Roughly 60 000 South Africans die annually – before they turn 70 – from diseases that are not caused by an infection like tuberculosis or HIV, with about a fifth of these deaths being from diabetes, the country’s leading cause of death.
But without getting better at diagnosing and treating these people, trying to hit a global goal for lowering these mortality stats anytime soon will be futile, experts say.
In 2020, writes Zano Kunene for Bhekisisa, diabetes killed 32 000 South Africans – about 40% of them before they turned 65.
It’s about 1.5 times the number of people who died of TB, a curable disease, that year. Moreover, TB deaths have dropped by about two-thirds since 2010, while diabetes has steadily become the leading killer in the country in the same decade.
And just like TB, diabetes doesn’t have to kill, but unlike with TB, little is being done about it.
Diabetes is one of four non-communicable diseases (NCDs) World Health Organisation (WHO) member countries agreed to lower deaths from by 25% by the end of this year. Others are heart disease, cancer and chronic airway ailments like asthma.
But no country is yet on track to hit this so-called 25 x 25 (read: 25 by 25) goal, The Lancet reported in January.
This, said Katie Dain, CEO of the NCD Alliance, at their Global Forum in Rwanda last week, will result in more people dying early – instead of fewer, as the United Nations set out in the targets to reach the goals for sustainable development by 2030.
Said Dain: “Seven months before the United Nations High-Level Meeting (on curbing NCD deaths), when we actually look at the progress on NCDs, it’s very clear we’re off track.”
But experts say until South Africa ramps up diagnosing and treating people with diabetes, trying to get on course to lower premature deaths from NCDs will be futile.
‘Progress is lacking’
The WHO’s most recent NCD progress monitor shows that in 2019, NCDs led to the deaths of around 61 000 South Africans, aged 30 to 70.
It’s roughly the same number as in 2010, nowhere near the goal of recording only around 45 000 early deaths from these conditions, as a 25% reduction would mean.
Zandile Mchiza, chief specialist scientist in the NCD research unit of the SA Medical Research Council (SAMRC), says the country has veered off course thanks to the high number of people already living with NCD and not being able to get good healthcare; and lifestyle choices like smoking, eating fatty or sugary foods while not exercising enough, all of which contribute to overweight and obesity, and lays the groundwork for developing diabetes.
Add to that about 270 000 South Africans with TB, making them even more prone to developing diabetes.
It’s probably fair to assume that if there’s been little change in almost a decade, the number of premature deaths from NCDs would have hovered around 60 000 in 2020 too. In that year, about a fifth – just more than 13 000 – were linked to diabetes, StatsSA data show.
Foster Mohale, spokesperson for the Health Department, says they’ve not seen a reduction in diabetes-related deaths since signing up for the 25 x 25 target in 2013, but that “continued interventions in the prevention and control (of the disease) will contribute to reduction in NCD mortality”.
Therein lies the rub.
Although South Africa has a National Strategic Plan for NCDs (running from 2022 to 2027), which sets out to “halt the rise of diabetes and obesity”, Mohale says progress was being planned to be tracked through the 2026 Demographic Health Survey – way after the 2025 deadline for reaching the UN’s goal.
And with the Trump administration’s withdrawal of funding to South Africa and dismantling of the US Agency for International Development – a big partner in the survey – it’s uncertain whether it will happen on time, or at all.
“Overall, progress is lacking,” says Dain. “In many low- and middle-income countries we don’t have basic things like screening programmes and packages of essential medicines, and data collection remains a challenge.”
Gaping data hole
Smaller monitoring projects, like the SAMRC’s cohort studies (in which a group of people with the same characteristics or experiences are tracked over time), statistical modelling and surveys, help to estimate the extent of NCDs like diabetes, says Mchiza.
But there are gaps in the numbers because of under-reporting, the cause of death being misclassified or not being recorded at all. Moreover, many clinics and hospitals still use paper records to collect patients’ health statistics, making it hard to track their medical history, know whether their medication is working, and report on the number of patients being treated for a condition like diabetes.
This lack of reliable data is holding up monitoring progress, says Patrick Ngassa Piotie, chair of the Diabetes Alliance, a non-profit umbrella organisation bringing together diabetics, civil society and health experts.
“People with diabetes are not adequately counted, meaning you can’t assess or evaluate the efficacy of your policies, or the lack thereof. You can’t identify hot zones or identify the impact of your policies.”
Making the community healthy
Getting a grip on diabetes will save not only many lives but also money.
According to the International Diabetes Foundation, around 5.4m adult South Africans will have diabetes by 2030, about 1.2m more than in 2021. Given the trend in 2021, nearly half are likely to be undiagnosed and so will not be on treatment.
Unchecked diabetes can damage nerve cells, blood vessels and kidneys. Apart from this leading to complications like blindness or amputations, uncontrolled diabetes can also make someone more likely to develop other NCDs, like heart or blood circulation system problems, which can lead to high blood pressure or stroke.
These knock-on effects come at a big price.
In 2018, treating diabetics cost the state R2.7bn for medication, tests and check-ups, and health workers’ salaries. If all of the undiagnosed patients had been factored in, the department would have had a bill of nearly R21.8bn – about 10% of the total budget for that year – an analysis shows.
Also, says Ngassa Piotie, if diabetes complications cause someone to miss work or lose their job, it can affect an entire family, with most cases being in people aged 35 to 64, the most economically productive age group in a population.
Investing in prevention, like getting people to stop smoking, reduce alcohol use and eat less fatty and sugary foods, instead of investing so much money into managing diabetes, could ease the pressure on the system, he says.
“When you have a whole-society approach to preventing diabetes and NCDs, it will, in the long run, lead to better outcomes because the community as a whole becomes healthy.”
The Lancet article – Can we turn the tide on NCDs in 2025? (Creative Commons Licence)
Bhekisisa article – Why SA needs to get a grip on diabetes — fast (Creative Commons Licence)
See more from MedicalBrief archives:
SA facing diabetes ‘pandemic’ as cases soar among young people
SA’s diabetes crisis needs urgent response
Diabetes a leading killer in SA, but we don’t know how many have it