South Africa's diabetes burden - 70.3% undiagnosed in 2024, billions in preventable hospital costs

Why earlier diagnosis deserves greater attention in South Africa's response to diabetes

By Merilynn Steenkamp – General Manager, South Africa Multi-Country Network at Roche Diagnostics

The cost of not knowing

The human cost of diabetes shows in South Africa's mortality statistics. According to Statistics South Africa, diabetes was a leading cause of death in 2024, accounting for 28,767 registered deaths (6.1% of the total). Among women, it accounted for 7.9% of deaths.1

Although mortality statistics don’t tell us how many deaths could have been prevented through earlier diagnosis, they provide a sobering indication of the growing disease burden. There is also a substantial economic cost. A South African study examining diabetes expenditure in two medical schemes found that hospitalisation accounted for approximately 65% of direct medical costs during the period studied.2 These findings relate to an insured population and cannot be applied directly to the public healthcare system, but they illustrate the considerable expense associated with hospital-based diabetes care. In public healthcare, a study published in Global Health Action estimated that the direct medical cost of treating diagnosed type 2 diabetes was approximately R2.7 billion in 2018.3 

Of this, around R1.3 billion was attributable to managing complications. The researchers estimated that providing treatment to everyone with type 2 diabetes who needed it, including those who are undiagnosed, would have increased the annual cost to approximately R21.8 billion.2,3

These findings reveal the substantial economic burden of diabetes throughout South Africa's healthcare systems – both public and private. They also strengthen the case for earlier diagnosis and effective long-term management, which can help prevent or delay complications that require costly, resource-intensive treatment.

For patients and their families, avoiding serious complications can mean preserving the ability to work, maintaining independence and reducing the financial pressure that chronic illness places on households.

What South Africa's laboratory data reveals

South Africa's public healthcare laboratories are already generating information that can help us understand the challenges of managing diabetes.

A national study published in 2026 examined approximately 5.49 million HbA1c test results recorded between 2019 and 2024. HbA1c measures average blood glucose levels over approximately two to three months and is widely used to assess diabetes management.4

These results offer an opportunity to identify patterns in diabetes management, highlight gaps in care and guide more targeted interventions across the public healthcare system. The value of diagnostic information doesn’t end after confirming diabetes. Used appropriately, it can inform treatment decisions, reveal changes over time, and clarify where healthcare resources may be needed.

Connecting diagnosis with effective care

The first step is identifying people who may be living with diabetes without knowing it. The next is ensuring that diagnosis leads to appropriate treatment and continued monitoring. Blood glucose and HbA1c tests provide healthcare professionals with information needed to diagnose and manage diabetes. Depending on the patient's circumstances, assessment may also include kidney function, blood pressure, cholesterol and checks for complications affecting the eyes and feet.5

The clinical decisions that follow are equally vital. A patient with an elevated result may need further investigation, treatment or a change to an existing management plan. Regular monitoring allows healthcare professionals to assess whether treatment is working and respond when the patient's condition changes.

For many South Africans, attending these appointments involves practical considerations. Transport costs, working hours, caregiving responsibilities and household finances can influence how easily someone accesses routine healthcare. 

Point-of-care testing can help address some of these barriers by making certain tests available closer to where people live and work, reducing the need for additional visits to healthcare facilities and allowing healthcare professionals to make more timely decisions.

South Africa has already recognised this need in its national health priorities. The Department of Health's National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022–2027 establishes a 90-60-50 approach for diabetes and hypertension. Its targets are for 90% of adults to know whether they have raised blood glucose or blood pressure, 60% of those affected to receive an intervention and 50% of those receiving an intervention to achieve control.⁶

The scale of the challenge is considerable. According to the International Diabetes Federation's 2025 Diabetes Atlas, an estimated 70.3% of South African adults living with diabetes were undiagnosed in 2024.⁷ That means fewer than one in three knew they had the condition. Without a diagnosis, people may miss the opportunity to receive treatment and ongoing monitoring that could help prevent or delay serious complications.

The World Health Organization has also established global diabetes coverage targets for 2030, including diagnosing at least 80% of people living with diabetes and achieving good blood glucose control in at least 80% of those diagnosed.8

These targets provide a useful framework for measuring progress across the continuum of care. Increasing the number of people tested is important, but so is understanding whether those diagnosed receive treatment, remain in care and achieve better health outcomes.

Making better use of what we know

South Africa has established primary healthcare services, laboratory infrastructure and experience in managing chronic conditions. These provide a foundation for improving the detection and long-term management of diabetes.

There are opportunities to build on that foundation by strengthening appropriate testing for people at increased risk, improving the communication of results and supporting continuity of care. Making better use of laboratory information may also help identify patterns that warrant closer attention, including patients with persistently elevated glucose levels or communities where additional support may be beneficial.

These interventions require coordination between healthcare professionals, laboratories, health planners and the people receiving care. They also require a clear understanding of what diagnostic information can and cannot tell us.

A laboratory result does not explain every factor affecting a patient's health. It does, however, provide evidence that can guide further investigation and clinical decisions. When results are interpreted alongside medical history, individual circumstances and ongoing monitoring, they become part of a much more complete picture.

We have an immediate responsibility to the substantial number of South Africans who may already be living with diabetes without knowing it. For them, the difference between an undetected condition and a timely diagnosis may be the opportunity to begin treatment before serious damage occurs, continue earning a living, and stay independent for longer.

That is where the value of earlier detection becomes tangible: in the complications that may be delayed or avoided, the livelihoods that can be protected and the opportunities for better health that might otherwise be lost.

References

1. Statistics South Africa. Mortality and causes of death in South Africa: Findings from death notification, 2024. 2026.
   https://www.statssa.gov.za/publications/P03093/P030932024.pdf
2. Opperman AM, De Klerk M. A total cost perspective of type 1 and 2 diabetes mellitus in two South African medical schemes servicing the public healthcare sector. South African Medical Journal. 2021.
   https://pubmed.ncbi.nlm.nih.gov/34382546/
3. Erzse A, Stacey N, Chola L, et al. The direct medical cost of type 2 diabetes mellitus in South Africa: a cost of illness study. Global Health Action. 2019.
   https://doi.org/10.1080/16549716.2019.1636611
4. BMC Endocrine Disorders. Temporal and geographic trends in HbA1c results in South Africa: a retrospective NHLS analysis (2019–2024). 2026.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC13343962/
5. World Health Organization. Diabetes: Questions and answers.
   https://www.who.int/news-room/questions-and-answers/item/diabetes
6. South African National Department of Health. National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022–2027.
   https://www.health.gov.za/wp-content/uploads/2025/05/NCD-NSP-FINAL-VERSION-20-SEPT-22-1.pdf
7. International Diabetes Federation. IDF Diabetes Atlas, 11th edition. 2025. South Africa country estimates for 2024. https://diabetesatlas.org/media/uploads/sites/3/2025/10/IDF_Diabetes_Atlas_11th_Edition_2025_WEB.pdf
8. World Health Organization. First-ever global coverage targets for diabetes adopted at the 75th World Health Assembly. 2022.
   https://www.who.int/news-room/feature-stories/detail/first-ever-global-coverage-targets-for-diabetes-adopted-at-the-75-th-world-health-assembly/