South Africa desperately needs evidence-based science and decisive leadership to address the mounting diabetes crisis
Diabetes has become one of South Africa’s most pressing public health issues. It is a leading cause of death and a significant source of morbidity. In 2021, it was estimated that around 4.6 million South African adults between 20 and 79 years old were living with diabetes. This is exacerbated by limited access to diagnosis and care in under-resourced regions. Addressing the crisis requires a commitment to evidence-based science and decisive action from government leaders and healthcare systems.
The diabetes challenge
The rising tide of diabetes in South Africa is fueled by a combination of limited public knowledge about symptoms and risks, restricted access to healthcare in rural and underserved areas, and the high cost of diabetes management, including medications and monitoring. Additionally, the country’s overburdened healthcare centers, with staff and resource shortages, face challenges in offering consistent and comprehensive diabetes care. Compounding these issues are cultural and dietary factors and diabetes related co-morbidities, which make prevention and management more difficult, increasing the complexity of patient care.
Leading with policy: government’s role
In recent years, the South African government has enacted several policies aimed at combating non-communicable diseases (NCDs), with diabetes at the forefront. Key among these efforts is the National Department of Health’s Strategic Plan for the Prevention and Control of NCDs, which aims to curb diabetes rates through increased screenings, public awareness initiatives, and more robust management practices. Additionally, the 2018 sugar tax was implemented as a preventive measure, discouraging high-sugar consumption linked to increased diabetes risk. However, challenges remain and more extensive, targeted policies are needed to make a measurable difference in diabetes care.
The essential role of evidence-based science
For policies and interventions to effectively address diabetes, they must be rooted in evidence-based science tailored to South Africa’s unique socio-economic and healthcare realities. Research, like that conducted by Prof Bradshaw (SAMRC), underscores the importance of context-specific interventions, such as community-based exercise programs and culturally informed dietary counseling, which have shown considerable success in managing Type 2 diabetes. Promoting prevention and self-management skills, in both developed and rural communities, will facilitate the reduction of disease burden.
The SAMRC’s annual Health Awareness Walk, set to take place this year at Mouille Point Lighthouse in Cape Town on November 16, is one such initiative aimed at raising awareness about lifestyle modification. In empowering people with diabetes, Sweet Life, a registered non-profit in South Africa, has launched a WhatsApp™ diabetes education chatbot. “Free diabetes education, for all South Africans.” The Chatbot is available through the Unu Health app (https://unuhealth.org/get-unu).
Mobile health (mHealth) solutions present another promising frontier in diabetes care. Studies reveal that SMS reminders and digital consultations can improve adherence to treatment, especially in areas where professional healthcare access is limited.
Overcoming challenges in healthcare delivery
Although evidence supports the efficacy of various diabetes interventions, applying these insights on the ground remains a challenge. A disproportionate share of healthcare resources is concentrated in urban centers, meaning rural patients often face difficulty accessing regular care, medications, and educational resources. Many South Africans experience delays in diabetes diagnosis, often leading to more severe complications by the time they seek care. Expanding proactive screening and ensuring that life-saving medications, such as insulin, are accessible nationwide is vital to reducing diabetes-related complications.
Additionally, there is a critical shortage of healthcare professionals trained in diabetes management, as outlined by SAMRC researcher Dr Pillay-van Wyk in The Lancet. This deficit results in a dependency on general practitioners who may lack the specialized expertise required to treat complex diabetes cases effectively. Addressing this gap will involve not only training more healthcare workers but also providing the resources and infrastructure necessary to support them.
The path forward: A vision for sustainable diabetes care
Effectively addressing diabetes prevention and management in South Africa requires a multifaceted approach centered on evidence-based science and strategic, decisive leadership. Government agencies, healthcare providers, and academic institutions must collaborate to up-scale prevention programs, ensure equitable access to healthcare resources, and develop locally tailored interventions.A commitment to sustainable, long-term investment in both prevention and management is essential. Without it, diabetes will continue to strain an already overburdened healthcare system, leaving many South Africans vulnerable to the disease’s devastating impacts. Leadership rooted in evidence-based practice will be essential in charting a path forward, ensuring that diabetes care in South Africa meets both current needs and anticipates future demands in a manner that is accessible, effective and sustainable for all.