We will sit with an uncle at a funeral and say, softly, that he was only 52 - then drive home and change nothing.
Image: Towfiqu barbhuiya /pexels
Diabetes has overtaken TB and HIV as South Africa’s leading natural cause of death, and in Durban the warning signs are already showing up in people in their thirties, writes Sanjith Hannuman.
SOMEWHERE in Chatsworth this week, a 34-year-old man will collect a prescription he never expected to need. He is not old. He does not feel unwell. He took a blood test because his employer offered one, and it came back with a condition that will follow him for the rest of his working life.
That man, more than any wellness campaign, is what this column is about. In Mortality and causes of death in South Africa, 2023, released last month, Statistics South Africa recorded diabetes mellitus as the country’s leading underlying natural cause of death: 27 692 deaths, or 5.8% of all recorded deaths.
It has overtaken tuberculosis and HIV. Cerebrovascular disease, which includes stroke, followed at 5.4%, and hypertensive disease at 5.2%.
On our own statisticians numbers, the top three natural killers in this country are now conditions shaped, in large part, by how we sleep, eat, move and manage stress.
It is starting far earlier than we admit
Stats SA tells you where we finish. Local research tells you where it begins.
A retrospective study run through the University of KwaZulu-Natal and King Edward VIII Hospital, published in Clinical Epidemiology and Global Health in 2023, screened Durban patients aged 25 to 45. It found an average pre-diabetes prevalence of 68%, with the Indian participants most predisposed at 62.7%.
Those were hospital patients, not a random sample, so the street-level figure in Phoenix or Verulam will be lower. It remains a warning shot fired at our community, in our city, in our thirties.
The national picture is no gentler. The 2016 South African Demographic and Health Survey found 68% of women and roughly a third of men overweight or obese.
Writing in the South African Medical Journal in October 2025, researchers put the cost of that to this country in 2020 at 15.4% of all government health expenditure.
In my own practice, advising employers on benefits, the pattern shows long before the death certificate. Disability and critical illness claims that once arrived in a member’s late fifties now arrive in the mid-forties. This is not only a health story. It is a household balance sheet story, written in advance.
We did not inherit this. We adopted it
My grandmother could not have explained insulin resistance to you. She woke at the same hour without an alarm, ate at the same hours, walked because there was no alternative, and was in bed shortly after dark. Her routine did the work our medication now does badly.
What replaced it is a working life that treats exhaustion as commitment. We stay in overdrive all week, then attempt repair on Saturday - a punishing gym session, a juice cleanse, a detox tea sold by someone with a ring light. The body is not a machine that gets serviced. It responds to what it is given daily, not occasionally.
Ayurveda calls the alternative dinacharya, the practice of aligning daily life with the body’s natural cycles. I came across the term again in an article by the Ayurvedic physician Dr Sreelal Sankar, and its claim is easy to dismiss precisely because it asks so little: what you do everyday shapes you more than what you do occasionally.
I am not asking anyone to abandon their doctor for a herb. I am pointing out that the discipline our grandparents kept without naming it is now being confirmed in peer-reviewed journals. Three papers are worth your time.
What the evidence says about small habits
Start with the myth. The claim that a habit forms in 21 days traces back to Psycho-Cybernetics, a 1960 book by the plastic surgeon Maxwell Maltz about how his patients adjusted to their new faces. It was never a study of habit formation.
The actual research was done by Phillippa Lally and colleagues at University College London, published in the European Journal of Social Psychology in 2010. Ninety-six volunteers each adopted one daily behaviour, tied to a fixed cue, for 12 weeks.
The median time to automaticity was 66 days, with a range of 18 to 254 days depending on the person and the difficulty of the behaviour.
Two findings matter more than that number. The early repetitions carry the most weight. And missing a single day did not break the curve - which demolishes the all-or-nothing thinking that kills most good intentions by the second week of February.
Regularity beats effort
Here is the finding that changed how I think about my own week.
A team led by Daniel Windred at Monash University analysed more than 10 million hours of accelerometer data from 60 977 UK Biobank participants. Published in the journal SLEEP in January 2024, it found that people with more regular sleep and wake timing had a 20% to 48% lower risk of death from any cause, and a 22% to 57% lower risk of cardiometabolic death, than the most irregular group.
Regularity predicted mortality more strongly than sleep duration did.
Going to bed and waking at roughly the same time is not a lifestyle preference. On that evidence it is one of the strongest signals you can send your physiology, and it is free.
The biology is not mysterious. As a 2024 review in Frontiers in Endocrinology sets out, a master clock in the hypothalamus coordinates smaller clocks in nearly every organ, governing sleep, hormone release, digestion and repair across 24 hours.
They take their cues from light, from when you eat and from when you move.
The same review links disruption of that system, of the kind shift workers live with, to raised type 2 diabetes risk. Then the cheapest intervention in medicine. A trial led by Loretta DiPietro in Diabetes Care in 2013 found that three 15-minute walks after meals improved 24- hour glucose control in older adults at risk of impaired glucose tolerance better than a single 45-minute walk. A 2025 crossover trial in Scientific Reports found even a 10- minute walk immediately after a glucose load lowered the peak.
Ten minutes. After dinner. That is the whole prescription.
Three things, and nothing else
The urge is to overhaul everything on the first of the month, which is why most overhauls collapse by the fifteenth. Lally's data argues the opposite: choose one habit, anchor it to something you already do, and let it become automatic before adding the next.
Fix your bedtime - same window, seven nights, including Saturday. Get daylight on your face within an hour of waking; stand outside with your tea rather than under a kitchen light. Walk for ten minutes after your largest meal.
That is it. No membership, no supplement, no equipment.
We are a community that will spend R40 000 on a wedding function and not R400 on a blood panel. We will sit with an uncle at a funeral and say, softly, that he was only 52 - then drive home and change nothing.
Stats SA has told us plainly what is killing us, and most of it was assembled slowly, in ordinary hours, by ordinary choices nobody thought worth changing.
The good news, in every study named above, is that it comes apart the same way.
Boringly. Ten minutes at a time.
Sanjith Hannuman is a director at AVIB and an employee benefits consultant who holds an MBA from UKZN, is an FSA of the Financial Planning Institute of South Africa, a Human Values Practitioner, and a Behavioural Life Coach who believes in the betterment of life for all.
