It is estimated that 422 million people in the world live with diabetes. WHO forecasts that this number will reach 622 million by 2040. The majority of people with diabetes live in developing countries. The number of people with diabetes is increasing, notably in Africa, from 3 adults among 100 people in 1980 to 7 adults among 100 people in 2014.

In Senegal, it is estimated that 400 000 people have diabetes, although only 40 000 people have been diagnosed and are receiving treatment. Khady, 43 years, and Gaye, 24 years, are among persons diagnosed and receiving treatment. Khady was found with diabetes in 1993 and Gaye in 2010. Both patients have type 1 diabetes. This form of diabetes is referred to as insulin-dependent diabetes, usually found in young people. Its symptoms or signs may be the same as in type 2 diabetes. Type 2 diabetes generally affects adults aged above 50 years, particularly obese or overweight persons.

Khady and Gaye ate a lot, but were losing weight. They were always very thirsty, causing them to drink abundantly and urinate profusely. These signs, particularly suggestive of diabetes, enabled to diagnose both cases.

Diabetes occurs when glucose (sugar), because it is not absorbed by the cells, gets back into the blood and raises blood sugar level. The disease could be hereditary, as is the case with type 1 diabetes. Khady and Gaye inherited the gene of type 1 diabetes. They did medical tests to eventually come to terms with the evidence that they had no other option than to live with this chronic disease that has no cure.

Living with diabetes: a financial challenge

Insulin is the blood sugar (level of glucose or sugar in blood) regulator. It is a substance in the body, produced by the pancreas. Its main function is to prevent the sugar level from rising excessively. In people with diabetes, insulin is either lacking because the pancreas does not produce sufficient quantity or it is not properly utilized in the body. Treatment therefore consists in injecting the patient with insulin to control blood sugar.

In Khady’s case, treatment consists in one insulin injection once a day and a strict diet comprising in particular fruits and vegetables, meat that is free from fat, fish and chicken at will. Gaye, in his case, is subjected to the same diet with insulin injection twice a day. In both cases, it is recommended to practise physical exercise regularly. Khady therefore does physical exercise every Sunday and Gaye, almost every day.

 But that’s not all. Both patients are bound to regular medical follow up. Khady must see a doctor every month and Gaye, every six months. Every month, they spend between CFA francs 60 000 to 100 000 in order to avoid complications of type 1 diabetes. This is very costly for both patients. Khady is unemployed; Gaye a student in accounting.

"mDiabetes is a good programme, in particular for people with limited resources" 

The mDiabetes programme is a component of the national diabetes control plan of the Ministry of Health and Social Action of Senegal. It is part of the WHO "Be He@lthy, Be Mobile" initiative.  This initiative aims to step up the prevention and control of some noncommunicable diseases and their risk factors. Senegal aims to prevent diabetes and its complications through the use of mobile telephony. The programme was launched jointly by WHO, the Ministry of Health and Social Action and the International Telecommunications Union (ITU).

One of the objectives is to help known or diagnosed diabetes patients manage the disease better in order to slow down its evolution, mitigate complications and improve quality of life, using mobile telephony. This is possible in a country where close 90% of the population have a mobile phone.

In Senegal, the programme benefits, since 2014, from the collaboration of the Ministry of Posts and Telecommunication, mobile telephone operators and health actors such as the Senegalese Association for Support to Diabetes Patients (ASSAD), an essential partner for the programme. During the first phase, from 2014 to 2015, whose key moment was the 2015 month of Ramadan, 12 000 people who expressed their will to participate in the programme throughout the country received SMS messages on their mobile phones. They received one SMS message every day during the previous four weeks to help them prepare the month of fasting and, during the month of Ramadan, two messages a week.

 Khady and Gaye received SMS messages on their mobile phones before, during and after the 2015 Ramadan. They also received messages before and after the 2016 Ramadan, which certainly augured well for Gaye’s loved ones, notably as he could still fast during the Ramadan.  He simply needed to follow advice delivered through his mobile phone free of charge. Before the Ramadan, the message said: “You have diabetes; Ramadan is soon! See a doctor now: if your blood sugar is between 0.90g/l and 1.20g/l then you surely could fast”. He followed the instructions. During Ramadan, every time he received the message "get used now to checking your blood sugar every day, at least in the morning and in the evening; objective: blood sugar before meal between 0.90g/l and 1.20 g/l”, he was reminded and checked his blood sugar before meals.

The mDiabetes programme has enabled Khady and Gaye to watch their blood sugar and follow a balanced diet, since they were regularly reminded through messages sent to them in that regard. Hence, at a lesser cost, they have managed their condition and enjoyed better quality of life since the mDiabetes programme started. Khady affirms that “mDiabetes is a good programme, in particular for people with limited resources". She has had a wonderful experience through this programme. Before, she took 10 units of insulin a day. Thanks to the programme, which helped her improve her diet through the SMS messages she received, her daily insulin intake has dropped from 10 to 6 units. Her blood sugar has become normal and she feels much better. “following advice delivered through SMS messages helps people with limited resources to reduce cost of treatment", she concluded.

mDiabetes is an efficient tool for reducing unequal access to care due to financial, geographic or social reasons. It is planned, under the second phase of the programme covering the period 2016-2017, to deliver voice messages or SMS in national languages. Khady thinks it would be really good to send to the general population and patients, not only text but also voice messages, in particular for illiterate people who cannot read or write.

Sustainable Development Goal 3 of the United Nations Organization seeks to ensure healthy lives and promote wellbeing for all at all ages. Through the mDiabetes programme that involves mobile telephony applications and reaches out to the populations directly, WHO and its partner, ITU, are making strides towards achieving this Goal.