Diabetes in the Western Cape: an eight-year profile

Abstract

Background: The need for greater information on the burden of diabetes has never been more significant than at present, especially when considering the association between diabetes and the severity of COVID-19. Statistics South Africa has identified diabetes mellitus (DM) as the leading cause of death in the Western Cape (WC) province, South Africa.
Aims: This study aimed to analyse diabetes-related data collected on patient visits, screening frequency, age proportion and distribution of new patients at primary health levels in the WC public healthcare sector.
Methods: An eight-year (2012–2019) audit was conducted of all diabetes-related public health data routinely collected using the WC District Health Information System (DHIS). The data were analysed using Excel® 2016. Time-series and cross-sectional analyses were made possible using pivot tables to gain insight into data trends and incidence rates.
Results: This study found that the eight-year crude incidence rate for diabetes increased by 2% between 2012 and 2019. In addition, the incidence rate of diabetes increased by an average of 21% when private institutions were excluded. The recorded number of patients diagnosed with type 1 DM (T1DM) decreased annually between 2013 and 2017 (796 vs. 217, respectively). This decreasing trend could be due to the late onset of T1DM in patients from the African continent or possible data misinterpretation and inadequate training at a primary collection level. The cumulative number of patients screened for diabetes within the WC public health sector (2016–2019) depicts a compound annual growth rate of 16%. A strong positive correlation (p = 0.98) was found between patients screened and the frequency of patients newly diagnosed with DM. The majority (64%) of clinical visits by patients registered with a confirmed diagnosis of diabetes were seen in the metropolitan municipality of ‘The City of Cape Town’.
Conclusions: The incidence of DM in the WC province, as in South Africa and globally, is increasing. Intensified screening translates into improved ‘pick-up’ rates and decreases the overall prevalence of undiagnosed DM with its complications. The findings of this study have implications for the development of public healthcare policies and guidelines. Personnel training and resources are suggested to improve the quality of the clinical data and strengthen the DHIS.