Category Archives: technology

Medical aids and the future?


In my opinion which some may argue is not humble. I argue it is.

Medical aids restrict care for patients as well as shoot themselves in the foot when it comes to downstream costs.

Particularly in an environment like south africa where we have this tsunami wave of a diabetes epidemic. Approaching things holistically (as CDE which originated in Joburg and is now all over RSA) is the only way to manage the finances we have. Yet the push back from some medical aids is interesting to use a word so as not to offend.

I am merely a GP – general practitioner. I have made it my mission to stay up to date (as well as the most qualified I can be) regarding diabetes at large. I am passionate about it. I am even more passionate about the best care for my patients. This largely could translate to the best money spent for medical aids but alas it does not turn out that way 9 times out of 10.

There are medical aids who are open minded and practice preventative care like Discovery and medications and appliances are provided with insight and good application.

I wish this were across the board. Alas not in our beautiful country.

Patients vote with where they pay their money.  The next few years are critical as to both the direction of medical aids and whether the money will be spent effectively saving downstream costs or whether the whole thing just implodes. Every day another massive wave of patients are added to this problem. It is soon to hit that critical mass where devastation occurs.

We have to become more preventative, we have to manage what we have to the best of our abilities with what we have.  That is best done with more brains. Team is key. Technology is key and unfortunately not everyone is on this boat.

Think before you drink before you drive, think before you eat that cake and you don’t survive.

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Tidal wave required


Ok so life is interesting in south africa. I would like the kind of money that Manyi  has, 450 million? was it. I would use it to “fund” my patients needs.

Diabetics, type 1’s in particular have many needs. Most of these are not taken care of by their medical aids and despite the fact that patients pay a LOT of money for the privilege of being on one.

Type 1’s require tight control of glucose above a certain range and below a certain range and everything including the weather impacts on blood sugar. Thus continuous monitoring is a tool that can make a very very big difference in a patient’s life – it can also make such a difference that the medical aid is spared costs of admissions for highs and lows, for amputation, renal dialysis, heart attacks as well as costs attached to being blind.

However medical aids at large do not seem the slightest bit interested in saving themselves money.

Far rather milk the patient for all they are worth and at the same time provide the minimum service and complain about any request made by the health care provider who has studied long and hard and has a passion to save the medical aid costs.

Yes I am angry, perhaps at this time of day I am even h”angry”.

I am tired of begging, pleading for minimum standards of care.

I am tired that overseas things get “accepted” years before they do in south africa. Are we really 3 rd world? Despite having the “Manyi’s” ???

We require a tidal wave of protest in the form of intelligent debate with the stakeholders that matter in the realm of diabetes. I am just so tired of fighting.

Please from far and wide across  this beautiful country we call home join me, join the debate, write to your medical aid. Email me : drleethegp@gmail.com.

Please.

Continous monitoring is available in 4 forms in south africa : dexcom G5 and G4, libre flash abbott, medtronic standalone CGM and most new to the scene : ever sense.

Coming in at the lower end is the abbott flash R990 once off and R990 every 2 weeks. Dexcom is a cost upfront more than about 25k and then monthly around 4 k, medtronic around 15 and 2k per month and ever sense brand new so not too sure but in the ball park for the last 2 mentioned.

What is boils down to is MARD and quite frankly this is the bottom line with CGM is accuracy. The lower the MARD the more accurate. There are really only 2 in the market that a great on MARD : dexcom G5 and ever sense, however for the cost the libre is actually a very good value for money.

The other thing that helps me as a practitioner is a trend and all of the devices are good for this.

What we need is for the medical aids to realise that CGM is a tool they their patients can NOT afford to be without! FOR THEIR own sakes – the medical aid’s sakes.

Please tsunami arrive and let’s flood the medical aids with the truth.

Alternatively could the guptas or the Manyi’s or maybe Grace Mugage give me 450 million to spend on my very deserving patients.

Thanks ;).

Pump for me or not for me?


Report back : We had a marvellous discussion about pumps on wednesday evening. Highly enjoyable and informative, even our pump patient learnt something.

JOIn us today : On wednesday night 530 pm in Hilton Pietermaritzburg we will be holding an informal hour discussion about pumps -insulin pump therapy. What is pump therapy ? Who “qualifies”? What is the benefit. Is it for everyone who injects insulin?

Feel free to join us for free for an hour to explore the “pump market” in south africa and get first hand feedback from “pump” patients 😉

Diabetes and drama


What will it take to get people to sit up and listen and apply very simple steps to their lives to prevent type 2. What will it take to get governments to realise that uncontrolled diabetes is financially crippling as well as a complete disaster.

These things are preventable and treatable BEFORE we get to economic crumble – which is seemingly inevitable at the current pace. Not too sure if the politicians realise the implications, however far and wide it seems the people who choose politics don’t always have the general public’s best interest at heart.

Type 2 diabetes is essentially a lifestyle induced disease and yet uncontrolled the repercussions are : amputations, blindness, heart disease and kidney failure (dialysis). The  cost implications of these aforementioned are HUGE as well as the loss of able body and minded people in the system of generating income.

Type 1 diabetes has exactly the same repercussions if not controlled and right from the get go is more expensive to manage properly. And yet with better management you ensure a healthy body that if targets are met will generally outlive the general public.

In south africa especially in the state sector both type 1 and 2 are poorly managed to say the very least and this knocks on to a growing population of patients requiring expensive treatments – that they inevitably get. It would make so much more sense to be preventative in terms of spending the money more wisely.

You don’t have to be a mathematician to understand what a log curve is. This is the current trajectory that we are on. With no sign of a slight dip of any relenting any time soon.

And yet – with simple interventions – like sugar tax and awareness we could really make a HUGE impact. Why ? Why are we not doing it? Is it because we do not WANT to??

It just boggles my mind.obesity4money

Dexcom spaghetti


How does one unravel the download of dexcom spaghetti? I find continous monitoring is HUGELY beneficial to the patient on a literally minute to minute basis and in terms of the “knowing” what their sugars are and in terms of littlies the mom or dad “knowing” minute to minute “where” things are at.

For the health care professional however there is a lot of spaghetti to wade through.

My personal favourite is the graph that averages everything out and plots one average on a 24 hour day. For me I can USE this information to adjust settings and give advice. NO two days are quite the same, diabetes remains a learning game, but if you use your trends you will always win, just a little rhyme for a bit of fun.

Diabetes is a challenge, an obstacle, a learning game. I learnt recently from a very inspirational type 1 diabetic that one needs to dance with the obstacle. I am learning myself (as a health care provider) to dance with the obstacles I have in caring for diabetics.

how to unravel

how to unravel