By Dr Patrick Ngassa Piotie, Chairperson of the Diabetes Alliance
In South Africa, diabetes is no longer a looming threat — it is already here, claiming lives every day. According to Statistics South Africa, diabetes is now one of the leading causes of death based on death notification certificates.
That sobering fact alone should have triggered a national reckoning. Yet when it comes to knowing how many South Africans are actually living with diabetes, we are left with guesswork rather than certainty.
For years, the International Diabetes Federation (IDF) Diabetes Atlas has been the most widely cited source of diabetes statistics. In its 10th edition (2021), the Atlas estimated that 4.2 million adults (20–79 years) in South Africa were living with diabetes. Just three years later, the 11th edition (2024, published in 2025) revised this number down to 2.324 million adults, a 7.2% prevalence.
That represents a staggering 45% drop in estimates – not in actual cases, but in what we think we know. This is not the result of a miraculous decline in diabetes cases, nor the impact of bold public health interventions. It’s a data failure. It is a reflection of our fragile and inconsistent surveillance systems.
Missing millions
At first glance, one might be tempted to celebrate. Some may even say: “Perhaps those diabetes advocates have been making noise for nothing.” But therein lies the danger. Diabetes has long been called a silent killer. Weak and unreliable data risk turning it into an invisible killer too — with millions of people living with diabetes going unseen, uncounted, and unsupported.
These “missing millions” are not statistical abstractions. They are parents who lose limbs to preventable complications, children diagnosed too late with type 1 diabetes, workers forced into early retirement by kidney failure, and countless families shattered by premature deaths. When the numbers on paper do not match the reality in clinics and communities, the result is not just confusion — it is systemic neglect.
We must acknowledge that the IDF data have been incredibly useful in raising global awareness. They provide a starting point. But considering the sheer magnitude of diabetes in South Africa, relying on fluctuating international estimates is no longer good enough. Our country urgently needs real, local, reliable, and accurate data.
That means building a national diabetes registry and investing in strong, transparent surveillance systems. It means disaggregating data to understand not only how many people have diabetes, but where they live, which services they access, and what outcomes they face. It means ensuring that every person living with diabetes is seen and counted — because only then can they be supported.
Dangers of not knowing
Without this, policymakers are planning in the dark. Budgets are misaligned. Health workers are left to fight a tidal wave of cases without clear guidance. And diabetes continues to devastate lives — quietly, invisibly, and preventably.
This is more than a data problem. It is a matter of justice and accountability. If we cannot even count how many South Africans are living with diabetes, how can we possibly claim to be addressing the epidemic with seriousness?
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Dr Patrick Ngassa Piotie is a Senior Programme Manager at the University of Pretoria Diabetes Research Centre and the Chairperson of the Diabetes Alliance
The views expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
