Diabetes has become one of South Africa’s most pressing public health challenges, claiming tens of thousands of lives each year and emerging as the country’s leading natural cause of death.
Story audio is generated using AI Diabetes has become one of South Africa’s most pressing public health challenges, claiming tens of thousands of lives each year and emerging as the country’s leading natural cause of death. This status has been officially recognised by the Diabetes Alliance after its review of mortality data released by Stats SA. According to death notification forms processed by Stats SA, diabetes was the leading underlying natural cause of death in 2023, accounting for 27,692 deaths — about 5.8% of all recorded fatalities. This was the second consecutive year that diabetes had topped the list of natural causes of death in the country. The figures translate to an average of about 78 deaths every day. Cerebrovascular diseases, including strokes, followed closely behind at 5.4% of recorded deaths, while hypertensive diseases accounted for 5.2%. Diabetes is having a particularly devastating impact on women. More than 16,000 women die from the disease annually. Among men, tuberculosis is the leading cause of death, accounting for 5.1% of fatalities, followed by cerebrovascular diseases at 4.4%, with diabetes ranking third at 4.3%. In response to the growing crisis, the Diabetes Alliance has written to President Cyril Ramaphosa, finance minister Enoch Godongwana and health minister Dr Aaron Motsoaledi, urging government to recognise diabetes as a national public health emergency. “The reality has hit home. It’s undeniable now; diabetes has grown into an even bigger health crisis than many other major challenges South Africa faces,” said Diabetes Alliance chairperson and global health expert Dr Patrick Ngassa Piotie. “Several critical public health determinants are driving this trend. Most notably, South Africa is experiencing a growing burden of type 2 diabetes, a crisis exacerbated by climbing obesity rates, nutritional transitions, sedentary behaviour, urbanisation, poverty and inadequate access to preventive health services.” Piotie pointed to findings from the 2016 South African Demographic and Health Survey, which showed that 13% of women and 8% of men were living with diabetes, while 68% of women and 31% of men were overweight or obese. He said many South Africans are diagnosed too late or remain undiagnosed until severe complications develop. “Diabetes is often silent in its early stages, but over time it damages the kidneys, heart, blood vessels, eyes and nerves. By the time complications such as kidney failure, stroke, heart disease or severe infections occur, the risk of death is much higher,” he said. Piotie also highlighted a significant imbalance in healthcare resources, noting that diabetes receives far less attention and funding than HIV. Without a national patient registry or routine monitoring systems, health authorities struggle to track who has been diagnosed, who is receiving treatment and whether patients are successfully managing the condition. Health advocates warn that inadequate public awareness is worsening the crisis. They argue that without sustained education campaigns in both urban and rural communities, preventable deaths and severe complications will continue to rise. The consequences are already being felt across the public healthcare system. State hospitals face growing backlogs of patients requiring cataract surgery and other diabetes-related procedures, while many South Africans are losing their sight from complications that could have been prevented through earlier diagnosis and treatment. Advocates say millions of South Africans may be living with undiagnosed diabetes, underscoring the need for urgent intervention. “This is the time when the national department of health should strategically collaborate with businesses to urgently provide evidence-based, localised diabetes education to stop more deaths,” Piotie said. He stressed that diabetes should no longer be viewed solely as a metabolic disease. “Diabetes is not only a metabolic condition; it is a major driver of premature death, kidney failure, cardiovascular disease and widening health inequality in South Africa. Its position as the country’s leading recorded underlying cause of death should be treated as a national public health priority.” Meanwhile, the diabetes awareness initiative Fighting Diabetes is encouraging South Africans to visit their local clinics for free blood sugar screenings. The organisation says recognising warning signs such as excessive thirst, frequent urination, unexplained fatigue and sudden weight changes — combined with regular testing — is critical for early diagnosis, effective management and preventing life-threatening complications.
