The prevalence of diabetes in South Africa has increased to 11.3% – the highest in Africa – yet almost 50% of people living with the condition are undiagnosed, said Gauteng MEC for Health and Wellness Nomantu Nkomo-Ralehoko during the 2023 Diabetes Summit recently hosted by the University of Pretoria’s (UP) Diabetes Research Centre and the Diabetes Alliance.

The summit was held a day after World Diabetes Day, which is observed globally on 14 November to raise awareness about the urgency to prioritise the prevention, early detection and management of diabetes. The event was hosted at UP’s Future Africa, and convened diabetes advocates, policymakers, healthcare providers, researchers and individuals living with diabetes.

With its theme ‘Diabetes Targets, Translating Policy into Reality’, the summit focused on the newly adopted 90-60-50 cascade for diabetes and hypertension, a policy of the national Department of Health, as the first step to improving early detection and treatment of non-communicable diseases. UP Interim Vice-Chancellor and Principal Professor Themba Mosia explained the cascade.

UP Interim Vice-Chancellor and Principal Prof Themba Mosia delivers the opening address at the 2023 Diabetes Summit hosted by UP and the Diabetes Alliance.

“Our shared goal is clear: we aim to ensure that 90% of all individuals over the age of 18 will know whether they have elevated blood pressure or blood glucose levels. Furthermore, 60% of those with raised levels should receive timely interventions, and 50% of individuals receiving interventions should be effectively controlled.”

The summit brought together stakeholders from 23 local and international organisations like the World Health Organisation to discuss the prevalence of diabetes in South Africa and find impactful solutions. Throughout the day, discussion panels focused on various components of the National Strategic Plan for the Prevention and Control of Non-communicable Diseases, as well as implementation barriers and enablers. Attendees also explored the role of the government, academia, healthcare providers, non-governmental organisations and other players in improving the prevention and control of diabetes and hypertension in the context of integrated and people-centred health services.

Urgent action needed to address the diabetes crisis

In South Africa, the characteristics of diabetes include increasing mortality, as reflected in Statistics South Africa’s latest report, which showed that over the past 10 years, deaths due to diabetes more than doubled, said Dr Patrick Ngassa Piotie, senior programme manager of UP’s Diabetes Research Centre and chairperson of the Diabetes Alliance.

“All other mortalities are on the decrease, but non-communicable diseases and diabetes are on the increase,” he added. “This calls for urgent action to address the diabetes crisis. It is also important to note that women in South Africa are most affected; diabetes is the number one cause of death among them.”

MEC Nkomo-Ralehoko said diabetes has become a global health challenge that affects millions of people around the world, adding that statistics showed that one in 10 adults live with the disease, with over 90% of them having type 2 diabetes. She added that in Gauteng, the Department of Health has been educating residents about diabetes and encouraging them to do regular health checks at public health facilities.

“Gauteng has reached about 19.4% and 25.7% for diabetes and hypertension,” MEC Nkomo-Ralehoko said. “The cause for concern is that when diabetes is undetected or inadequately treated, there is a risk of serious and life-threatening complications such as heart attack, stroke, kidney failure, blindness and lower-limb amputation. Preventing type 2 diabetes and its complications is within our reach. By adopting and maintaining healthy habits, we can delay or even prevent the onset of this condition. Small lifestyle changes such as regular physical activity, a balanced diet and maintaining a healthy weight can make a significant difference in reducing the risk of type 2 diabetes and many other diseases.”

Collaborative-society approach crucial

Dr Ngassa Piotie said it was evident that targets are not being met when it comes to tackling diabetes, and implored MEC Nkomo-Ralehoko to call on her colleagues in public health to innovate, because “we ought to do things differently if we are to meet the diabetes targets and mitigate the impact of diabetes”. He believed the National Strategic Plan for the Prevention and Control of Non-communicable Diseases could be used as a tool by all stakeholders to change the situation in South Africa.  

“To achieve the ambitious targets of the 90-60-50 cascade, it is crucial that we embrace a collaborative-society approach,” Prof Mosia said. This idea is at the core of the Diabetes Research Centre’s work.

In 2019, after receiving a grant from the Lilly Global Health Partnership, the centre initiated the Tshwane Insulin Project (TIP) to assist people living with type 2 diabetes transition from oral medication to insulin. Through a decentralised care model, the TIP team enabled nurse-led insulin initiation at clinics, proactive patient follow-ups and insulin titration at home, supported remotely by a physician. In 2021, UP’s business incubator TuksNovation connected the TIP team with Aviro Health, leading to a collaborative effort in enhancing and digitalising the TIP programme, a digital solution that included educational materials in video and PDF formats that are readily accessible for healthcare providers.

“I am confident that by joining forces and collaborating across sectors, we can make significant progress in translating policy into reality,” Prof Mosia said. “Together, we can improve the lives of countless individuals and ensure a healthier, more resilient future for our communities.”