Once considered rare in young people, diabetes has become an increasingly common health issue, especially in urban areas where high crime rates often limit outdoor play and physical activity for children. 

Socioeconomic conditions in urban settings have resulted in many children spending more time indoors playing with their gadgets while indulging in unhealthy snacks. This sedentary behaviour leads to a higher risk of obesity and related complications. Around 13% of South African children under five are overweight. This can lead to further health complications, particularly type 2 diabetes. 

“Obesity is a strong predictor for type 2 diabetes as excess fat, particularly visceral fat, leads to insulin resistance. In South Africa the prevalence of childhood obesity is growing in tandem with rising rates of type 2 diabetes,” says Dr Michelle Carrihill, a paediatrician and endocrinologist. 

It’s estimated that childhood obesity quadruples the risk of type 2 diabetes either during childhood or later on in life.

In South Africa, around 4.2 million people live with diabetes, most of these cases are type 2 diabetes which occurs when the body cannot regulate glucose leading to high blood sugar levels. Less common is type 1 diabetes which tends to affect younger people and occurs when the body does not produce enough insulin. 

The exact prevalence figures can be challenging to pinpoint due to variations in reporting, regional differences, and the relatively recent rise in diagnosis. The Diabetes Summit report released earlier this year highlights major gaps in the way data around the number of people diagnosed with the condition are collected.  

Carrihill says type 2 diabetes in children and adolescents is most commonly diagnosed in those aged between 10 and 19 years old. 

“The incidence of early-onset type 2 diabetes in children as young as five and nine years old is increasing. Factors such as rising rates of obesity and physical inactivity are contributing to the shift towards younger ages for type 2 diagnosis,” she says.

Drivers of childhood diabetes 

While type 2 diabetes is preventable, some factors that drive prevalence in urban areas are beyond individuals’ control. 

Karsas emphasises how lower-income urban areas often lack access to healthy food.  A recent study led by Dr Tamryn Frank, an obesity prevention researcher at the University of Western Cape, shows that ultra-processed foods make up 40% of diets of adults in low-income areas. These foods are high in salt, sugar, and saturated fat; they are widely available and cheaper than whole foods. 

These foods are easy to prepare, tasty, affordable and have a long shelf life. These are important considerations for Noluthando*. She’s a 42-year-old single mother of three children aged 5, 9 and 13. Her busy work schedule means she often buys fast food as she gets home late from work.

“I stay in Roodepoort and work in Johannesburg. I don’t have family members around here, they’re all back home in Mthatha in the Eastern Cape. It’s just me and my children,” she tells Health-e News.  

“I try to cook on weekends when I am at home. But during the week it’s very difficult to stick to healthy meals. I always buy fish and chips from the local mall because I am sometimes too tired to cook.”

Another compounding factor is the lack of safe recreational spaces. Women who took part in a study done in Soweto cited safety as a key barrier to their ability to exercise. Carrihill explains that as cities grow and urbanise, children spend more time indoors and have fewer opportunities for physical exercise contributing to weight gain and metabolic disorders that predispose them to diabetes. 

This is the lived reality of Noluthando’s children. 

“We live in a gated complex, when the school transport drops them after school they are not allowed to play outside as I fear for their safety,” says Noluthando. 

She adds that her house is always stocked with snacks so her children don’t get bored.

Efforts to root out obesity 

Rising rates of diabetes pose serious risks to individuals and threaten a health system that’s already under pressure. A 2022 Wits University study estimates that South Africa spends R19,86 billion, annually on diabetes treatment. These researchers called for rapid steps to be taken to decrease the rate of obesity. 

Several advocacy campaigns have been pushing the government to put pressure on the food industry by increasing the tax on sweet drinks and introducing front-of-package food labels so that consumers know exactly what is in their food.

Carrihill points out that, in some areas of South Africa, food insecurity and poverty can contribute to both undernutrition and overnutrition.

“Many children in underserved communities do not receive timely medical attention or diabetes management resources. This can lead to misdiagnosis or delayed treatment which worsens health outcomes and raises the burden of childhood diabetes in the population,” she says. – Health-e News

* Not her real name