By Dr Gareth Kantor, Insight Health Solutions
Diabetes is South Africa’s leading underlying natural cause of death. According to Stats SA, diabetes claimed 28 767 lives in 2024, accounting for 6.1% of all recorded deaths.
Type 2 diabetes accounts for about 90% of cases, and it does not develop overnight.
The good news is that, with early detection, type 2 diabetes can often be prevented or significantly delayed, people living with it can reduce their risk of complications, and some can even put it into remission.
1. Understand your risk before symptoms appear
High blood sugar is the hallmark, but the underlying biology is more complex: changes in how the body responds to insulin, regulates appetite and processes energy (what we call metabolism) appear years before diagnosis.
Excess body weight and physical inactivity are well-known risk factors – and ones over which individuals have some control.
Systemic and societal factors also matter: food affordability, chronic stress, long working hours and limited opportunities for safe exercise all influence metabolic health. Family history and genetics – which we cannot change – play a role.
Understanding one’s personal risk is an important first step, particularly if diabetes runs in the family or a previous blood glucose reading has been high.
2. Make healthier habits part of everyday life
Most people with type 2 diabetes are overweight. In overweight people at risk, losing 5–7% of body weight through dietary and activity changes or other means can halve the risk of developing diabetes.
Affordable first steps are to fill half your plate with vegetables, a quarter with protein such as beans, eggs or pilchards, and no more than a quarter with starch such as pap or brown rice. Limit sugary drinks and highly processed foods and find ways to move more regularly throughout the day. Cutting back on carbohydrates, especially sugar and refined starches, is an effective way to lower blood glucose but anyone on diabetes medication should check with their doctor first.
For someone working long hours or managing a tight household budget, these changes are not always straightforward. The aim is realistic improvements that can be maintained, rather than restrictive diets or quick fixes.
3. Don’t wait until you feel unwell
Type 2 diabetes often causes no obvious symptoms. An estimated seven in ten South African adults with diabetes have not yet been diagnosed.
A simple blood glucose or HbA1c test can identify diabetes or prediabetes, where glucose is above normal but below the diabetes threshold. Prediabetes is an important opportunity to intervene before the condition progresses.
If you have risk factors, ask a healthcare professional, clinic or pharmacy about screening. An abnormal result should be followed by confirmation, advice and ongoing support.
4. Managing diabetes means protecting more than blood sugar
For people already diagnosed, controlling blood glucose is important, but only one aspect of effective treatment.
Over time, diabetes can damage the heart, kidneys, blood vessels, eyes and nerves, leading to heart attacks, strokes, kidney failure, blindness and amputations.
Good management therefore includes taking prescribed medication, monitoring blood glucose, managing blood pressure and cholesterol, and avoiding smoking.
Regular kidney, eye and foot checks are also essential: they detect problems early, when treatment can prevent further damage.
Newer medicines such as GLP-1 receptor agonists improve glucose control, protect the heart and kidneys, and can benefit related conditions like sleep apnea and knee arthritis. For now, however, high cost means access is limited for most South Africans.
5. Understand what remission really means
An important development in diabetes care is the recognition that some people with type 2 diabetes can achieve remission, particularly within the first six years after diagnosis.
Remission – blood glucose below the diabetes threshold without medication – usually follows substantial weight loss, most often through a structured nutrition plan with exercise. For some, metabolic surgery may be an option to discuss with a doctor.
However, remission is not a cure.
Blood glucose can rise again, and complications that developed before remission may still require treatment, so regular check-ups stay essential.
Prevention is only the beginning
For those at risk, this means understanding their risk, getting screened and making sustainable lifestyle changes. For those already diagnosed, it means staying engaged with treatment and looking beyond blood sugar readings to protect their overall health.
Individuals cannot do this alone: government, employers, medical schemes and the food industry must help make healthy food affordable, and screening and treatment accessible.
Ultimately, diabetes care is not about a number on a blood test, but about helping people live longer, healthier lives, with fewer complications and a better quality of life.
Dr Gareth Kantor, Consultant, Actuarial Solutions at Insight Health Solutions
