Diabetes-related mortality is on the rise in South Africa, and the management of the condition remains suboptimal, even within the private healthcare sector – yet despite the high burden on healthcare resources, numerous cases go undiagnosed. 

Against this backdrop, the 2023 Diabetes Summit Report and Recommendations were recently presented to the National Department of Health following the 2023 Diabetes Summit held at the University of Pretoria's (UP) Future Africa Campus late last year. 

The summit brought together people living with diabetes, diabetes advocates, healthcare professionals, health authorities, government officials, policymakers, academics, public health specialists, private medical scheme and pharmaceutical company representatives, as well as nonprofit organisations, to highlight the challenges faced by people living with diabetes and contribute to improving their well-being.

"Diabetes can be prevented, treated and managed. No one should be left behind," said Dr Patrick Ngassa Piotie, Chairperson of the South African Diabetes Alliance and Co-Founder of the University of Pretoria Diabetes Research Centre. The South African Diabetes Alliance is a nonprofit organisation that organises the bi-annual Diabetes Summit in partnership with the University of Pretoria Diabetes Research Centre and SA Diabetes Advocacy, with support from the National Department of Health.  

"Diabetes is the number one killer in South Africa… we have increasing mortality and suboptimal management of the disease. Even in the private sector, diabetes is not well managed – we sit at about 10-30% of people achieving control [of managing the disease]. Obviously, that leads to a heavy emotional, physical and economic burden not only on families but also on communities, and eventually on the health system, and the country," Dr Ngassa Piotie said.

South Africa has the highest prevalence of diabetes in Africa. According to the International Diabetes Federation (IDF), an estimated 4.3 million people are living with the condition. Tragically, diabetes has become the leading cause of death in the country since 2019.

Despite the high mortality rate and prevalence, however – with one in nine adults in the country living with diabetes – many patients remain undiagnosed, leading to additional health complications and further burdens on an already strained public health system.

The lack diagnosis, suboptimal management, and inadequate investment in diabetes prevention and control lead to higher financial and resource expenditures by the health system when addressing the complications that arise from unmanaged diabetes.

"If we don’t spend today, we will have to spend more tomorrow, on complications such as amputations, kidney failures, dialysis, heart failures… I don’t believe that the country can cope if this is left unabated," Dr Ngassa Piotie said.

According to the Diabetes Summit Report and Recommendations, some of the main challenges that impede optimal diabetes prevention and care in South Africa are a lack of awareness and education about diabetes, as well as a lack of structured education for people living with diabetes and healthcare workers.

"There is a pervasive lack of awareness about diabetes and non-communicable diseases (NCDs) across the healthcare system and within communities," the report states. "The absence of an evidence-based diabetes education programme for health workers at all levels of care poses a significant obstacle. Despite their pivotal role, professional nurses trained as Diabetes Nurse Educators remain unrecognised and inadequately integrated into the public healthcare system, despite being embraced in the private sector. 

This lack of dedicated diabetes education contributes to patient struggles in managing their condition. Diabetes predominantly requires self-management, underscoring the vital role Diabetes Nurse Educators play in empowering patients to understand and navigate their condition."

The report recommends that professional nurses be encouraged and incentivised to specialise as Diabetes Nurse Educators and for the government to establish dedicated positions for them within public healthcare facilities.

The report also recommends leveraging community healthcare workers (CHWs) as a valuable resource: "The potential of CHWs remains largely untapped. They should be actively involved in community screening for diabetes and hypertension, as well as in recognising diabetes symptoms and complications, and facilitating timely referrals for appropriate care."

Jeanette Hunter, Deputy Director-General for Primary Health Care at the National Department of Health, says the recommendations outlined in this report are aligned with South Africa’s national response to combat diabetes. "Our strategy, which we are already implementing, includes – among others – fully using and further extending use of the Health Promotion Levy [commonly referred to as the sugar tax] as a resource to promote health and prevent NCDs – including diabetes – focusing on prevention, early detection and effective management. 

"In collaboration with provinces and districts, we’re conducting NCD campaigns, intensifying community-based screening activities to prevent and control NCDs and promote healthy lifestyles. The training of healthcare workers is a priority, and we have partnered with the World Health Organization in this regard."

Dr. Joseph Kibachio Mwangi welcomed the release of the Report and its recommendations on behalf of the World Health Organization (WHO) Country Representative, Dr. Fabian Ndenzako. Dr. Mwangi reiterated the organization's support to the National Department of Health, stating, “WHO will further contribute to strengthening the health system to address diabetes prevention and control in South Africa through a grant received from the World Diabetes Foundation.” He also praised the active involvement of individuals living with diabetes, underscoring that their meaningful participation is a fundamental principle championed by WHO.

The National Department of Health has committed to collaborating with the Diabetes Alliance, the UP Diabetes Research Centre, the WHO and all partners to combat diabetes and fulfil the promise of 'a long and healthy life for people living with diabetes in South Africa'.

>> Download the full report here