OPINION: World Diabetes Day
The need for awareness, education and responsible AI innovation
By Tersia Ellis
This reality highlights the importance of collaborative efforts to ensure early diagnosis, effective treatment and robust prevention strategies.
In this vein, World Diabetes Day, on 14 November, serves as a global call to action for greater awareness, education and innovation in the management of diabetes. As the second leading cause of death in South Africa, diabetes demands urgent attention. Globally, one in nine adults lives with the condition, yet over 40% remain undiagnosed,
Diabetes and well-being: a workplace imperative
This year, the IDF’s theme for World Diabetes Day is “Diabetes and well-being,” with a special focus on the workplace. The slogan “Know more and do more for diabetes at work” reflects the need to combat discrimination and promote inclusion. Many workplaces still lack basic awareness of diabetes symptoms — such as recognising low blood sugar — and how to respond appropriately. Education is essential for creating supportive environments where individuals with diabetes can flourish.
The growing burden in South Africa
Accurate data on diabetes prevalence in South Africa remains elusive due to the absence of a national registry. Estimates vary:
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The IDF’s 2024 Atlas (published in 2025) reports 2.324 million adults aged 20 –79 living with diabetes.
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Previous IDF editions and other sources suggest figures closer to 4.2 million.
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One advisory firm projects the number could reach 5.7 million by the end of 2025.
Despite these discrepancies, one fact is apparent: nearly half of those affected remain undiagnosed. Diabetes continues to be one of the country’s leading causes of death, and education is vital to reversing this trend.
Understanding diabetes: types and prevalence
Diabetes is not a one-size-fits-all condition. The main types include:
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Type 1 Diabetes: An autoimmune disorder where the immune system attacks insulin-producing cells. It often begins in childhood or adolescence and requires daily insulin therapy.
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Type 2 Diabetes: Caused by insulin resistance, often linked to genetics, lifestyle, and obesity. It typically affects adults over 40 but is increasingly seen in younger populations. Management includes lifestyle changes, oral medications and sometimes insulin.
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Gestational Diabetes: Occurs during pregnancy due to hormonal changes affecting insulin use.
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Prediabetes: Also known as intermediate hyperglycemia, this stage features elevated blood sugar levels not yet high enough for a diabetes diagnosis.
According to 2025 statistics, South Africa’s adult diabetes prevalence is 7.2%, with 2.3 million diagnosed cases among 38 million adults. However, nearly one million may be unaware of their condition. Risk factors include age over 40, increased Body Mass Index or waist circumference, sedentary lifestyle, specific ethnic backgrounds, history of gestational diabetes and family history of Type 2 diabetes. A free online risk assessment is available at www.cdediabetes.co.za.
Diagnosis and early detection
In workplace settings, individuals with risk factors should undergo a simple finger-prick test. A random blood sugar level of 11 mmol/l or a fasting level of 7 mmol/l, accompanied by symptoms, indicates diabetes. Regular fasting blood sugar should be below 5.6 mmol/l—levels between 6.1 and 6.9 mmol/l warrant further testing, such as an oral glucose tolerance test.
Many people delay testing until symptoms appear, but diabetes can remain silent for years. Often, diagnosis only occurs after serious complications like strokes or heart attacks. Other ways in which it can also affect the body is with eye complications like cataracts often leading to blindness, chronic kidney disease and peripheral nerve problems that affects sensation or movement. It is the leading cause of death among woman in South Africa.
Symptoms such as excessive thirst and urination typically emerge when blood sugar exceeds 15 mmol/l—especially in individuals over 50. Early testing is essential to prevent irreversible damage.
Importance of HbA1c monitoring
For those living with diabetes, the HbA1c test is a crucial tool for monitoring long-term blood sugar control. HbA1c reflects the average blood glucose level over the past two to three months. Elevated sugar levels bind to red blood cells, forming glucose “branches” that can damage organs such as the eyes, kidneys, and brain. This damage accumulates silently over time, often before diagnosis. Managing HbA1c effectively is essential to preventing life-altering complications.
Prevention through lifestyle changes
Preventing Type 2 diabetes can be as simple as losing 7% of body weight. Increasing dietary fibre slows glucose absorption, reducing blood sugar spikes. Pairing carbohydrates with protein — like peanut butter on bread — can also help. Regular exercise builds muscle mass and improves insulin sensitivity, both of which are critical for prevention and management.
Artificial intelligence
While education remains the cornerstone of diabetes care, emerging technologies like Artificial Intelligence (AI) offer transformative potential. As noted by Stefan R. Bornstein and colleagues in a July 2025 article in The Lancet, AI can revolutionise diabetes management through innovations such as insulin pumps and continuous glucose monitoring systems.
AI can also enhance early diagnostics and identify at-risk populations by analysing large datasets. This is especially valuable in regions with limited access to advanced medical care. Affordable biomarkers monitored by AI could detect diabetes in its early stages, improving outcomes for individuals and healthcare systems alike.
Currently, insulin pumps are not widely available in South Africa’s public sector due to cost. However, wearable patches with continuous glucose monitors offer a promising alternative. These devices, which provide real-time sugar readings via smartphone apps, could become more accessible if prices decrease.
Responsible innovation and equitable access
As AI tools evolve, responsible implementation is paramount. The diabetes community must prioritise real-world evidence, clinical validation and ethical standards. Equitable access must guide innovation, ensuring that AI solutions are adapted for low-resource settings and delivered in culturally sensitive ways.
The IDF is committed to training future diabetes professionals in AI literacy and ethics. Education and preparedness are essential to ensure that AI benefits all communities, not just those with financial or technological privilege.
Ultimately, the true value of AI will be realised only when it becomes accessible and affordable for everyone — regardless of geography, income, or digital literacy. As Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world.”
Meeting global targets
Achieving the World Health Organisation’s Global Targets by 2030 will require coordinated efforts across sectors. These targets include:
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Diagnosing 80% of people with diabetes.
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Ensuring 80% of those diagnosed have controlled blood sugar and blood pressure.
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Providing cholesterol-lowering medication to 60% of people with diabetes aged 40 and above.
World Diabetes Day is more than a symbolic observance — it is a rallying cry for action, innovation and compassion. By combining education, lifestyle changes and responsible AI integration, we can transform diabetes care and improve lives across South Africa and beyond.
Tersia Ellis is a Senior Lecturer in Internal Medicine at the Faculty of Health Sciences, Medical School, Nelson Mandela University.