South Africa: Why South Africa Need to Get a Grip on Diabetes –

Roughly 60 000 South Africans die in a year from diseases that are not caused by an infection such as tuberculosis (TB) or HIV — before they turn 70. About a fifth of these deaths are from diabetes, which is now the country’s leading cause of death, killing about 1.5 times more people than TB. But without getting better at diagnosing and treating people with diabetes, trying to hit a global goal for lowering these deaths anytime soon will be futile, experts say.

In 2020, diabetes killed 32 000 people in South Africa — about 40% of them before they turned 65.

It’s about 1.5 times the number of people who died of tuberculosis (TB), a curable disease , that year. Moreover, TB deaths have dropped by about two-thirds since 2010 — while diabetes has steadily become the number 1 killer in the country in the same decade.

But just like TB, diabetes — a preventable disease in many cases — doesn’t have to kill.

Unlike with TB though, little is being done about it.

Diabetes — a condition in which someone has too much sugar in their blood because their body doesn’t get or respond to the signal from the hormone insulin to absorb glucose — is one of four noncommunicable diseases (NCDs) World Health Organisation (WHO) member countries agreed to lower deaths from by 25% by the end of this year. Others on this list are heart disease , cancer and chronic airway ailments like asthma .

But no country — including South Africa — is on track to hit this so-called 25 x 25 (read: 25 by 25) goal, The Lancet reported in January. This, said Katie Dain, CEO of the NCD Alliance , at their Global Forum in Rwanda last week, will result in more people dying early — instead of fewer , as the United Nations set out in the targets to reach the goals for sustainable development by 2030 .

Said Dain: “Seven months ahead of the United Nations High-Level Meeting [on curbing NCD deaths], when we take a step back and actually look at the progress on NCDs, it’s very clear that we’re off track.”

But experts say until South Africa ramps up diagnosing and treating people with diabetes, trying to get on course to lower premature deaths from NCDs will be futile.

‘Progress is lacking’

The WHO’s most recent NCD progress monitor shows that in 2019, NCDs led to around 61 000 South Africans dying between the ages of 30 and 70.

It’s roughly the same number as in 2010 — and nowhere near the goal of recording only around 45 000 early deaths from these conditions, as a 25% reduction would mean.

Zandile Mchiza, chief specialist scientist in the NCD research unit of the South African Medical Research Council (SAMRC), says that the country has been veered off course by the high number of people already living with NCDs, their not being able to get good healthcare and lifestyle choices like smoking, eating fatty or sugary foods, and not exercising enough, all of which contribute to overweight and obesity — and can set someone up for developing diabetes .

Add to that about  270 000 people in South Africa with TB , an infectious disease that  makes someone even more prone   to developing diabetes.

It’s probably fair to assume that if there’s been little change in almost a decade, the number of premature deaths from NCDs would have hovered around 60 000 in 2020 too. In that year, about a fifth — just over 13 000 — were linked to diabetes, StatsSA data  shows .

Indeed, Foster Mohale, spokesperson for the health department, says they’ve not seen a reduction in diabetes-related deaths since signing up for the 25 x 25 target in 2013 , but that “continued interventions in the prevention and control [of the disease] will contribute to reduction in NCD mortality”.

Therein lies the rub.

Although South Africa does have a National Strategic Plan for NCDs (running from 2022 to 2027) and which sets out to “halt the rise of diabetes and obesity”, Mohale says progress was being planned to be tracked through the 2026 Demographic Health Survey — way after the 2025 deadline for reaching the UN’s goal.

And with the Trump administration’s withdrawal of funding to South Africa and dismantling of the US Agency for International Development, who was a big partner in the survey, it’s uncertain whether it will happen on time — or at all.

“Overall, progress is lacking,” says Dain. “In many low- [and] middle-income countries we don’t have basic things like screening programmes [and] packages of essential medicines, and data collection remains a real challenge.”

A gaping data hole

Smaller monitoring projects, such as the SAMRC’s cohort studies (in which a group of people with the same characteristics or experiences are tracked over time), statistical modelling, and surveys, do help to estimate how big the problem of NCDs such as diabetes is in the country, says Mchiza.

But there are many gaps in the numbers because of underreporting, the cause of death being misclassified or not being recorded at all. Moreover, many clinics and hospitals still use paper records to collect patients’ health statistics, which makes it hard to track their medical history, know whether their medication is working and report on the number of patients being treated for a condition such as diabetes.

This lack of reliable data is holding up monitoring progress, says Patrick Ngassa Piotie, chair of the Diabetes Alliance , a non-profit umbrella organisation that brings together people with diabetes, civil society, and health experts in the field.

“People with diabetes are not adequately counted in the country, which means you can’t assess or evaluate the efficacy of your policies — or the lack thereof. You can’t identify hot zones [and] you can’t identify the impact of your policies.”

Making the whole community healthy

Getting a grip on diabetes will save not only many lives but also lots of money.

According to the International Diabetes Foundation, around 5.4-million adults in South Africa are set to have diabetes by 2030, about 1.2-million more than in 2021. Given the trend seen in 2021, nearly half are likely to be undiagnosed and so will not be on treatment.

If someone has too high blood sugar levels for a long time, as in the case of diabetes going unchecked, it can damage their nerve cells, blood vessels, and kidneys. Apart from this leading to complications like blindness or amputations , uncontrolled diabetes can also make someone more likely to develop other NCDs, such as problems with their heart or blood circulation system, which can lead to high blood pressure or stroke.

These knock-on effects come at a big price.

In 2018, treating people diagnosed with diabetes cost the state R2.7-billion to pay for medication, tests and check-ups, and health workers’ salaries. If all the undiagnosed patients had been factored in, the health department would have had to foot a bill of nearly R21.8-billion — about 10% of the total budget for that year — an analysis shows.

Also, says Ngassa Piotie, if diabetes complications cause someone to miss work or lose their job, it can affect an entire family in South Africa, with most cases being in people between the ages of 35 and 64 , the age group that is the most economically productive in a population.

Investing in prevention — like getting people to stop smoking, cutting down on alcohol use, and eating less fatty and sugary foods — instead of putting so much money into managing diabetes could help ease the pressure on the health system, he says.

“When you have a whole-society approach to preventing diabetes and NCDs, it will, in the long run, lead to better outcomes because the community as a whole becomes healthy.”

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.