Prioritising action on diabetes during COVID-19

Diabetes is emerging as an important determinant of disease severity in patients with COVID-19.[1,2] International reports from China,[3] Italy[4] and the UK[5,6] suggest that diabetes per se, and uncontrolled glycaemia in particular, and other non-communicable diseases (NCDs) are associated with increased mortality in COVID-19. These findings are of concern in South Africa (SA), where >4 million people live with diabetes,[7] and type 2 diabetes is recorded as the second leading cause of death after tuberculosis.[8] The diabetes epidemic is fuelled by high rates of overweight and obesity, with almost 70% of women and 40% of men being either overweight or obese.[9] Diabetes goes largely unnoticed until complications emerge, with 60% of cases being unscreened and undiagnosed. Close to 70% of people diagnosed with diabetes are uncontrolled.[10] Without adequate diabetes screening and treatment, complications and premature death will exact a high toll on households and on the health sector. In 2018, type 2 diabetes cases alone (diagnosed and undiagnosed) cost the SA public healthcare system an estimated ZAR21.8 billion.[11] This amount is more than the additional ZAR20 billion budget projected to address COVID-19.