Medical schemes and employers can fund prevention, effective treatment, and sustained support that prevents the harm and costly complications of type 2 diabetes.
In 2024, diabetes was South Africa’s leading underlying natural cause of death for the third consecutive year, claiming 28,767 lives, or 6.1% of the national total.
A local study using 2018 cost inputs estimated public-sector costs for treating type 2 diabetes at R21.8 billion and projected they would reach R35.1 billion by 2030.
Medical schemes face the same pressures.
Immediate prevention and treatment costs must be weighed against long-term consequences of delayed diagnosis and inadequate support. Diabetes-linked kidney and eye complications, heart attacks, strokes and peripheral vascular disease result in hospital, procedure and rehabilitation costs. Employers see productivity losses through absenteeism, reduced performance at work, disability and early retirement. Households bear high costs through lost income, transport and caregiving. Earlier, preventive care and better treatment can limit these later adverse outcomes.
Fund earlier care
Underdiagnosis is common: an estimated 70% of South African adults with diabetes – about 1.6 million people – do not know they have it. [3] Community testing, such as pharmacy and workplace checks, can identify diabetes earlier, but diagnostic confirmation and treatment must follow; otherwise screening is of little value.
Screening should be part of a better-connected, end-to-end service. Success is measured by confirmed diagnoses, entry into care and retention in follow-up; a screening event without an accessible referral route has not done its job.
Screening will identify prediabetes, in which blood glucose is raised but below the threshold for diabetes. About 10% progress to type 2 diabetes each year, 70% over a lifetime. Prediabetes is better understood as a sign of being on a path that, like diabetes itself, can be reversed. An HbA1c test can detect prediabetes, but there is a risk of overdiagnosis and over-medicalisation, so funded follow-up should focus on those at highest risk.
Employers can support workplace screening and provide healthier food. Funders can design benefits around care pathways that reduce financial barriers to diagnostic confirmation, annual complication checks and follow-up. Employers should receive only de-identified, aggregate reports. The affordability of healthy food, working conditions, and access to care affect whether people can sustain health changes.
Fund the full treatment programme
Advances in treatment make funding decisions more complex. Blood-glucose control is a simple and essential target. Still, the focus has shifted to more meaningful measures and outcomes, including protection for the heart, kidneys and other organs affected long term by diabetes.
In international trials, semaglutide, the best-known GLP-1 medication, has reduced major kidney complications and cardiovascular death in people with type 2 diabetes. Another class of medication, SGLT2 inhibitors such as dapagliflozin, has also demonstrated kidney and heart benefits in certain patient populations.
Medicine benefits covering these newer agents need to account for affordability and support for safe, effective use. Coverage needs defined eligibility criteria, supervised dose adjustment, nutritional support, follow-up and regular scheduled review of treatment benefit.
WHO’s latest guidance places GLP-1 therapies in the context of comprehensive care, with attention to affordability, access and ongoing support. Treatment duration is critical: most trial participants regained weight after stopping semaglutide, so funders need to consider continued treatment and clinical review when assessing programme cost.
Fund remission and what follows
Structured weight loss programmes can lead to remission in selected patients with type 2 diabetes, particularly early in the disease. In the 2026 RESET for Remission trial, a low-calorie diet combined with supervised exercise led to remission in 54% of adults with early-onset type 2 diabetes, compared with 4% on usual care. Remission does not mean cure. Relapse can occur, and existing complications may persist, making sustained support and monitoring necessary.
Benefit design should provide for structured support for suitable patients and maintenance after remission. Patients should have at least an annual review of blood glucose, blood pressure, kidney and eye health. Continued funding recognises that improved glucose levels do not eliminate the need for follow-up.
Test what works here
International evidence needs to be assessed alongside local factors: patient characteristics, affordability and the capacity to deliver care. African populations are underrepresented in metabolic research, and diabetes varies in ways that affect both treatment and outcome.
Local studies could test programmes that combine primary-care referral, affordable structured dietary support (perhaps supported by community organisations), and newer medicines where clinically appropriate. Before expansion, routine-care pilots should establish who enters and remains in care, the resources required to deliver the programme, and the outcomes they improve.
The Lifestyle Africa trial enrolled 494 participants in 28 community groups using trained community health workers and video-based sessions. Modest improvement in blood-glucose control resulted without significant difference in weight, blood pressure, or triglycerides (blood fats). The principles are clear, but more and longer-term studies are needed to evaluate programme delivery and the extent of meaningful outcome benefit.
Evaluate care in the real world
Funders, providers and employers should agree a set of measures. These can include the proportion of high-risk people who enter prevention programmes; the proportion of positive screens that result in confirmed diagnosis and treatment; retention in follow-up; and completion of annual kidney, eye and foot checks. Providers should report clinical outcomes, while funders can use claims and benefit data to assess utilisation and continuity of care.
Treatment reviews should consider glucose and weight response, side effects, adherence and continuing engagement with care. Longer-term measures should include disease remission where appropriate, heart attacks and strokes, lower-limb amputations, new dialysis starts and vision loss. Programmes should be assessed against a pre-specified baseline or comparable usual-care group, rather than against enrolment alone.
Medical schemes and employers should start by checking whether their diabetes benefits fund the connections between screening, treatment and continued care. Each stage needs a budget, a named clinical or operational responsibility, and a measure of success. Funders can coordinate benefit design and aggregate reporting; providers can deliver and monitor care; employers can reduce practical barriers through workplace services and supportive conditions. Programmes earn expansion when patients enter care earlier, stay engaged and have fewer complications.
By Gareth Kantor, Insight Health Solutions
