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Africa: Most Patients Not in Control of Their Diabetes
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Business Day (Johannesburg)
26 March 2008
Posted to the web 26 March 2008
Tamar Kahn
Paris
More than two-thirds of type 2 diabetes patients in Africa and the Middle East are failing to keep their blood sugar under control, increasing their risk of debilitating complications such as strokes and blindness, new research has shown.
This is believed to apply to diabetes patients in SA too.
Preliminary findings from the International Diabetes Management Practice Study also highlight a worrying gap between international treatment guidelines and the way patients are cared for in practice, said principal investigator Huda Ezzeddin, a specialist at Abu Dhabi's health authority.
Maintaining the correct blood sugar is important as elevated levels can cause damage to nerves and blood vessels. According to the America Diabetes Association's (ADA's) guidelines, type 2 diabetes patients should aim to get their glycated haemoglobin (HbA1c) levels below 7%, but Ezzeddin's research shows only a quarter (25,9%) of the African patients included in the study were below this threshold.
The amount of HbA1c in a patient's blood reflects their average blood sugar for the past three months, and indicates how well their diabetes treatment plan is working.
"Type 2 diabetes patients are massively uncontrolled," Ezzeddin told a diabetes seminar in Paris earlier this month. The study included patients from north Africa and the Middle East.
Ezzeddin said there was no reason to believe the South African figures would buck the trend, as the data collected so far were more or less in line with trends in Europe and the US.
Type 2 diabetes is the most common form of the disease. In type 2 diabetes, the pancreas does not produce enough insulin, or the body does not use it properly. Insulin is a hormone that helps the body's main energy source, glucose, enter the cells: without insulin the cells starve and glucose builds up in the blood.
The International Diabetes Federation expects the number of Africans suffering from diabetes to almost double by 2025, rising from an estimated 10,4-million people, or 3,1% of the adult population last year, to 18,5-million, or 3,5% of the population, by 2025.
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Most of these patients will have type 2 diabetes. The rising number of cases is largely due to the increasing number of people who are overweight or obese.
Ezzedin said diabetes was poorly controlled because patients were not monitoring their blood sugar closely and often started insulin therapy too late. The study found patients tested their blood sugar on average three to five times a week. The ADA advises testing blood sugar at least once a day. Similarly, only 30% of patients had taken an HbA1c test in the past six months: the ADA recommends testing every three months. "We really have to get this up," Ezzeddin said.
Patients began insulin therapy on average seven years after diagnosis. "We'd like to introduce insulin earlier, but there is a lot of resistance from patients" who were afraid of low blood sugar, or found testing inconvenient, Ezzeddin said.
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