Dr Olivier believes quality of life is important for her patients who live with diabetes
Ensuring good quality of life for people who live with diabetes is key for general practitioner (GP) Dr Christel Olivier. She works towards this goal with the support of the Diabetes Care Programme and the team of health professionals she works with at her practice.
"Normally when we treat diabetes, we focus so much on life expectancy and preventing complications," says Dr Olivier. "But we need to remember that quality of life is also important for patients who live with diabetes."
"You don't want to live to the age of 90, but be restricted in your freedom, say not wanting to leave the house because you're scared of having a hypoglycaemic episode. That is why my colleagues and I work together to provide not only the most effective treatment, but also the education a patient needs to use their blood sugar monitoring devices and medicine effectively," she says.
- A hypoglycaemic episode occurs when someone who has diabetes doesn't have enough glucose (sugar) in their blood. Glucose is the main source of fuel for the body and brain, so you can't function well if you don't have enough on hand. People may experience symptoms such as sweating, shaking or fatigue, although these symptoms can differ from person to person or from episode to episode. Hypoglycaemia can be life-threatening.
Diabetes is best managed by a diabetes healthcare team
Dr Olivier has worked exclusively with patients who live with diabetes since 2008. She recently moved her Centurion practice to new premises to accommodate more team members on site to be able to better facilitate a multidisciplinary approach to treating her patients. Her practice consists of:
- Two GPs
- Two diabetes nurse educators
- A biokineticist
- A podiatrist
- A dietitian
- A pathology testing facility.
Dr Olivier also refers patients to ophthalmologists, psychologists, cardiologists, nephrologists and other specialists when necessary, so covering all areas that a person who has diabetes may need care for.
She explains why a diabetes care team is so important.:"Diabetes is such a complex disease. Most of our patients don't only suffer from the direct complications of diabetes, but they also have other chronic conditions that they need to manage. I don't think a single healthcare provider can attend to all those needs. You need a more holistic approach."
Her team of healthcare providers work together to provide care that is based on the specific needs of each patient. "Being on the same premises makes things easier, because we can grab a patient's file and discuss their needs," she adds. Many of Dr Olivier's patients have been visiting her practice regularly for the past 15 years. "It's nice to build a relationship with patients and to walk a journey with them. It also makes it easier to stay up to date with how they're doing."
Each patient's needs are different and must be addressed accordingly
While her patients are encouraged to see each member of their care team yearly, Dr Olivier points out that the frequency at which a patient will see certain care providers depends on their condition, lifestyle and needs.
"The challenge that we have with diabetes is that it's a progressive disease, so you're chasing a moving target," says Dr Olivier. The longer a patient has diabetes, the higher their risk of complications. The ideal [situation] would be for every patient to tick every box every year, but that's not always possible, which is why we try to individualise their care."
"For example, with an uncomplicated or newly diagnosed patient, we can usually see them once or twice a year. But the moment a patient develops complications, they will need to see their care providers more often. A patient that is at risk of developing a foot ulcer might need to see the podiatrist every three months.
Another patient might benefit from an extra visit to the biokineticist but might not need to see the dietician. And pregnant patients should see their doctor every month and the dietitian and ophthalmologist every trimester.".
"There isn't a single regime (treatment routine) that will work for everyone. You need various care providers to work together to find the right care regime for each patient based on the stage they are at in their life and in their diabetes journey."
"We also like to make sure that our patients are doing okay psychologically. There is a higher incidence of depression in patients with diabetes. We also saw a huge emotional impact on our patients during the COVID-19 pandemic."
A personalised approach to diabetes is life-changing
A personalised approach, rather than a one-size-fits-all approach, can be life-changing for a person with diabetes. One of Dr Olivier's patients was very overweight, unhappy and on an outdated medicine regime when she started visiting her practice.
"This patient was on 110 units of an outdated type of insulin. I changed her insulin and asked the dietitian to teach her how to count carbs so that she could eat how she wants to eat and then estimate how much insulin she needs to inject. She's now using a quarter of the insulin she used previously, her blood sugar is more stable and she's lost weight. The improvement to her quality of life has been huge."
Dr Olivier points out that many of her patients with type 1 diabetes experience severe changes in glucose levels and have debilitating hypoglycaemic episodes. "These patients can't even climb into their car and drive to the shops without measuring their blood glucose levels first. But now we can help them by teaching them how to use technology such as wearable sensors. They monitor the patient's blood glucose levels every five minutes and warn them if their blood sugar is too high or low," she says.
- According to the Mayo Clinic, Type 1 diabetes - once called juvenile diabetes or insulin-dependent diabetes - is a chronic condition. Here, the pancreas makes little or no insulin (the hormone the body uses to allow sugar (glucose) to enter cells to produce energy). It can be caused by different factors, such as genetics or even some viruses and although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.
- Find out about cover for Type 1 diabetes and continuous glucose monitoring.
DHMS Diabetes Care Programme makes life easier for patients
Dr Olivier is thankful for programmes such as Discovery Health Medical Scheme's Diabetes Care Programme, which makes it easier for her member patients to manage their condition and comply with their treatment. "The Diabetes Care Programme is successful in providing the benefits that these patients need, including access to multiple healthcare providers," she says.
- Access the Diabetes Care Programme benefit guide to give you more information on this unique programme. You can use this to see which healthcare professionals you have access to on your health plan.
"When patients don't have to pay per consultation, this enhances compliance. If you ask them to come for a follow-up appointment, it doesn't cost them anything extra. It's an investment in their health."
"The communication that patients receive through the programme, reminding them of what their benefits are and whether they're due for a visit to their doctor, is very valuable, because the practice isn't always able to phone every patient to remind them."
Regular screening is essential for patients at high risk of diabetes
It is not only patients who have diabetes who must regularly go for check-ups at their doctor, but also people who are at high risk of developing diabetes, warns Dr Olivier. "Screening for diabetes is so important because we know that especially with type 2 diabetes, it has around a 10-year lag time before the blood glucose goes above the normal range. It's always better if diabetes is detected early, because then you can avoid complications."
"My father was a type 2 diabetic with cardiovascular disease. He was diagnosed when he had his first heart attack, which is not ideal. You don't want to be diagnosed when you already have serious complications, but rather at the first signs of the onset of diabetes, which is why regular health screening checks are so important."
"People who should get screened annually are those with risk factors such as a family history of diabetes and those who are overweight, very inactive, and over the age of 30. If both your parents have diabetes, you should start getting screened in your 20s already."
There's a lot the world can learn from a medical team working in small-town KwaZulu-Natal, and treating diabetes through innovation and collaboration.
"The Diabetes Care Programme is of great benefit," explains Dr Joffe. "Patients on the programme are engaged in their care, and know they have to come in for a certain number of visits which are funded in full. People are price-sensitive, particularly through the economic decline we saw in 2020. The fact that access to the Diabetes Care Programme is funded through risk benefits - so does not impact members' savings - goes a long way to encouraging their adherence to the programme's timetable. In this way I can keep good tabs on them too."
Half of people living with diabetes don't know they have it. We know that more than 4.5 million adult South Africans have diabetes. 14 November is World Diabetes Day, now is the time to know your blood sugar. And if you have diabetes, we have the enhanced support and benefits to help you.