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= Development of diabetes in South Africa =

In South Africa, the amount of people living with diabetes is 1.826.100 as of 2018. Diabetes mellitus, more commonly known as diabetes, is a group of metabolic disorders. Common effects of diabetes include long-term damage, dysfunction and failure of various organs. According to the World Health Organisation, an estimated 422 million people globally are living with diabetes. In Africa, this number is up to 14.2 million as of 2015. This region has the lowest health expenditure spent on diabetes, which is one of the main causes for Africa having the highest diabetes related mortality rates. Also, the percentage of undiagnosed diabetes cases is highest in this region, with 66.7%. In South Africa, prevalence of the disease is changing due to an epidemiological transition, with South Africa slowly turning into one of the most overweight nations in the world. As far as treatment of the disease is concerned, innovations in ICT applications for self-management are looking promising for South Africa, as the country is working on addressing issues regarding access to broadband internet.

Epidemiology
The national diabetes in South Africa prevalence is estimated at 8.39%, with diabetes-related deaths accounting for 68.977 cases. The magnitude of the diabetes burden is further reflected in the mortality and causes of death statistics. These statistics show a worrying trend of diabetes moving from being the fifth leading underlying cause of death in 2013 to being the second leading underlying cause of death in 2015.

For South Africa, the prevalence of diabetes is quite comparable with other low- and middle income countries. The burden of disease for South Africa is disproportionate to higher income countries. This inequality can be explained largely by a considerable difference in lifestyle. However, South Africa is undergoing an epidemiological transition characterized by an increase in non-communicable diseases. This transition is mainly caused by rapid urbanisation and sociocultural factors, involving the perception of being overweight as a sign of success and beauty. As a result of this change in perception, a nutritional transition also takes place towards a diet consisting of high fat and refined sugars. This nutritional transition mainly effects women and is therefore is leading cause of a considerable increase in the prevalence of gestational diabetes (GDM) among women, with the prevalence reaching from 1.6% in 1969 to 25.8% in 2018. The nutritional transition has lead to South Africa being regarded as one of the most obese nations in the world.

Innovations in treatment of diabetes in South Africa
In South Africa, but also many other low- to and middle income countries, there is a high unavailability and low quality of service received by patients with chronic diseases. This is largely due to critical shortages of health professionals and resources in public health sectors. Therefore, providing quality health care can be an immense challenge for these countries. This also accounts for health care related to the treatment of diabetes. However, much research is conducted to improve the treatment and self-management of diabetes, for instance, by use of ICT for medical self-care. ICT tools can be used to address risk factors such as diet, physical activity and tobacco use by interventions to reduce smoking and increase physical activity. There are several examples of how ICT may be beneficial for diabetes self-management. Mobile phones can be used for uploading glucose levels and the internet, for example, might be useful for sending clinical information to health care professionals. Also, when phones are used to manage health, people might adhere better to treatment regiments, leading to reduction of serious implications. These interventions are found to reduce premature deaths by delivering effective interventions. To ensure that these kind of interventions are succesful, training and education must be incorporated into self-management of diabetes. Besides that, future ICT interventions need to put emphasis on communication and promotion of the benefits of the use of these interventions.