Diabetes is the second leading cause of death after tuberculosis (TB) in South Africa, according to the report: “Enabling Telemedicine for People Living with Diabetes: Focus on South Africa” by The Economist Intelligence Unit (EIU) and supported by Abbott.
Considering the upward trajectory of the illness, deaths due to diabetes are set to overtake those due to TB, if they have not already. A condition such as diabetes needs regular check-ins with healthcare professionals and close monitoring; however, considering Covid-19, the seriousness of diabetes led to an imperative shift to remote patient consultations and telemedicine in the country.
The reason for the rapid shift in 2020 is attributed to the direct impact of the Covid-19 lockdown and subsequent restrictions, which limited in-person interactions in hospitals and clinics to limit the spread of transmissions. This saw rise in digital literacy, high technology adoption rates and more patients being monitored via virtual calls, WhatsApp and mobile phone apps.
In South Africa, an analysis of Covid-19 patients in the Western Cape found that almost half of those who died had diabetes as a comorbidity.
In addition, people living with uncontrolled diabetes, including those using insulin, are more likely to develop more severe Covid-19 symptoms if they become infected.
Thus, as a precaution, the role of telemedicine for people living with diabetes is instrumental for an adequate management and better clinical outcomes.
“Before Covid-19, telemedicine, in terms of remote consultations with patients, essentially did not exist in South Africa,” says Dr Bruno Pauly, from the Department of Diabetes and Endocrinology at the Chris Hani Baragwanath Academic Hospital. “There was no infrastructure, no legal framework and the Medical Aids schemes, which cover the 15% of the population under the private health system, would not pay for such consultations, until March 2020.”
Bernard Brisolier, Business Unit Director for Abbott’s diabetes care business in Africa, adds: “Diabetes is one of the most prevalent non-communicable conditions in South Africa.
“However, technology like Abbott’s FreeSyle Libre are enabling people living with diabetes to better monitor their glucose levels without the need for finger sticking.
“By simply scanning their compatible smartphone over a coin-sized sensor worn on the back of their upper arm, users can measure their glucose levels and voluntarily share valuable information with their treating doctors through secure cloud-based digital tools, like LibreView. FreeStyle Libre system improves HbA1c (average glucose levels over three months), time-in-range and clinical outcomes, while reducing the need for in-person hospital appointments.”
Doctors are also starting to see the use of new innovations in diabetes care, which can complement telemedicine services, such as smart glucose monitors which have made continuous glucose monitoring available to people living with diabetes in the private sector. These devices collect data on glucose levels, per the consent of the user, which is shared with healthcare professionals in real-time.
“A large pool of people have diabetes and other non-communicable diseases (more than 30% of the global population) and they are especially vulnerable to Covid-19,” says Professor David Segal, Paediatric Endocrinologist. “Telemedicine offers solutions to deliver healthcare services at scale, at the right time and at any location. Especially in this time of the pandemic, we need to use technology to create ‘health care with no address’.
“We cannot build enough hospitals, or spend enough money, to treat everyone with legacy hospital-based systems of care. The mobile phone is a disruptive technology, and that is where the hospital will move to. Telemedicine can take healthcare to the people rather than the other way around. It has potential to improve outcomes, reduce costs, increase convenience and customer satisfaction.”
Bridget McNulty, co-founder of the NGO Sweet Life Diabetes Community, comments: “Not only will electronic patient records enable patient outcomes to be better tracked to improve care, they are also likely to help engage nurses in primary care as they will be able to see patient improvements from their direct interventions.”
“Telemedicine, digitalisation and technology as a whole have huge potential to improve the care of people living with diabetes. The first steps to utilising telemedicine in the private sector have been made, but huge obstacles remain in building upon that and expanding use, particularly in the public sector,” Dr Pauly concludes.
The report projects that, as lockdown restrictions ease down, new hybrid models of care will emerge, and a balance will be struck by alternating patients between in-person and virtual appointments. This has been simpler with the introduction of new, easier-to-use self-monitoring tools.