AIM: The aim was to describe the demographics, comorbidities and outcomes of care for patients with diabetes at primary care facilities in the Western Cape, South Africa, between 2015 and 2020. METHODS: This was a secondary analysis of the diabetes cascade database. RESULTS: The database included 116726 patients with mean age of 61.4 years and 63.8 % were female. The mean age at death was 66.0 years. Co-morbidities included hypertension (69.5 %), mental health disorders (16.2 %), HIV (6.4 %) and previous TB (8.2 %). Sixty-three percent had at least one previous hospital admission and 20.2 % of all admissions were attributed to cardiovascular diseases. Coronavirus was the third highest reason for admission over a 10-year period. Up to 70% were not receiving an annual HbA1c test. The mean value for the last HBA1c taken was 9.0%. Three-quarters (75.5 %) of patients had poor glycaemic control (HbA1c >7 %) and a third (33.7 %) were very poorly controlled (HbA1c>10 %). Glycaemic control was significantly different between urban sub-districts and rural areas. Renal disease was prevalent in 25.5 %. CONCLUSION: Diabetes was poorly controlled with high morbidity and mortality. There was poor compliance with guidelines for HbA1c and eGFR measurement. At least 7% of diabetic patients were being admitted for complications annually.