Deaths due to non-communicable diseases (NCDs) are on the rise in South Africa.  The increase in these deaths is particularly startling because, overall, South Africa has been recording a decrease in deaths.  

The highest increase was for diabetes-related deaths. These deaths have more than doubled in the past decade. A recent report  by Statistics South Africa (Stats SA) shows that the condition claimed more than 26 800 lives in 2018.  In 2008, this number was 19 692. 

Diabetes is a chronic condition that affects how the body turns food into energy. With diabetes, either the body doesn’t produce enough insulin or the body cannot use the insulin it makes effectively. As a result, the levels of sugar (glucose) in the blood are high. 

This can cause serious health problems including nerve damage, kidney problems, heart disease, stroke and vision loss. Diabetes also impacts the mental health of people living with the condition. Untreated or poorly managed diabetes can even result in death.

But if managed correctly, a person with diabetes can live a healthy and happy life. 

Undiagnosed cases

According to the International Diabetes Federation, 4.2 million adults in South Africa have diabetes. 

Of great concern is the fact that one out of two South Africans with diabetes don’t know they have it. Such high levels of undiagnosed diabetes have devastating consequences. By the time they are diagnosed, people often have advanced organ damage.

Diabetes was the number one killer of women in South Africa. Women accounted for 60% of all deaths due to diabetes between 2008 and 2018. 

Diabetes-related deaths among women also increased by a higher percentage, 39.3% (from 11 889 in 2008 to 16 447 in 2018), compared to those in men, which increased by 33.5% (from 7 795 in 2008 to 10 405 in 2018).

Radical disparities

The study from Stats SA also found racial differences in mortality due to diabetes.

The highest number of deaths were among the Indian/Asian population group, followed by coloured and black people.  At the same time diabetes-related deaths were increasing in the black and coloured populations. The trend was decreasing for the Indian/Asian population group and stable for the white.

The report argued that the racial disparities observed could be due to  several factors. These include access to healthcare, behavioural practices or genetic factors.

Impact on health system

Diabetes in South Africa is characterised by suboptimal management and high rates of otherwise preventable complications and deaths.

The South African National Department of Health recognises that unless proven interventions, innovative and sustainable funding models and high-level political support are rapidly implemented, healthcare costs related to diabetes and other NCDs will increase exponentially.

The consequences for individuals, families, communities and the economy will be severe. 

It is estimated that public sector costs of people diagnosed with type 2 diabetes amount to around R2.7bn. These costs could escalate to R21.8bn if both diagnosed and undiagnosed patients are considered. This is equivalent to approximately 12% of the total national health budget in 2018. 

Interventions

The cost of type 2 diabetes is partly driven by the cost of treating and managing diabetes complications. Preventing and managing complications better will prevent death and lead to cost savings. 

The one-size-fits-all approach to diabetes management adopted in South Africa was proven to be deficient. Most people with diabetes do not meet the recommended treatment targets to prevent expensive complications. The American Diabetes Association and the European Association for the Study of Diabetes recommend a holistic person-centred approach to diabetes management that prevents complications and optimises quality of life.

South Africa’s National Strategic Plan for the Prevention and Control of Non-Communicable Diseases proposes clear targets for diabetes and hypertension: the 90-60-50 targets. The goal is to ensure that 90% of all people over 18 who have diabetes or hypertension are diagnosed; 60% of people who are diagnosed receive an intervention; and 50% of people receiving interventions are controlled. 

This is an ambitious plan, seeing that an estimate placed the number of people with diabetes on treatment who are controlled at less than 20%. However, a similar cascade approach to the AIDS epidemic has produced good results.

But a major challenge to implementing and monitoring the progress of the strategic plan for NCDs is the lack of data. Surveillance data for diabetes and NCDs are not available. The Stats SA report recommendations include the implementation of a comprehensive surveillance and monitoring system for NCDs. 

Strategies to combat diabetes and NCDs include: 

• strengthening the health system to cater for the needs of people living with diabetes;
• capacitating the healthcare workforce;
• developing a comprehensive diabetes education programme accessible to all; and
• ramping up health promotion efforts to address modifiable risk factors such as unhealthy diet, physical inactivity and tobacco use.

The department should also explore the cost-effectiveness of introducing the latest drugs and technologies to the public sector.

Dr Patrick Ngassa Piotie is a senior programme manager at the University of Pretoria Diabetes Research Centre and the Chairperson of the Diabetes Alliance.

The Diabetes Alliance, supported by the Department of Health, will convene the 2023 Diabetes Summit on 15 November 2023 to commemorate World Diabetes Day. 

This article first appeared on Health-E News on 7 November 2023.

Disclaimer: The opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the University of Pretoria.