The burden of diabetes mellitus in KwaZulu-Natal's public sector: A 5-year perspective.

Abstract

BACKGROUND Diabetes mellitus (DM), together with its devastating complications, has a huge impact on both the patients it affects and the global economy as a whole. The economies of developing countries are already under threat from communicable diseases. More needs to be done to stem the tide of non-communicable diseases like DM. In order for us to develop new strategies to tackle this dread disease we need to obtain and analyse as many data as possible from the geographical area where we work. OBJECTIVE To describe the burden of DM in the public sector of the province of KwaZulu-Natal (KZN), South Africa (SA). METHOD Data on the number of diabetes visits, DM patients that were initiated on treatment, defaulters and DM-related amputations were accessed from the Department of Health records for the period 2010 - 2014 inclusive. RESULTS There was a decline in the number of patients initiated on treatment per 100 000 population from 2010 to 2014 inclusive (265.9 v. 197.5 v. 200.7 v. 133.4 v. 148.7). Defaulter rates for 2013 compared with 2014 were 3.31% v. 1.75%, respectively and amputation rates were 0.09% v. 0.05% for 2013 and 2014, respectively. There was a strong proportional relationship observed between the number of defaulters and number of diabetes-related amputations (r=0.801; p=0.000) (Pearson correlation). A notable percentage of DM patients ranging between 63% and 80% were commenced on pharmacological therapy at their local clinics rather than at hospitals in the province. CONCLUSION Strategies directed towards detection and treatment of DM, together with decreasing defaulter rates and thereby decreasing diabetes-related amputations, need to be addressed urgently. The majority of patients were initiated on therapy at the clinic level. This emphasises the need to strengthen our clinics in terms of resources, staffing, and nursing and clinician education, as this is where diabetes control begins. Although this study was based solely in KZN, the second most populous province in SA, it probably reflects the current situation regarding DM in other provinces of SA as well.