As the world wrestles with COVID-19, a quieter and even more violent pandemic destroys the world. Type 2 diabetes tariffs continue to rise internationally, linked to lifestyle factors such as poor diet, excessive sugar beverage use, sedentary, stressful and smoking. It is so ‘normalized’ in modern culture that diabetes escapes attention and urgent action.
According to the International Diabetes Federation, 463 million people have diabetes worldwide. Look in South Africa approximately 12.8% is estimated. This puts the number of people affected at about 4.5 million, many of whom are undiagnosed.
New treatments and technologies that have a significant impact on diabetic outcomes are still being developed in clinical trials. But real world data shows that most patients with diabetes do not achieve the treatment goals. Rates of complications such as cardiovascular diseases, amputations of the lower limbs, eye diseases and kidney diseases, especially in the developing world, remain high. The reason for this is a complex interplay between access to health care, economy, poor resources and lack of nursing care designed specifically for diabetes. Patient compliance also remains a critical issue. The diabetic nurse can play a crucial role in these cases.
This year’s the theme of World Diabetes Day ‘Diabetes and the nurseThe aim is to emphasize the importance of nurses in diabetes care.
Challenges
Currently, there is a huge shortage of the number of nurses needed internationally for diabetes care. The International Diabetes Federation estimates that at least 6 million nurses are needed worldwide. This is also true in South Africa. And most diabetes nurses are employed in the private sector, which has a huge shortage in the congested public health sector.
Diabetes care requires a specialized nurse who knows what the causes of diabetes are, the behavior of people (diet, exercise), diabetes medications and technology, and the treatment of complications. The nurse must also be able to look after people from different cultures and religions. What’s more, almost every specialty field of medicine is affected by diabetes. Nurses in these fields need skills to manage diabetes as an underlying condition. However, such training and experience is lacking.
The Society for Endocrinology Metabolism and Diabetes of South Africa highlighted a number of gaps. The South African Nursing Council does not recognize the educator of diabetes nurses as a subspecialty in nursing. No dedicated educator posts for diabetes nurses are available in the public sector. These nurses are not paid more than others, so they opt for other specialties, such as intensive care unit training. There is no public sector training program that enables nurses to optimally manage patients living with diabetes.
Nurses must also take care of themselves. One study at Tygerberg Hospital in Cape Town, showed high incidence (11%) among nurses. It highlighted the need for education and lifestyle interventions for health workers, and ways to regulate environments at risk of obesity.
Safety and security of nurses in the community and hospitals must also be addressed as crime and gender-based violence levels in South Africa remains high.
Where there is a crisis, there is an opportunity
Healthcare providers and governments need to realize that they need to invest in training and education for diabetes nurses. The nursing profession must attract men and women from different backgrounds to cater to the needs of a diverse population. Training in diabetes care as a specialized field is required and training in diabetes nurses should be recognized as a subspecialization.
Government and other stakeholders need to take action to improve nurses ‘and patients’ relationships, autonomy, salaries and working conditions.
Existing educators of diabetes nurses should also consider what changes they can make themselves, using their own strengths, resources and abilities and knowing their limitations.
Well-trained, self-sufficient diabetes nurses placed in communities and hospitals across the country can become role models and mentors for patients in the prevention and treatment of diabetes. They can provide physical, emotional, intellectual and mental support to help patients achieve their health goals. COVID-19 emphasized the need to improve the metabolic health of the population, as patients with diabetes and obesity are at high risk for severe COVID-19 infection. Diabetes nurses are essential to achieve this.
Caring is the essence of nursing. In an increasingly technological world, this is even more critical. The world needs nurses who treat individuals, but they are aware of the larger issues that affect the prevention and treatment of diabetes. Nurses with the right balance between head and heart are the need of the hour. By investing in this need, it can ensure a better future for diabetic patients. Poet and writer, Walt Whitman emphasizes the importance of good care:
There is something in personal love, caresses and the magnetic flux of sympathy and friendship, which in its way does more good than all the medicine in the world. ‘
Sundeep Ruder, Clinical endocrinologist and associate professor, University of the Witwatersrand