Is Dr Diab a GP?
Yes and No! Dr Diab can practice as a GP but has chosen to focus her practice on diabetes management. She is also registered as a specialist Family Physician with a masters’ degree and additional post-graduate training in chronic disease management and integrated care. She has also completed the CDE advanced course in diabetes management with distinction and is currently completing her PhD in the field of Diabetes. She has a passion for individualised care and patient empowerment through education.
Is the practice contracted into medical aids?
No. We are not contracted in to medical aids. The reason for this is that medical aids all have different tariff codes which become almost impossible to administer. Secondly, the practice does not focus on curative care which is re-imbursed by medical aids but rather on regular education of patients and their families and prevention of complications of diabetes. Preventative and holistic education of patients is time-consuming but effective in the long run and as such consultation times are usually much longer than the normal 10-20 minute curative consult.
What is the CDE?
The Centre for Diabetes and Endocrinology is a specialised network of doctors throughout South Africa that all have a special interest and training in diabetes. This is different from GP networks that are based on practice attributes alone. All CDE centres in South Africa are accredited on an annual basis in terms of their staffing, practice administration, practice offerings and clinical expertise of the health care practitioners. Those patients whose medical aids are contracted into the CDE programme can sign up with a specific centre where they will receive all their diabetes care in a co-ordinated and managed fashion. Dr Diab runs one of a handful of CDE Centres of Excellence in KZN and in 2016 was awarded a prize for the Best Clinical Practice in South Africa. Even if your medical aid is not contracted in to the CDE, you can still make use of this Centre of Excellence on a fee-for-service basis. If you would like to join the programme, details are on the practice website www.theatrium.org.za or www.cdecentre.co.za.
What is a nurse educator and why should I see her?
A diabetic nurse educator (DNE) works alongside a diabetologist in educating and adjusting therapy according to the patients’ lifestyles. Sr Fiona Prins has a wealth of experience in diabetes and approaches her consultations from a coaching perspective so that patients feel empowered and motivated to adapt their lifestyles as necessary. A DNE can also monitor regular downloads of your glucometer, make adjustments to therapy and liaise with the doctor to advise on the best therapy options. Sr Fiona also runs regular diabetes conversation map groups where patients can get together in small groups and discuss and learn from each other. Speak to her directly to arrange a suitable time for these groups.
Why can’t I just get a repeat script every 6 months without all the fuss and bother?
That is how we used to treat diabetes! And that approach led to high rates of morbidity – amputations, heart attacks, strokes, loss of vision etc. These complications are all preventable and have little place in modern day diabetes management. The changes that occur in diabetes are also not purely a result of “bad behaviour” but often a combination of the natural progression of diabetes and sub-optimal management. By reviewing your diabetes regularly, actively looking for complications, checking your bloods, having your eyes, heart & feet examined and being in control of your condition, it has been shown that you can prevent or at least delay the onset of complications. Education and patient empowerment are pivotal to this style of management and are the cornerstone of treatment offered at The Atrium Lifestyle Centre.
Why do I need to test my sugars all the time?
Your glucose (sugar) levels fluctuate on a daily / hourly basis depending upon the food you eat, the activity you are doing, your stress levels, intercurrent infections and a variety of other factors. In order to avoid excessive peaks and troughs in your blood glucose levels, most people need to monitor their levels regularly. Your doctor or DNE will advise exactly when this should be done but usually before & after meals is the most common time to test. Fasting blood levels first thing in the morning or bedtime levels are also useful. If you notice changes in your readings, rather contact your health care provider and ask her to adjust your medication so as to keep your glucose levels as stable as possible. Please remember to bring your glucometer with you to all appointments so that the machine can be downloaded and important treatment decisions made.
But my eyesight is fine. Why do I need to get it checked?
Your eyes have thousands of tiny blood vessels that supply your retina. Not all of these have to be damaged to cause a loss of vision. By the same token, because there are so many of them, it often takes a while to develop a loss of vision. By regular screening and examination of the eyes, these vessel abnormalities can be detected and treated early. They also give a very good indication as to the state of other vessels in the body as well.
Why all those expensive blood tests so often?
Diabetes can have many and multiple complications. Some of these are poorly reversible and as such, regular monitoring of blood tests ensures that downward trends are picked up timeously. Diabetes is also often found to co-exist with other conditions and therefore blood tests need to be done to detect these diseases promptly. Please consider requesting a blood referral form prior to your appointment so that the results of the tests can be considered with the rest of your clinical findings at your appointment. Otherwise, follow-up appointments sometimes need to be made to re-adjust treatment decisions. Medical aids do re-imburse most of the tests required under chronic benefits but not all. Dr Diab and Sr Fiona do not just run off a battery of tests on each patient but tailor them for individual needs, weighing up the costs of the tests against clinical need. If you do not wish to have additional tests done that your chronic benefits do not cover, please let them know but also be aware that this may compromise your management plan.
When can medications be collected from the centre?
For some patients who have chosen to have their chronic medication delivered to the centre, these medications can be collected on Tuesdays between 9 and 11am and Thursdays between 2 and 4pm. Should you wish to collect at another time, please phone a day or two in advance and make an arrangement that will suit you. Medications can also be collected on Saturdays by special arrangement. Please remember to bring your glucometer with you when you collect your medication so that adjustments to therapy can be made where necessary.
Who else is part of the multi-disciplinary team?
Diabetes management requires the support and input of a full multi-disciplinary team. At the Atrium Lifestyle Centre we are blessed to have many experienced and wonderful practitioners who complement and extend the services offered to patients. Many of them do have a special interest in diabetes and chronic disease but do not limit their services to chronic diseases only. We currently have a psychologist, physiotherapist, occupational therapist and health coach as well as an audiologist. Two visiting specialists, a specialist physician and palliative care specialist also work on a part-time basis at The Atrium. Please refer to the website for more information on each of these practitioners.
Can I get a script for my other chronic conditions from Dr Diab as well?
Although Dr Diab is a registered family practitioner and legally allowed to prescribed all chronic and day-to-day medication, her consultations, do not focus on these conditions. Managing diabetes from a holistic perspective and preventing the multiple co-morbidities and complications through education and support is a time-consuming process. Most patients prefer to utilise this time to gain better control of their diabetes. All chronic medication needs to be clinically reviewed every 6 months and as such other conditions such as asthma, arthritis and depression may require x-rays, lung function tests etc in order to manage them optimally. Sometimes, these conditions go hand-in-hand with diabetes management and the management thereof is intertwined. In these cases, Dr Diab may well make recommendations as to your hypertension or cholesterol or thyroid function treatment. In other cases, Dr Diab may recommend a more thorough investigation by another physician. Please remember that these decisions may be made on an individual basis with the patient’s best interests at heart. Medications all have side effects and very often may require specialist knowledge of therapy in order to prescribe the best medication for the individual.