- Managing diabetes effectively requires careful monitoring of glucose levels
- Technological advancements like apps and continuous glucose monitoring are incredibly useful for this
- In South Africa, there are, however, certain barriers to more widespread use of these technologies
In the last twenty years, medical technology has made great progress in how we diagnose, treat and recover from all kinds of ailments.
And when it comes to chronic diseases, new developments can help sufferers lead better, healthier and longer lives.
Especially diabetics can manage their illness far more effectively with the help of technology, but not everyone is on board.
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History of glucose monitoring
Managing diabetes involves close monitoring of glucose levels to prevent severe complications that can lead to hospitalisation. From the beginning of the 20th century up to the 1960s, glucose monitoring involved urine tests. Then strips were developed which changed colour according to the glucose level in the blood. These tests still had to be administered by doctors, though.
In the 80s, at-home test strips using smaller blood drops revolutionised diabetic care (self-monitoring), but it still involved a lot of effort by the patient.
Glucose monitoring further evolved into electromechanical strips, enzymatic tests and eventually continuous glucose monitoring, not requiring any fingerstick testing, as well as self-regulating insulin pumps.
Rise of apps
But technological help for diabetics doesn't end there. There are now apps that can help them to monitor their health while developing a better understanding of diabetes and optimal lifestyles.
"These apps can be very useful, especially where the glucometers connect to the apps via Bluetooth," says Dr Zane Stevens, a specialist physician and endocrinologist at the Christiaan Barnard Memorial Hospital in Cape Town.
"They provide graphs to identify trends, estimate [glycated haemoglobin] and can even be used to assist in helping to decide how much insulin to give. This information can be easily shared with the doctor, providing a great deal of information used to make adjustments to therapy."
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Are South Africans using this technology?
In South Africa, the prevalence of diabetes in adults is 12.8% according to the International Diabetes Federation, with the highest prevalence among Asian and coloured populations. They also predict that in sub-Saharan Africa, the number of diabetics will increase by 140% by 2040, driven by urbanisation and obesity.
But are South Africans using these technologies to manage this rising epidemic?
"In general, most medical aids will only pay for testing devices once patients are started on insulin therapy. This is because there is not a great deal of scientific evidence that glucose testing changes outcomes in patients on oral therapies only," says Stevens.
"It may however motivate certain patients to make necessary lifestyle changes. More expensive technologies such as continuous glucose monitoring, which can be very useful for patients on multiple daily doses of insulin are unfortunately less readily reimbursed by medical aids, which limits access significantly."
But according to research conducted in Cape Town, it can be difficult to convince patients to use the technologies at their disposal, especially in poorer countries like South Africa.
The researchers surveyed 497 respondents – most were women over the age of 50 with type 2 diabetes – from Mitchell's Plain, Belhar and Khayelitsha. They were asked how keen they were to use apps to manage their condition, how easy they thought they were to use, and about their access to the required technology.
Despite ticking positive intent and reasonable accessibility, few actually followed through. Some of the factors that limited use included internet access, age, education level and cost. South Africa, unfortunately, has some of the highest data costs in the world, which can hinder the adoption of these kinds of technologies.
Some cell phones also don't connect well with glucometers, requiring users to buy a more expensive mobile device, which is another barrier.
Language is another hurdle to overcome. While we have 11 official languages and most diabetic apps are in English, so a concerted effort from the government is needed to develop apps in all these languages.
Stevens added that some patients are not tech-savvy and prefer their handwritten diaries, but that this doesn't have to be an obstacle.
"A photo of a few days of monitoring can easily be WhatsApped to the doctor or diabetic educator and prove just as useful!"
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What should you use
The coronavirus pandemic has encouraged the use of e-health, and may encourage patients to use these apps and messaging services to send data to their healthcare professionals without having to see them in person.
"At our practice, we prefer our patients using glucometers with Bluetooth capability, and many of these are fully reimbursed by most medical aids," advises Stevens.
"There are a number of great apps available, but we mostly make use of MySugr as this can link up with a number of different testing machines and provides great reports that can be emailed to us ahead of appointments directly from the app."
Another useful free app is Diabetes Words, a companion application for type 2 diabetics and their caregivers that provides useful information on how to manage the disease using simple language that's easy to understand.
Might a smartwatch be a good investment for a diabetic? Stevens says that smartwatches like Fitbits can motivate exercise, which is important for diabetics, but the most important aspect to monitor is diet, especially for type 2 diabetics who need to manage their weight.
"I really wish continuous glucose monitoring was more accessible, especially to individuals living with type 1 diabetes, and we are constantly putting pressure on the medical aids to see the benefits that this provides in optimising glucose control and thereby avoiding complications long-term.
But education remains key
"While there have been great developments in technologies for glucose testing and information storage, the most important thing is that patients are well educated on what to do with this information. Patients need to know what their glucose targets are and speak to their healthcare providers if they are struggling to achieve these."
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