Diabetes has once again claimed the title of the leading killer in South Africa, resulting in the death of approximately 79 people daily. According to the latest Mortality Report from Stats SA, published this month, diabetes accounted for 6.1% of 474,366 registered deaths in 2024.
Now, the top three causes of death in the country are non-communicable diseases, which include diabetes, heart disease, strokes, cancer, and high blood pressure. In contrast, infectious diseases such as tuberculosis, HIV, and pneumonia are contagious.
Hypertensive diseases ranked second with a rate of 5.5%, and cerebrovascular diseases, including strokes, were third at 5.4%. These three conditions together caused more deaths than any infectious diseases in the country, as indicated in the report.
Diabetes, a chronic condition affecting blood sugar regulation, most severely affects women, accounting for 7.9% of all female deaths. Among men, tuberculosis remains the main cause of death at 4.8%. HIV accounted for 3.8% of all deaths, lower than the rates of 4.3% in 2022 and 4.0% in 2023.
COVID-19, which was the country's leading killer in 2020 and 2021, resulted in only 450 deaths in 2024, making up less than 0.1% of the total.
Regional Mortality Statistics
Gauteng recorded the highest share of deaths at 21.2%, followed by KwaZulu-Natal at 18.8%. The lowest percentage of deaths was noted in the Northern Cape at 3.1%. Furthermore, 63,367 people died from unnatural causes, with three-quarters of these cases related to accidents, and 12% due to assault.
Scientists' Views on the Causes of Diabetes
Professor Tim Knox, a renowned scientist from Cape Town and founder of the Knox Foundation, stated that the three largest causes of mortality mentioned in the statistics are 'not actually separate diseases.' Knox, who previously advocated for carbohydrates as fuel for endurance athletes, later became one of the most prominent proponents of the low-carbohydrate, high-fat 'Banting' diet in South Africa.
He faced disciplinary action from the South African Medical Professions Council for unprofessional conduct after advising a breastfeeding mother to switch to a low-carbohydrate, high-fat diet. In 2017, he was acquitted after a four-year battle, and then again on appeal a year later.
Knox, aged 77, was ridiculed a decade ago for warning of an impending 'diabetes tsunami' in South Africa. He argued that 'all these diseases are caused by insulin resistance and high-carbohydrate diets.' He explained that with insulin resistance, when carbohydrates are not metabolized efficiently, they eventually convert into fat in the liver, pancreas, and other organs, worsening insulin resistance.
He noted that unlike the past when everyone was thin, today everyone suffers from obesity, and this is a problem. In his view, 'we are in the middle of the tsunami I spoke about years ago, and the problem will only worsen if the government does not change its food policy.' He added that politicians cater to sponsors rather than public health.
The Importance of Diet Over Medication
Knox insisted that the solution lies in completely eliminating ultra-processed foods from the diet and consuming meat, chicken, fish, eggs, dairy products, nuts, and certain vegetables. He also proposed that subsidies should be directed towards livestock products rather than grains and seed oils, arguing that poor children should be given eggs and canned fish instead of maize.
His foundation ran the 'Eat Better SA' campaign in impoverished areas, teaching people how to eat well on a limited budget, and patients in this program were able to reverse their diabetes. However, Knox maintained that traditional diabetes treatment is meaningless without dietary changes, which contradicts national treatment guidelines and is disputed by doctors.
While the Department of Health leadership published a treatment literacy pamphlet recommending a varied, fiber-rich diet such as whole-grain bread, brown rice, oats, and barley, along with vegetables, fruits, beans, lentils, lean proteins, and healthier fats, other sources point to a broader picture.
According to the same recommendations, over half of adults in South Africa live with at least one chronic disease; diabetes affects one in eight adults, and the disease has replaced tuberculosis as the leading cause of death in the country.
Debunking the Sugar Myth
Father Shaun Cameron Hahn, manager of the Diabetes SA branch in Durban, emphasized that sugar itself is not the cause of the disease. He explained that there are many factors, but the misconception that sugar causes diabetes is untrue.
Hahn noted that people diagnosed with type 2 diabetes typically have very poor eating habits and engage in little exercise. Type 1 diabetes, conversely, often begins as an autoimmune disease where the body stops producing insulin. In this case, diet, medication, and injected insulin play a decisive role. He added that type 1 diabetes is irreversible, whereas type 2 diabetes can be reversed through diet and physical exercise, as confirmed by studies from the International Diabetes Federation.
Hahn reported that his branch is observing a rise in the disease among adolescents, and the incidence rate in Indian and African communities in Durban is now almost equal. He attributes this largely to both parents working, children not receiving prepared meals at home, and spending less time outdoors.
Dr. Nomathemba Chandidwana, Chief Scientist at Desmond Tutu Health Foundation, stated that the increase was not sudden but accumulated over two decades in South Africa and across the continent, driven by population aging and an unhealthy dietary environment. She suggested that people have lived longer due to successful HIV control, and consequently, chronic diseases have emerged among the elderly population.
Dr. Adil Razak, working in the public health system, noted that staff simply do not have time to screen patients for conditions they did not come in for. He stated that they constantly face time shortages and focus only on the primary issues presented.
The Cost of Healthy Eating
Armand de Wet, a sports return specialist from Stellenbosch who works with professional athletes, observed a similar issue with insulin in people far from retirement age. He explained that consuming high-carbohydrate foods reduces insulin sensitivity, and this excess constantly turns into visceral fat around the organs. As soon as carbohydrate intake decreases, the body becomes more sensitive to insulin again.
De Wet reported that elite endurance athletes consume between 120 to 150 grams of carbohydrates per hour, compared to 60–80 grams several years ago, and some of them become prediabetic as a result. In the last year, he trained 20–30 people who had prediabetic or diabetic forms, and about 10 of them managed to reverse the condition.
When asked about a healthy diet for a low-budget family, he mentioned that offal is cheap and rich in vitamins, minerals, and protein, but admitted that the financial aspect is difficult. He added that meat and milk are expensive, so everyone has to choose based on their budget.
The Diabetes Alliance sent letters to President Cyril Ramaphosa, Finance Minister Enoch Godongwana, and Health Minister Dr. Aaron Mosoadledi, urging the government to take action regarding the mortality rate. In April 2024, NGOs united and demanded the creation of a national diabetes registry and the reallocation of healthcare funds to manage this disease.
Stats SA warned in its report that 18.2% of natural deaths in 2024 were registered for unclear reasons, which hinders the correct tracking of disease trends and distorts the perception of public health status.