Diabetes mellitus remains one of the rapidly increasing noncommunicable diseases (NCDs) in South Africa, contributing substantially to morbidity, premature mortality and increasing health system costs.
Despite the availability of effective pharmacological therapies, outcomes for many people living with diabetes mellitus remain suboptimal, driven in part by poor glycaemic control, late diagnosis and preventable complications, such as amputations, kidney failure, cardiovascular disease and vision loss.
The 2023 South African Diabetes Summit identified diabetes education and self-management support as the most critical gaps in the national diabetes response.
Before the 2025 Diabetes Summit, the Diabetes Alliance convened a national meeting of key stakeholders, including CSOs involved in diabetes advocacy, national and provincial government representatives, and the World Health Organization (WHO), to collectively reflect on the state of diabetes education and peer support in South Africa. This conference report synthesises the key insights emerging from the workshop and considers their implications for diabetes policies and practices.
The convening was organised by the Diabetes Alliance in partnership with the National Department of Health (DOH) and the WHO as part of the preparatory activities for the 2025 Diabetes Summit. Its primary aim was to create a dedicated space for civil society actors to reflect on diabetes education and peer support following the 2023 Summit, in which these issues were identified as priority areas for action.
The workshop participants included representatives from the National DOH, WHO, Gauteng DOH and CSOs involved in diabetes education, peer support, community outreach and advocacy. Many participants had lived experiences of diabetes mellitus, either personally or through close engagement with communities affected by the condition. This diversity of perspectives was intentionally leveraged to foreground experiential knowledge alongside organisational and programmatic insights.
The meeting was structured around facilitated group discussions, allowing participants to share their experiences, identify challenges and propose solutions related to diabetes education and peer support. In this report, a peer refers to a person with lived experience of diabetes, either as someone living with the condition or as an individual closely engaged with diabetes-affected communities, who uses this experiential knowledge to support others. Peer support refers to structured or informal support provided by such individuals to people living with diabetes, including practical self-management guidance, emotional support, shared problem-solving, encouragement and linkage to information or services. The authors drew on discussion notes and collective reflections from the meeting to summarise the key themes and priorities.
The dominant theme across discussions was the fragmented and inconsistent nature of diabetes education in South Africa. Participants described a landscape in which education was delivered unevenly across provinces, facilities and sectors (public vs. private), with little coordination or standardisation. In many public sector settings, diabetes education is limited to brief verbal advice provided during clinical consultations, often without written materials, follow-up or adaptation to patients’ social and cultural contexts.
Civil society actors noted that this inconsistency contributes to confusion among people living with diabetes mellitus, undermines self-management and exacerbates inequities in care. Individuals with access to private care or well-resourced NGOs may receive comprehensive education and support, whereas others rely solely on overstretched clinics with limited capacity for patient education.
Closely linked to fragmentation was the perceived absence of a
This gap places additional pressure on CSOs to develop their own educational materials and programmes, often with limited resources and variable levels of clinical oversight. While many organisations have developed innovative and contextually appropriate approaches, participants expressed concern that the lack of national guidance limits scalability and sustainability.
Civil society actors highlighted peer support as a particularly valuable component of diabetes education. Participants described peer support as uniquely positioned to address not only knowledge gaps, but also the emotional, social and practical challenges of living with diabetes mellitus.
Peer support was described as taking multiple forms, including group education sessions, community-based support groups, one-to-one mentoring and increasingly, digital platforms such as messaging groups and online forums.
Despite strong enthusiasm for peer support, discussions highlighted tensions between informal peer-led initiatives and the formal health system. Participants noted that peer support programmes often operate in parallel to clinical services, with limited recognition, referral pathways or supervision from health professionals. This separation can lead to mistrust, duplication of efforts and missed opportunities for integration.
Some participants expressed concerns that without appropriate training and oversight, peer educators might feel ill-equipped to address complex clinical questions or complications. Simultaneously, overly rigid professional control was seen as potentially undermining the relational strengths that make peer support effective.
Finally, the participants highlighted challenges related to sustainability and organisational capacity. Many peer support and educational initiatives rely on short-term donor funding and substantial amounts of uncompensated or minimally compensated time from peer supporters and community members. Burnout, high turnover, and limited opportunities for skill development were identified as risks to programme continuity.
Civil society actors emphasised that while CSOs can innovate and respond rapidly to community needs, long-term impact requires predictable funding, institutional support and stronger linkages with government programmes.
The insights from the convening underscore why civil society increasingly views peer support as a strategic opportunity to strengthen diabetes care in South Africa. Peer support closely aligns with the reality of living with a lifelong condition that requires daily self-management, motivation and psychosocial resilience.
International and local evidence suggests that peer support can improve diabetes knowledge, self-efficacy and self-management behaviours, and in some contexts, glycaemic outcomes.
From a civil society perspective, peer support is not viewed as a replacement for professional diabetes education but as a complementary approach that can extend the reach of the health system, enhance the continuity of care and address psychosocial needs that are often overlooked in clinical settings.
The workshop highlighted the need for greater visibility and structural recognition of diabetes education and peer support in South Africa’s diabetes response. Participants emphasised the importance of national-level dialogue on how peer support could be formally integrated into diabetes care pathways. This would require the development of standardised training frameworks, supervision structures and referral mechanisms, while ensuring that the relational and experiential strengths that underpin peer-led approaches are preserved.
These insights highlight the importance of moving beyond problem identification to concrete discussions on implementation. Civil society actors recognised the need to engage explicitly with questions of scale-up, sustainability and system integration, including how peer support models can align with national NCD strategies and PHC reforms.
More broadly, the convening underscored the role of civil society as an important site of knowledge generation. The experiential insights shared during the discussions provided perspectives that are often absent from formal policy processes but are critical for designing interventions that are responsive to the lived realities of people affected by diabetes mellitus.
This convening provided a timely opportunity to reflect on diabetes education and peer support in South Africa. The discussions revealed widespread concerns about fragmented education provision, the absence of a national DSME framework and the sustainability of community-led initiatives. Simultaneously, they underscored a strong collective belief in the potential of peer support to strengthen diabetes self-management, particularly when grounded in lived experiences and community engagement.
These insights offer an important foundation for advancing more coordinated, equitable and person-centred approaches to diabetes education. Recognising and integrating peer support within the broader health system may be a critical step towards improving outcomes for individuals living with diabetes mellitus and reducing the long-term burden of the disease.
The authors acknowledge all civil society organisations and individuals who participated in the convening and generously shared their experiences and insights.
This article forms part of a themed collection linked to the 2025 Diabetes Summit, held at the Radisson Hotel and Convention Centre, Johannesburg, O.R. Tambo Airport, from 11 to 13 November 2025. The Summit served as a multi-stakeholder platform for dialogue, collaboration and advocacy on diabetes prevention and care in South Africa.
All manuscripts authored by guest editors were handled independently of the guest editorial team. The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Lorrein S. Muhwava: Conceptualisation, Methodology, Writing – original draft and Writing – review & editing. Patrick Ngassa Piotie: Conceptualisation, Methodology, Writing – original draft and Writing – review & editing. Kibachio J. Mwangi: Funding acquisition and Writing – review & editing. Melanie Pienaar: Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication and take responsibility for the integrity of its findings.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.