Treating diabetes means treating the whole person

Dr Hemant Makan began practicing as a general practitioner (GP) in 1985. "Back then, I referred patients who had diabetes, and especially those who needed insulin, to specialists," he says. "Partly, I wasn't adequately equipped to treat them - we only had a few hours of training on diabetes in medical school back then. But mostly, as a young doctor, I wanted to see as many patients as I could."

"In fact, what the patients really needed was more time with me."

Dr Makan soon realised that the patients he referred remained poorly controlled from a diabetes perspective and were disappointed when it came to their health.

"I also realised that the patient's ability to understand and manage their condition themselves, day to day, was fundamental to their outcomes."

Dr Makan practices in Lenasia, where many members of the local Indian community present with diabetes, often at a young age, and commonly with lower body weight than other population groups.

"I began to take a greater interest in diabetes and also found fulfilment in interacting with people with diabetes," says Dr Makan. In 1995, he completed a Fellowship in Family Medicine through the Colleges of Medicine, which enhanced his understanding of how to provide patient‑orientated, comprehensive care. Dr Makan brought a dietitian and diabetic nurse educator on board to help him manage and educate his patients, now in a patient‑centred way.

"This is where the Diabetes Care Programme has made a huge impact"

"Often, holistic patient care is lacking. Also, a patient's ability to understand and manage their condition themselves, day to day, is fundamental to good outcomes. They deal with and make decisions relating to their diabetes throughout the day. Patients have to be equipped and supported to do this," says Dr Makan.

"This is where the Discovery Health Medical Scheme's Diabetes Care Programme has made a huge impact. I signed up to the programme in 2019. Diabetes Care fairly remunerates GPs like me for the additional time that we spend with our patients who have diabetes, and really expands the access our patients have to us too."

"These are all the disciplines a person with diabetes needs access to, to optimise their care."

Our patients also have cover to see members of a multidisciplinary team who they can access through the programme. The team includes a dietitian, bio kineticist, podiatrist and ophthalmologist. These are all the disciplines a person with diabetes needs access to, to optimise their care."

"If we enrol patients onto the Diabetes Care programme upon diagnosis and teach them what they need to do, while supporting them, we undoubtedly lower their risk of complications over time. This is key to securing a good quality of life for them."

"Patients don't have to be concerned about out-of-pocket expenses."

"Diabetes Care removes issues around billing for every interaction and the administration for healthcare providers, and patients don't have to be concerned about out-of-pocket expenses."

Dr Makan has over 500 patients on the Diabetes Care programme. "We monitor their overall health, blood sugar control, cholesterol levels as well as kidney function at regular intervals. Their care is coordinated with referrals to related providers who take care of their eyes, feet, diet and exercise," he says.

• A haemoglobin A1c (HbA1c) test measures the amount of blood sugar (glucose) attached to haemoglobin in our blood. It shows our average level of blood sugar over the past two to three months, so it is a good way to check blood sugar control (diabetes control) over time.

"We individualise target levels for glucose control. In a recent analysis of our practice, the average HbA1c of our diabetic patient population was 7.6%. This is a good metric, considering that a large proportion of my patients are over 60 years old with longstanding diabetes," says Dr Makan. "The younger people with diabetes in our practice are encouraged to get their HbA1c levels below 6.5%."

"My patients have access to me in person or via virtual platforms at any time"

"My patients have access to me in person or via virtual platforms at any time," says Dr Makan, who engages digitally with his patients regularly. All patients use glucometers (handheld devices that read one's blood sugar). These readings can be viewed remotely, or they send their records to him for his input if there are concerns. Patients are also encouraged to have their meters downloaded on their visits to the practice so that this can be reviewed together. Patients using Continuous Glucose Monitors can also be monitored remotely.

"Having a patient orientated approach is essential in managing a person with diabetes"

"Having a patient orientated approach is essential in managing a person with diabetes. And it's critical to build a relationship with our patients so that we understand, not only their condition, but also their social and financial circumstances. This overall picture is meaningful to a doctor's true understanding of a patient and optimising their care. Here Diabetes Care is a key tool that helps me."

More information about Dr Hemant Makan

Dr Hemant Makan: MBBCh (Wits) FCFP (SA) PG Dip Diabetes (Cardiff) MSc Diabetes (Cardiff)

Dr Hemant Makan is a graduate of the University of Witwatersrand. He followed this with a Fellowship in Family Medicine through the Colleges of Medicine in 1995. In 2010, he completed the Postgraduate Diploma in Diabetes and then completed a master's degree in Diabetes. He obtained both these qualifications with distinction through the University of Cardiff in the United Kingdom.

Dr Makan's clinical practice was awarded the accolade of the best Centre for Diabetes and Endocrinology (CDE) in 2005. His centre has maintained the accreditation of a Diabetes Centre of Excellence. In 2016, he was awarded the Donnell D. Etzwiler International Scholarship. He runs a dynamic clinical research site with active participation in numerous Phase 2 and 3 international multi-centre clinical trials in the field of diabetes. He serves as both Principal Investigator and National Principal Investigator. Dr Makan's special interest is in the field of improving the self‑management of people living with diabetes.

Dr Makan served as an honorary lecturer at the University of Leicester in their postgraduate diabetes programme from 2011 to 2016. Locally, his involvement in lectures and workshops facilitates training of fellow healthcare providers. Dr Makan is a member of The Society for Endocrinology, Metabolism, and Diabetes of South Africa (SEMDSA). His passion remains the pursuit of excellence in diabetes care.