Worldwide Fall Prevention Awareness Week is in September. We learn about falls with special consideration to the fall risk of people living with diabetes, and the inner ear in maintaining balance.

The stats of falls

Falls are one of the leading contributors to unintentional injuries, hospital admissions, and under severest circumstance, may result in death.

One in five of those who fall are injured. In the USA alone, an older adult falls every second; is admitted to hospital due to fall-related injury every 11 seconds; and every 19 minutes, an older person dies from these injuries.

Even if falls don’t cause a physical injury, fear of falling can reduce physical activity, and so can increase fall risk. Globally, at least one in three older adults (65 years and above) will fall every year.

No country is spared the problem of falls, with data from emerging regions suggesting falls are as much of a challenge as in developed countries.

Moreover, ageing is growing at a disproportionate rate in low-and-middle-income countries, who have had less time to prepare for the health needs of an older population.

Diabetes increases the odds for falls

While ageing is the biggest predictor for falls, chronic health conditions also increase the odds. One of these conditions is diabetes.

Diabetes is one of the most prevalent non-communicable diseases. In 2020, the International Diabetes Federations (IDF) reported that approximately 4 581 200 million adults in South Africa have diabetes. These numbers will increase considering the undiagnosed cases.

Recently, scientific evidence suggests that people living with diabetes are at increased risk of falls, including acquiring injuries resulting from falls.

The function of the ear

Our ears are not merely a structure that aid our physical appearance. The function goes beyond what we see externally. Medically, the ear is referred collectively as the auditory system and gives the sense of hearing and contributes to balance, the sixth vital sense.

Balance is controlled by the vestibular system. The vestibular organs are in the inner part of the ear, deep within the skull, next to the hearing portion of the inner ear, called the cochlea.

The vestibular system can’t be viewed by looking in to the ear canal, but the diagram below shows what it looks like. This figure illustrates its location relative to the external ear and the shape of the semi-circular canals bones.

The vestibular system uses intricate structures to sense movement of the head and body. It works in collaboration with our eyes, brain, muscles, and joints to keep our vision stable and our entire body balanced while in motion or performing daily activities.

Unlike our other senses (e.g. vision, hearing, smell, touch), we typically don’t notice our vestibular sense when it’s working normally. However, if the vestibular system is damaged, the effects can be devastating and include dizziness, imbalance, and falls.

A large population-based survey, in the USA, suggested that the vestibular sense starts to decline as early as the 40^th year.

The question is, how is my diabetes putting me at risk from falling?

Link between diabetes and falls 

Risk factors for falls are issues that increase your chance of falling. Generally, these can be divided into what are called intrinsic risks and extrinsic risks.

Intrinsic risks are individual risk factors like age, sex and health conditions. Extrinsic risks are related to the environment. For example, poor lighting, potholes in the road, and uneven pavements.

Challenges faced by people living with diabetes include the following: 

• Use of multiple medications. These include medications prescribed by your doctor as well as anything over the counter. Use of four or more medications increases your fall risk. Do not stop your medications. Rather discuss with your doctor and see if any can be adjusted or stopped. Medications like sleeping pills, tranquilisers and anticonvulsants are particularly associated with fall risk.
• Possible loss of sensation due to vascular damage to the nervous system. For example, peripheral neuropathy.
• Dizziness and imbalance.

The sense of balance is the result of processing and responding to incoming signals from three senses. These are vision, vestibular and somatosensory (awareness of where the body is in space) inputs.

Diabetes can affect all these senses negatively. For example, peripheral neuropathy, or nerve problems can result in not being able to sense where the feet are.

Retinopathy, or vision problems, reduces important visual inputs necessary to identify slip and trip hazards and respond quickly^*.

To be able to balance, visual input plays a crucial role.

Alongside the retinopathy that may be related to diabetes, older adults often have as issues with poor low-contrast visual acuity and impaired depth perception. Activities, such as climbing steps or stepping off pavements in bright sunlight or dappled shade, will be risky for adults with such visual changes.

Multifocal, bifocal and transitional lenses are particularly difficult and increase fall risk. The image below shows the distortion of the lower visual field when viewed with multifocal lenses.

Distortion of the lower visual field due to wearing multifocal lenses.

How diabetes affects the cochlea

As with other sensory systems, diabetes can also result in damage to the cochlea (the hearing organ) and its neighbouring vestibular system.

Within the inner ear, the balance organs are highly dependent on the tiny blood vessels for blood and nutrients. Studies report that diabetes is known to affect small blood vessels first before reaching the large ones. Therefore, compromising the ear’s ability to function properly.

When diabetes has been present for a long period, both inflammation and vascular damage are more likely*. Negative effects of diabetes on the vestibular system have been noted in both animal studies and clinical studies in humans*.

The vestibular system is a major contributor to our overall balance, and vestibular damage and its associated dizziness is an independent risk factor for falling*.

Large-scale epidemiological studies have shown that people with diabetes are associated with significantly higher odds of vestibular damage and, even after adjusting for nerve loss and vision loss, patients with diabetes and vestibular loss have a two-fold higher odds of falling*.

Fortunately, audiologists can assess vestibular function and fall risk. There are physical therapies that can help improve balance, which may be offered either by a suitably qualified audiologist or physiotherapist.

How to prevent falls 

The National Institutes of Health, Department of Health and Human Services (newsinhealth.nih.gov) provides the following practical tips on how to prevent falls:

• Talk openly with your healthcare provider about falls.
• Find out about the side effects of any medicine you take and ask for a medication review.
• Have your blood pressure tested lying down and standing. Blood pressure that drops when moving from lying to standing is an easily reversible risk factor for falls and imbalance.
• Stay hydrated and ensure your iron levels are normal. Dehydration and anaemia are common in all older adults and can contribute to dizziness and falls.
• Stay physically active to improve your balance and strength. Guidelines for physical activity for older adults recommend 150 minutes of moderately intense physical activity per week; or 75 minutes of vigorous physical activity per week, as well as balance and strengthening exercises.
• Have your eyes and hearing checked regularly. Ensure your vision and hearing are both as good as they can possibly be. Don’t hesitate to try spectacles and hearing aids, if needed.
• See your healthcare provider about any foot problems. Make sure to discuss proper footwear.
• Make your home safer. Remove things you can trip over from stairs and walkways. Have grab bars and non-slip mats in bathrooms.
• Hold on to handrails when using stairs.

Which health professionals to consult when experiencing falls 

Falls are predictable events and are therefore preventable. They are not ‘accidents’. Although prevention (through education and healthy lifestyle) is better than cure, in an event where prevention wasn’t possible, there are numerous health professionals involved in the identification and treating balance problems. Hence, it’s a team effort.

Within the context of diabetes, an audiologist may be able to assess your balance and risk for falls using a variety of testing modalities. Recommendations on how to perform your activities of daily living, considering the balance problem that you might be experiencing will be provided.

Also, audiologists will facilitate referrals to other professionals as illustrated in below, should the need arise.

Multi-disciplinary team approach in the management of people with balance and falls disorders.

To conclude, falls are common occurrences in all adults. The presence of factors, such as age, and chronic health conditions, such as diabetes, increase the risk of falls.

However, falls are predictable and thus preventable. Maintaining a healthy lifestyle, careful monitoring of health and medication, and management of environmental fall risk factors all contribute to reducing the risk of falls.

References: 

1. Agrawal, Y., Carey, J.P., Santina, C. D., Schubert, M.C., & Minor, L. B. (2010). Diabetes, Vestibular Dysfunction, and Falls: Analyses From the National Health and Nutrition Examination Survey. Otology & Neurotology, 31(9), 1445-1450. 
2. Agrawal, Y., Carey, J. P., Santina, C. D., Schubert, M. C., & Minor, L. B. (2009). Disorders of Balance and Vestibular Function in US Adults: Data From the National Health and Nutrition Examination Survey, 2001-2004. Archives of Internal Medicine, 169(10), 938-944. 
3. D’Silva, L. J., Lin, J., Staecker, H., Whitney, S. L., & Kluding, P. M. (2016). Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System. Physical Therapy, 96(3), 400-409. 
4. Jacobson, G. P., McCaslin, D. L., Grantham, S. L., & Piker, E. G. (2008). Significant Vestibular System Impairment Is Common in a Cohort of Elderly Patients Referred for Assessment of Falls Risk. Journal of American Academy Audiology, 19, 799-807. doi:10.3766/jaaa.19.10.7 
5. National Institutes of Health Department of Health and Human Services. September 2019. newsinhealth.nih.gov/2019/09/preventing falls 
6. Rybak, L. P. (1995). Metabolic Disorders of the Vestibular System. Otolaryngology–Head and Neck Surgery, 112(1), 128-132. doi:https://doi.org/10.1016/S0194-59989570312-8 

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Although it is still lockdown and we are not allowed to have public Diabetes Wellness Meetings, we still receive many calls for advice and assistance. We may be contacted via the cell and social media.

The mother of a newly diagnosed young fellow contacted us from the hospital. As he is under twelve years old, she could stay with him for the duration of his time in hospital. But, she had to remain in the hospital. If she left she would not have been allowed to return to her son. So, we were her lifeline while they were both confined to the hospital. They live on a small holding just outside Port Elizabeth.

Once he was released from hospital we drove out to their home, all masked and keeping our social distance and donated a brand-new glucometer to him, his free pair of mohair socks and the handy Diabetes Focus A to Z info booklet. These are some of the benefits of becoming a member of DSA.

Diabetes dog

We recently had an unusual request from a friend, Vasti Barkhuizen. She needed advice as her seven-year-old spayed Great Dane, Debbie, had just been diagnosed with diabetes. Debbie started to drink excessive water which Vasti noticed as it was mid-winter. A urine sample showed high glucose, and a urinary tract infection which was treated with antibiotics.

Debbie the Diabetic Dane is relaxing in her garden.

Debbie’s first fasting blood glucose level, taken on 13 July, was 23,7. She was started on 16 units of Protaphane 100 IU/mm twice daily, which is taken after meals.

Diabetes in dogs is very similar to Type 1 diabetes in humans. Female dogs are more frequently affected and known triggers for diabetes include pregnancy, dioestrus, Cushing’s disease and hypothyroidism as well as drugs, like progestogens and cortisone.

Debbie is lying on her bed and thinking “Please help me to feel better soon.”

Vasti’s biggest challenge was to get samples of blood to test Debbie’s blood glucose readings. This is when Elizabeth Prinsloo, from DSA Port Elizabeth, donned her mask and went to Vasti’s home to assist with Debbie, a huge gentle giant. The blood samples are usually taken from the ears or the inner lips of dogs. As our Rottweiler also had diabetes, Elizabeth could assist Vasti and show her how to get a blood sample.

Debbie looking at a piece of her reward, a few slices of low-fat biltong, when she stands quietly to have her insulin injection.

Debbie’s blood glucose tests are still in the 20s and her insulin is being gradually increased to find the optimum dose. She now receives 26 units of insulin twice daily. She has lost much weight but should soon start regaining it once she reaches her correct dose.

Dietitian, Retha Harmse, guides us on how to avoid the snack trap and rather to eat smarter.

In family movies, like Home Alone, we see those sneaky traps, where the child lightly rakes leaves over a hole and then when the bad guys step on the leaves, they fall for the trap and fall into the hole.

The hole which the bad guys fall into is often extremely deep, so it’s hard to get out of. And, sometimes even the good guys fall in this cleverly-disguised trap.

The snackish, nibbly, grazing feeling when you constantly want to eat and feel hungry might often feel like one of those traps: the snack trap. And when you are in that hole, it’s so challenging to get out. Besides the fact that it might be detrimental to your waistline, it can also wreak havoc with your blood glucose control.

What is the snack trap?

Especially during this pandemic and in winter months, we have seen various people falling into the snack trap: the habit of nibbling and snacking the whole day. Whether it is because the food is readily available or if they are just bored or really hungry, people have been eating a lot.

To snack or not to snack, that is the question?

A quick side note: I became a dietitian because I really love food and not despise it. So, I really encourage snacking and don’t discourage it.

Snacking, if done in a correct and healthy manner, can be beneficial and protective for good glycaemic control. Therefore, inform your doctor and dietitian if you enjoy small regular meals and snacks in your daily routine so that they can adjust your insulin-regime accordingly.

Also, if your lifestyle does not welcome snacking so openly and it is something you don’t particularly enjoy, then you don’t have to snack. It all comes down to your preference.

Mindfulness

Where snacking may become a problem is when it’s done mindlessly and out of boredom or habit. Remember that listening to your hunger and satiety cues are extremely important.

Do a hunger-fullness scan before eating and remember that emotional hunger will never be satisfied by eating.

Dr Michelle May states it perfectly, in the book series Eat What You Love, Love What You Eat: “When a craving doesn’t come from hunger, eating will never satisfy it.”

It is worth HALTing if you experience any of the following:

• Hungry: Do I need something physically or emotionally?
• Angry: What is causing me to feel this way?
• Lonely: Am I having difficulty connecting with others?
• Tired: When was the last time I took a break?

What makes a healthy snack?

Every time you snack, it’s an opportunity to give your body the beneficial nutrients you need to, not just survive but to thrive. Seeing it that way, we often think twice and make every bite count.

Same as with meals, snacks also need to be nutritious and filling. Therefore, it’s important that it contains complex carbohydrates, lean protein and/or healthy fats.

• Complex carbohydrates: These might be in the form of whole or multigrain, with the low-GI and diabetes stamp of approval, containing sufficient fibre, and so the glucose can be steadily released into the bloodstream.
• Lean protein: In the form of eggs, low-fat cheese, tuna, chicken (without the skin) or biltong (without the fat). This is also which causes satiation and will help regulate the glucose.
• Healthy fats: These not only help to lower the GI of a meal but also makes it a nutrient powerhouse. These can be in the form of nuts and seeds, nutbutters or avocado. Beware of fats though, remember too much of a good thing can also be a bad thing so keep your portion sizes in check (e.g. thumb size for fats).

Healthy snack options

• Cucumber slices topped with fat-free cottage cheese and paprika
• Mushroom pizza (take big brown mushrooms, top with desired toppings, oregano and cheese. Bake in the oven or microwave)
• Crudités, like veggies (carrots, cherry tomatoes, mini mealies, cucumber, celery) with hummus
• Baked whole-wheat pita, veggies and tzatziki
• Fruit dipped in yoghurt and frozen
• Fresh fruit
• Trail mix (nuts, seeds, raisins or dried cranberries) *
• Avocado and Black pepper*
• Rice rolls with soy and tahini-based sauce
• Popcorn
• Apple slices and peanut butter
• Veggie chips
• Game biltong (or normal biltong without the fat)
• Yoghurt (plain non-sweetened)
• Rice cakes, corn thins, cracker breads topped with fat-free cottage cheese
• Boiled egg
• Overnight oats*
• Smoothie*
• Small quiches (chop veggies in muffin pan, cover with beaten egg, bake 10 min).
• Yoghurt bark (yoghurt on a baking sheet with fruits and seeds, freeze)
• Chocolate bark (dark chocolate on a baking sheet with fruits and seeds, freeze)
• Lettuce rolls (fill lettuce with lean protein, veggies, grain)
• Roasted chickpeas (sweet: cinnamon and honey | savoury: paprika and coriander
• Taco cups (whole-wheat wraps cut with a round cookie cutter, baked in a muffin pan, filled with chopped tomato, onion, peppers, etc.)
• Cracker breads with sardines/pilchards/salmon or tuna
• Veggie fritters (basic recipe is veggie + aromatics and spices + cheese + binding Agent)

*If on a weight loss diet beware of the portion size.

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Diabetes nurse educator, Christine Manga, explains why thrush is so common in people living with diabetes.

What is thrush?

Thrush is a common fungal infection that affects both men and women. It is also referred to as yeast infection. It is an overgrowth of the naturally occurring fungus Candida albicans.

Any person with a weakened immune system will be more susceptible to thrush. These conditions include but are not limited to diabetes, iron or vitamin B12 deficiency, HIV and autoimmune hypothyroidism. It was even picked up in studies that people with prediabetes had elevated levels of candida.

Where does thrush occur?

Oral and genital thrush are the most common. However, it can also occur in the armpits, between the fingers, in the groin area and under the breasts. Throat and oesophageal thrush are often found in people suffering from HIV/AIDS.

Causes of thrush

Thrush occurs when there is a disruption of the natural balance of good bacteria allowing an overgrowth of the Candida fungus. There are numerous causes for these imbalances.

• People with diabetes, especially poorly controlled, high blood glucose levels lower the pH of the saliva, making it more acidic. Candida thrives in a lower pH environment.
• In people with diabetes, there is a diminished tissue response to injury allowing for colonisation of Candida. Examples of injuries include a toothbrush slipping and cutting the gum, braces that cause ulcers as well as ill-fitting dentures.
• Poor oral hygiene has been positively linked to an increased risk of developing thrush.
• Xerostomia (low levels of saliva/dry mouth) can be caused by certain medications, such as antidepressants, dehydration and high blood glucose levels. Smoking may not necessarily cause a dry mouth, but it does exacerbate it as well as irritating the mucosal lining of the mouth.
• Medications that are known to cause thrush include cortisone, inhaled corticosteroids, antibiotics. This is because these kill the good bacteria rendering them unable to control the fungal growth. Hormonal birth control methods can increase the risk of developing thrush by disturbing the body’s natural hormonal balance.
• Diets that are high in refined and sugary foods. Candida loves sugar!
• Pregnancy, due to the changes in the hormones.
• Antibacterial soaps wash away the naturally occurring good bacteria, once again allowing for the overgrowth of fungus. This would be pertinent to genital thrush
• Overuse of antibacterial mouthwashes.

Symptoms

Oral thrush

• It usually presents as creamy white patches on the inner cheeks, tongue and gums. It can also be found on the palate.
• Soreness or a burning sensation.
• A cotton-like sensation in the mouth.
• A bad taste in the mouth.
• Loss of taste.
• Angular stomatitis – cracks in the corners of the mouth.
• Possible difficulty in eating and swallowing.

Genital thrush

Males

• A whitish grey clumpy discharge resembling cottage cheese under the foreskin.
• Redness or red patches on the head of the penis (glans) and under the foreskin.
• Difficulty pulling back the foreskin (phimosis).
• Pain during sex.
• An unpleasant odour may be present but not always.
• Can cause burning when passing urine.

Females

• Vaginal itching.
• Swelling of the vulva (external part of vagina).
• Soreness and redness.
• Pain when passing urine.
• Whitish grey cottage cheese-like discharge.
• Pain during sex.

Diagnosis

Thrush can be self-diagnosed by looking for the symptoms. You could also visit your doctor who would usually be able to identify it just by having a look. If there is uncertainty, a painless swab of the area can be taken and sent to the laboratory for investigation. If you experience more than four episodes a year, it is advised to visit your doctor.

Treatment

Treatment is simple. Thrush can clear up on its own. With treatment, it can clear up within three days.

• An antifungal tablet taken orally and/or cream will be prescribed for both men and women for genital thrush. Women also have the option of a pessary, a soft gel capsule inserted into the vagina.
• Antifungal tablets, lozenges, oral gels or oral suspensions are used for oral thrush.
• Natural remedies include eating plain yoghurt or using it as a cream on the affected area. Yoghurt contains naturally good bacteria.
• Salt water or baking powder baths. Salt is an antiseptic and has soothing properties. Baking soda has been found to be antifungal.
• Gentian violet can be applied to the affected area in the mouth.
• In complicated cases, thrush may cause severe damage to the mucosal lining, causing a secondary bacterial infection, possibly needing antibiotic treatment.

Prevention

• Good blood glucose control is paramount.
• Maintaining good hydration.
• Proper, regular dental care including flossing and brushing teeth. Be careful about the mouthwash that you use.
• Maintain good hygiene.
• Avoid antibacterial soaps. Our bodies need the good bacteria. Do not use a loofah, exfoliator or rough sponge on the genitals, this will cause microscopic tears to the mucosa.
• Try to follow a diet with a lot of whole foods with a low sugar content.
• Taking probiotics may reduce the risk of thrush infections.
• Rinse your mouth thoroughly with water after taking and inhaled corticosteroid.
• Women should wipe from front to back after urinating.
• Wear cotton underwear.
• Wear loose fitting clothing.

Although many people with diabetes do suffer from thrush, it is also a very common symptom of diabetes. Many people are tested and diagnosed with diabetes due to recurrent thrush episodes.

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Dr Larisse Badenhorst explains the correlation between body image and sexual function.

Body image is the confluence of your perception of your physical self and the thoughts and feelings that result from that perception. It involves how you see yourself compared to the standards that have been set by society.

It is evident that body image is highly subjective, whereas body mass index (BMI) is more objective. Your BMI is the measure of your weight compared to your height. Using this calculation, you are classified into categories (either underweight, healthy weight, overweight or obese).

Your perception of your physical self can be either positive or negative (body satisfaction versus dissatisfaction). This is not necessarily dependent on body habitus, but on how you perceive yourself.

How is body image formed?

The evaluation of your appearance is shaped and developed in a socio-cultural contact where cultural messages convey standards, valued physical characteristics, and gender-based expectations to certain physical attributes.

The media is often claimed to be the most influential source of presenting the ideal body. It is believed that body image is well-established by the age of 16. For both genders, an exercised and slender body symbolises values that are highly-regarded in our society, such as will power, control and success.

The difference between men and women

Body image as a construct is not gender-specific, but literature on it correlates overwhelmingly focus on women’s experiences. Many women’s self-worth is tied in with their perceptions of their attractiveness. Women are socialised to believe that if they fail to attain the cultural ideals of thinness and beauty, men will not see them as attractive.

Although there is pressure on men to fulfil the male body ideals, men are socialised to believe that other characteristics are also important when women evaluate their attractiveness.

Women’s bodies are regarded more as objects of observation. Particularly by men, in a way that is sexually satisfying for men. Thinness rather than health has been described as the most valued physical attribute in women.

Self-objectification, body dissatisfaction and the desire to change one’s body to more closely meet the ‘thin cultural ideals’ are normative among women in the western culture. Consequently, many young women may view their sexual desirability as synonymous with thinness.

Effects on sexual relations

Situations where body-related concerns are more prominent and the body is at focus is during sexual intercourse. Body dissatisfaction may result in avoidance of exposing the body in sexual encounters. This in turn may inhibit sexual desire, pleasure and performance.

Negative body image has been found to be a predictor for lower intercourse frequency or sexual avoidance; being distracted during sexual intercourse; and inhibited sexual arousal, pleasure and satisfaction, especially in women.

Given that messages around women’s bodies are fractured and contradictory, being dependent on intrapersonal and cultural-level ideas around fat and shape, may leave women at the whim of things out of their control.

Mental health factors, such as anxiety, depression or eating disturbances directly or indirectly through BMI and body image, may influence sexual satisfaction. People who experience body-related anxiety may also be experiencing sexuality-related concerns.

Accepting your body

Size acceptance has the goal of decreasing negative bodily regard and increasing acceptance of your body as it currently is. Rather than focusing on weight loss.

A woman resisting self-objectification may have a different perception of her appearance to others and a different reaction to a partner’s attraction to her and may experience a more integrated and satisfying sexually healthy self.

Sexual satisfaction, specifically in women, stems from the need to feel accepted and emotional closeness with their partner, as well as commitment and love in their relationships. This shows that a person’s perception of intimacy with his or her partner is important for sexual satisfaction.

However, negative body image is often associated with feeling sexually insecure and dissatisfied. This may in turn have consequences for the perception of intimacy with your partner. If the body becomes too much of an object and does not feel emotionally intimate with the partner, this is likely to result in reduced sexual satisfaction.

In studies done, the relationship between body image and sexual satisfaction disappeared when relationship satisfaction was introduced in the model. The most important predictors of high sexual satisfaction were perceived intimacy with a partner, followed by body image. Sexual satisfaction is likely to stem from feeling acceptance and emotional intimacy with the partner, in both men and women.

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Guidepost, a digital healthcare solution, is emerging as an effective tool for safe, remote diabetes management and has attracted investment to take on the challenge.

About Guidepost

Guidepost is a South African healthcare technology business that has been innovating in the telemedicine space since 2012. The company’s unique diabetes offering has grown into a national network, serving leading visionary health insurers, life insurers and pharmaceutical companies.

Guidepost’s technology platform enables diabetes coaching that is long-term, relationship-based and driven by trained diabetes coaches.

The Guidepost programme has served over 15 000 patients and has collected over one million clinical data points. On average, patients on the programme have seen a 2,5% point decline in their HbA_1C levels.

COVID-19 results in telemedicine services

The recent pandemic is a serious risk for the estimated 4,6 million people with diabetes in South Africa as high blood glucose levels increase the mortality risk posed by COVID-19.

“COVID-19 is far more serious for people with chronic conditions like diabetes and hypertension” says Professor David Segal, Chief Medical Officer and co-founder of Guidepost. “A recent study by the provincial Health Department in the Western Cape found that diabetes was a factor in more than half of the province’s 2 000 COVID-19 deaths of people older than 20. As the risks related to chronic conditions are now more ‘real’, people are more aware of the risks and are taking the management of their chronic conditions seriously. They are looking to digital healthcare services, such as telemedicine, as safe, effective and efficient ways of managing their conditions.”

Joint investment to scale up impact

AlphaCode, the fintech investment arm of Rand Merchant Investment Holdings (RMI), and the local investment fund of Endeavor, a global entrepreneur network, have recently concluded a joint investment in Guidepost.

“We believe in the work being done by Guidepost and continually invest in the technical tools that are enabling a technologically advanced future for our country. Guidepost has demonstrated its ability to reduce claim costs for clients and improve the lives of thousands of diabetes patients and we’re excited to support the growth and development of their services locally and internationally through this second-round investment. We also believe that the skilled leadership team could roll out this methodology for other diseases and chronic conditions,” says Dominique Collett, Senior Investment Executive at RMI and Head of AlphaCode.

Managing Director at Endeavor South Africa, Alison Collier, added, “Endeavor supports high-impact entrepreneurs that are scaling their business rapidly, and looking to grow to be the market leader in South Africa and expanding internationally. We’re delighted to be investors in Guidepost, helping a South African success story to scale their business globally leveraging Endeavor’s strong local and international mentor base. Guidepost’s service is particularly relevant given the COVID-19 crisis – offering diabetes patients improved healthcare while simultaneously reducing the total care cost for these patients as patients using Guidepost are healthier.”