CLINICAL SERVICES

Diabetes

DIABETES

Diabetes is a condition that results in too much glucose (a form of sugar) in the blood. People with diabetes have an increased risk of developing serious health problems. Persistently high blood glucose levels can lead to damage of the blood supply to the heart, brain and legs (macrovascular disease), as well as the eyes, kidneys and nerves (microvascular diseases). People with diabetes also have a higher risk of developing infections. Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help prevent these problems.

DIABETES

ENDOCRINOLOGY

+TYPE 2 DIABETES

Type 2 Diabetes accounts for 90% of all cases of diabetes. It is a disorder of metabolism, and its primary characteristic is an elevated blood sugar level. This is caused by a relative lack of insulin together with insulin resistance where insulin does not work well in the body tissues. It occurs more commonly with older age, increasing body weight and where there is a family history. As symptoms are not always present, some people may have had the condition for many years before being diagnosed, and may even have complications at the time of diagnosis.

+TYPE 1 DIABETES

Type 1 Diabetes is an autoimmune disorder in which the immune system attacks the insulin producing beta cells in the pancreas. Lack of the hormone insulin then leads to high blood glucose levels and other associated effects. Type 1 diabetes often occurs for the first time in younger people but can occur at any time of life. Treatment with insulin is always required.

+GESTATIONAL DIABETES

Gestational Diabetes is a form of high blood sugar which occurs for the first time in pregnancy. Excellent blood sugar control is essential to ensure the healthy development and growth of the baby and to improve pregnancy outcomes for mother and baby.

DIABETES IS THE MOST COMMON OF ALL ENDOCRINE DISORDERS AND AN INCREASING GLOBAL PUBLIC HEALTH PROBLEM

The latest International Diabetes Federation (IDF) Diabetes Atlas (2025) reports that 11.1% – or 1 in 9 – of the adult population (20-79 years) is living with diabetes, with over 4 in 10 unaware that they have the condition.

Diabetes prevalence has been rising more rapidly in middle and low income countries, such as South Africa.

The prevalence of diabetes mellitus has rapidly increased in South Africa, from 4.5% in 2010 to 12.7% in 2019. Of the 4.58 million people aged 20–79 years who were estimated to have diabetes in South Africa in 2019, 52.4% were undiagnosed (source: International Diabetes Federation 2021).

Diabetes is a major preventable cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. It also reduces life expectancy.

Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.

Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.

+SYMPTOMS OF TYPE 1 DIABETES

People with type 1 diabetes are likely to have early symptoms that come on suddenly. These include:

  • Increased thirst
  • Increased urination
  • Weight loss
  • Blurred vision
  • Tiredness

+SYMPTOMS OF TYPE 2 DIABETES

Type 2 diabetes may occur without any symptoms, or symptoms may develop gradually. These include:

  • Tiredness
  • Increased urination
  • Increased thirst
  • Weight loss may or may not occur
  • Frequent yeast infections (such as thrush)
  • Slow healing of wounds or sores
  • Blurred vision

Dr Ogilvie uses a multifaceted and multidisciplinary approach to diabetes, in keeping with best international practice.

+INDIVIDUALISED CARE

Every person is unique and therefore each individual’s care needs to be personalised to match their individual needs.

+EMPOWERMENT

While the input of doctors and other health care professionals is important, individuals with diabetes make choices and decisions on a daily basis in dealing with their condition. Diabetes education is therefore vital in empowering patients with the knowledge, skills and confidence to manage their own care.

+TEAM APPROACH

Individuals with diabetes need to be supported by a team of professionals to provide diagnosis, counselling, coaching, education, treatment, support and motivation. In addition to the doctor, input from a diabetes educator, dietician, podiatrist, ophthalmologist, pharmacist, biokineticist and psychologist (amongst others), is needed at different times to optimise care and quality of life.

It is not the doctor who is in charge of this team – it is the person with diabetes and where appropriate, their family.

+MONITORING

Best practice requires that diabetes is ‘Treated to Target.’ Ideally every person with diabetes and all members of their support team will know their targets for:

  • HbA1c (glycated haemoglobin)
  • Blood glucose
  • Cholesterol and other lipids
  • Blood pressure
  • Weight

These parameters need to be measured regularly and the care programme adjusted in order to achieve ongoing targets. Additionally, kidney function, growth (in children), and eyes and feet need to be checked.

+CORNERSTONES OF DIABETES CARE

  • Regular activity and exercise
  • Healthy and sustainable eating
  • The right medication at the right dose at the right time