27-06-2025
Letter to Mahlamba Ndlopfu: Diabetes is on the march, ushering in death like a thief in the night
Ah, Chief Dwasaho. I had hoped, perhaps naïvely, that a ceasefire to end the Israel-American war on Iran might lift my spirits, but it seems I remain a child of a lesser God. While the world held its breath following Iran's reciprocal attack on the American military base in Qatar, I found myself wrestling anew with my own silent killer, type 2 diabetes — one I had thought was buried for good beneath tablets and self-injections.
Before the Israel-US-Iran skirmishes, I had already made a poor judgement call. I accepted Novo Nordisk's courtesy to attend the 85th American Diabetes Association (ADA) Congress, which concluded this past Monday in Chicago, US. I should have known better.
The word 'diabetes' still sends a shiver down my spine. Twelve years of sweat, blood and tears have passed since I first heard that diagnosis. The years have blurred into struggle, yet hope persists, fragile as the fleeting peace we celebrate in far-off lands, uncertain how long it will last.
I am lying, my leader; I was hoping that the science boffins at the ADA would announce a breakthrough for a cure that will improve my blood glucose without my having to lift a finger. I have tried better diets and newer drug regimens, and now I find myself among the ranks of those who rely on injectables. The nightmare worsens with each fasting glucose test.
Let the facts speak. Our local figures show that non-communicable diseases, including diabetes, are now a leading cause of death and disability in the country, and their burden is growing at an unprecedented rate.
According to the Department of Health's 2023/24 Annual Report, non-communicable diseases such as cardiovascular diseases, cancer, diabetes, chronic lower respiratory diseases, and mental health disorders have increased by 58.7% between 2002 and 2022.
Sadly, diabetes has now overtaken tuberculosis (TB) as the leading cause of death among non-communicable diseases. At a 2024 World Diabetes Day event, Dr Zaheer Bayat from Helen Joseph Hospital raised the alarm. Bayat said South Africa's growing obesity epidemic was fuelling type 2 diabetes, now increasingly diagnosed in children and young adults. There were at least 5.6 million people with diabetes in South Africa in 2019, according to advisory firm Percept. That number was projected to rise to 5.7 million by 2025 and to 7.2 million by 2030.
Stubborn digits
The numbers, those stubborn digits that know neither spin doctor nor party whip, do not lie. We are bleeding silently, internally and nationally. The sugar monster, better known by its formal name, diabetes mellitus, is no longer content with its rank as a lifestyle disease. It has launched a full-blown missile attack on our health system and our households. It is now a national emergency, stalking us in rural clinics and urban e-hailing taxis alike.
Once upon a time, we held nightly vigils for HIV and tuberculosis. Now, as the clocks of modernity tick on, diabetes tightens its grip, especially in our rural hamlets where the old enemies once reigned supreme. In these forgotten corners of the republic, a new horror dawns: poorly managed diabetes now trumps HIV and TB in its cruelty, ushering in death like a thief in a night clinic.
I know this not from theory, my leader, but from the red soil of my own family. My beloved mother, MaMlambo, who had a warm embrace and an iron will, lost her fight against Covid-19. But it was diabetes that signed her death certificate.
A year later, my middle brother followed. He lived in Ulundi, a place where health services are as scarce as ANC renewal. Fifty years young, armed only with faith and insulin, he too succumbed to the silent killer. His children were double orphaned, their mother long claimed by the pandemic of HIV/Aids and poverty — a lethal cocktail.
I fear the very word, my leader, diabetes. I do not whisper it; I wince. For me, the battlefield is not some sterile clinic with motivational posters and lukewarm nurses. It is the blood test queue, the quarterly HbA1c verdict, and the trembling hand reaching for a glucometer. That number, calculated over 90 bitter days, is both my confessor and executioner. It tells me what the doctors won't: that I am losing ground.
Once, I held the line. My glucose levels were stable. I marched to the beat of clean eating and regular medical check-ups. Then came Covid-19 twice. Each wave carved a little more of me away. The sugars spiked. Early this year, pneumonia arrived like an uninvited third cousin. The steroid treatment, my lifesaver, became the sugar saboteur. And so, I joined the ranks of the injectables.
But let us not pretend the enemy arrived with the pandemic. No, diabetes had long danced in my bloodstream, chuckling as I downed beers in smoky taverns. What I called me-time was, in fact, a slow suicide. I drove while low on sugar, thinking I was only tipsy. I crashed into a gate in Sunnyside, barely avoiding the wrath of a mob thanks to a security guard who knew the signs. He had seen this sugar demon before, in his own brother's eyes.
Years before that, I blacked out at the wheel and took out an electricity pole. Darkness descended on the neighbourhood, but it was the light of truth that hit me hardest: I had to stop drinking and driving. Four years clean now, 12 months without a car, but still I fight for control of this body.
Medical A-team
This is despite having a medical A-team, including a GP, endocrinologist, dietician, and private medical aid; I remain a man under siege. Diabetes is a cunning general. You never win. You negotiate, you stall, you beg. It requires 'unconditional surrender' to its management routine.
My leader, this is not a lifestyle issue. This is war. Thus, we must do more than count corpses and preach wellness from podiums. We must fight for newer medicine that lasts the month, clinics that open on weekends, and nurses who do not yawn through their shifts.
We need political will, not wellness seminars. Unfortunately, the war is here. It is in my blood. It is scorching our land.
Let me tell you, my leader, there is hope, though. The science community is united in fighting diabetes and its twin evil, obesity. This week at the ADA Congress, Novo Nordisk, the Danish healthcare giant, released fresh results from the Step-Up trial in Chicago.
The trial, led by Novo Nordisk and international researchers, tested a higher dose of semaglutide — the active ingredient in the weight loss drugs Wegovy and the type 2 diabetes injectable Ozempic — on people living with obesity but without diabetes.
The results show that this 7.2 milligramme dose delivered an average weight loss of 21% over 72 weeks, with a third of participants shedding at least 25% of their body weight. The safety profile remained consistent with that of previous semaglutide trials, with most side-effects being mild to moderate gastrointestinal issues that resolved over time. The Danish firm now plans to file for a label update in the European Union and other markets where Wegovy is approved.
I have asked: When is South Africa's turn? Soon. I am told.
Why is the scientific community so fixated on obesity, you ask? The answer lies in the complex relationship between health and suffering that links obesity to diabetes. Scientists aren't merely chasing accolades or enriching their pockets through suffering; they are pursuing the root cause of the diabetes epidemic.
The link between obesity and this deadly disease is the scientific gospel. The results released this week serve as a stark reminder that, in the battle against diabetes, the war must be fought first on the battlefield of obesity. Novo Nordisk is not just selling a drug; it is offering hope, a lifeline to those drowning in the flood of excess weight and its deadly consequence, uncontrolled diabetes, like me.
Instead of hosting dialogues and unveiling the Eminent Persons Group, we should focus on reforming the healthcare system and working closely with scientists to fast-track the introduction of new, life-saving drugs into our public health system.
If not for me, please do it for MaMlambo, a faith healer who gave of herself to save humanity and 5.6 million people facing death daily.
Till next week, my man — send me to a clinical trial near me. DM
