Young, South African, and Pre-Diabetic: Why You Need to Get Tested

November 14th marks World Diabetes Day, a date that should alarm every young South African, but doesn’t. Diabetes is now the second leading cause of death in South Africa after tuberculosis, yet we still treat it like someone else’s problem.

The numbers are gruesome, with over 4.2 million South Africans who currently live with diabetes, a figure projected to rise to 8.75 million by 2040. However, here’s the real crisis: these numbers are conservative. An estimated 67% of South Africans are pre-diabetic, and millions don’t even know they have the disease. Among those who’ve never been tested, 10% of women and 6% of men are already diabetic.

For generations, low- to middle-income households dismissed diabetes as the elderly disease -something inevitable that arrived with old age. That myth, along with other misconceptions, is killing us. Between 2011 and 2021, diabetes cases among children and teenagers under 19 surged fivefold.

Today, 13% of children under five are already overweight, their young bodies primed for a disease we still think belongs to their grandparents. The question isn’t whether diabetes will touch your life – it’s whether you’ll know before it’s too late.

The Youth Crisis

The notion that diabetes belongs to older generations no longer exists. Between 2011 and 2021, South Africa witnessed a sharp rise in youth living with diabetes – and this isn’t solely about diet. Youth in cities, major metros, and even small towns live in a whirlwind of convenience: processed foods, screen-heavy routines, long work hours, and constant economic anxiety.

It’s a common misconception that diet alone determines diabetes risk, yet a study from the South African National Health and Nutrition Examination Survey (SANHANES-1) revealed that chronic stress and psychological distress are also key drivers.

Children, too, are bearing the brunt of this shift. Thirteen per cent of South African children under five are already overweight, a signal that the crisis begins earlier than most realise.

A Hidden Epidemic

It was found in one national survey conducted in 2016 that up to 67% of South African adults were already in the pre-diabetic range. If we describe someone as pre-diabetic, it doesn’t mean they’re sick; it means their body has raised the alarm, has said, “Hey, I’m struggling” It’s that in-between state when people’s blood sugar is already elevated compared to what it should be, but doctors do not yet call it diabetes.

This warning for many South Africans goes unnoticed until it is too late. Research indicates that most South Africans living with diabetes do not even realise they have it, with around 10% of women and 6% of men remaining undiagnosed. So the problem is not neglect but access. Most public healthcare facilities don’t routinely offer diabetes testing, and for most people, tests are only taken when symptoms are severe.

But this early stage is crucial; with timely intervention through stress management, lifestyle changes and regular screening, diabetes can be controlled and even reversed before it can take hold.

Who’s Most At Risk & Why

The rise is not random. It’s rooted in how we live, how we eat, and how we survive. As I described earlier this year, consumerism has priced nutrition out of reach, flooding townships with cheap, processed calories.

Youth living in urban neighbourhoods are overstimulated, under-rested, and constantly marketed to. But risk is also inherited. Diabetes is passed down through generations – not just through the genes, but through shared habits and cultural silence.

The trap is systemic: cheap food, expensive wellness, and a public health message that speaks past the people most at risk.

The Bottlenecks

So why aren’t young people getting tested and treated? It’s social and structural, and both are ongoing barriers. Socially, there is an ignorance of diabetes and who it affects. Young people don’t believe chronic disease applies to them until the symptoms force them to act. There is also a stigma – diabetes is still thought of as a willpower problem, not a systemic health crisis.

Infrastructurally, the public health system is broken. Public clinic patients are required to go monthly to pick up medicine because the state doesn’t issue supplies for longer periods. These visits can take hours, due to long lines, and can force people to miss work.

Staff shortages mean diabetes education is minimal, and patients leave without being educated on how to manage diet, exercise or blood sugar spikes. And most young South Africans, interestingly, have no idea that testing and treatment at public clinics are free.

Free insulin, free glucometers, free test strips, annual screenings, all available. But if no one tells, and clinics don’t actively screen you, you won’t know until it’s too late.

What You Can Do

And if you are under 30 and do not see that diabetes is your concern, you should try to reframe your mind. Here’s where to start:

Get tested:
Free diabetes screening is available at public clinics nationwide – for example, some urban medical centres offer daily walk-in hours from early morning to evening. Clicks Clinics have full screening options offered. Pharmacies such as Dis-Chem offer consultations, too.

Know what’s available:

At public clinics, people with diabetes receive free insulin, oral medication, needles, glucometers, test strips, and annual eye and foot screenings. Dietitian consultations are available.

Find support:

Youth With Diabetes (YWD) is a non-profit organisation which empowers all of our youth through peer counselling at diabetes camps and training seminars. Diabetes South Africa has a community wellness group that provides personal support.

The Diabetes Alliance brings together government, civil society and business to address better prevention and access to treatment.

Why This Matters

Longevity is not guaranteed, but it’s also not predetermined. The difference between living well into your 70s and dying in your 40s often comes down to what you know and when you act. Diabetes is preventable. It’s manageable. But only if you’re aware.

World Diabetes Day should not just be the next unnoticed date. It should be the day young South Africans awaken to a crisis that’s right on their doorstep – and choose to do something about it.

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Sources:

• Opperman, C. & de Klerk, J. (2021). A total cost perspective of type 1 and 2 diabetes mellitus in two South African medical schemes servicing the public healthcare sector. South African Medical Journal, 111(7).
• Sifunda, S. et al. (2023). Prevalence and psychosocial correlates of diabetes mellitus in South Africa: Results from SANHANES-1. PLoS One. PMC10218408.
• University of the Witwatersrand. (2023). Diabetes – SA’s second biggest killer. Available at: wits.ac.za

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About the Author:

I’m Aphelele Mtwecu, a proud member of the Activate Change Drivers Network and a 2016 Activator. I am a 33-year-old ambivert who works as a content writer, activist, and creative. My true passion lies in youth development, transformation, and making a meaningful impact. Every day, I encounter the world seeking healing, innovative solutions, and fresh methods to drive social change on my personal journey. My work and advocacy reflect my unwavering commitment to fostering positive change.