The scourge of diabetes shows no sign of waning in South Africa, with the latest Stats SA Mortality Report revealing that the disease accounted for 6.1% of the 474 366 deaths recorded in 2024, claiming 79 lives a day and ranking as the country’s biggest killer ahead of TB and HIV, reports IOL.
The three leading causes of death in the country are now all non-communicable diseases – diabetes, heart disease, strokes, cancer and high blood pressure – while hypertensive diseases came second at 5.5%, and cerebrovascular diseases, which included strokes, third at 5.4%.
Diabetes hit women hardest, accounting for 7.9% of all female deaths, while TB remained the leading cause of death among men, at 4.8%.
HIV accounted for 3.8% of all deaths, down from 4.3% in 2022 and 4.0% in 2023. Covid-19, the country’s biggest killer in 2020 and 2021, accounted for just 450 deaths in 2024, less than 0.1% of the total.
Gauteng recorded the most deaths at 21.2%, followed by KwaZulu-Natal at 18.8%. The Northern Cape recorded the lowest at 3.1%.
A further 62,871 people died from non-natural causes, with three-quarters recorded as accidental injuries and 12% as assault.
Diabetes tsunami is here
Professor Tim Noakes, the controversial Cape Town scientist who founded the Noakes Foundation, told IOL the three biggest killers in the figures were “not separate diseases at all”.
Noakes, who made his name with Lore of Running and had previously advocated carbohydrates as fuel for endurance athletes, later became one of SA’s most prominent proponents of the low-carb, high-fat Banting diet.
That landed him before the Health Professions Council of SA on an unprofessional conduct charge after he advised a breastfeeding mother on X to wean her infant on to a low-carbohydrate, high-fat diet.
He was cleared in 2017 after a four-year fight and again on appeal a year later.
A decade ago Noakes (77), was also ridiculed for warning that a diabetes tsunami was coming for SA.
“All of those diseases are caused by insulin resistance and high-carbohydrate diets,” Noakes said last week. “If you’re insulin resistant, which means you can’t metabolise carbohydrates effectively, then over time, decades, 10, 20, 30 years, you have to convert the carbohydrates that you eat into fat in your liver and fat in the pancreas and fat in your other organs.
“And that then worsens your insulin resistance, so you get this compounding problem.
“When I was born in the 1940s, everyone was lean, but today everyone’s obese, and that’s the problem. We’re in the middle of the tsunami I talked about years ago, and it’s only going to get worse.
“It’s never going to go away if government doesn’t change food policy. But politicians don’t listen to biology, they listen to who’s funding them, and who do they look after? They look after the food industry, they don’t look after the health of the people.”
Noakes said the answer was to take ultra-processed food out of the diet entirely, and to eat meat, chicken, fish, eggs, dairy, nuts and some vegetables.
He said subsidies should go to animal produce rather than to grains and seed oils, and that eggs and tinned fish were what poor children should be getting every day instead of maize.
His foundation ran a campaign called Eat Better SA in poor communities, teaching people to eat well on very little, and patients had reversed their diabetes on the programme, he said.
Conventional treatment of diabetes, he added, made no difference without dietary change, a claim that runs against the national treatment guidelines and one that doctors dispute.
The health department's treatment literacy flip chart, published this year, recommended a varied diet that includes high-fibre foods like wholewheat bread, brown rice, oats and barley, alongside vegetables, fruit, beans, lentils, lean proteins and healthier fats.
The same guidance recorded that more than half of South African adults have at least one chronic condition, that diabetes affects one in every eight adults, and that the disease has replaced TB as the number one cause of death.
'Sugar not the villain'
Reverend Sean Gunn, branch manager of Diabetes SA in Durban, said people needed to understand that sugar itself did not cause the disease.
“It’s a misconception. People diagnosed with type 2 diabetes generally have very poor eating habits and do little exercise.
“Type 1 diabetes almost starts off like an autoimmune disease, where your body begins to fail to produce any form of insulin. This is where diet, medication and injectable insulin are brought into play – and unfortunately, type 1 diabetes is not reversible. But type 2 diabetes is.”
Gunn said his branch was seeing the disease in teenagers, and that rates among Durban’s Indian and African communities were now almost on par with each other.
Armand de Wet, a return-to-play specialist in Stellenbosch who works with professional athletes, said he was seeing the same insulin problem in people who were nowhere near retirement age.
“Someone eating a high-carb diet becomes less insulin sensitive, and constantly it gets converted to visceral fat, the really bad fat around your organs,” he told IOL.
“As soon as we start removing it by eating fewer carbs, the body becomes more insulin sensitive again.”
De Wet said elite endurance athletes were taking in between 120 and 150 grams of carbohydrates an hour, against 60 to 80 grams a few years ago, and that some were turning up pre-diabetic as a result.
He had trained between 20 and 30 people over the past year who were pre-diabetic or diabetic: at least 10 of them had reversed the condition.
The Diabetes Alliance has written to President Cyril Ramaphosa, Finance Minister Enoch Godongwana and Health Minister Dr Aaron Motsoaledi, urging government to act on the death toll.
In April, 24 civil society organisations joined forces and called for a national diabetes registry and for health funding to be redirected towards managing the disease.
Stats SA warned in the report that 18.2% of natural deaths in 2024 were recorded under ill-defined causes, making it impossible to track disease trends properly.
“It also creates a distorted view of the health status of a population,” it said.
IOL article – Diabetes is South Africa’s biggest killer, claiming 79 lives a day (Open access)
See more from MedicalBrief archives:
Call for action as diabetes now leading cause of natural deaths
SA facing diabetes ‘pandemic’ as cases soar among young people
SA’s diabetes crisis needs urgent response
Noakes study finds that T2D may be reversible through LCHF 'lifestyle'