Diabetes among men is beyond being a medical issue only

WHEN James Sawana, a 45-year-old public transport driver, fell asleep behind the wheel and was rushed to the hospital, he assumed exhaustion was to blame. 

Instead, he received a diagnosis he never expected: Type 2 diabetes. Less than a year later, James is still struggling—not only with his health, but with the emotional weight of his illness. Out of fear and shame, he has not told his wife. The secrecy has strained their relationship: changes in his energy, mood and sexual performance—symptoms of poorly controlled diabetes—have been misinterpreted as signs of infidelity.

Even everyday decisions have become difficult. Asking for lighter meals or reducing traditional dishes like chakalaka and meat-based stews feels like challenging the household’s rhythm. 

Medication has been another stumbling block. Taking metformin inconsistently, often without food, has led to uncomfortable side effects such as diarrhoea, deepening his mistrust of treatment. James’s story reveals a complex truth: managing chronic illness is not simply biomedical—it is deeply social, shaped by relationships, economic pressures and cultural expectations of masculinity.

His experience is far from unique.

Across Africa, diabetes is rising at an alarming rate. Globally, 537 million adults live with the condition, and projections estimate that this number will increase to 643 million by 2030. 

Africa has one of the fastest-growing burdens, with prevalence doubling in the past two decades. However, up to 60% of people with diabetes on the continent remain undiagnosed—fuelling preventable complications, blindness, amputations and premature death.

While limited access to primary care, transport costs and food insecurity play significant roles, emerging evidence shows that narratives—the stories individuals and communities use to interpret illness—are equally influential.

Among men, norms of stoicism, self-reliance and emotional restraint shape whether symptoms are acknowledged or minimised. This is something that we should continue focusing beyond observing Diabetes Awareness Month and Men’s Mental Health Awareness Month in November.

In community workshops that we facilitated, many men describe tingling, blurred vision or excessive thirst as signs of “normal ageing.” 

Others working in informal jobs avoid screening altogether, fearing that a diagnosis could threaten their income. This is the case for Akhona, a 33-year-old driver who delayed testing for months because he worried that disclosing a chronic condition might jeopardise his employment. Such choices are not irrational; they are grounded in real economic precarity, but they also delay life-saving interventions.

These decisions are further shaped by persistent myths: that diabetes only affects wealthy people; that too much sugar alone causes it; that insulin means a patient is dying; or that traditional remedies can cure the disease. 

In reality, poverty increases risk, Type 1 diabetes is autoimmune, and Type 2 arises from a complex mix of genetics, environment and lifestyle. Insulin is a standard, lifesaving therapy. Herbal remedies may support wellbeing, but they do not replace biomedical care.

These myths are not simply misunderstandings—they reflect alternative explanatory systems rooted in lived experience. Addressing them requires communication that respects cultural knowledge while correcting harmful misconceptions.

A gender-responsive approach is essential. Evidence shows that diabetes care improves when screening is framed as responsible behaviour rather than weakness, and when men’s concerns—about work, sexual health, family roles and emotional strain—are openly acknowledged. 

Trusted community figures, such as leaders of drivers' associations, sports coaches, and faith leaders, can play powerful roles in reshaping these conversations. Dietary guidance must be culturally grounded, not dismissive of cherished foods or traditions.

Ultimately, Africa and South Africa’s diabetes crisis is not only a medical issue—it is a narrative.  What we tried to show in this article is how gendered narratives and socio-economic realities shape men’s responses to diabetes, and why shifting these narratives is critical for effective prevention and care.

For men like James and Akhona, health outcomes depend on shifting the stories that shape how symptoms are recognised, shared and acted upon. 

By strengthening communication, centering community perspectives and deploying technology responsibly, we can change these narratives—and in doing so, change lives.

•  Carolus,  Ngobese &  Jacobs are affiliated with the Division of Health Systems and Public Health in the Faculty of Medicine and Health Sciences at Stellenbosch University.