Diabetes is a condition that can develop without obvious symptoms and affect people from different backgrounds, requiring lifelong care. Dr Rendani I. Manenzhe’s book, Diabetes – The Load Shedding of Our Health: The Book Every Family Needs to Prevent a Diabetes Blackout, raises questions about unequal access to diagnosis, medication and treatment. The author’s personal experience with diabetes in his family sparked his interest in understanding the condition and its effects.
Manenzhe’s book provides a comprehensive understanding of diabetes, including its types, warning signs, screening, nutrition, exercise, family support and complications. The book explains that type 1 diabetes involves the destruction of insulin-producing cells and requires insulin, while type 2 involves insulin resistance and declining insulin production. Gestational diabetes develops during pregnancy, and these conditions cannot all be reduced to someone eating too much sugar.
The World Health Organization’s theme for World Diabetes Day, “Early action on diabetes”, connects earlier diagnosis with comprehensive care and reducing stigma. South Africa’s Department of Health identifies excess weight as a risk factor for type 2 diabetes, cardiovascular disease, hypertension and some cancers. The 2016 South Africa Demographic and Health Survey reported that 68% of women and 31% of men aged 15 and older were living with overweight or obesity.
Internationally, the scale of diabetes is enormous, with an estimated 828 million adults aged 18 and older having diabetes in 2022, approximately 630 million more than in 1990. Adult prevalence had roughly doubled, from around 7% to 14%. A 2024 analysis published in The Lancet estimated that 212 million adults in India, 148 million in China and 42 million in the United States had diabetes.
The treatment gap for diabetes is equally disturbing, with an estimated 445 million adults aged 30 and older with diabetes, or 59% in that age group, not receiving glucose-lowering medication in 2022. A separate study covering 55 low- and middle-income countries found that fewer than half of participants with diabetes reported a previous diagnosis, and just 4.6% reported receiving all recommended treatments.
Prevention and education are key to addressing the diabetes challenge. The United States Diabetes Prevention Program enrolled 3,234 adults at high risk of type 2 diabetes and found that a supported lifestyle programme reduced diabetes incidence by 58% relative to placebo. A 2024 systematic review including 44 studies across 21 low- and middle-income countries found that diabetes self-management education reduced HbA1c by an average of approximately 0.64 percentage points.
The findings of these studies show that supported, timely intervention can change outcomes for people at increased risk of type 2 diabetes. Education has measurable value in managing diabetes, and comprehensive care can make a difference in preventing and treating the condition. Diabetes care should not depend on what patients can afford, and efforts to address the unequal access to diagnosis, medication and treatment are necessary.
Key points
- Diabetes does not discriminate based on age, income or background, but access to diagnosis, medication and treatment is far from equal in South Africa.
- Supported lifestyle programmes and diabetes self-management education can reduce diabetes incidence and improve outcomes.
- Comprehensive care and early action on diabetes are crucial in preventing and treating the condition.
