Diabetes is a disease that thrives on inequity
It's not every day one finds themselves navigating the buzz of McCormick Place convention centre in downtown Chicago, dwarfed by towering banners, energised scientists and a swirling stream of conversations in a dozen different languages, all united by a single cause: tackling diabetes.
For me, attending the 2025 American Diabetes Association (ADA) Scientific Sessions wasn't just about science. It was a reckoning. A moment to understand, reflect and reimagine what this disease means for my country, and for me as a South African woman.
I arrived late on Friday, 20 June, after a long-haul flight with cramped legs, airport sandwiches and anticipation. By the time I checked into my hotel, I had missed most of the day's sessions.
But there was one I was determined to catch, and I made it just in time. The session was called Social Drivers of Health Needs and Cost. What unfolded in that packed hall was less a session and more a raw, honest confrontation with reality.
Dr Jennifer Wallace, the moderator, opened with something that hit me square in the chest: 'If we want to treat diabetes effectively, we cannot ignore the world outside the clinic.'
It's a sentiment that resonates deeply in South Africa, where the world outside the clinic, townships, informal settlements and communities living in food deserts, is precisely where the battle against Type 2 diabetes is being lost.
Dr Marcus Lee told a story about a patient who managed her insulin levels by eating less. I could immediately picture women back home doing the same, sacrificing meals so their medication lasts longer.
Alicia Ramos, a community health navigator, reminded us that for many, the choice is not just between food and medicine, but between survival and wellness.
The truth? Type 2 diabetes is no longer a condition we see in sick or older people. It's knocking loudly on the doors of the working class, of families earning just enough to survive but not enough to eat well.
Saturday's session, Type 2: From Biology to Behaviour: Is it all in the Family?' took the conversation even deeper. The message was clear: diabetes doesn't just run in our blood. It runs in our habits, our kitchens and our cultures.
In South Africa, many of us grow up eating pap, vetkoek, sugary tea, deep-fried carbs and processed meats. These aren't indulgences. They're affordable staples. They have a high-calorie count and they don't break the bank. When healthier options cost twice as much or simply aren't available, how can we realistically expect people to choose better?
The session unpacked how family history and intergenerational behaviour create cycles that are hard to break. But what stood out to me was the shift in tone. This wasn't about blaming families for bad choices. It was about compassion, care and giving people the tools and environments they need to choose health.
Back home that means school programmes, public health campaigns and food subsidies. But, I thought, are we doing enough to combat the crisis? Or is our inherent socio-economic system jeopardising the problem?
Later that day, a quieter ePoster session titled Obesity-Associated Diabetes and Cancer Risk offered a chilling insight: Type 2 diabetes is tied not only to heart disease, but also to several cancers, especially in women.
As someone who has watched family members battle both diabetes and cancer, this hit hard. It's another layer of urgency for prevention and early screening, especially in women's health initiatives.
In a session, aptly named Are You What You Eat?, the spotlight turned to nutrition. But rather than scolding or moralising, the speakers reframed the conversation. People aren't unhealthy because they don't care. They're unhealthy because they don't have options.
One poster presented data showing measurable improvements in insulin sensitivity from small upgrades in food quality, such as switching to whole grains or reducing sodium.
But even those small steps can be unattainable luxuries in under-resourced communities. Junk food is cheaper than a tomato and provides more energy per serving, so with a limited income, why would I choose the tomato? We're treating diet like a choice, but it's often dictated by economics.
By Sunday, the most emotional session of the conference, Rising Risks, Real Solutions: Tackling Childhood Type 2 Diabetes and Obesity, laid bare a terrifying trend. More children are getting Type 2 diabetes, and earlier. It's aggressive, fast-moving and robs young people of a healthy adulthood. South Africa isn't immune from this; we're on the front lines.
The success stories came from schools with integrated nutrition and mental health programmes. This kind of holistic care could transform South African schools. I wondered how much we could change if our health and education systems worked in tandem (on the ground in communities) and how much this synergy could change how we approach diabetes in the future.
The final sessions I attended on Monday were visionary. They explored how hunger signals are regulated in the brain, how muscle mass affects metabolism and how next-gen drugs are not just managing, but potentially reversing diabetes. The promise? Therapies that promote weight loss, cardiovascular protection and even remission. The problem? Access.
I learnt a lot about the various medicines on the market, but just because they exist, doesn't mean they're readily available. In South Africa, even metformin can be out of reach for some. GLP-1 therapies such as semaglutide are available (technically), but are they accessible to the majority?
That's where Danish pharmaceutical multinational Novo Nordisk and others like it have a crucial role to play. Novo Nordisk has been pioneering research and partnerships for more than 25 years to improve the lives of people with diabetes and obesity.
This symposium made me think about equity in a different light. Equity isn't just about distribution, it's about systems, partnerships and policies that bring the future to those who need it most.
And equity is about having choice and the option to choose. Being denied options is being denied agency.
What I took from ADA 2025 wasn't just knowledge, it was clarity. Type 2 diabetes is no longer a niche concern or an affluent disease. It's a social epidemic, shaped as much by economics as by biology.
South Africa must act: boldly and collaboratively. From health policies to supermarket aisles, from school lunchboxes to transport infrastructure.
If we want to treat diabetes, we must treat the conditions that breed it. That means making healthy food accessible. That means reimbursing community health workers. That means equipping clinics with tools to screen not only glucose levels, but social risk. The shift isn't just from control to cure. It's from treatment to transformation.
I arrived in Johannesburg jetlagged and overloaded with information, but I returned with purpose. Diabetes is not a disease that exists in isolation, it is something proliferated by our socio-economic systems. And if we don't change our systems, diabetes will continue to become more and more of a concern.
In the end, health isn't just about science. It's about justice.
Katie Mohamed is the chief executive of BrandFusion, W-Suite and ChangeHub.
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