Category: 2020 Autumn – Diabetes Focus eMag

RetinaRisk app

The RetinaRisk app

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We learn how the RetinaRisk app eliminates diabetic blindness through empowerment and predictive analytics.

The RetinaRisk app is a unique and novel tool that empowers persons with diabetes to monitor their individualised risk of developing sight-threatening diabetic retinopathy, which is one of the most common causes of blindness worldwide.

It is designed by an Iceland-based company, founded by academics and healthcare providers with over 30 years’ experience in screening, for persons with diabetic retinopathy and treating diabetes.

Diabetes stats

The global diabetes epidemic has tripled since 2000, to some 430 million persons worldwide, and is expected to exceed 600 million by 2045.

Two-thirds of persons with diabetes develop diabetic retinopathy and one-third develop sight-threatening diabetic retinopathy over twenty years. These patients are at high risk of vision impairment or even blindness if not diagnosed and treated in a timely manner.

How the RetinaRisk app works

Systematic eye screening and preventive treatment are known to dramatically reduce diabetic blindness. The RetinaRisk app is a clinically-validated risk calculator that allows people with diabetes to assess, in real-time, their individualised risk for sight-threatening diabetic retinopathy, based on their risk profile, and to track the progression of the disease over time.

The app includes detailed guidelines and useful information on diabetes, diabetic retinopathy and improved self-care, which allows patients to better understand their condition and become an active participant in their own wellness journey.

The RetinaRisk app empowers persons with diabetes to become more involved in their healthcare decision-making. It supports patient self-management by demonstrating the importance of regular eye examinations and seeking timely medical assistance.

It motivates persons with diabetes to become more responsible and better-informed patients. The app’s easy-to-visualise, effective and efficient patient education tools vividly demonstrate how improvement of modifiable risk factors (e.g., blood glucose, HbA1c, blood pressure) could significantly lower the risk of potentially blinding diabetic eye disease and expensive interventions.

The algorithm at the core of the RetinaRisk app is based on extensive international research on risk factors known to affect the progression of diabetic retinopathy, such as duration of diabetes, gender, blood pressure and blood glucose (HbA1c) levels.

Clinical validation in 20 000 persons with diabetes is robust and the results have been published in several respected medical journals.

The RetinaRisk app is free of charge and our goal is to get it in the hands of as many persons with diabetes as possible around the world.

The RetinaRisk App can be downloaded using the following links:

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Accu-Chek® Testing in Pairs

Meaningful monitoring with the Accu-Chek® Testing in Pairs

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We learn how to monitor blood glucose levels with purpose with the Accu-Chek® Testing in Pairs.

Whether you are newly diagnosed or have been living with diabetes for some time, it is important to manage your blood glucose. Monitoring your blood glucose (or sugar) levels forms an important role in helping you understand what is happening on a day-to-day basis.

Remember that one blood glucose value from a check does not tell you the whole story! When you consistently check at the right time and frequently enough in a structured manner, blood glucose patterns emerge. This can give you a better understanding of the fluctuations in your blood glucose, which are linked to your daily habits.

Accu-Chek® Testing in Pairs is a simple paper tool designed to help you see changes in your blood glucose before and after a specific meal, exercise, or other event. Use it to discover how one thing in your daily routine can affect your blood glucose.

What could you learn?

  • Does what and how much I eat make a difference in my result?
  • How does activity/exercise affect my blood glucose?
  • Does packing my lunch instead of eating out affect my blood glucose?

Tumi’s example

Tumi would like to learn how breakfast affects her blood glucose. Here’s how it works:

  1. Start with a simple question and use your blood glucose results to see what works for you.
  2. Each day, check your blood glucose before the meal or activity, and write the number in the Before column. Check it again two hours after the meal or activity, and write it in the After column.
  3. How did your blood glucose change? Look out for any changes above 2,8 mmol/L.

What do I want to learn?

How does breakfast affect me?

Day Before After Change Notes
Monday 4,0 8,0 4,0 Oats with milk
Tuesday 7,4 9,7 2,3 Boiled eggs and 1 slice whole wheat bread
Wednesday 8,6 12,2 3,6 Bran Flakes with milk and a banana
Thursday 9,8 11,2 1,4 Avocado and tomato on 1 slice of toast

Tumi learnt that a breakfast lower in carbohydrates had a much smaller impact on her blood glucose levels than a breakfast higher in carbohydrates. The Accu-Chek® Testing in Pairs tool showed her that even small changes could make a big impact on her blood glucose control.

You can take that same step today. Simply visit the Accu-Chek® website to download a copy of the Accu-Chek® Testing in Pairs tool, and see for yourself how before-and-after testing can make a difference.

JEFF

Meet JEFF: the fitness friend we all deserve

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In a world saturated by health gimmicks, miracle eating plans, and fitness fads, there is finally something that takes its clients’ goals as seriously as they do. It goes by the name of JEFF.

Introducing JEFF

Johno’s e-Fitness Faculty (JEFF) is a revolutionary new fitness service that balances the ease and accessibility of a mobile fitness programme, with the comfortingly human input of a personal trainer and a simple, balanced eating plan.

The brainchild of top sports conditioning coach, Johno Meintjes, JEFF is an innovative digital fitness, nutrition, and coaching concept that can serve anyone, anywhere, at any time.

How does it work?

The JEFF model is designed to help refine your health and fitness strategies by providing a structured training routine and personalised nutritional programme that is overseen by a remote team of real-life, approachable, and fully qualified personal coaches. It puts you in charge but makes you 100% accountable to making real, sustainable, life-long habit changes.

The reality is that if you could have done this by yourself, you would have done it already. The mentoring and coaching side of JEFF is the part that brings it all together.

Tried, tested, and trusted

Before creating the programme, JEFF’s founder, Johno, spent six years working with South Africa’s top national cricket, hockey, and rugby teams.

Since launching, JEFF has been used by the likes of Maps Maponyane, Lady Kitty Spencer, Graeme Smith, Jacques Kallis, and Mark Boucher (to name but a few) to become slimmer, fitter, happier versions of themselves.

What does it consist of?

Whether signing up for the 7-week gym-based programme, 14-week gym-based programme, or 7-week home-based programme, clients receive the following support to ensure that they smash their fitness objectives:

  • Tailored eating plan
  • Bespoke weekly training programme
  • Five-six hours/week of self-paced training
  • Personal coach
  • Virtual coach support daily
  • Assessments every three weeks
  • Supportive community vibe

It’s clear that the combination of clean eating, daily support from a skilled coach and the flexibility of independent exercise is a winning formula for overall well-being.

Dependable results

On average clients lose 5-7kg, 1-2 clothing sizes and 8cm off the waist on the seven-week plan, and 10kg, 1-3 clothing sizes, and 13cm off the waist on the longer 14-week plan.

With clients logging dependable results such as these in short periods of time, it is small wonder that JEFF has welcomed hundreds of clients on six different continents over the last year.

Helping ordinary people become their best selves

From professional athletes to people who simply feel as though their health and fitness goals have slipped by the wayside, with JEFF’s affordable professional help, there has never been an easier way to regain mastery of your own health.

Click here for more information on JEFF

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medical aid

Make your medical aid work for you

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Sarah Nicholson, Justmoney’s commercial manager, offers ten tips to help ensure you enjoy the medical aid scheme benefits to which you’re entitled.

Extremely high medical costs mean that many South Africans prudently subscribe to a medical aid scheme. But how do you make the most of your selected package, which needs to meet your medical needs for the year ahead?

Read the fine print

You may have stayed with the same plan for many years. Take time to understand the rules and benefits, which may have changed since you first signed up.

Maximise your money

Take up preventative health screenings and tests, free vaccinations, and baby programmes. You may also decide to register for a programme to better handle a chronic condition.

Explore loyalty programmes

Benefits could vary from product discounts to travel and retail promotions, and subsidised gym memberships.

Spread out claims

Rather than blow your allocation early in the year on over-the-counter purchases, speak to your pharmacist and health practitioners about how to best allocate medical, optical, and dental purchases.

Keep your benefits for essential medicines and services to be used as the need arises. This is especially important if you have small children or sickly dependants.

Choose wisely

Build up a good relationship with your pharmacist, who can advise you on general health topics from seasonal allergies to stress management.

Ask your doctor to prescribe generics which cost less. Whether you are looking at over-the-counter medication, or prescription drugs, generics can cut your bill considerably. You can also shop around and compare prices.

On the record

Be meticulous about filing claims and saving correspondence.

Plan for a procedure

If you require an operation or specialist treatment, obtain pre-authorisation. Do your homework, get a quote from the hospital and medical practitioners before you are admitted. Determine if there will be a shortfall and plan how to fund this. Check if you can use designated healthcare providers on your medical aid’s network for cheaper negotiated rates.

Back a buddy

Oncology and other treatments can make one feel under par for a lengthy period. Ask a family member or friend to help you keep track of medical claims and submissions, or offer to do the same for them.

Conflict resolution

If you’re having difficulties resolving a problem with a call centre agent, find out if your medical aid has a walk-in service. Dealing with someone face to face can help resolve a problem quicker.

Saving grace

Should you have problems keeping up with payments,speak to your medical aid about alternative, cheaper plans. Don’t drop your medical aid completely as medical bills can be enormous.

If you don’t yet have a medical aid, do comparisons online or ask for advice from a qualified broker. This will help you to choose the scheme and plan that offers the best possible cover for your age and personal circumstances.

MEET THE EXPERT

Sarah Nicholson is the commercial manager for Justmoney. Justmoney is a personal finance website that provides busy and digitally savvy South Africans with easy access to financial products, services and information, including medical aid.

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COVID-19

COVID-19 and diabetes

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Andrew JM Boulton, President of International Diabetes Federation, informs us of IDF’s current position on the developing pandemic of the COVID-19 virus.

These are indeed very difficult times with the COVID-19 pandemic. At times of uncertainty it’s important that we all remain strong and supportive of each other.

There is no doubt in our minds that this is a serious development across the world but there is some reassurance from China that the peak has passed there and the number of new cases of COVID-19 is decreasing daily.

Numerous people have expressed concerns because diabetes is listed as a ‘chronic condition’ and there have been worries that infection with COVID-19 might be more serious in people with diabetes.

Young Type 1s

There is some relatively good news for our younger people with Type 1 diabetes and that is COVID-19 appears to be relatively mild in young people, especially in children.

There is also no doubt that several people get COVID-19 without any symptoms and for the majority who do have symptoms, these are relatively mild and similar to an attack of a cold or influenza. Of course, there are some greater risks for older people with diabetes, especially with the chronic complications.

Personal hygiene

There is no doubt, reading the advice from many experts in this area, that it behoves us all to take great care with personal hygiene whatever age, whether we have diabetes (Type 1 or Type 2) or are perfectly well with no other medical problems.

Most important is to encourage all our friends across the world to take special care with personal hygiene, such as washing hands regularly and carefully for at least 20 seconds; using alcohol gel to clean hands after washing and drying; avoiding intimate personal contact including hugs, kisses, handshaking, etc.

This can be difficult for those of us who are used to greeting friends in a seemingly friendlier way. But, at the present time, I would strongly recommend that you adopt other ways of greeting friends and relatives.

Travel advice

The situation is somewhat more complex regarding travel advice and certainly a lot of major gatherings and medical meetings have been cancelled or postponed because of this. There are a few countries for which strong advice has been given not to travel to until the situation is showing signs of resolution. Such countries include China, South Korea, Italy and Iran.

The advice for people living in countries with a number of cases is: travelling in crowded public transport should be avoided. But it appears that short flights do not carry any increase in risk because of frequent re-cycling of air on all modern planes.

South African COVID-19 hotline

National Institute for Communicable Diseases Corona Virus Emergency 24 hour Hotline 0800 029 999

What’s App 060 012 3456

IDF’s COVID-19 advice

The IDF has posted advice on the website and we are continually updating this. Click here.

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Medical resolutions

Medical resolutions and planning for the next decade

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Dr Louise Johnson updates us on the latest changes in the diabetes arena to help you plan your medical resolutions for the next decade.

The basis of diabetes treatment has always revolved around the ‘three wild horses’: diet, exercise, and medication. Going into a new decade, there are quite a few dramatic changes in this arena.

SMART

The American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) 2018/19 consensus report has coined the acronym SMART. The goals that you and your doctor set must be SMART. This is:

S – Simple. Goals should be one step at a time and easy to follow.

M – Measurable. Blood pressure, cholesterol, HbA1c, fasting and postprandial (after meals) glucose, kidney function, eye       check annually, feet examination once a year by a podiatrist. Stop smoking.

A – Achievable. Goals should be small enough. A problem is like an elephant. You eat it bite by bite.

R – Realistic. Weight loss should be five to 10% of total weight and re-evaluated regularly.

T – Time limited. The time frame set on this is three months until goals are met. This is important with all goals set.

Goals for 2020 onwards:

Get your body mass index (BMI) between 18 and 24

This is calculated by length multiply by length (in meters). The weight in kg is divided by this number. For example: 1,6 x 1,6m = 2,56. Weight (80 kg) divided by 2,56 = 31,1. This is the BMI. There are a few diets to try to lose weight effectively.

The number one diet is still the Mediterranean diet. The Predimed trial (NEJM) showed weight loss and improvement in cardiovascular health with this diet.

The best weight loss diet for 2020 is still Weight Watchers. This is a low-carbohydrate diet with good nutrition.

Talk to a dietitian about the correct diet for you. The goal waist circumference for females is 80 cm and for males 94 cm.

People who battle to lose weight can consider bariatric surgery for permanent weight loss and reversal of Type 2 diabetes. Contact a qualified bariatric team for this.

Stop smoking

Vaping can be used as an interim measure to help stop smoking without gaining weight. Set a clear three-month goal of lesser nicotine vape liquid and then stop after month three.

Exercise

The newest data, in The Journal of the American Medical Association (JAMA), for 2020, showed that in 17 000 women, it was found that the cut-off to improve mortality is 4 400 steps per day.

There are many apps and smart watches available to assist in the achievement of exercise goals. Remember the guidelines for diabetic exercise is cardio-training (30 minutes) five times per week.

Blood pressure

Your blood pressure should be measured regularly and should not be above 140/90mmHg. Get yours checked at every doctor’s visit. Consider buying your own electronic upper arm blood pressure machine should you suffer from ‘white coat hypertension’ (high blood pressure in doctor’s office).

Lipogram

The risk of cardiovascular disease (heart attacks, strokes and peripheral vascular disease (leg blood vessels) are closely linked to low-density lipoprotein (LDL). The bad cholesterol. In people living with diabetes, the LDL should be 1,8 mmol/L or lower. Get your number and push to target. Remember there are a few different cholesterol-lowering drugs that your doctor can prescribe. Some have fewer side effects.

HbA1c

This is the three-month glucose average. In 2020, the range is from 6,5 to 8,0%. This variation depends on the duration of diabetes, existence of comorbid diseases, such a kidney failure and cardiovascular disease, and age. This range will be discussed and determined by your doctor.

Time in range (TIR)

This is a brand-new term for 2020 and equates to the percentage of 24 hours that your blood glucose can stay in the range decided on by your doctor. Usually 5 mmol/L to 8 to 10 mmol\L.

The TIR is important since this determines your glucose variability (GV). This means how much your glucose is going up and down, which can be easily monitored with a continuous glucose monitor (CGM).

The International Diabetes Federation (IDF) suggest that all Type 1 diabetes patients use a CGM.

Medication

Obtain the correct medication. This will be a tablet or injection that lowers blood glucose without gaining weight and without causing unnecessary hypoglycaemia (low blood glucose levels).

Immunisation

Get your Prevnar 13 injection to prevent streptococcus infections life-long and influenza injections yearly around the end of March to prevent influenza.

Mouth hygiene

See your dentist and get your teeth cleaned annually to lower inflammation.

For females

Regular bone mineral density tests are important since diabetes patients have an increased risk of osteoporosis. Also go for regular mammograms since diabetes patients have a 4-fold increase risk of cancer.

For men

Go for regular urology visits to examine the prostate since diabetes patients have a 4-fold increase risk of cancer. Should erectile dysfunction (ED) or impotence occur, visit your specialist physician, and cardiologist for a coronary evaluation since there is an increase in cardiovascular disease in men with ED.

Type 2 ‘hot-off-the-press-trials’

In the Type 2 diabetes portfolios, there is a new class with dramatic data. Most Type 2 diabetes patients should be on this class should they qualify.

Medication and trials

  • DAPA–HF trial

The dapagliflozin heart failure trial is the most talked about trial of 2019. Dapagliflozin is a sodium glucose cotransporter 2 inhibitor (SGLT2i).

This class of drug works in the kidney on the proximal tubule (top absorbing pipe). It prevents the re-absorption of glucose into the circulation by blocking the enzyme SGLT2. This causes an increase of glucose in the urine. The amount of sugar lost is 14 teaspoons per day which equals 70g of carbs.

It is quite clear to deduct that this will cause weight loss (3 to 6kg), lowering in blood pressure and lowering in blood glucose. It also causes lowering in gout levels (uric acid).

The group of SGLT2 inhibitors that are available in South Africa is dapagliflozin (Forxiga) and empagliflozin (Jardiance).

The DAPA-HF trial was of interest because it looked at people with heart failure with poor heart function (less than 40%) with and without Type 2 diabetes.

This drug showed after 18 months of taking the active drug versus the placebo that heart failure occurrence was reduced by 16%. This is currently the ‘wonder drug’ in cardiology and diabetes and there are a lot of investigations to exactly establish all the mechanisms of action. Some people called it a ‘smart diuretic’ (tablet causing loss of water by producing more passing of urine). There are many more mechanisms involved.

  • CREDENCE trial

This trial was done with canagliflozin, a SGLT2i, in people with impaired kidney function. The estimated glomerular filtration rate (eGFR) (average kidney function) was between 30 and 60ml/min.

This trial was stopped early due to its phenomenal outcome. It improves the kidney function and the lower the number the better the result. The two drugs available in South Africa, dapagliflozin (Forxiga) and empagliflozin (Jardiance), will have their data at the end of the year and next year.

This is good news for all Type 2 diabetes patients. The data with these classes of drugs are still ongoing and should not be used in Type 1 diabetes due to the risk of diabetic ketoacidosis.

Smart things coming for Type 1 diabetes

The newer and faster short-acting insulins will launch in the last part of 2020.

There are two basal (background) insulins that last longer than 24-hours available: Glargine U300 (Toujeo) and Degludec (Tresiba). They both have less hypoglycaemia effects.

The newer, smart ‘artificial pancreas’ is available with a pump that stops insulin if glucose levels goes too low and increases insulin if glucose levels go too high. This is done with the help of a sensor that sends data via Bluetooth to the pump. Unfortunately, this is still very pricey.

Remember that every person living with diabetes is a unique individual and needs unique individual attention and treatment. Find your unique team and start working together.

Dr Louise Johnson

MEET THE EXPERT

Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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