Deaths due to non-communicable diseases (NCDs) are rising in South Africa, the increase being particularly startling because overall, the country has been recording a decrease in deaths, writes Dr Patrick Ngassa Piotie in Health-e News.
The highest increase was for diabetes-related deaths, which have more than doubled in the past decade. A report by Stats SA shows the condition claimed more than 26 800 lives in 2018. In 2008, this number was just 19 692.
Diabetes is a chronic condition, and untreated or poorly managed, can result in death. But if managed correctly, diabetics can live healthy, happy lives.
Undiagnosed cases
According to the International Diabetes Federation, 4.2m adults in this country have diabetes.
However, of great concern is that one out of two South Africans with the condition don’t know they have it. Such high levels of undiagnosed cases 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, accounting for 60% of all deaths, 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 with men, which increased by 33.5% (from 7 795 in 2008 to 10 405 in 2018).
Racial disparities
The Stats SA study also found racial differences in mortality due to diabetes. Most 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 suggested the racial disparities could be due to several factors, including access to healthcare, behavioural practices or genetic factors.
Impact on health system
The disease is characterised by suboptimal management and high rates of otherwise preventable complications and deaths.
The 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 are around R2.7bn, which could escalate to R21.8bn if both diagnosed and undiagnosed patients are considered. This is equivalent to 12% of the total national health budget in 2018.
Interventions
The cost of type 2 diabetes is partly driven by the treatment and management of complications, so preventing and managing these better will reduce deaths and save money.
The one-size-fits-all approach to diabetes management adopted in South Africa has proven to be deficient, however. Most diabetics 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 90% of all people over 18 with diabetes or hypertension are diagnosed; 60% of those diagnosed receive an intervention; and 50% receiving interventions are controlled.
Yet this is ambitious, seeing that an estimate placed the number of diabetics 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 diabetics’ needs,
• capacitating the healthcare workforce,
• developing a comprehensive diabetes education programme accessible to all
• boosting health promotion efforts to address modifiable risk factors like 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 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.
Report-03-08-012018
Health-e News article – diabetes-related deaths more than doubled in the past decade (Creative Commons Licence)
See more from MedicalBrief archives:
At least 60% of Africa’s diabetes goes undiagnosed – global report
More than 1.3bn people will have diabetes by 2050, study predicts
High prevalence of prediabetes in HIV positive people – SA review
SA Diabetes Alliance calls for urgent education programme