘with

76% of deaths from diabetes occurring in

people under 60.’

In South Africa, four out 10 men and

seven out of 10 women are overweight

or obese, which is a major risk factor for

the development of type 2 diabetes, a

largely silent, asymptomatic condition with

devastating cardiovascular outcomes. Figures

just released by StatsSA report that diabetes

Diabetes is the most potentially devastating and fastest-growing health

crisis of our time

became the biggest killer of South

African women in 2015, and the

second biggest killer overall, up

from fifth two years ago.

Newton say against the backdrop

of increasingly scarce and costly

healthcare resourcing, increasing but

preventable costs of admissions for

diabetes, and complications

of poor diabetes care, it is

imperative that the sector

urgently starts looking at

integrated approaches to

preventative, community-

based diabetes care.

‘We are clearly lacking critical research

funding and resources to improve healthcare

and treatment and there is an urgent need

for more education and a change in the

way diabetes is managed and funded in

South Africa’. Newton says while one can’t

move away from cost restrictions, the real

challenge is finding a way of reducing costs

without impacting on quality of care. ‘We

appreciate medical schemes are under

enormous pressure to manage their costs,

but it is concerning when the focus moves

to cost-saving rather than patient service

utilisation and improved clinical outcomes.

We need to start being far more proactive

in treating and promoting patient health,

particularly when one considers economic

studies from the US showing that in people

with diabetes, in-patient hospital care

accounts for 43% of the total medical

costs of diabetes and that poor long-term

clinical outcomes increase the cost burden

of managing diabetes by up to 250%.’

Over the last 20 years, Newton

says the CDE programmes have

seen a significant overall reduction

in all acute diabetes-related hospital

admissions. ‘We have seen a reduction

as high as 40% in all-cause hospital

admissions and a 20% reduction

in the length of hospital stay.

This can only be good for


Newton admits the

challenge, however, is

that these programmes

are not universally accessible to everyone.

‘Programmes need to be revised to ensure

lower-income patients are not excluded and

education platforms need to be extended.’

He says that CDE is currently repositioning its

offerings to accommodate this need and will

be announcing some exciting new changes

next month. ‘We will also be focusing on

how we can partner better with the public

sector to extend our postgraduate diabetes

training and education.

Currently, CDE through its central

office in Houghton, Johannesburg, trains,

accredits, administers and audits the

biggest network of diabetes providers with

specialised postgraduate training in Africa.

With 25 endocrinologists, 216 CDE centres

of excellence and over 340 contracted

general practitioners, the CDE has a unique

ability to provide risk-stratified diabetes care

and cardiovascular risk management at

primary, secondary and tertiary levels of care


Grant Newton