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South Africa’s diabetes crisis cannot be solved by glucagon-like peptide-1 (GLP-1) medicines alone, with experts calling for earlier diagnosis, better primary health care, healthier food choices and long-term support for patients.
Diabetes was the leading underlying natural cause of death in South Africa in 2023, accounting for 27,692 deaths, or 5.8% of all recorded deaths, according to Stats SA.
GLP-1 medicines have attracted growing attention because they can help people with diabetes, control their blood sugar and also help some patients lose weight.
GLP-1 is a hormone that helps regulate blood sugar and appetite. It mimics the hormone’s effects in the body. Some can also reduce the risk of certain heart and kidney problems in appropriate patients.
However, experts warned the growing focus on the medicines should not overshadow the wider problems driving South Africa’s diabetes burden.
A GLP-1 RA [receptor agonist] can be one tool inside that system. It cannot substitute for the system itself
— Lungile Kasapato, PPO Serve CEO
Lungile Kasapato, CEO of health-care management company Professional Provider Organisation Services (PPO Serve), said tackling the crisis requires several parts of the health-care system to work together. These include:
screening people early for diabetes, pre-diabetes and high blood pressure;co-ordinated care involving different health-care professionals; and social support to help patients maintain healthier lifestyles.
“A GLP-1 RA [receptor agonist] can be one tool inside that system. It cannot substitute for the system itself,” Kasapato said.
Cost is also a major barrier. Kasapato said GLP-1 treatments could cost between R3,000 and R6,000 a month, putting them beyond the reach of many South Africans. While cheaper generic versions could improve access, she said the cost of the medicine was only one part of the problem.
“Affordability isn’t only the drug cost. Patients also need access to clinicians who can monitor treatment, dietitians who can provide nutritional support and ongoing care to manage side-effects and other health conditions,” she said.
“Real affordability means bundling the drug into a funded, co-ordinated care pathway, not leaving patients to self-manage it in isolation.”
Dr Uhuru Motjuwadi, a GP specialising in family medicine and diabetes, said GLP-1 medicines had an important role in diabetes treatment but could not address all the factors driving the disease.
You cannot manage diabetes properly if you look at the patient in isolation. The food environment also makes managing diabetes difficult, particularly in poorer communities
— Dr Uhuru Motjuwadi
Late diagnosis remained a major concern, he said.
“Chronic conditions are often silent, so people can live with diabetes for years before they know they have it,” Motjuwadi said. “By the time they present, complications may already be developing,”
Motjuwadi said South Africa was facing a growing burden of diabetes and other non-communicable diseases while dealing with HIV, TB and other infectious diseases.
This placed additional pressure on the health-care system and made teamwork between doctors, nurses, community health workers and other healthcare professionals important.
“In diabetes we can track measures such as HbA1c and see whether a patient’s control is improving,” he said. “You cannot manage diabetes properly if you look at the patient in isolation. The food environment also makes managing diabetes difficult, particularly in poorer communities.
“This made the duration of treatment, monitoring and ongoing support important because making GLP-1 medicines cheaper would not, on its own, address the wider problems affecting diabetes outcomes.
“South Africa needs to place greater emphasis on screening, education and early intervention. It will help identify diabetes before complications developed, while education around food, physical activity and treatment could help patients manage the disease.”
TimesLIVE