Currently, around 382 million people live with diabetes worldwide, a further 316 million with impaired glucose tolerance are at high risk from the disease and by 2035, it is estimated that without concerted action to prevent diabetes, 592 million people will be living with this chronic disease. (International Diabetes Federation 2013 Atlas)

South Africa has joined the ranks of nations with a high and rapidly growing prevalence of diabetes.  In Africa, 76% of deaths due to diabetes were in people under the age of 60, and in terms of prevalence, South Africa clocks in at number two with 2.6 million diagnosed, after Nigeria which has the highest prevalence in Africa of 3.9 million diagnosed diabetics.  It is estimated that another five million South Africans have pre-diabetes, a condition where insulin resistance causes blood glucose levels to be higher than normal, but not high enough yet to be type 2 diabetes.  The highest prevalence of diabetes is among the Indian population in South Africa (11-13%) as this group has a strong genetic predisposition for diabetes. This is followed by 8-10% in the coloured community, 5-8% among blacks and 4% among whites. (Source:  Centre for Diabetes and Endocrinology in Johannesburg.)

What does this all mean for your client’s financial planning?

Diabetes and long-term cover

If you have clients who are diabetic, it is important to discuss how their condition will impact on their cover.  Hayley Taylor, managing underwriter at specialist long-term risk cover provider Altrisk, says the financial consequences and economic impact of living with a serious illness such as diabetes are often overlooked.

Heart disease, stroke, blindness, amputations and kidney failure are some of the complications that could result from diabetes. In most cases these complications could be avoided by early diagnosis and proper treatment, but the reality is that many people don’t seek medical help until the complications have progressed.

“These complications are very likely to have an impact on your client’s ability to earn a living, jeopardising their present and future financial security.  Diabetics need to understand and manage their condition carefully to ensure not only a longer and healthier life, but also their insurability and future financial stability,” she says.  

If you’re in the business of providing financial advice, it is important that you understand the most common health and medical conditions such as diabetes and how to get the best cover for your client.  You can do this by knowing how high risk conditions are viewed by an insurer’s underwriters and dealing with a specialist insurer focused on clients with pre-existing health conditions. 

Diabetes explained

Diabetes occurs when the body is unable to convert glucose into energy. It develops when the pancreas fails to produce sufficient quantities of insulin (Type I), or the insulin produced is defective and cannot move glucose into the cells (Type II).  Insulin is the hormone that helps your body to convert sugar into energy.  Diabetes may be hereditary, but lifestyle and diet also play a big role. 

Who is affected by diabetes?

 - Type I (insulin-dependent) diabetes occurs frequently in children and young adults, although it can occur at any age and can run in families.

- Type II (maturity onset/non-insulin dependent) diabetes is more common, accounting for 90-95% of all diabetes. It primarily affects adults but is also becoming prevalent in children, showing a strong correlation with physical inactivity and obesity. 

Treatment for diabetes includes insulin, oral medications, or a combination of both.  In some cases, particularly when treating Type II diabetes, a few simple lifestyle changes such as a healthy diet and more exercise could make a major difference. 

Diabetes complications

There are a variety of medical complications associated with diabetes. These include:

- Nerve and kidney damage
- Vision disorders - retinopathy, glaucoma, cataract or corneal disease
- Heart disease
- Stroke
- Peripheral vascular disease - possible ulcers and gangrene, which could result in amputation

The complications are less severe in people who have well-controlled blood sugar levels. This means that their blood sugar levels are kept as close to normal as possible. It is also important to note that wider health problems accelerate the destructive effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure and lack of exercise. 

What does this mean for your client’s cover?

When applying for insurance your client will be required to undergo various medical tests. One of the most important tests is the diabetic questionnaire which should cover the following:

- Date of diagnosis
- Treatment
- Associated diagnosed risk diseases
- Medical check-up frequency
- Details of any hospitalisation and in particular, whether the client does any home checks for glucose control.

The feedback from your client provides a very good barometer of their insight into their medical condition and attitude towards their health.

In addition to the standard medical tests, diabetics will be required to undergo:

- an HbA1c test: indicates average sugar levels over an extended period of time and how well controlled the diabetes is.  A result of 6.8 is considered within healthy levels.
- a urine microalbumin: indicates signs of early kidney damage.
- a rest and effort ECG: screens for signs of heart disease.

What cover can a client expect?

Based on an individual underwriting assessment, diabetic applicants can expect some combination of the following: 

- a loading on life cover.
- exclusions on critical illness for those impairments related to diabetes, such as cardiac and renal diseases.  The advantage of this is that the client still gets the benefit of cover for all other critical illnesses.  Discounts are also applied to the premium in terms of the excluded critical illnesses.
- impairment cover with diabetes exclusions.
- income benefits for accidental causes.

Same condition, different underwriting results 

“It is important to remember that an underwriter makes an assessment based on the applicant’s individual profile and test results. This is why the medical tests are important. So while two clients may seemingly have the same condition (both might be male and around the same age), the medical evidence tells a different story. 

“One applicant may control the diabetes well, be disciplined in medical care, respond well to treatment and have minimal organ damage. The second applicant may not manage their diabetes as effectively and have significant organ damage. These two individuals will have different underwriting outcomes and rates,” concludes Hayley.