Around 4.2 million people in South Africa have diabetes. The International Diabetes Federation estimates that one in nine adults live with diabetes. 

But these numbers are just that. Estimates. The actual number of people with diabetes in the country – despite its increase – is not known. 

This is among the red flags raised in the recently released Diabetes Summit report. 

“There is a significant underestimation of the challenges posed by diabetes in South Africa. Currently, diabetes prevalence data for the country is primarily obtained from estimates released by the International Diabetes Federation. Despite the escalating prevalence of diabetes in the country, there is a lack of data to closely track the trends,” the report states. 

Another glaring problem is that diabetes patient records are still predominantly paper-based and there is no standardisation of the information being collected. This is indicative of the absence of a coordinated diabetes surveillance system that has led to unreliable data for monitoring diabetes prevalence, trends and outcomes in the country. 

”Poor surveillance hampers efforts in prevention and care as a result there is an urgent need to streamline data collection processes to make it easier for healthcare workers to capture accurate and comprehensive data,” says Dr Patrick Ngassa Piotie, one of the compilers of the Diabetes Summit report and  co-founder of the University of Pretoria’s Diabetes Research Centre.   

Piotie, who’s also the chairperson of the non-profit organisation Diabetes Alliance says an integrated, digitised diabetes surveillance system can provide real-time data on diabetes prevalence, risk factors and outcomes, enabling targeted interventions and research initiatives.

Diabetes is among the top causes of death in South Africa, claiming 32,100 lives in 2020.

Speaking to Health-e News, Dr Nireshni Chellen a specialist scientist at the South African Medical Research Council’s Biomedical Research and Innovation Platform adds that unreliable data for monitoring diabetes prevalence significantly hampers the country’s ability to effectively combat the disease. 

“When data is inconsistent or inaccurate, it becomes difficult to gauge the true scale of the problem, allocate resources effectively and implement targeted interventions. Policymakers and healthcare providers rely on accurate data to understand trends, identify high-risk populations and monitor the success of treatment programmes,” she says. 

Flying blind and other gaps

Diabetes is an escalating public health crisis in South Africa. A recent Stats SA report shows that diabetes-related deaths more than doubled in the decade from 2008-2018. 

The government’s efforts to address this issue are outlined in the National Strategic Plan (NSP) for the Control and Prevention of Non-Communicable Diseases. In particular the NSP sets the goals of 90-60-50. That is, that 90% of adults know whether they have raised blood pressure; 60% of people with raised blood pressure will receive interventions; and 50% of people receiving interventions for hypertension will have controlled blood pressure levels. Hypertension is a key risk factor for diabetes. 

However, Piotie points to a roadblock: there were no baselines when the targets were announced. There have also been no efforts to monitor the implementation of diabetes policies. 

“The country is not on track to meet the 90-60-50 targets because we haven’t seen any significant intervention towards achieving them,” he says.

According to the report the lack of diagnosis, suboptimal management, and inadequate investment in diabetes prevention and control lead to higher financial and resource expenditures by the health system when addressing the complications that arise from unmanaged diabetes.

Diabetes-related deaths more than doubled in the past decade

A compounding issue highlighted in the report is that many South Africans do not undergo regular screening and lack awareness of the symptoms of diabetes –  as a result one out of every two people living with diabetes remains undiagnosed. 

Chellen says that that lack of awareness leads to late diagnosis and poor management of the diseases. She adds that the high cost of diabetes management is a significant burden on patients, many of whom do not have adequate health insurance coverage. 

“Access to healthcare facilities, especially in rural areas, is limited which restricts the ability of many people in getting regular check-ups, early diagnosis and proper management of diabetes. For many South Africans particularly those in low income communities, the cost of managing diabetes is prohibitive,” she says.

There are also significant disparities between resources available in the public and private healthcare sectors in South Africa.  Even though there is availability of new diabetes drugs, many patients who rely on public health services don’t have access to them. 

“Funding for diabetes care in South Africa is generally insufficient. Public healthcare is underfunded and overburdened with limited resources allocated to non-communicable diseases like diabetes. Most of the health budget is directed towards communicable diseases such as HIV and Tuberculosis (TB) leaving less funding for diabetes and other chronic conditions. This results in limited access to essential medications, diagnostic tools and education programmes for diabetes patients,” she says. 

Recommendations  

“South Africans are more likely to die from diabetes than from any other diseases. Investment in research can ensure that the interventions that the Department of Health decides to implement are evidence based,” Piotie says.

He says the country should prioritise funding specifically earmarked for diabetes research to facilitate the implementation of research projects aimed at improving the South African diabetes response.

“If we don’t spend today, we will have to spend more tomorrow, on complications such as amputations, kidney failures, dialysis, heart failures.I don’t believe that the country can cope if this is left unabated.” – Health-e News