South Africa is grappling with a severe diabetes crisis, with recent statistics revealing that the condition claimed 28,767 lives in 2024. This translates to an average of 79 deaths per day, accounting for 6.1% of all deaths nationwide. Diabetes has now been the leading underlying natural cause of death in the country for three consecutive years, surpassing previous years' figures. The numbers underscore the urgent need for a comprehensive approach to address this growing health concern.
The burden of diabetes in South Africa is not only significant but also unequal. Women bear the heaviest loss, with diabetes being the leading recorded natural cause among women, claiming 17,429 lives, or 7.9% of all female deaths. In contrast, it accounted for 11,334 deaths, or 4.5% of all male deaths. The disease also disproportionately affects working-age adults, ranking first among people aged 45-64, with 9,364 deaths, or 7.9% of deaths in this group.
Geographically, diabetes ranked as the top natural cause in five provinces: Western Cape, KwaZulu-Natal, Limpopo, Eastern Cape, and Gauteng. Hypertensive diseases led in the remaining four provinces. These provincial rankings highlight the need to investigate whether access to diagnosis, treatment, and quality care differs between and within provinces. This disparity underscores the importance of region-specific questions about access and system performance.
While mortality statistics provide valuable insights, they have limitations. They record the primary cause listed on a death notification but remain blind to what happened along the way. The data cannot tell us how many South Africans live with undiagnosed diabetes or whether patients had consistent access to insulin and testing supplies. To address these gaps, experts stress the need for real-time clinical data that helps facilities respond promptly.
A public health specialist and chairperson of the non-profit organisation Diabetes Alliance emphasises that diabetes is manageable with timely support, enabling people to lead long, healthy lives free from preventable complications. To achieve this, the Department of Health must establish a national diabetes strategy with clear targets for prevention and care. The finance minister must resource it, and the Presidency must lead a coordinated, whole-of-government response.
South Africa already has a framework in place – the National Strategic Plan for Non-Communicable Diseases and its 90-60-50 targets. However, the challenge lies in making policy work in practice. Tools like the National Health Laboratory Service diabetes dashboard offer valuable insights, but a national diabetes registry and integrated digital tracking are urgently needed to understand who enters care, who remains in care, and who is being left behind.
The latest mortality report underscores the urgency of the situation, prompting renewed calls for coordinated national leadership, sustainable financing, decentralised primary care, and direct participation by people living with diabetes. Experts stress three practical priorities: connecting early diagnosis to sustained care, measuring quality of care, and addressing the conditions in which health choices are made. By addressing these challenges, South Africa can mitigate the impact of its diabetes crisis.
Key points
- Diabetes has been the leading underlying natural cause of death in South Africa for three consecutive years.
- Women bear the heaviest loss, with diabetes accounting for 7.9% of all female deaths.
- A national diabetes strategy with clear targets for prevention and care is urgently needed to address the crisis.
