Unequal Disorders: Diabetes Day Highlights Global Prevalence, Disproportionate Toll on Low-Income South Africans and Women

World Diabetes Day held annually on November 14th is a significant global awareness date highlighting the diabetes mellitus pandemic, which chronically receives a low degree of attention in relation to its household impact and mortality rates. A silent killer; according to the World Health Organization about 422 million people worldwide have diabetes – the majority living in low and middle-income countries, with 1.5 million deaths directly attributed to diabetes each year. 

With type 2 diabetes being the most common form, making up 90 percent of cases, approximately one in nine South African adults have it, totalling around 4.2 million individuals. Tens of thousands of South Africans die from diabetes every year, a number which demonstrated a startling increase of 36,5 percent between 2008 and 2018 according to Stats SA. This frames diabetes both as the leading cause of death in the country and the leading cause of death for women specifically.  

The ubiquity of diabetes is an international distress. The Center for Disease Control reports that nearly 12 percent of people in the United States have diabetes alongside an astonishing estimated 40 percent of Americans who have pre-diabetes. An estimated cost of diagnosed diabetes in the US in 2022 was USD 412.9 billion, including USD 306.6 billion in direct medical costs and USD 106.3 billion in various indirect costs attributable to diabetes, according to the National Institutes of Health.

In South Africa the annual cost to our health system is ZAR 2.7 billion (USD 150 million) exclusively for patients who have been formally diagnosed and not including undiagnosed cases, especially prevalent in rural and low-income areas. The School of Public Health at the University of the Witwatersrand estimates that if all cases were diagnosed and treated it would cost ZAR 21.8 billion (USD 1.2 billion) a year, rising to ZAR 35 billion (USD 1.9 billion) in total cost by 2030.

The ruinous impact of diabetes as a leading non-communicable disease [NCD] both in South Africa and abroad manifests significant societal and economic impacts, escalating dramatically as the present decade progresses. A new study published in January 2024 by the Physicians Association for Nutrition South Africa showed that plant-based eating can have positive outcomes for diabetes. Participants in their 21-Day ‘Diabetes Reversal Challenge,’ run by the Ubuntu Wellness Institute [UWI], followed a sugar-free, oil-free, plant-based regimen with remarkable results in the management of the disease and a reduction of reliance on medication.

“Increasing the production and consumption of pulses can solve many of our health, ecological, and economic challenges,” says Dr. Nanine Wyma, Executive Director of PAN South Africa. “Our research shows that plant-based nutrition offers a sustainable solution to South Africa’s public health crisis.”

A plant-based diet is a powerful tool for preventing and managing type 2 diabetes, and even putting type 2 diabetes into remission. The Physicians Committee for Responsible Medicine [PCRM] in the United States estimates that dietary factors are responsible for more than 70 percent of new cases of type 2 diabetes. Plant-rich diets have been consistently found to be protective against developing type 2 diabetes. The Adventist Health Study, which looked at nearly 61,000 people, found that the incidence of diabetes was merely 2.9 percent among those consuming a vegan diet. Processed meat, aside from being classified as a carcinogen by the World Health Organization, is noted by PCRM to increase the risk of type 2 diabetes more than any other type of meat, the consumption of which is estimated to result in one in five new cases of type 2 diabetes. In 2023 their researchers showed that a whole food, plant-based diet can improve insulin resistance in one week. Individuals with type 2 diabetes who were dependent on injecting insulin were enrolled in a crossover trial comparing the Dietary Approaches to Stop Hypertension [DASH] diet and a whole food, plant-based diet. The whole food, plant-based diet was more effective than both their starting diets and the DASH diet, resulting in lower insulin doses, improved insulin sensitivity and improved blood sugars. This clearly demonstrates that plant-based diets offer considerable advantages in both the prevention and treatment of type 2 diabetes.

Most South Africans with diabetes are either diagnosed very late, by which time they are much sicker, or are not diagnosed at all. The SA Demographic Health Survey data from 2016 found that 67 percent of all men and women were pre-diabetic and suggested that a large portion  of South Africans remained undiagnosed. Untreated or badly controlled diabetes can result in amputations, kidney failure and blindness. Many of these same individuals also have high blood pressure and end up with stroke as a result of brain haemorrhage.

A core tenet of ProVeg South Africa is its emphasis on the health benefits of a plant-based diet. The organisation offers a free plant-based solution for newcomers to this nutritional pattern with its Veggie Challenge, guiding participants through 30 days of lifestyle adjustment towards healthier eating and addressing dietary-relevant NCDs such as diabetes mellitus.