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In 2020, diabetes killed 32,000 people in South Africa — about 40% of them before they turned 65.
It’s about 1½ 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 No 1 killer in the country in the same decade.
But just like TB, diabetes — a preventable disease in many cases — doesn’t have to kill.
Unlike with TB though, little is being done about it.
Diabetes — a condition in which someone has too much sugar in their blood because their body doesn’t get or respond to the signal from the hormone insulin to absorb glucose — is one of four noncommunicable diseases (NCDs) that World Health Organisation (WHO) member countries agreed to lower deaths from by 25% by the end of this year. Others on this list are heart disease, cancer and chronic airway ailments like asthma.
But no country — including South Africa — is 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 its Global Forum in Rwanda last week, will result in more people dying early — instead of fewer, as the UN set out in the targets to reach the goals for sustainable development by 2030.
Said Dain: “Seven months ahead of the UN high-level meeting [on curbing NCD deaths], when we take a step back and actually look at the progress on NCDs, it’s very clear that 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 about 61,000 South Africans dying between the ages of 30 and 70.
It’s roughly the same number as in 2010 — and 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 South African Medical Research Council (SAMRC), says the country has been thrown off course by the high number of people already living with NCDs, their not being able to get good health care and lifestyle choices like smoking, eating fatty or sugary foods, and not exercising enough, all of which contribute to overweight and obesity — and can set someone up for developing diabetes.
Add to that about 270,000 people in South Africa with TB, an infectious disease that makes someone 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 over 13,000 — were linked to diabetes, StatsSA data shows.
Indeed, 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 a reduction in NCD mortality”.
Therein lies the rub.
Though South Africa has a national strategic plan for NCDs (running from 2022 to 2027), which sets out to, among other things, “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, which was 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 real challenge.”
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