Shifting Health Challenges in South Africa: The Rise of Diabetes

Many countries, especially those with low and middle incomes, are facing a change in the main health problems they encounter. In the past, infectious diseases like HIV, malaria, and tuberculosis were the biggest threats. Now, non-communicable diseases (NCDs) like type 2 diabetes mellitus (T2DM) are becoming more common. In South Africa, the number of people with T2DM has risen from 7.1% in 2011 to 10.8% in 2021. A significant number, around 60%, of those with diabetes often do not know they have it. This is a serious concern because undiagnosed diabetes can lead to severe health issues like heart attacks, strokes, kidney failure, and eye problems.

Even those who know they have diabetes can struggle if they are not getting proper treatment or if their condition is not under control. The good news is that there are ways to manage T2DM, primarily through lifestyle changes such as better food choices. However, many of the approaches that work in rich countries may not be suited for South Africa. Over the past 30 years, obesity has increased in sub-Saharan Africa, with South Africa having the highest rates in the region. This growing obesity problem, combined with insufficient diabetes screening, places many people at risk for T2DM and its complications.

#Socioeconomic Issues and Diet Diversity

South Africa is classified as an upper-middle-income country. However, it still faces significant social and economic inequalities due to its historical background, such as colonialism and apartheid, leading to one of the highest rates of inequality in the world. People of different racial and economic backgrounds often have different access to healthy food and healthcare. Studies have shown that Black South Africans generally have poorer diets compared to White South Africans, often relying on high-energy, low-nutrient foods from informal sources.

A national study revealed that many South Africans consume very little fruit and vegetables, which are essential for good health. With 62% of South Africans now living in urban areas, the shift from rural to urban living affects diets. Urban environments are often linked to higher rates of obesity and diabetes, as diets change to include more processed foods, which are high in calories but low in nutrients. This pattern of eating can create problems like obesity and food insecurity, making it harder for healthcare providers to help those in need.

#The 2016 South African Demographic and Health Survey

The South African Demographic and Health Survey (SADHS) conducted in 2016 gathered a wealth of information about health and social conditions in the country. It included measurements of blood samples to track diabetes levels along with survey data on various health outcomes. Findings from the survey indicated that 13% of women and 8% of men over the age of 15 had poor blood sugar control, even though only a small percentage had been diagnosed with diabetes. Furthermore, 64% of women and 66% of men were found to have prediabetes, putting them at risk for developing T2DM.

Despite the alarming numbers, there is limited research on how diet affects diabetes in South Africa. Most studies tend to focus on small groups rather than providing a broader view. This study aims to determine if healthy eating habits vary based on diabetes status while considering important social factors and to explore the connection between social factors and healthy eating among people living with diabetes (PLWD).

#Data Collection Process

This study analyzed data from the SADHS, which was collected from June to November 2016. The survey was managed by national health authorities and involved a structured sampling method that ensures a representative selection of the population. Participants voluntarily took part in the survey, and informed consent was obtained before collecting blood samples to measure blood sugar levels. To determine diabetes status, the study used specific blood sugar levels as defined by health organizations.

The overall outcome measure was based on participants’ reported eating habits, focusing on five dietary choices: fast-food intake, Fruit And Vegetable Consumption, and sugary drink (SSB) intake. Healthy eating choices included high intake of fruits and vegetables and low intake of fast food and sugary drinks. Those with unhealthy eating patterns had low fruit and vegetable intake and high fast-food and sugary drink consumption.

#Analyzing the Results

A total of 10,336 people took part in the SADHS, but only 6,709 were included in the analysis for this study, as many did not provide valid blood samples or did not have known diabetes diagnoses. The results showed that most people had a mix of healthy and unhealthy eating habits, with many consuming more unhealthy food choices.

Data revealed that low fast food consumption was a positive sign in most dietary groups, while low fruit juice consumption was the most common unhealthy choice. The pattern of dietary habits was similar across genders. Participants were grouped based on their number of healthy choices, with the majority falling into the category of having a mix of healthy and unhealthy choices.

#Participant Characteristics and Findings

Among the participants, the majority had never been diagnosed with diabetes. The data indicated that many people with diabetes struggled to control their blood sugar levels. Interestingly, those who had received a diabetes diagnosis were more likely to practice healthier eating habits compared to those who did not know they had diabetes.

The study found that different social and demographic factors influenced dietary choices. Those from Black African backgrounds had lower chances of following a healthy diet compared to other ethnicities. Being covered by Health Insurance increased the likelihood of having a healthier diet. Moreover, age was also a significant factor, with older adults showing better dietary choices than younger individuals.

#Insights on People Living with Diabetes

When focusing on individuals with uncontrolled diabetes, the data showed that dietary choices were similar to those in the general population. Women living with diabetes were found to make healthier dietary choices compared to men. Those belonging to higher income groups were also more likely to follow healthier eating patterns.

People who had not previously been diagnosed but had high blood sugar levels were less likely to make healthy dietary changes. This highlights a significant concern because many people living with undiagnosed diabetes are at risk due to poor eating habits, which can lead to serious health problems.

#Importance of Diet in Diabetes Management

The exploration of dietary choices among individuals with diabetes showed that there is a clear need for targeted interventions to promote healthier eating habits. Evidence indicates that better access to healthy foods can lead to improved health outcomes. Strategies focusing on increasing the availability of fruits and vegetables are essential, especially for younger populations and those from lower socioeconomic backgrounds.

Current plans by the South African health department aim to improve early detection of non-communicable diseases, including diabetes. They propose integrating diabetes screening into primary healthcare settings, which could help catch the disease earlier and encourage healthier lifestyle choices.

#Patterns of Food Consumption in South Africa

The data showed an overall trend of low consumption of fruits and vegetables across both the general population and those living with diabetes. Previous studies have identified similar challenges. The ongoing issue of low consumption of healthy foods, combined with increased intake of unhealthy options, places South Africa in a difficult position regarding managing diabetes and related health problems.

#Age and Gender Differences in Diet

Interestingly, the study revealed that older individuals tended to have healthier eating patterns compared to younger people. This could be due to various factors, including a preference for vegetables in older populations. However, some studies focusing on people living with diabetes found no difference in diet quality based on age, stressing the need for further investigation.

Women were generally found to follow healthier dietary practices compared to men, which aligns with broader trends in health and lifestyle changes. As conditions related to diabetes continue to rise, it is essential to address these gender differences in public health strategies.

#The Socioeconomic Factors at Play

The findings also underscored the connection between socioeconomic status and diet. Those with lower income levels and of Black African ethnicity were less likely to have healthy diets. These inequalities are rooted in the complicated historical context of South Africa and continue to define food access today.

Strategies that aim to improve dietary diversity and increase access to healthy foods should focus on vulnerable populations, particularly in addressing economic barriers that limit food choices.

#Recommendations for Future Action

To combat the rising rates of T2DM and related health issues, it is crucial to focus on enhancing the availability and affordability of healthy foods. Public health initiatives should target young, low-income populations who are most at risk. The South African health department’s NCD plan sets forth intentions to improve access to fruits and vegetables, but specific actionable steps are still needed.

Research shows that programs providing financial incentives for purchasing healthy foods have proven beneficial, yet these initiatives must reach those who need it the most.

#Strengths and Limitations of the Study

This study benefited from a large, nationally representative sample, which allowed for a deeper understanding of the dietary habits of South Africans. Using objective measures of diabetes status provided more reliable insights compared to self-reported data but also presented limitations. The cross-sectional nature of the study means it is difficult to determine long-term dietary trends.

Additionally, the focus on diet quality was based on a limited number of indicators, which means potential variations in individual dietary habits may not have been fully captured. A more comprehensive approach would help to paint a complete picture.

#Conclusion

As South Africa continues to face rising rates of T2DM, understanding the dietary patterns and social factors that influence health is vital. This study highlights the urgent need for health interventions tailored to the unique challenges faced by different populations.

Targeting younger and economically disadvantaged groups can pave the way for healthier lifestyles, and initiatives should be undertaken to ensure that nutritious foods are accessible to all. With growing urban populations and changing dietary trends, proactive measures are essential to promote better health outcomes and prevent the ongoing rise of diabetes in South Africa.