The number of deaths related to non-communicable diseases are on the rise in South Africa, with the highest increase in deaths related to complications from diabetes. A Statistics South Africa (Stats SA) report shows that in the space of 10 years, diabetes-related deaths increased from 19 692 in 2008 to 26 880 in 2018.

Diabetes is a chronic health condition that affects how the body turns food into energy: the body either doesn’t produce enough insulin or cannot use the insulin it makes effectively. This results in high levels of sugar (glucose) in the blood, which can cause serious health complications such as nerve damage, kidney problems, heart disease, stroke and vision loss. Diabetes also impacts the mental health of people living with the condition.

World Diabetes Day is observed annually on 14 November, and this year, the campaign is centred on the idea ‘Know your risk, know your response’. As such, campaign efforts are focused on the importance of knowing your risk of type 2 diabetes to help delay or prevent the condition; the impact of diabetes-related complications; and the importance of access to the right information and care to ensure timely treatment and management.

Diabetes management is difficult, relentless and all-consuming. Those who live with the condition and/or their families or carers need to manage the condition seven days a week, 24 hours a day in order to prevent complications, which can affect every organ system in the human body. If managed correctly, a person living with diabetes may live a healthy and happy life. However, untreated or poorly managed diabetes results in life-altering complications or even death.

South Africa’s diabetes crisis

According to the International Diabetes Federation, 4.2 million adults are living with diabetes in South Africa. Of great concern is the fact that one out of two South Africans with diabetes is not aware of their condition. Such high levels of undiagnosed diabetes have devastating consequences, as by the time these individuals are diagnosed, they often have advanced organ damage.

Women in South Africa are the most affected; in fact, diabetes is the number one killer among this group. According to the Stats SA report, women accounted for 60% of diabetes-related deaths between 2008 and 2018. These deaths also increased by a higher percentage (39.3%) compared to those among men (33.5%).

Not all equal before diabetes

The Stats SA report also shows demographic differences in diabetes-related mortality. Indians/Asians in South Africa were the most affected, followed by the coloured and black South African population groups. While diabetes-related deaths are on the increase among coloured and black South Africans, the number is declining among Indians/Asians and is stable for the white population.

The report argued that the racial disparities observed could be due to access to healthcare, behavioural practices or genetic factors. In other words, coloured and black Africans are arguably not receiving quality diabetes care.

Preventable complications and avoidable deaths

Diabetes in South Africa is characterised by suboptimal management and high rates of otherwise preventable complications and deaths. The national Department of Health acknowledges the need for proven interventions, innovative and sustainable funding models, and high-level political support to slow the rise of healthcare costs related to non-communicable diseases, including diabetes. Similarly, the World Diabetes Day campaign calls on governments to increase investment in diabetes care and prevention.

It is estimated that public sector costs of people diagnosed with type 2 diabetes amount to about R2.7 billion. These costs could escalate to R21.8 billion if both diagnosed and undiagnosed patients are considered – that is the equivalent of approximately 12% of the total national health budget in 2018. About 50% of expenditure on diabetes was the result of diabetes-related complications. The South African health system needs to shift from a treatment to a prevention mind-set by increasing its focus on the prevention of diabetes complications.

Delivery of better diabetes care

Better management and prevention of complications can prevent death and lead to cost savings. The one-size-fits-all approach to diabetes management adopted in South Africa is deficient as most people do not meet the recommended treatment targets. Both the American Diabetes Association and the European Association for the Study of Diabetes recommend a holistic, person-centred approach to diabetes management, one which prevents complications and optimises quality of life.

UP’s Tshwane Insulin Programme produced encouraging results. The programme had a direct impact on hundreds of people in the Tshwane district with diabetes through capacity development for health workers, patient empowerment, proactive treatment optimisation and personalised follow-ups. People with diabetes recruited on the programme saw a dramatic reduction in their glycated haemoglobin levels, thus preventing complications. After five years, the programme has come to an end, leaving patients vulnerable to deterioration.

The 2023 Diabetes Summit

In response to South Africa’s diabetes epidemic, the national Department of Health adopted the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases in 2021. It proposes clear targets for diabetes and hypertension: the 90-60-50 targets. The goal is to ensure that 90% of 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.

UP’s Diabetes Research Centre, in collaboration with the Diabetes Alliance, will convene the 2023 Diabetes Summit to discuss the implementation of the 90-60-50 targets for diabetes and hypertension. The summit provides a platform for local and international experts, healthcare providers, policymakers and people living with diabetes to find solutions that are sustainable and contextually appropriate.

Dr Patrick Ngassa Piotie is senior programme manager at the University of Pretoria (UP) Diabetes Research Centre and chairperson of the Diabetes Alliance

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.

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Email Dr Patrick Ngassa Piotie at [email protected] for enquiries.