International United Scientific and Social Population (IUSSP): 28 th International Population Conference (IPC) Assessment of the effect of climate change on self-care management of Type 2 diabetes; using Type 2 diabetes patients at Phiphidi Village located in Vhembe District in Thulamela Municipality in Limpopo Province of South Africa as a case study Author : Fhulufhedzani Nembambula Organisation: Statistics South Africa Year : 2017
Abstract In South Africa, three-and-a-half million people are suffering from diabetes and there are many more that goes undiagnosed. On the other hand, climate changes are felt across the globe. Diabetes and climate change as inter-related elements are globally impacting human health at an accelerated rate, and are two urgent challenges facing the 21st century today. The study outlines the effect of climate change or more specific, extreme hot conditions on the self-care management of Type 2 diabetes. Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose) which is the body's important source of fuel and also known as adult-onset or noninsulin- dependent diabetes. The study mainly focused on the self-care management of Type-2 diabetes (blood sugar levels, healthy eating, medication and physical activities) during extreme heat conditions. For the purpose of the study, randomly selected households were visited, using questionnaires to collect information about the effect of extreme heat condition on self-care management of Type-2 diabetes. Furthermore, climate information was collected using temperature trends data obtained from the South Africa Weather Service. The study will pave a way forward for the Limpopo Department of health in better assisting rural diabetic patients with the management of their diabetes during times of extreme heat conditions. 1
Background Globally, more than 300 million people suffer from diabetes and it is estimated that by 2030 the number will reach half a billion. The implications are that families could be impoverished, labour productivity could be hampered and health systems could be overwhelmed. Globally, according to the International Diabetes Federation (IDF) (2011), diabetes are responsible for the deaths of 4.6 million people per year and furthermore, four out of five people suffering from diabetes are living in low to middle income countries. On the other hand, climate changes are felt across the globe. This is evident considering that sea levels are rising, tropical storms are causing damages along coastlines, fertile lands are battling floods or drought and the permafrost in the Polar Regions is melting. Diabetes and climate change as inter-related elements are globally impacting human health at an accelerated rate which are two critical challenges faced by the 21st century. The research was initiated when I worked as a diabetes medical sales representative. The one thing that stood out for me was that during extreme hot conditions, diabetes patients struggled to self-care manages their condition especially when considering eating healthy food, regular exercising and taking their medications as prescribed. The aim of the study will outline the effect extreme hot conditions has on the self- care management of Type 2 diabetes. Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose) which is the body's important source of fuel and also known as adult-onset or noninsulin-dependent diabetes(Mayo Clinic,2017). The study focused on the self-care management of Type-2 diabetes considering blood sugar levels, healthy eating, taking medication as prescribed and physical activities. The outcome of the research will endeavour to answer the key question on how does extreme heat conditions affect the self-care management of Type 2 diabetes as a chronic condition. 2
Research Methodology In Rajasekar et al. (2013) view, research is a logical and systematic search for new and useful information on a particular topic for finding solutions to scientific and social problems through objective and systematic analysis. Research methodology in essence is the study of the method of which the information is gained and could be quantitative, qualitative or both. Quantitative research is based on the measurement of quantity or amount results being a number or a set of numbers. Qualitative on the other hand is non-numerical, descriptive, and exploratory which applies reasoning and is concerned with qualitative phenomenon involving quality (Rajasekar et al.2013). The study includes both quantitative and qualitative research. It is qualitative in the sense that randomly selected households were visited, using a questionnaire (see Annexure A) to collect information on the effect hot conditions has on self-care management of Type 2 diabetes when taking into account blood sugar levels, healthy eating, taking of medication as prescribed and other challenges. It is quantitative based on the fact that climate change information was collected using temperature trends data obtained from the South Africa Weather Service. Furthermore, the Statistical Package for the Social Science (SPSS) was used to analyse the primary data collected using questionnaires. Lastly to illustrate the challenges faced by especially black rural diabetic patients. Phiphidi village located in the Vhembe District in Thulamela Municipality in Limpopo Province was used as a case study (see figure 1 and 2). Case studies excel at bringing to understand what is known through previous research or real-life events (Soy, 1997). Case studies contextualise the relationships between events or certain conditions. Basically, as summarised by Yin (1984 and 2009), case studies explains the contemporary phenomenon within its real life context. 3
Figure 1: Map of South Africa 4
Figure 2: Map of Limpopo Province showing Vhembe District and Thulamela Municipality and Thulamela Municipality Map. Literature Review Climate change as defined by the National Aeronautics and Space Administration (NASA) (2014) is a change in the usual weather found in a place which can be a change in how much rain a place usually gets in a year or a change in a place's usual temperature for a month or season. Climate change according to IDF (2011) is the biggest threat to human health and exacerbates existing health risks including increased morbidity and mortality from non-communicable diseases (NCDs) such as diabetes. The effects of climate change, including climatic extremes, may increase risk of diabetes in populations by curtailing physical activity, disrupting traditional food supplies, and increasing food insecurity. On the other hand, extreme climatic events such as heat waves increase morbidity and mortality in people with underlying conditions such as diabetes, and damage healthcare infrastructure and its capacity to deliver essential care for people with diabetes (IDF, 2011). 5
As mentioned, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces (World Health Organisation (WHO), 2010). There are two types of diabetes, Type 1 diabetes which is characterized by a lack of insulin production and without daily administration of insulin can be fatal and Type 2 diabetes which results from the body’s ineffective use of insulin. According to WHO (2010) approximately 90 percent of people with diabetes around the world suffers from Type 2 diabetes. Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin - the cause is unknown. The general assumption is that genetics and environmental factors, such as excess weight and inactivity, seem to be the contributing factors (Mayo, 2016). Furthermore, new research conducted by Waters(2017) suggests that if the state of fresh food supply which is essential for the diet of those diagnosed with diabetes is affected by climate change (high temperature) could lead to a rise in Type 2 diabetes. This is further emphasised by Orenstein (2011) stating that diabetes patients normally end up in emergency rooms during extreme hot conditions and as a result higher number of deaths occur during summer seasons. Therefore, according to WHO (2016), lifestyle measures shown to be effective in preventing or delaying the onset of Type 2 diabetes are: 1) maintaining a healthy body weight; 2) being physically active; 3) eating a healthy diet, 4) avoiding sugar and saturated fats intake; and 5) avoiding tobacco use as smoking increases the risk of diabetes as well as cardiovascular diseases. Moreover, eating well also helps to manage blood glucose levels and body weight and exercising helps the insulin work more effectively, lowers blood pressure and reduces the risk of heart disease (Diabetes Australia, 2015). MedLinePlus (2017) to ensure that the management of diabetes especially during extreme hot conditions is maintained, it is essential to take the following precautions measures, namely 1) to stay hydrated, 2) to store medication properly, 3) to stay out of the heat, and 4) to know the signs of low blood sugar such as sweating and shakiness or confusion. 6
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