Diabetes has overtaken every other individual disease to become South Africa's single biggest killer, according to new government data, and it has held that position for three years running.
Statistics South Africa (Stats SA), the government agency that records every registered death in the country, released its latest mortality report on 22 September 2026.
It shows that of the 474,366 deaths recorded in 2024, 28,767 were recorded with diabetes mellitus as the underlying cause, 6.1% of all deaths that year.
Spread across the 366 days of 2024, a leap year, that averages about 79 recorded deaths a day.
Hypertensive diseases, conditions caused by high blood pressure, ranked second, with 25,972 deaths (5.5%).
Cerebrovascular diseases, which include strokes, ranked third, at 25,539 deaths (5.4%).
Together these three noncommunicable conditions accounted for 80,278 deaths, more than any single infectious disease recorded in the report.
Tuberculosis, the largest infectious cause, killed 18,666 people (3.9%); HIV killed 18,025 (3.8%); influenza and pneumonia killed 14,959 (3.2%).
Covid19, which drove a major increase in national mortality in 2020 and 2021, was recorded as the underlying cause of just 450 deaths in 2024, less than 0.1% of the total.
Diabetes accounted for 7.9% of all female deaths (17,429), making it the leading recorded cause of death among women in the country.
Among men, tuberculosis was the leading recorded cause of death at 4.8% (12,175), followed by cerebrovascular diseases at 4.5% (11,352) and diabetes very close behind, also at 4.5% (11,334).
Diabetes was the leading recorded cause of death in five of South Africa's nine provinces: Western Cape (7.3%), KwaZulu-Natal (7.0%), Limpopo (6.9%), Eastern Cape (5.8%) and Gauteng (4.6%).
Gauteng recorded the highest overall share of the country's deaths (21.2%), followed by KwaZulu-Natal (18.8%). Northern Cape recorded the lowest share (3.1%).
This isn't a sudden shift.
Diabetes was already South Africa's leading recorded cause of death in 2022 (33,126 deaths, 6.7%) and 2023 (27,967 deaths, 5.8%), according to the same report's three year comparison.
SUPPORT INDEPENDENT JOURNALISM
Help keep health journalism independent
I report and explain important health and medical stories independently, with accuracy, context and African relevance. Your support helps me continue this work.
That's part of a longer pattern the report's own historical data show.
The gap between noncommunicable disease deaths and communicable disease deaths widened substantially from 2010 to 2018, narrowed sharply during the Covid19 years, and has widened again since 2022, reaching 34.7 percentage points in 2024, the highest level recorded across the report's full series covering 2003 to 2024.
Stats SA flagged a significant gap in its own report. .
18.2% of all deaths in 2024 were recorded under "symptoms and signs not elsewhere classified," a category of ill defined natural causes where the information given was too vague or nonspecific to identify a precise underlying cause.
The agency said this makes it harder to accurately identify and track the true causes of death in the country.
It doesn't provide a basis for estimating how many of those unclassified deaths might belong to diabetes or any other specific disease, but it means the rankings above should be read with that limitation in mind.
Professor Tim Noakes, the Cape Town scientist who founded the Noakes Foundation, told IOL that the three leading causes were not "separate diseases at all."
"All those diseases are caused by insulin resistance and high carbohydrate diets," Noakes said.
Noakes, who faced a Health Professions Council of South Africa misconduct case over diet advice he gave online and was cleared twice, has warned since around 2015 of what he calls a "diabetes tsunami."
He wants government subsidies shifted away from grains and toward foods like meat, eggs, fish and dairy.
Not everyone in the field agrees with his focus on carbohydrates specifically.
Reverend Sean Cameron Gunn, branch manager of Diabetes SA in Durban, told IOL that sugar itself is commonly and wrongly blamed for the disease.
He said type 2 diabetes is generally linked to poor eating habits and low levels of physical activity, while type 1 is an autoimmune condition and is not caused by diet.
Sources: Statistics South Africa, Mortality and causes of death in South Africa, 2024: Findings from death notification, released 22 September 2026; Brandon Nel, IOL, 25 September 2026.
.jpeg){kind=logo}
