Diabetes control demands earlier action
Clinical evidence supports the principle of the right patient, the right insulin and the right time as a way to reduce preventable harm
Johannesburg, 27 May 2026: Diabetes is one of South Africa’s fastest-growing health challenges and is a leading cause of chronic illness, premature death and growing pressure on primary and specialist care services. Early detection and coordinated management are key to improving long-term outcomes.
“Improving early recognition, assessing risk proactively and escalating treatment at the right time are key to reducing preventable complications,” says Dr Rust Theron, Physician at Mediclinic Durbanville. “Applying the principle of the right patient, the right insulin and the right time helps ensure that therapy is intensified based on clear clinical indicators rather than after avoidable deterioration.”
Rising risk and delayed diagnosis
South Africa’s high prevalence of obesity is a key driver of Type 2 Diabetes risk. Half of South African adults are overweight or obese, significantly increasing their likelihood of developing Type 2 Diabetes, cardiovascular disease and other non-communicable conditions. Nearly half of all women are classified as obese, compared with 15% of men, placing many at elevated metabolic risk.
Much of this risk goes unrecognised. Because Type 2 Diabetes often develops gradually, symptoms such as polyuria, thirst, fatigue and unintended weight loss are frequently attributed to stress, ageing or lifestyle factors. This contributes to diagnostic delays during which microvascular and macrovascular damage may already be progressing.
Type 1 and Type 2 Diabetes require different approaches
Type 1 Diabetes is an autoimmune condition in which the pancreas produces no insulin. Type 2 Diabetes, representing approximately 90% of cases, is characterised by insulin resistance and/or insufficient insulin production influenced by factors such as genetics, age, adiposity and ethnicity. Both forms require lifelong management, with poor glycaemic control increasing the risk of cardiovascular disease, chronic kidney disease, neuropathy and retinopathy.
Timely intensification improves glycaemic durability
Lifestyle modification and oral antihyperglycaemic agents are effective initial strategies for many patients with newly diagnosed Type 2 Diabetes. However, Type 2 Diabetes is progressive, and declining β-cell function reduces the effectiveness of oral therapies alone over time. Clinical guidance supports initiating insulin when non-insulin therapies fail to achieve glycaemic targets or when symptoms of hyperglycaemia are present.
Early and appropriate insulinisation helps to:
- Reduce glucotoxicity and metabolic stress
- Improve long-term glycaemic control
- Reduce the risk of complications
- Provide β-cell rest and improve responsiveness to therapy
“For many people with Type 2 Diabetes, insulin becomes necessary over time. It is a normal and anticipated part of managing a progressive condition,” says Dr Theron. “What matters is initiating the right treatment at the right moment, supported by clear clinical guidance and patient education.”
Addressing the psychological burden of Diabetes
International Diabetes Federation data highlight the emotional and cognitive demands associated with Diabetes self-management. Findings include:
- 77% of people living with Diabetes have experienced anxiety or depression linked to their condition
- 83% cite fear of complications as the biggest contributor to emotional distress
- 76% struggle with the demands of daily Diabetes management
- 58% have experienced stigma or discrimination
- 55% report fear of needles
- 79% report Diabetes burnout, and three in four say emotional strain has disrupted their treatment
These findings underscore the importance of addressing emotional well-being as part of routine Diabetes care.
“Living with Diabetes means making continuous, often complex decisions about food, medication, activity and daily routines,” says Dr Theron. “Patients may experience pressure, guilt, fear, frustration or burnout when their glucose levels fluctuate or when routines become difficult to maintain. Supporting emotional resilience is essential to achieving sustainable therapeutic outcomes.”
A call to action for healthcare professionals
Healthcare providers play a central role in improving the quality of Diabetes care by identifying risks earlier, monitoring glycaemic trends and adjusting treatment when current regimens are no longer effective.
Key actions include:
- Routine screening of high-risk individuals, including those with obesity, family history or previous gestational Diabetes
- Clear counselling at diagnosis about the progressive nature of Type 2 Diabetes
- Timely therapeutic intensification, including early basal insulin, where appropriate
- Regular emotional well-being assessments, with referral pathways in place
- Collaborative goal setting to improve adherence and patient confidence
“Our shared goal is sustainable glycaemic control supported by treatment plans that align with patients’ daily realities,” says Dr Theron. “Improving outcomes depends on recognising change early and intensifying treatment before complications develop. We call on healthcare providers to prioritise earlier screening, closer follow-up and timely escalation of therapy to protect patients from preventable harm.”
References available on request