Tackling South Africa’s diabetes epidemic with data and innovation

Diabetes has quietly become one of South Africa’s most pressing health challenges, one that demands urgent, co-ordinated and innovative action across the healthcare system. Current estimates indicate that 2.3 million South African adults live with diabetes, representing a 7.2% prevalence rate among adults aged 20–79. Even more concerning is that 70% of cases remain undiagnosed.

Far from being just a ‘sugar’ problem, diabetes affects the heart, kidneys, eyes, nerves and overall quality of life-often long before symptoms appear.

This epidemic has now overtaken tuberculosis as a leading cause of death in the country. Type 2 diabetes is largely driven by rapid urbanisation, sedentary lifestyles and dietary patterns dominated by processed foods and sugary beverages.

At Medscheme – an AfroCentric Group company and one of South Africa’s largest health administration and managed care providers managing the healthcare of more than four million lives – these national trends are reflected in our own data. The prevalence of diabetes among members of the schemes we administer has grown from 6.65% in 2021 to 7.26% in early 2025, while the costs associated with diabetes care now consume 24% of total scheme expenditure.

Hospital admissions related to diabetes have increased at a concerning rate, adding further pressure to already constrained healthcare budgets. The numbers tell a clear story: The burden of diabetes is escalating, and the system can no longer afford to treat the condition in isolation.

The factors fuelling this epidemic are multidimensional. Approximately 68% of South African adult women and 40% of adult men are either overweight or obese, and physical inactivity is widespread. Limited access to healthy food and quality healthcare, especially in lower income communities, further compounds the problem.

Among Medscheme’s members living with diabetes, co-morbidities such as hypertension (67%) and dyslipidaemia (65%) are alarmingly common. Urban dwellers, meanwhile, face both higher prevalence rates and lower adherence to self-care routines.

Yet, incremental progress offers hope.

Through targeted disease management initiatives, Medscheme has improved glucose control rates, with controlled HbA1c outcomes rising from 65.5% to almost 70%. To augment our existing outbound automated and telephonic interventions from our Disease Management teams, AI-driven screening and adherence alerts are being piloted within select schemes, representing a tangible shift from reactive to proactive care.

One of the most decisive factors in improving diabetes outcomes is adherence to treatment and self-management routines. Adherence goes beyond simply taking prescribed medication; it includes being fully invested in the treatment and self-management plan agreed upon between the individual and the doctor: attending regular checkups, following dietary guidance, monitoring glucose levels, managing stress levels, getting sufficient sleep, reducing or stopping smoking and alcohol consumption, and engaging in regular, consistent physical activity. When patients adhere to their treatment plans, they experience fewer complications, reduced hospital admissions and better quality of life.

Unfortunately, studies reveal that adherence rates remain low, with only approximately a quarter of patients meeting glucose targets. The reasons are complex, ranging from limited health literacy and psychosocial barriers such as stigma or depression, to fragmented care and insufficient follow-up support. Improving adherence, therefore, requires a holistic approach that combines patient education, behavioural support, digital reminders and stronger provider-patient engagement.

Globally, diabetes management is being reshaped by new drug classes such as GLP-1 receptor agonists and SGLT2 inhibitors, which lower glucose while reducing cardiovascular and renal risks. Digital tools like continuous glucose monitors, smart insulin pens and AI-driven risk stratification are transforming how care is delivered.

While access to these innovations remains uneven across South Africa, they represent a crucial frontier in reducing complications and improving quality of life. Cost is still a barrier to care from a population health perspective, but Medscheme is engaging with stakeholders to develop a more affordable and sustainable approach to ensure appropriate access and cost of care.

Our disease management programmes are designed to reinforce adherence through structured education, regular engagement and digital innovation, ensuring patients are supported not only clinically but also emotionally and socially in managing a lifelong condition. We don’t manage ‘diseases’, but adopt a patient-centric or ‘person-centric’ approach. We care about the individual and all the factors that impact his/her health state, starting the conversation with “How are YOU” and not “what is happening with your diabetes today”. The narrative is important.

The challenge with traditional fee-for-service healthcare models is that they reward volume, not value. They encourage more consultations, more procedures and more prescriptions rather than better outcomes. This approach fragments care, inflates costs and, ultimately, fails both patients and payers.

Medscheme is addressing this through its transition toward Value-Based Care (VBC), a model that realigns incentives around quality, outcomes and patient experience. The Medscheme Diabetes Care (MDC) programme exemplifies this transformation. By integrating multidisciplinary teams, digital tools and evidence-based clinical pathways, MDC ensures each patient’s journey is managed holistically: from early detection to sustained control and complication prevention.

Our VBC contracts are anchored on the Quintuple Aim framework:

• Improved clinical outcomes
• Enhanced access to care
• Better patient experience
• Improved provider satisfaction
• Cost containment

This integrated approach not only supports patients in managing their condition effectively but also promotes accountability and collaboration across the healthcare value chain.

Medscheme’s focus on clinically driven innovation positions it to harness these advancements effectively within a managed care framework. By combining data analytics, clinical insight and digital enablement, we are reimagining what sustainable, patient-centred diabetes care looks like in South Africa.

Prevention must remain the cornerstone of any national diabetes response. Lifestyle modification, nutrition education and early screening are far more cost-effective than managing late-stage complications.

But prevention cannot succeed in isolation; it requires aligned stakeholders across the public and private sectors, working within an ecosystem that rewards long-term health outcomes rather than short-term volume.

Our commitment is clear: to lead South Africa’s healthcare transformation through value-based, holistic care underpinned by clinical innovation. Managing more than four million lives gives us both the scale and responsibility to drive meaningful change and to ensure every person living with or at risk of diabetes receives care that is proactive, integrated and effective.

The future of healthcare in South Africa depends on how quickly we make that shift from treating disease to preventing it, and from fragmented care to value-based care.

Ayesha Kriel

Head: Disease and Medicine Management

Medscheme and AfroCentric Group Company

Image credit: Freepik/jcomp