1) Type 2 diabetes is a growing problem in sub-Saharan Africa, with prevalence rates varying from 2.0% to 14.8% across countries.
2) A large study of over 6,000 people in sub-Saharan Africa found high rates of diabetes complications like neuropathy, eye problems, and cardiovascular disease despite relatively short durations of diabetes.
3) Effective public health interventions are needed to address the growing burden of type 2 diabetes in sub-Saharan Africa, including earlier screening, access to affordable medications, and integrated clinics to manage diagnosis, risk factors, and complications.
1) Type 2 diabetes is a growing problem in sub-Saharan Africa, with prevalence rates varying from 2.0% to 14.8% across countries.
2) A large study of over 6,000 people in sub-Saharan Africa found high rates of diabetes complications like neuropathy, eye problems, and cardiovascular disease despite relatively short durations of diabetes.
3) Effective public health interventions are needed to address the growing burden of type 2 diabetes in sub-Saharan Africa, including earlier screening, access to affordable medications, and integrated clinics to manage diagnosis, risk factors, and complications.
1) Type 2 diabetes is a growing problem in sub-Saharan Africa, with prevalence rates varying from 2.0% to 14.8% across countries.
2) A large study of over 6,000 people in sub-Saharan Africa found high rates of diabetes complications like neuropathy, eye problems, and cardiovascular disease despite relatively short durations of diabetes.
3) Effective public health interventions are needed to address the growing burden of type 2 diabetes in sub-Saharan Africa, including earlier screening, access to affordable medications, and integrated clinics to manage diagnosis, risk factors, and complications.
1) Type 2 diabetes is a growing problem in sub-Saharan Africa, with prevalence rates varying from 2.0% to 14.8% across countries.
2) A large study of over 6,000 people in sub-Saharan Africa found high rates of diabetes complications like neuropathy, eye problems, and cardiovascular disease despite relatively short durations of diabetes.
3) Effective public health interventions are needed to address the growing burden of type 2 diabetes in sub-Saharan Africa, including earlier screening, access to affordable medications, and integrated clinics to manage diagnosis, risk factors, and complications.
Sub-Sahara Africa—The impact and challenge of type 2 diabetes
mellitus requiring urgent and sustainable public health measures AJ Sinclair a,b,c,∗ a Diabetes Care, King’s College, London, UK b Diabetes Frail, UK c Foundation for Diabetes Research in Older People, Bedfordshire, UK
a r t i c l e i n f o
Article history: Received 9 October 2019 Accepted 9 October 2019 Available online 24 October 2019
Sub-Sahara Africa (SSA) is cartographic term which comprises type 2 diabetes and received a comprehensive evaluation includ- just over 40 countries lying south of the Sahara desert in the ing lifestyle choices, anthropometry, cardiometabolic parameters, African continent and is highly distinctive compared with the re- complications screening including peripheral neuropathy, retinopa- gion north of the desert in terms of etymology, demographics, thy testing, comorbidity profiling, and had fasting blood samples culture, climate, socio-economics, religion and politics. Apart from taken for glucose, lipids and other clinical biomarkers. The me- South Africa, nearly half of all sub-Saharan people are aged less dian fasting blood glucose level among cases was 9.8 (IQR 5.9– than 15 years and average life expectancy is diminished, often be- 12.5) mmol/L, and four out of five cases took metformin and/or ing no higher than 60 years. Key health issues have been related a sulphonylurea as their main glucose-lowering medication. The to the HIV/AIDS epidemic, malaria and other infectious diseases, study revealed high prevalences of complications despite a rela- but now SSA, as a consequence of transitions connected with pop- tively short known duration of diabetes: the metabolic syndrome ulation dynamics and socio-cultural trends, also faces the rise of (78%), hypertension (71%), cataracts (32%), obesity (27%), hyperlipi- cardiovascular disease which poses significant challenges to ill- daemia, neurological deficits including sensory deficits (46% by his- equipped government controlled and funded health services. The tory), and 35% of men had erectile dysfunction. As expected, risk prevalence of diabetes in those aged 20–79 years in SSA countries factors for these findings indicated that in combination or in cases has increased rapidly in the last quarter of a century with vary- as a separate risk factor, older age, BMI, and longer duration of dia- ing rates of 2.0% in The Gambia, 6.3% in the Congo, 9.3% in South betes were associated with many of the defined complications and Africa, and as high as 14.8% in Mauritius [1] . In view of concerns comorbidities. A degree of heterogeneity of risk factor associations about the reliability of data about diagnosis rates, vascular com- across SSA was inevitable. plication burden, use of preventative measures, and application of This was an impressive study and builds on the findings of cost-effective strategies [2], the publication by Ekoru K et al, 2019 the previous Diabcare Africa Study [5]. The current study, how- [3] is a timely intervention to address gaps in our knowledge of di- ever, provides more precise diabetes prevalences data and risk fac- abetes complications and comorbidity profiles associated with type tor identification, and represents the largest cross-sectional study 2 diabetes in SSA. of type 2 diabetes and its associations with complications and co- Data in the latter study [3] was collected from approximately morbidities. These data suggest that a high proportion of cases are 6,0 0 0 participants of which nearly half had type 2 diabetes of diagnosed with diabetes late in the evolution of the condition and mean age 56 (SD 11) years and 5 years of known duration of di- along with the high prevailing rates of hyperglycaemia provide a abetes who were participating in the large case-controlled study part explanation for high microvascular rates. In addition, the high (the Africa America Diabetes Mellitus (AADM) Study) [4]. En- rates of hypertension, hyperlipidaemia and obesity in individuals rolled participants were aged 18 years and over with or without with poor glycaemia control provide a platform for developing car- diovascular disease and stroke which are now emerging as increas- ing causes of death in SSA. ∗ Correspondence to: AJ Sinclair, Clinical Trials Unit, Medici Medical Practice, Further research to complete important gaps in the nature of Luton, LU1 3UA, UK. type 2 diabetes in SSA and how it is managed would need to E-mail address: ajsinclair@diabetesfrail.org
include regional variations in the application of diagnostic crite- communicable disease (NCDs), 2013–2020 and its successors [6]. ria, the use of HbA1c as a marker of diabetes control, how health Such ambitions require significantly higher funding levels and this services are accessed and resourced, and establishing disease reg- continues to represent a key obstacle in one of the most economi- istries and longitudinal studies to more accurately interpret risk cally deprived areas of the world. factor influences. It is abundantly clear that the burden of type 2 diabetes in SSA References is now immense and that national and international public health [1] Data Source Workbank: World Development Indicators: available at: http:// interventions are necessary. Structured pathways that include ear- mecometer.com/topic/diabetes-prevalence/ lier screening for diabetes, offering inexpensive medications, and [2] Atun R, Davies JI, Gale EA, Barnighansen T, Beran D, Kengne AP, et al. Diabetes implementing an integrated clinic system that deals with diagno- in Sub-Saharan Africa: from clinical care to health policy. The Lancet Diabetes & Endocrinology Commission. Lancet Diabetes Endocrinol 2017;5(8):622–67. sis, risk factor identification, and complications should enable pa- [3] Ekoru K, Doumatey A, Bentley AR, Chen G, Zhou J, Shriner D, et al. Type tients to access a minimal level of diabetes care in one setting. 2 diabetes complications and comorbidity in Sub-Saharan Africans. EClini- An educational initiative to underpin and enhance success of pub- calMedicine; 10.1016/j.eclinm.2019.09.001 [4] Rotimi CN, Chen G, Adeyemo AA, Furbert-Harris P, Parish-Gause D, Zhou J, lic health measures is urgently required at the individual, health et al. A genome-wide search for type 2 diabetes susceptibility genes in professional level, and health provider level. A focus on complica- West Africans: the Africa America Diabetes Mellitus (AADM) Study. Diabetes tions prevention will be essential to reduce total healthcare costs 2004;53(3):838–41. [5] Sobngwi E, Ndour-Mbaye M, Boateng KA, Ramaiya KL, Njenga EW, Diop SN, attributable to diabetes in SSA which have been estimated to be et al. Type 2 diabetes control and complications in specialised diabetes care between US$35 billion to US$59 billion by 2030 [2]. Achieving suc- centres of six sub-Saharan African countries: the Diabcare Africa study. Diabetes cess in terms of improved well being and greater life expectancy of Res Clin Pract 2012;95(1):30–6. sub-Saharan Africans with diabetes will not only require the above [6] World Health Organisation. WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020. Geneva: World Health Organization; 2013. measures but a wider implementation of initiatives such as the WHO Global Action Plan for the Prevention and Treatment of non-
25. Progression to diabetes and regression to normoglycemia in pre-diabetic subjects results from a pragmatic community trial in a middle-income country
