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With timely support, people can lead long, healthy lives free from preventable complications.
High-protein everything: How SA’s weight-loss obsession is reshaping the snack aisle Health workers in a NHLS Mobile Testing Lab during intensified testing and screening in Alexandra on 27 April 2020.
Picture: Gallo Images/ Dino LloydStatistics South Africa recently released its report on deaths that occurred in 2024. The headline findings contain a sobering, recurring truth: diabetes was once again the country’s leading underlying natural cause of death. In 2024 alone, 28,767 people died from complications caused by diabetes, accounting for 6.1% of all deaths nationwide. Diabetes also claimed the top spot in 2022 and 2023.
These numbers cannot be accepted as South Africa’s new normal. Behind every data point is a human life, a grieving family and, all too often, years of encounters with a health system that missed opportunities to diagnose, treat and support people in time. As a public health specialist and chairperson of the non-profit organisation Diabetes Alliance, I view this three-year trend as an unacceptable tragedy. Diabetes is manageable.
With timely support, people can lead long, healthy lives free from preventable complications. The Department of Health must establish a national diabetes strategy with clear targets for prevention and care. High-protein everything: How SA’s weight-loss obsession is reshaping the snack aisle The top three causes of natural death – diabetes, hypertensive diseases and cerebrovascular diseases – frequently overlap in the same individuals.
Managing these interconnected conditions through isolated disease programmes makes little sense for primary care clinics or the patients navigating them. At first glance, the 2024 total is 800 deaths higher than the revised 2023 figure of 27,967 . Late death registrations and administrative backlogs are processed retroactively; this leads to revision or updating of prior years’ The updated count for 2022 stood at 33,126, higher than diabetes deaths recorded in 2023 and 2024.
Diabetes has remained South Africa’s single largest natural killer for three consecutive years. Women bear the heaviest loss: diabetes was the leading recorded natural cause among women, claiming 17,429 lives and 11,334 or 4.5% of all male deaths. Working-age adults are hard hit: it ranked first among people aged 45-64, accounting for 9,364 deaths .
Geographic split: diabetes ranked as the top natural cause in five provinces, Western Cape, KwaZulu-Natal, Limpopo, Eastern Cape and Gauteng, while hypertensive diseases led in the remaining four provinces. These provincial rankings are not a measure of individual care quality or residency. They are a starting point for region-specific questions about access and system performance. The geographic split shows the need to investigate whether access to diagnosis, treatment and good quality care differs between and within provinces.
Mortality statistics record the primary cause listed on a death notification, but remain blind to what happened along the way. They cannot show whether a patient had consistent access to insulin and testing supplies, whether their blood sugar was adequately controlled, or whether a simple follow-up could have prevented a fatal complication. Nor do they capture the full toll of diabetes when another condition is listed as the underlying cause.
– a nurse-led programme that helped people with type 2 diabetes start and adjust insulin treatment in primary care, with follow-up support at home – I have seen where care pathways break down, and where they succeed.a trained clinic nurse with the time to actroutine follow-up mechanisms when a patient misses an appointmentsupport systems that respect the economic reality of a person’s daily life. We need real-time clinical data that helps a facility respond today, not a national death tally published two years later.
South Africa already has a framework: the National Strategic Plan for Non-Communicable Diseases and its 90-60-50 targets. This cascade aims to ensure that 90% of adults know their blood pressure and blood glucose status, 60% of those with elevated levels receive treatment, and 50% of those receiving care achieve clinical control. Tools like the National Health Laboratory Service diabetes dashboard offer valuable insights into blood sugar levels control across districts.
But to close the loop, South Africa urgently needs a national diabetes registry and integrated digital tracking to understand who enters care, who remains in care, and who is being left behind. After the 2025 Diabetes Summit, the Diabetes Alliance launched the Johannesburg Declaration for Accelerated Action on Diabetes. The declaration calls for coordinated national leadership, sustainable financing, decentralised primary care, and direct participation by people living with diabetes.
It asks the Presidency to lead a multisectoral response and calls on the National Treasury and health sector to match policy commitments with financial resources. The latest mortality report gives this agenda even more urgency. There are three practical priorities: Connect early diagnosis to sustained care. Screening is only useful if a positive result leads to uninterrupted treatment, reliable medicines, blood glucose monitoring and clinical review.
Measure quality of care: publish a picture of diagnosis, treatment, retention and complication rates by district and province. Address the conditions in which health choices are made. Food prices, transport barriers and economic hardship shape health outcomes. People living with diabetes must help define what quality care looks like.
Their experience should guide national policy and daily clinic operations alike. This article, written by Patrick Ngassa Piotie, was republished from The Conversation under a Creative Commons licence. Read the original article
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