Diabetes contributes to more than five million deaths a year worldwide (IDF Atlas 2015), making it the eighth-leading cause of death in the world. In 2015 WHO listed it in the top 10 causes of death globally.
IDF World Atlas 2015 predicted that in Africa alone the deaths would double from 14.2 million in 2015 to 34.2 million by 2030. Africa has the highest number of undiagnosed individuals with diabetes at 62.5 per cent, which translates to higher morbidity and mortality, and increased stress on an already strained health system. The continent has the lowest diabetes-related expenditure worldwide, at one per cent of the global total.
WHO estimates that the prevalence of diabetes in Kenya is at 3.3 per cent and predicts a rise to 4.5 per cent by 2025.
To address the problems in diabetes patient care a multi-disciplinary team approach plays a fundamental role in the prevention and diagnosis. This includes an active case management of diabetic patients who may have multiple long-term conditions that cannot be managed by one physician alone.
Through a multi-disciplinary team approach the increasing costs in diabetes care can be lowered, minimise patients’ health risks through assessment, promote early intervention and surveillance to identify problems early and initiate timely treatment. Examples of a multi-disciplinary team approach include children who have diabetes where parent education is also essential for effective care, patients who have foot ulcers and/or uncontrolled neuropathic pain and patients who have risk factors/complications that have not been managed well during primary care.
Taking into account all the challenges of the increasing healthcare costs, staff training needs and requirements, continuous learning and a holistic approach – the Lions of Kenya opened two Lions Diabetes Care Centres, which were launched in April 2017 at MP Shah Hospital and Lions SightFirst Eye Hospital.
The concept behind the design of the LDCC is to ‘deliver better services to patients with long-term conditions’ – inpatient as well as outpatient. This is the first of its kind in the East Africa. These centres provide affordable healthcare at subsidised rates.
The LDCC promotes a coordinated service delivery model of a ‘one-stop centre’. It incorporates a collaborative model between patients playing an active role in determining their own healthcare and support needs with a multi-disciplinary team of expert physicians.
Examples of work already undertaken by the LDCC team include a nurse practitioner-physician team that manages patients with diabetes and hypertension;
A diabetes educator and nutrition team working on patient education;
A podiatrist initiating ongoing training with LDCC nurses to reduce lower-extremity amputation rates in footcare clinics and through effective wound management training;
An endocrinologist and counsellor managing new diagnoses;
A podiatrist working closely together with a vascular surgeon for any peripheral artery disease cases identified during reviews or
examinations at the Foot Clinic.
An initiative being worked on by the LDCC for 2018 is to ensure all healthcare professionals (nurses, pharmacists, diabetes educators, counsellors, nutritionists) and doctors (multi-disciplinary team) receive CDE accreditation for continuous learning and to ensure the best service is provided to diabetic patients.
The LDCC hosted their first Lions Diabetes Symposium on Saturday, November 11 at the Lions SightFirst Eye Hospital, which focussed on ‘In-patient care of diabetes’. Approximately 400 Industry healthcare professionals and doctors in Kenya from different clinics/hospitals with a keen interest in diabetes, attended this event.
Ongoing treatment of diabetes by a multidisciplinary team is feasible and facilitates the achievement of treatment goals that will result in the development of fewer long-term diabetic complications thus reducing healthcare costs in diabetes care in the long-term. Achieving these goals does not seem possible using traditional models of care and there is no excuse for delay. We must transform team care from an abstract concept to a common practice.
Arvinder K Kalsi is Director of Aratus Health Ltd