South Africa's first Diabetes Research Centre at a public academic institution is operational and is a collaborative initiative that brings together research that is often happening in silos in different departments, says UP Diabetes Research Centre senior project manager Dr Patrick Ngassa Piotie.

Although housed in the Faculty of Health Sciences, the centre adopts a transdisciplinary approach and works across faculties to develop research that aims to improve the lives of people living with diabetes.

“It is a holistic approach to address the challenges around diabetes, from prevention to care, and will lead to a new vision in diabetes research,” he says.

The centre’s research strategy is organised around six clusters: the prevention of diabetes, diabetes management in primary healthcare, its management in hospitals, gestational diabetes developed during pregnancy, diabetes in children and adolescents and diabetes technology.

Diabetes, which is caused when blood glucose levels are too high, is the second most common natural cause of death in South Africa and 4.6-million people live with the condition.

According to the Department of Health, only 19% of people with diabetes treated in the public health system manage to control their glucose levels.

The danger of uncontrolled diabetes is that it can lead to strokes, blindness, heart attacks, kidney failure or amputation. Uncontrolled diabetes also has dire economic consequences on individuals, families, communities and ultimately the country.

Diabetes can lead to increased healthcare expenses as well as people losing their income.

The gestational diabetes cluster, headed by UP Department of Obstetrics and Gynaecology Professor Sumaiya Adam, is the most prolific of the six clusters. PhD, MSc and MMed research includes a ten-year audit of pregnancies affected by diabetic ketoacidosis when the body breaks down fat too fast and becomes acidic, and a profile of circulating micro-ribonucleic acid genes in pregnancies complicated by diabetes.

The centre’s main project to date is the Tshwane Insulin Project. Described as translational research in its prime, it is impacting the lives of South Africans living with Type-2 diabetes as they transition from oral drugs to insulin through the implementation of a nurse-driven, app-enabled and community-oriented intervention.

“One of the centre’s mandates is academic development. Being a university, we want to keep producing scientific knowledge that is relevant and impactful. In the long term, we want to develop researchers, a new generation of African investigators in translational and health systems research and implementation science,” says Ngassa Piotie.

The centre has already received a number of proposals, including from UP Department of Psychology researcher Sonja Mostert to look at the challenges people with diabetes experience in adopting healthy eating habits and taking up exercise.

Existing research includes a study by the UP Department of Paediatrics and Child Health’s Dr Maria Karsas on Covid-19 and diabetes, which is a PhD in dietetics on the dietary implementation of glycaemic load on blood glucose control of patients with diabetes, and technology-based solutions to disease management, such as the use of sensors to monitor glucose continuously in patients admitted to hospital in a diabetic coma.

Another use of technology that the Diabetes Research Centre will pioneer is telehealth, where healthcare is provided remotely by means of telecommunication tools, such as phones or smartphones. These services can include patient education or consultations with a specialist, a crucial aid in the South African public healthcare environment where there is often a shortage of health professionals.

The centre recently obtained approvals from the Faculty of Health Sciences’ Research Ethics Committee and the Tshwane Research Committee to pilot a screening programme for diabetes retinopathy using telehealth and artificial intelligence. Primary care patients will have access to a state-of-the-art camera that detects eye damage as a result of diabetes.

In addition to its research activities, the centre will also offer healthcare providers training, including a three-day workshop on diabetes and insulin management for nurses in primary care that Enterprises UP will administer.

UP Department of Internal Medicine Professor Paul Rheeder serves as director of the Diabetes Research Centre. Its management committee includes Ngassa Piotie and the head of each research cluster.

UP Faculty of Health Sciences dean Professor Tiaan de Jager chairs the centre’s advisory board. Others on the 14-person board include representatives from the World Health Organisation, the South African Medical Research Council, Sweet Life and the Diabetes Alliance South Africa, Youth with Diabetes, the National Department of Health, the Gauteng provincial government and the City of Tshwane.

“Through the UP Diabetes Research Centre, the University will have a meaningful impact on the lives of thousands of South Africans who are alone and without voice before a dreadful disease,” Rheeder and Ngassa Piotie say.