A decisive call to declare diabetes a national public health emergency set the tone at the opening of the 2025 South African Diabetes Summit in Johannesburg, where leaders warned that the country can no longer afford fragmented responses or “business-as-usual” approaches as the disease continues to claim more lives than any other natural cause.

The South African Diabetes Summit is a flagship biennial event convened by Diabetes Alliance South Africa which brings together people living with diabetes, academics, healthcare professionals, policymakers, researchers, civil society, government and industry. The 2025 summit was hosted in collaboration with the University of Pretoria (UP), the National Department of Health, the Gauteng Department of Health, the South African Medical Research Council, the World Health Organization, and the World Diabetes Foundation.

More than 300 stakeholders presented a united front, demanding immediate action on what they described as a “spiralling national health crisis”. Dr Patrick Ngassa Piotie, Summit Convener and Chair of Diabetes Alliance SA, emphasised that diabetes is already a leading cause of death and imposes a heavy burden on the country’s overstretched public health system.

“Currently, the Department of Health has very few personnel who can dedicate their working time specifically to diabetes,” Dr Piotie said. “Declaring an emergency would unlock the dedicated human and financial resources required, while signalling clearly that business as usual is no longer acceptable.”

The urgency of the situation is reinforced by stark national statistics. Between 4.2 and 4.6 million South Africans are estimated to be living with diabetes and, without timely intervention, the numbers are expected to rise. The country faces an alarming intersection between diabetes and other non-communicable diseases such as cardiovascular disease, hypertension and obesity, while the increasing prevalence of diabetes among people living with HIV adds further complexity for clinicians and policymakers.

The human impact of these intersecting health burdens was highlighted by Pholo Ramothwala, founder of Live Life Beyond, a forum supporting people with chronic conditions. Ramothwala has lived with HIV for 26 years and was diagnosed with type 2 diabetes three years ago, which increased his daily medication from two tablets to eight. Long-term treatment has also resulted in high cholesterol and hypertension.

“It is one of the most confusing things,” he said. “The idea is that once you take medication, you get better. But technically, you get better from one side, [but] you develop something else.” His experience underscores the complex realities faced by millions of South Africans managing multiple chronic conditions.

The 2025 summit reinforced the need for a whole-of-society approach to drive urgent and coordinated action.

Representing UP, Vice Principal Student Life Professor Themba Mosia delivered the institutional address, highlighting both the severity of the crisis and the responsibility of universities to contribute research-driven solutions. “As I reflect on this year’s theme, ‘Let’s Innovate for Impact’, it is clear that much focus continues to be placed on saving lives through fresh approaches and evidence-based interventions,” he said. Describing diabetes as a “silent killer”, Prof Mosia underscored the need for collaborative, data-informed strategies that go beyond awareness campaigns.

“It is incumbent on all of us to address the rising levels of those diagnosed with diabetes and to confront the undisclosed cases across South Africa,” he added. While commending the “relentless efforts” of Diabetes Awareness Month (commemorated annually during November), he emphasised that measurable progress must follow. “Scientists should be able to produce data that show a tangible increase in diabetes education,” he said.

Prof Mosia further called for improved transparency, resource management, and budget allocations, noting that governance failures exposed through national commissions and parliamentary inquiries continue to weaken health outcomes.

Dr Piotie also acknowledged the National Department of Health’s recognition by the United Nations Interagency Task Force on Non-communicable Diseases for advancing the health-related Sustainable Development Goals. “This recognition reflects leadership, vision and commitment,” he said. “But it also raises the bar for all of us,” he said.

Throughout the opening session, speakers identified several structural reforms necessary to reverse South Africa’s diabetes trajectory. These include establishing a National Diabetes Task Team jointly chaired by government and civil society; creating a real-time national data surveillance system – because, as Dr Piotie stressed, “We cannot manage what we cannot measure”; reviewing procurement systems and the Essential Medicines List to prioritise modern insulins and continuous glucose monitoring; and strengthening provincial and national resource management to curb financial leakage and improve health service delivery.

The summit reinforced that the fight against diabetes requires shared responsibility. “Society will bring the mobilisation; government must bring the leadership and the urgent action. The time is now – and history will remember that we acted,” Dr Piotie said.

Prof Mosia echoed this call, expressing confidence that the summit’s outcomes “will bring meaningful changes in our lives, not only in our country but globally.” He reaffirmed UP’s commitment to supporting policy, research, and community engagement, positioning the University as a key driver of evidence-based solutions to one of South Africa’s most urgent health challenges.