The Diabetes Care Programme supports Dr Martine Joffe's patients entirely

GP, Dr Martine Joffe, has worked in a very busy general practice in Johannesburg North for the past 14 years. "We deal with everything from chronic disease management to psychiatric, gynecological issues and acute traumas," she explains. "We also work with a core team of specialists beyond the practice. We take a very holistic approach to our patient-management - particularly in our management of diabetes.

For the past 11 years, she has dedicated much of her time to a satellite unit within the broader practice, dedicated to treating patients who are affected by diabetes.

Dr Joffe has a personal interest in ensuring optimal diabetes management. "My late grandmother lived with type 2 diabetes and was a bilateral amputee, so I understand the effects of unmanaged diabetes very well," she explains.

"We aim to enrol every Discovery Health Medical Scheme (DHMS) member who require diabetes management - about 85% of our patients are DHMS members - on the Diabetes Care Programme. The programme ensures - and funds - specific, personalised and relevant care for each patient and aligns very much with the holistic approach that is fundamental to achieving optimal management of the condition and nipping complications in the bud.

Giving patients who have diabetes access to the right  healthcare providers at the right time

Once Discovery Health Medical Scheme members have registered their condition on the Chronic Illness Benefit, their Premier Plus GP can register them on the Diabetes Care Programme, which is designed to offer additional cover and support for people who have diabetes. This includes cover for:

• One additional consultation with a dietitian each year (in addition to the consultation covered through the Chronic Illness Benefit)
• One consultation a year with a biokineticist
• A diabetes coach (for qualifying members)
• And, on the Discovery app:
  • A personalised Diabetes Management Scorecard
  • Active Rewards.

"We also apply the Diabetes Care Programme holistic care model to all our patients"

"Using the Diabetes Care Programme as our scaffold, we have built up processes to make sure that all the healthcare providers within our satellite unit speak the same language around diabetes management, ensuring that our patients hear the same, consistent, clear messages," adds Dr Joffe. "At the end of the day, we apply the Diabetes Care Programme type model to all our patients, whether they are members of a medical scheme or not. What we do is about far more than just sitting a patient down and explaining blood sugar readings and how diabetes can affect their life. It's about creating a partnership between the patient and their doctor to catch the condition early, treat it optimally and connect the patient with the right allied healthcare practitioners  - a diabetic nurse educator, ophthalmologist, biokineticist, podiatrist and dietitian - at the right intervals through the year, to ensure that the complications associated with the progress of diabetes are prevented on every level."

"We are very hands on. We have an open door policy can call us with any query."

The unit's diabetic nurse educator plays a key role on several fronts. "She proactively books appointments with patients to ensure that they are on track with check-ups needed in line with the Diabetes Care Programme or over and above the programme's dictates, depending on the individual patient's needs. She also reminds people of their appointments, sorts out the few private accounts we have - the majority of claims go directly to the Discovery Health Medical Scheme - and educates our patients on all aspects of day-to-day diabetes management: taking their prescribed medicines correctly, insulin injection techniques, monitoring blood glucose levels and more."

"We are very hands on. We have an open door policy, and patients can call us with any query. Overall, we hold patients' hands all the way, whether we've managed to catch their diabetes early, or are dealing with the complications of progressed and unmanaged disease. Unfortunately, we have had people come in with diabetes that may have been picked up years ago, but that has been poorly managed and has resulted in advanced eye disease, kidney disease, peripheral vascular disease and other complications associated with unmanaged diabetes. We refer them on for specialist care but keep very close tabs on them.

"We see far fewer diabetes-related complications in those patients we have had attend our diabetes unit for years than in those who have come in already diagnosed with advanced, unmanaged disease."

The impact of lockdown, and COVID-19

At the start of last year when the pandemic began take hold, we sent a letter out to our patients who live with diabetes, explaining that they were not at added risk of contracting COVID-19 but were at high risk of severe COVID-19 illness. We advised that they take extra precautions to limit their exposure to the disease and also to take immune-boosting supplements. We really emphasised the need for vigilance."

"We had a few patients contract COVID-19 and only one was admitted to hospital. We managed at least 18 of these patients remotely while they recovered at home. As soon as they were diagnosed with COVID-19 we prescribed high-dose immune-boosting supplements and adapted their treatment according to the latest clinical evidence. 

"This year proved the value of well-managed diabetes clearly: Patients with well-managed diabetes were able to navigate the illness successfully and recover from home," adds Dr Joffe. "The progress made on the Diabetes Care Programme prior to the pandemic stood them in excellent stead."

Their peak of COVID-19 in the practice corresponded with the peak of the pandemic in the country: "In July last year we were on the phone to patients day and night," recalls Dr Joffe. "But patient cases have come down very nicely since, in line with national rates of infection."

Dr Joffe and her colleagues advised patients who contracted COVID-19 to get hold of a pulse oximeter - a lightweight device that fits over the fingertip and measures the amount of oxygen in the blood. This is necessary to quickly detect the onset of a potentially deadly aspect of COVID-19 - silent hypoxia - in which blood oxygen levels drop, without any symptoms until one is in a serious state. A pulse oximeter allows a person to pick up any hypoxia immediately and, for high-risk people, proved to be life-saving in 2020.

• Did you know? Members of Discovery Health Medical Scheme have, throughout 2020, been proactively sent a pulse oximeter when they test positive for COVID-19 - paid for through their WHO Global Outbreak benefit cover, supported by access to a Discovery wellness specialist and a follow-up virtual consultation with a GP, where necessary. Find out more.
• How important is access to a pulse oximeter in high-risk individuals? Discovery Health's data shows that for high-risk medical scheme members who used a pulse oximeter while they recovered from COVID-19, the risk of death decreased by around 50%.

"We also advised that patients who contracted COVID-19 had a thermometer," adds Dr Joffe. "Patients would send us their temperature, blood pressure, blood glucose and oxygen saturation readings to us twice a day, also letting us know and how they were feeling. That's how we successfully managed many of our patients during lockdown."

Dr Joffe and her team found it interesting that some patients who have diabetes and use on insulin saw their insulin requirements double, in the short-term, while they recovered from COVID-19. "Their glucose levels were transmitted to use remotely from their continuous glucose monitoring devices," she explains. Read more about continuous glucose monitoring and Discovery Health's benefit enhancements to cover continuous glucose monitoring devices for members.

Once lockdown restrictions began to ease and patients began to return to the practice for routine healthcare, Dr Joffe noticed that the effects of months of stress, little exercise and poor eating habits had accelerated the development of diabetes in people who were showed signs of pre-diabetes at the start of the year.

"Now, our focus is on supporting our patients to safely resume their regular check-ups with the allied healthcare team. I am confident that we will be able to get everyone back onto a trajectory of adherence and healthy habits in the coming months, supported by their access to the Diabetes Care Programme."

The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.