The prevalence of type 2 diabetes among older people in Africa: a systematic review

Performance of fasting plasma glucose for community-based screening of undiagnosed diabetes and pre-diabetes in sub-Saharan Africa

Introduction

Early diabetes screening is critical in sub-Saharan Africa (SSA), where the prevalence is increasing, yet a large proportion of cases remain undiagnosed. This study aimed to evaluate the performance of fasting plasma glucose (FPG) in screening diabetes and/or prediabetes compared to the 2-hour plasma glucose (2-h PG)-level in SSA.

Methods

Data from a population-based, cross-sectional diabetes screening survey involving 1550 individuals in Butajira, Ethiopia, and Enugu state, Nigeria were analyzed. Fasting plasma glucose and a 2-hour 75-g oral glucose tolerance test (OGTT) were utilized for diabetes screening. In addition, we determined and plotted the receiver operating characteristic curve for FPG against the reference standard 2-h PG to evaluate the screening tool's sensitivity and specificity.

Results

The mean (SD) age of the study participants was 44.5 (± 16.43) years, with men comprising 50.4% of the cohort. Among 1550 individuals analyzed, 4.6% and 16.8% demonstrated diabetes and prediabetes, respectively, as identified by either FPG or 2-h PG. The agreement between FPG and 2-h PG in identifying diabetes and prediabetes was moderate, with kappa statistic of 0.56 (95% CI, 0.51 - 0.61; p<0.0001) for diabetes and 0.45 (95% CI, 0.40 - 0.50; p<0.0001) for prediabetes. FPG failed to detect 34.1% of all prediabetes and 44.4% of all diabetes cases. The sensitivity of FPG in identifying diabetes cases was 44.3% at a cut-off 126 mg/dL with a specificity of 99.3%. We identified the optimal FPG cut-off for detecting newly identified diabetes cases using 2-h PG to be 105 mg/dL associated with a sensitivity and specificity of 67.2% and 94.0%, respectively.

Conclusion

FPG was able to correctly identify 99.3% of individuals with no diabetes but a significant percentage of diabetes cases would have remained undiagnosed if only FPG had been utilized instead of the 2-h PG. The use of 2-h PG test is recommended to diagnose diabetes in older individuals, females and non-obese persons who would be missed if tested by only FPG. Lowering the cut-off value for FPG to 105 mg/dL substantially increases the identification of individuals with diabetes, thus improving the effectiveness of FPG as a screening test for type 2 diabetes.

Insulin therapy adherence and its associated factors among diabetic patients in a Ghanaian primary care hospital

BACKGROUND

Diabetes mellitus (DM) is a global health problem. Adherence to intensive insulin therapy is necessary to achieve better glycemic control in types 1 and 2 DM. This study aimed to evaluate the extent of adherence to insulin therapy, its predictors and to identify barriers to its adherence.

METHOD

This was a cross-sectional survey among adult (≥18 years) diabetic patients who are currently using insulin, either alone or in combination with an oral antidiabetic regimen, and seeking primary care at Kwame Nkrumah University of Science and Technology Hospital in Ghana. A total of one hundred and eight-six patients were conveniently sampled, and interviewed. Insulin adherence was determined using the Medication Adherence Reporting Scale-5. Descriptive statistics, a chi-square test of independence, and a multiple logistic regression analysis were performed using STATA version 14 (StataCorp, TX USA).

RESULTS

The majority of the patients interviewed were over 60 years (40.32%); female (61.83%); married (68.82%); and had completed secondary education (48.39%). 67.20% of the patients were adherent to insulin therapy. Adherence level was associated with age (p = 0.020), marital status (p = 0.001), employment status (p = 0.012), type of DM (p<0.001), regular follow-up (p = 0.007) and comorbidities (p = 0.002) and was only predicted by the type of DM (aOR = 14.82 C.I 1.34-163.50, p-value = 0.028).

CONCLUSION

Adherence to insulin therapy among our study population was suboptimal, which is a concern considering the associated increased risk of complications. Adherence assessment and counselling by healthcare professionals to address barriers to poor adherence must be continually undertaken to achieve optimal glycemic control.

IMPACT OF FINDINGS ON PRACTICE STATEMENTS

Continuous adherence assessment and counselling must be offered to all diabetes mellitus patients on insulin therapy as part of their ambulatory care to help improve outcomes.Using the Medication Adherence Reporting Scale-5 to determine patient adherence levels is an easy-to-use and an inexpensive method; however, it should be used with caution due to the potential for misclassification.Efforts must be made to provide appropriate strategies to deal with barriers to insulin adherence at ambulatory care clinics as part of the individualized comprehensive diabetic care to reduce diabetic complications.

Physical activity interventions implemented for older people in Sub-Saharan Africa: a scoping review

BACKGROUND

Sub-Saharan Africa mirrors global patterns with an expanding elderly demographic, frequently characterised by a high incidence of non-communicable diseases (NCDs), manifesting as multimorbidity. Physical activity (PA) is a validated intervention for managing the increasing prevalence of NCDs in this demographic.

OBJECTIVE

This review aimed to elucidate the extent of PA interventions implemented in Sub-Saharan Africa for managing NCDs in older people (OP).

ELIGIBILITY CRITERIA

This review synthesised randomised controlled trials published in English since 2010, focusing on PA interventions for managing NCDs or associated risk factors in OP in Sub-Saharan Africa.

SOURCES OF EVIDENCE

The Joanna Briggs Institute methodology for scoping reviews was implemented with searches in the following databases: PubMed, EBSCOhost (Academic Search Premier AfricaWide Information, CINAHL, Health Sources Premier Academic/Nursing), Scopus and ProQuest.

CHARTING METHODS

Extraction and reporting adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews framework, ensuring rigorous and systematic synthesis.

RESULTS

A total of 3754 studies were initially identified, with 67 studies ultimately included after applying the exclusion criteria. The synthesised trials tested primarily supervised structured PA interventions (n=30), education on PA and lifestyle (n=30) and combined structured PA with lifestyle education (n=7). A structured supervised PA regimen combining aerobic exercise at 60-80% of maximum heart rate (three 45-60 min sessions per week) and resistance training starting at 50% of one-repetition maximum (3 weekly sessions of three sets with 10-12 repetitions per muscle group), progressively increasing to 60%, was the most effective in reducing risk factors associated with NCDs in this cohort.

CONCLUSION

This analysis confirms that a structured PA regimen paired with lifestyle education significantly mitigates NCDs in Sub-Saharan Africa's elderly population. Furthermore, it highlights the imperative for further investigation into non-pharmacological strategies, especially those targeting hypertension, diabetes and cognitive health disorders.

Analyzing Diabetes Detection and Classification: A Bibliometric Review (2000-2023)

Bibliometric analysis is a rigorous method to analyze significant quantities of bibliometric data to assess their impact on a particular field. This study used bibliometric analysis to investigate the academic research on diabetes detection and classification from 2000 to 2023. The PRISMA 2020 framework was followed to identify, filter, and select relevant papers. This study used the Web of Science database to determine relevant publications concerning diabetes detection and classification using the keywords "diabetes detection", "diabetes classification", and "diabetes detection and classification". A total of 863 publications were selected for analysis. The research applied two bibliometric techniques: performance analysis and science mapping. Various bibliometric parameters, including publication analysis, trend analysis, citation analysis, and networking analysis, were used to assess the performance of these articles. The analysis findings showed that India, China, and the United States are the top three countries with the highest number of publications and citations on diabetes detection and classification. The most frequently used keywords are machine learning, diabetic retinopathy, and deep learning. Additionally, the study identified "classification", "diagnosis", and "validation" as the prevailing topics for diabetes identification. This research contributes valuable insights into the academic landscape of diabetes detection and classification.

GOAT rs10096097 and CREB1 rs6740584 single nucleotide polymorphisms are associated with type 2 diabetes mellitus in Egyptians

Diabetes mellitus (DM) is a chronic disorder that affects nearly half a billion people around the world and causes millions of deaths annually. Treatment of diabetes or related complications represents an economic burden not only for developing countries but also for the developed ones. Hence, new efficient therapeutic and preventive strategies and screening tools are necessary. The current work aimed to assess the potential association of single nucleotide polymorphisms (SNPs) in ghrelin O-acyltransferase (GOAT) rs10096097, cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) rs6740584, and v-maf musculoaponeurotic fibrosarcoma oncogene homolog A (MafA) rs62521874 genes with type 2 DM susceptibility in Egyptians. A total of 96 patients with type 2 DM along with 72 healthy individuals participated in this study. Genotyping was executed via real-time polymerase chain reaction (PCR), and the serum protein levels of GOAT, CREB, and MafA were measured by enzyme-linked immunosorbent assay (ELISA). Genotyping revealed a significant association of GOAT rs10096097 and CREB1 rs6740584 SNPs with type 2 diabetes risk, with significantly higher GOAT rs10096097 G allele and CREB1 rs6740584 T allele frequencies in diabetic patients than in controls. However, insignificant association was identified between the MafA rs62521874 SNP and diabetes in the examined sample of the Egyptian residents. Serum GOAT, CREB1, and MafA protein levels did not vary significantly between diabetic and control individuals. Yet, significant variation in serum GOAT and CREB1 levels was detected between CREB1 rs6740584 genotypes within the diabetic group, with CT and TT genotype carriers showing higher levels than AA genotype patients. GOAT rs10096097 and CREB1 rs6740584, but not MafA rs62521874, SNPs are associated with type 2 diabetes risk in the studied Egyptians.

Causes of Chronic Kidney Disease and Their Associations with Cardiovascular Risk and Disease in a Sub-Saharan Low-Income Population

Introduction

The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain.

Methods

In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population.

Results

Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p<0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to <0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p<0.05). HNP and DNP were associated with pulsatile pressures (pulse pressure and systolic blood pressure) independent of one another (p<0.01). In adjusted product of coefficient mediation analysis, mean arterial or distending pressure accounted fully for the potential impact of HNP on pulsatile pressures (103.9-115.7%) but not for that of DNP on the respective pressures (-2.0%-(-)7.5%).

Conclusion

HNP is by far the most prevalent presumed cause of CKD in this African population. Cardiovascular risk and disease differ markedly across CKD etiological categories.

The association between body weight indices, behavioral factors, and type 2 diabetes mellitus in Africa: A systematic review and meta-analysis of population-based epidemiological studies

BACKGROUND AND AIM

Type 2 diabetes mellitus (T2DM) is a significant public health concern in Africa. While the associations between modifiable risk factors and T2DM are likely to be Africa-specific, their overall estimations have not been published. This study aimed to use systematic and meta-analytic methods to examine the strength of associations between modifiable risk factors and T2DM in Africa.

METHODS AND RESULTS

A systematic search of literature published between January 2000 to March 2022 was conducted. The review included only population-based studies and data extracted from 57 studies. Of these, unadjusted data from 50 studies were included in meta-analysis. With considerable heterogeneity between studies, random-effect models were calculated to ascertain the odds ratios (OR) and 95% confidence intervals (CI) for the associations between obesity (OB) and overweight (OV), defined by BMI; central obesity (waist circumference (OB-WC), waist-to-hip-ratio (OB-WHR)), alcohol, fruit and vegetable consumption, smoking, physical activity (PA) and T2DM. Moderator effects of age, African regions, and urban/rural location were assessed. Risk factors associated with T2DM include BMI-OB [OR = 3.05, 95% CI: (2.58, 3.61)], BMI-OV [OR = 2.38, 95% CI: (1.51, 3.75)], and BMI-OV/OB [OR = 2.07, 95% CI: (1.82, 2.34)]; OB-WC [OR = 2.58, 95% CI: (2.09, 3.18)] and OB-WHR [OR = 2.22, 95% CI: (1.69, 2.92)]; PA [OR = 1.85, 95% CI: (1.50, 2.30)]. Significant moderator effects were not observed.

CONCLUSION

Obesity defined by BMI and central obesity, but not behavioral risk factors were most strongly associated with T2DM in African populations, emphasizing the need for obesity prevention to limit the rise of T2DM.

REGISTRATION

The PROSPERO registration number is CRD42016043027.

The Association Between Malignant Otitis Externa and Diabetes Mellitus in Africa: A Systematic Review

Diabetes mellitus is one of the risk factors for malignant otitis externa. There are very few studies on the disease in Africa and there is a need to pool the prior studies to highlight the characteristics of the disease. The study type is a systematic review and the PRISMA guidelines were followed. Using the appropriate terms, relevant medical databases were systematically searched. Thirty-two studies met the eligibility criteria with a total sample size of 848, who were mainly elderly. Diabetes mellitus was present in 94% of the participants. Average duration of diabetes diagnosis in the participants was 12.4 years. The pooled HbA1c was 9.8%. The most common symptoms were otalgia (96.1%), otorrhoea (75.8%) and hearing loss (56.1%). Pseudomonas was the most common isolate (72%). Fluoroquinolones and the 3rd-generation cephalosporins were the preferred antibiotics. The pooled cure rate from antimicrobial usage was 76.2%. In addition to medications, 24.6% of the affected individuals required debridement. About 1.6% of the participants died from malignant otitis externa. Malignant otitis externa is associated with poorly controlled diabetes. Pseudomonas is the most common cause and a significant proportion gets cured with prolonged antibiotherapy.

The role of structural racism and geographical inequity in diabetes outcomes

Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.

Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study

OBJECTIVES

We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention.

DESIGN

Cross-sectional study.

SETTING

Community-based study in four sub-Saharan African countries.

PARTICIPANTS

10 700 individuals, aged 40-60 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis.

RESULTS

Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes.

CONCLUSIONS

There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes.

Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities

Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable epidemiological transition fuelled by the pace of urbanization, with disease burden profiles shifting from communicable diseases to non-communicable diseases (NCDs). Information on the epidemiology of T2DM has increased, but wide variations in study methods, diagnostic biomarkers and criteria hamper analytical comparison, and data from high-quality studies are limited. The prevalence of T2DM is still low in some rural populations but moderate or high rates are reported in many countries/regions, with evidence for an increase in some. In addition, the proportion of undiagnosed T2DM is still high. The prevalence of T2DM is highest in African people living in urban areas, and the gradient between African people living in urban areas and people in the African diaspora is rapidly fading. However, data from longitudinal studies are lacking and there is limited information on chronic complications and the genetics of T2DM. The large unmet needs for T2DM care call for greater investment of resources into health systems to manage NCDs in SSA. Proposed health-system paradigms are being developed in some countries/regions. However, national NCD programmes need to be adequately funded and coordinated to stem the tide of T2DM and its complications.

The Young Age and Plant-Based Diet Hypothesis for Low SARS-CoV-2 Infection and COVID-19 Pandemic in Sub-Saharan Africa

Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the coronavirus disease-19 (COVID-19), in December 2019, the infection has spread around the globe. Some of the risk factors include social distancing, mask wearing, hand washing with soap, obesity, diabetes, hypertension, asthma, cardiovascular disease, and dysbiosis. Evidence has shown the incidence of total infection and death rates to be lower in sub-Saharan Africa when compared with North Africa, Europe and North America and many other parts of the world. The higher the metabolic syndrome rate, the higher the risk of SARS-CoV-2 infection. Africa has a lower rate of metabolic syndrome risk than many other continents. This paradox has puzzled several in the biomedical and scientific communities. Published results of research have demonstrated the exciting correlation that the combination of young age of the population coupled with their native plant-based diet has lowered their risk factors. The plant-based diet include whole grains (millet, sorghum), legumes (black-eye peas, dry beans, soybean), vegetables, potato, sweet potato, yams, squash, banana, pumpkin seeds, and moringa leaves, and lower consumption of meat. The plant-based diet results in a different gut microbiota than of most of the rest of the world. This has a significant impact on the survival rate of other populations. The "plant-based diet" results in lower rates of obesity, diabetes and dysbiosis, which could contribute to lower and less severe infections. However, these hypotheses need to be supported by more clinical and biostatistics data.

Patients' knowledge of diabetes foot complications and self-management practices in Ghana: A phenomenological study

Background

The prevalence of diabetes is increasing in low and middle-income countries (LMICs) and over two-thirds of these are not diagnosed. Consequently, diabetes complications usually exist at the time of diagnosis. Foot ulcers is a leading cause of disability and mortality among diabetes patients.

Purpose

To assess the knowledge and experiences of adult patients with Diabetes on diabetes complications and self-management practices with emphasis on foot care.

Methodology

This applied phenomenological study design. Twenty patients attending Diabetes clinics were purposively sampled from two hospitals in Ghana. Face-to-face semi-structured interviews were conducted to evaluate patient’s understanding of diabetes and self-management practices. The interviews were audio-taped, transcribed, and analysed to generate themes using the constant comparison method.

Results

Three-quarters of the participants in the study correctly defined diabetes as high blood glucose levels, but few knew the risk factors and complications of diabetes. Stroke and Hypertension were the most popular complications known, whiles diabetes foot complications were the least known. Almost all participants showed awareness of dietary self-management practices, but few had limited knowledge in foot care practices.

Conclusion

Diabetes education in LMICs should promote self-management practices, especially foot care and clear dietary guidelines. There is also opportunity to invest in specialist diabetes training for healthcare providers and increase community-based care for people living with diabetes in Ghana.

Cardiovascular Health and Near Visual Impairment Among Older Adults in the Republic of Congo: A Population-Based Study

BACKGROUND

Visual impairment (VI) and determinants of poor cardiovascular health are very common in Sub-Saharan Africa. However, we do not know whether these determinants are associated with VI among older adults in this region. This study aimed at investigating the association between the determinants of poor cardiovascular health and near VI among older adults living in Congo.

METHODS

Participants were Congolese adults aged 65 or older included in Epidemiology of Dementia in Central Africa-Follow-up population-based cohort. Near VI was defined as visual acuity less than 20/40 measured at 30 cm. Associations between determinants of poor cardiovascular health collected at baseline and near visual acuity measured at first follow-up were investigated using multivariable logistic regression models.

RESULTS

Among the 549 participants included, 378 (68.8%; 95% confidence interval [CI]: 64.9%-72.7%]) had near VI. Of the determinants of poor cardiovascular health explored, we found that having high body mass index of at least 25 kg/m2 (odds ratio [OR] = 2.15; 95% CI: 1.25-3.68), diabetes (OR = 2.12; 95% CI: 1.06-4.25) and hypertension (OR = 1.65; 95% CI: 1.02-2.64) were independently associated with near VI.

CONCLUSIONS

Several determinants of poor cardiovascular health were associated with near VI in this population. This study suggests that promoting good cardiovascular health could represent a target for VI prevention among older adults.

HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

Background

Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey.

Methods

Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population.

Results

Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa.

Discussion

HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV.

Conclusions

The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

Prevalence of Type 2 Diabetes in South Africa: A Systematic Review and Meta-Analysis

Synthesis of existing prevalence data using rigorous systematic review methods is considered an effective strategy to generate representative and robust prevalence figures to inform health planning and policy. The purpose of this systematic review was to identify, collate, and synthesise all studies reporting the prevalence of total and newly diagnosed type 2 diabetes (T2DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in South Africa. Four databases, PubMed, Scopus, Web of Science, and African Index Medicus were searched for articles published between January 1997 and June 2020. A total of 1886 articles were identified, of which 11 were included in the meta-analysis. The pooled prevalence in individuals 25 years and older was 15.25% (11.07–19.95%) for T2DM, 9.59% (5.82–14.17%) for IGT, 3.55% (0.38–9.61%) for IFG, and 8.29% (4.97–12.34%) for newly diagnosed T2DM. Although our pooled estimate may be imprecise due to significant heterogeneity across studies with regard to population group, age, gender, setting, diagnostic test, and study design, we provide evidence that the burden of glucose intolerance in South Africa is high. These factors contribute to the paucity of representative T2DM prevalence data. There is a need for well-designed epidemiological studies that use best-practice and standardised methods to assess prevalence.

Renal Failure among Women of Reproductive Age in Burundi: Estimating the Prevalence and Associated Factors Using Population-Based Data

Background

Renal failure is a leading cause of morbidity and mortality in many resource-constrained settings. In developing countries, little has been known about the prevalence and predisposing factors of renal failure using population-based data. The objective of this study was to examine the prevalence and associated factors of renal failure among women of reproductive age in Burundi.

Methods

We used nationally representative cross-sectional data from the 2016-2017 Burundi Demographic and Health Survey (BDHS). Data on 17,269 women of reproductive age were included. The outcome variable was a renal failure as determined by the patient's report. Percentage, chi-square test, and multivariable logistic regression model were used to analyze the data. The results from the logistic regression model were presented as adjusted odds ratio (AOR) and confidence interval (95% CI). The significance level was set at p < 0.05.

Results

The overall prevalence of renal failure was 5.0% (95% CI: 4.4%, 5.7%). Higher-aged women were more likely to have a renal failure when compared with women aged 15-19 years. Rural dwellers were 1.65 times as likely to have a renal failure when compared with women in the urban residence (AOR = 1.65; 95% CI: 1.24, 2.20). Women who had secondary + education had a 39% reduction in the odds of renal failure when compared with women with no formal education (AOR = 0.61; 95% CI: 0.46, 0.81). Health insurance coverage accounted for a 23% reduction in the odds of renal failure when compared with women who were not covered by health insurance (AOR = 0.77; 95% CI: 0.63, 0.93). Women who had a terminated pregnancy were 1.50 times as likely to have a renal failure when compared with women with no history of terminated pregnancy (AOR = 1.50; 95% CI: 1.24, 1.82). Furthermore, women with a history of contraceptive use were 1.32 times as likely to have a renal failure when compared with women without a history of contraceptive use (AOR = 1.32; 95% CI: 1.11, 1.57).

Conclusion

Lack of formal education, having no health insurance coverage, and ever used anything or tried to delay or avoid getting pregnant were the modifiable risk factors of renal failure. The nonmodifiable risk factors were old age, rural residence, certain geographical regions, and having a history of pregnancy termination. Understanding the risk factors of renal failure will help to instigate early screening, detection, and prompt treatment initiation. In addition, early detection of the risk factors can help to reduce the adverse health impact including maternal death.

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.

Plasma cytokines for predicting diabetic retinopathy among type 2 diabetic patients via machine learning algorithms

AIMS

This study aimed to investigate changes of plasma cytokines and to develop machine learning classifiers for predicting non-proliferative diabetic retinopathy among type 2 diabetes mellitus patients.

RESULTS

There were 12 plasma cytokines significantly higher in the non-proliferative diabetic retinopathy group in the pilot cohort. The validation cohort showed that angiopoietin 1, platelet-derived growth factor-BB, tissue inhibitors of metalloproteinase 2 and vascular endothelial growth factor receptor 2 were significantly higher in the NPDR group. Machine learning algorithms using the random forest yielded the best performance, with sensitivity of 92.3%, specificity of 75%, PPV of 82.8%, NPV of 88.2% and area under the curve of 0.84.

CONCLUSIONS

Plasma angiopoietin 1, platelet-derived growth factor-BB, and vascular endothelial growth factor receptor 2 were associated with presence of non-proliferative diabetic retinopathy and may be good biomarkers that play important roles in pathophysiology of diabetic retinopathy.

MATERIALS AND METHODS

In pilot cohort, 60 plasma cytokines were simultaneously measured. In validation cohort, angiopoietin 1, CXC-chemokine ligand 16, platelet-derived growth factor-BB, tissue inhibitors of metalloproteinase 1, tissue inhibitors of metalloproteinase 2, and vascular endothelial growth factor receptor 2 were validated using ELISA kits. Machine learning algorithms were developed to build a prediction model for non-proliferative diabetic retinopathy.

Correlates of diabetic polyneuropathy of the elderly in Sub-Saharan Africa

Background

Diabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults.

Methods

Over a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16.

Results

A total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes.

Conclusion

A third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.

[Effect of acute insulin therapy on the concentration of vascular endothelial growth factor A (VEGF-A) in the intraocular fluid in an experiment]

PURPOSE

To study the effect of insulin therapy on the concentration of vascular endothelial growth factor A (VEGF-A) in the intraocular fluid of rats with alloxan model of diabetes mellitus.

MATERIAL AND METHODS

The experiment was conducted on 80 mongrel rats. In 65 rats, the alloxan model of diabetes mellitus was simulated by a single intraperitoneal injection of 100 mg/kg alloxan hydrate saluted in 0.4 ml of citrate buffer. 72 hours after intraperitoneal administration of alloxan monohydrate, these animals were divided into 2 groups. The main group (group 1) consisted of animals with alloxan model of diabetes mellitus, who started daily single intraperitoneal administration of prolonged-acting insulin at a therapeutic dose of 0.9 U/kg Body weight. The comparison group (group 2) consisted of animals with alloxan model of diabetes mellitus who did not receive specific therapy. 15 healthy rats constituted the control group (group 3). Experimental animals were removed from the study on day 31 of insulin therapy. The concentration of VEGF-A was determined in 80-90 μl of intraocular fluid collected from both eyes of each animal.

RESULTS

In the main group, the median of VEGF-A concentration [25th; 75th percentiles] in the intraocular fluid was 140 [136; 210] pg/ml, which is 1.94 times higher than in the comparison group (72 [58; 86] pg/ml) and 1.84 times higher than in the control group (76 [62.5; 88] pg/ml). The concentration of VEGF-A in the intraocular fluid in the main group was statistically significantly higher, as compared with the comparison group (p_m-u<0.0004), and compared with the control group (p_m-u=0.0045). The comparison group had no statistically significant differences when compared with the control group (p_m-u=0.9979).

CONCLUSION

Insulin therapy for 31 days increases the concentration of VEGF-A in the intraocular fluid of rats with alloxan model of diabetes mellitus.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

Background

There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention.

Objective

Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases.

Our Approach

Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance.

Ongoing Activities

A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities.

Conclusion

There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

The prevalence of undiagnosed type 2 diabetes and prediabetes in Eastern Mediterranean region (EMRO): A systematic review and meta-analysis

BACKGROUND

Previous studies of diabetes in Eastern Mediterranean Region (EMRO) did not assess the prevalence of either unknown diabetes or prediabetes. We conducted a systematic review and meta-analysis to estimate the prevalence of undiagnosed type 2 diabetes and prediabetes as well as variations by region in EMRO, using the relevant publications since 2000.

METHODS

We carried out a comprehensive electronic search on electronic databases from January 1, 2000 to March 1, 2018. We selected cross-sectional and cohort studies reporting the prevalence of undiagnosed type 2 diabetes, prediabetes, or both. Two independent reviewers initially screened the eligible articles; then, synthesized the target data from full papers. Random- or fixed-effect models, subgroup analysis on Human Development Index (HDI), and publication year and sensitivity analysis to minimize the plausible effect of outliers were used.

RESULTS

Amongst 849 identified citations, 55 articles were entered into meta-analysis, involving 567,025 individuals. The forest plots estimated 5.46% (confidence intervals [CI]: 4.77-6.14) undiagnosed diabetic and 12.19% (CI: 10.13-14.24) prediabetics in EMRO. Low HDI countries and high HDI countries had the highest (7.25%; CI: 4.59-9.92) and the lowest (3.98%; CI: 3.11-4.85) undiagnosed diabetes prevalence, respectively. Very high HDI countries and low HDI countries had the highest (13.50%; CI: 8.43-18.57) and the lowest (7.45%; 1.20-13.71) prediabetes prevalence, respectively. In addition, meta-regression analysis showed a statistically significant association between publication year and prevalence of prediabetes (Reg Coef = 0.059, P = 0.014). But such finding was not observed for undiagnosed diabetes and publication year (Reg Coef = 0.034, P = 0.124), prediabetes and HDI (Reg Coef = 0.128, P = 0.31) and undiagnosed diabetes and HDI (Reg Coef = - 0.04, P = 0.96).

CONCLUSION

The prevalence of undiagnosed diabetes and prediabetes was high and increasing. The notion of universal health coverage is a priority; that is the integration of the primary, secondary and tertiary health levels, as well as employing the available action plans. Therefore, future studies, using identical screening tool and diagnostic criteria, are warranted to make an accurate picture of diabetes in EMRO.

An observational study found large methodological heterogeneity in systematic reviews addressing prevalence and cumulative incidence

OBJECTIVES

The objective of this study was to assess reporting and methodological aspects of systematic reviews (SRs) on prevalence and cumulative incidence data.

STUDY DESIGN AND SETTING

We searched PubMed up to 18 April, 2018, and drew a random sample of eligible SRs.

RESULTS

The included 215 SRs were reported in 187 different journals. 58.1% were published between 2015 and 2018. Few SRs were registered with PROSPERO (5.6%). One-quarter considered articles without languages restrictions (25.1%). Regional restrictions of included studies were applied in 22.8%. A meta-analysis was carried out in 40.5% of the SRs. One hundred and six studies (49.3%) assessed risk of bias or study quality. A total of 41 different existing tools as well as 15 tools developed by the authors themselves were used. The most commonly applied tools were the Newcastle-Ottawa Scale (15.1%), STROBE (13.5%), and the Cochrane Collaboration's tool for assessing risk of bias (7.9%).

CONCLUSION

We found large heterogeneity in characteristics, reporting, and methodological aspects of SRs on prevalence and cumulative incidence data, especially when compared with other types of SRs. Newly developed or revised guidance on how to conduct and report SRs as well as instruments for critical appraisal should consider the diversity of review types.

Diabetic Retinopathy, lncRNAs, and Inflammation: A Dynamic, Interconnected Network

Diabetic retinopathy (DR) is reaching epidemic levels globally due to the increase in prevalence of diabetes mellitus (DM). DR also has detrimental effects to quality of life, as it is the leading cause of blindness in the working-age population and the most common cause of vision loss in individuals with DM. Over several decades, many studies have recognized the role of inflammation in the development and progression of DR; however, in recent years, accumulating evidence has also suggested that non-coding RNAs, especially long non-coding (lncRNAs), are aberrantly expressed in diabetes and may play a putative role in the development and progression of DR through the modulation of gene expression at the transcriptional, post-transcriptional, or epigenetic level. In this review, we will first highlight some of the key inflammatory mediators and transcription factors involved in DR, and we will then introduce the critical roles of lncRNAs in DR and inflammation. Following this, we will discuss the implications of lncRNAs in other epigenetic mechanisms that may also contribute to the progression of inflammation in DR.

Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000-2016: a systematic review and meta-analysis

OBJECTIVES

The aim of this research was to estimate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in African women of childbearing age.

STUDY DESIGN

Systematic review and meta-analysis of relevant African studies published from January 2000 to December 2016.

DATA SOURCES

We searched several databases, including EMBASE, MEDLINE, CINAHL, grey literature and references of included studies.

SETTING

Studies carried out in African communities or any population-based studies were included.

PARTICIPANTS

We included studies, carried out in Africa, with non-pregnant women of childbearing age. Studies must have been published between the years 2000 and 2016.

OUTCOMES

The primary outcome was prevalent T2DM. The secondary outcomes were IFG and IGT.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and, using the adapted Hoy risk of bias tool, independently assessed for risk of bias. We used random-effects meta-analysis models to pool prevalence estimates across studies. We used Cochran's Q statistic and the I² statistic to assess heterogeneity.

RESULTS

A total of 39 studies from 27 countries were included, totaling 52 075 participants, of which 3813 had T2DM. The pooled prevalence of T2DM was 7.2% (95% CI 5.6% to 8.9%) overall and increased with age. The pooled prevalence was 6.0% (95% CI 4.2% to 8.2%) for impaired fasting glycemia while the prevalence of IGT ranged from 0.9% to 37.0% in women aged 15-24 and 45-54 years, respectively. Substantial heterogeneity across studies was not explained by major studies characteristics such as period of publication, rural/urban setting or whether a study was nationally representative or not.

CONCLUSION

This review highlights the need for interventions to prevent and control diabetes in African women of childbearing age, in view of the significant prevalence of T2DM and prediabetes.

PROSPERO REGISTRATION NUMBER

CRD42015027635.

Hypertension and diabetes control along the HIV care cascade in rural South Africa

INTRODUCTION

Participation in antiretroviral therapy (ART) programmes has been associated with greater utilization of care for hypertension and diabetes in rural South Africa. The objective of this study was to assess whether people living with HIV on ART with comorbid hypertension or diabetes also have improved chronic disease management indicators.

METHODS

The Health and Aging in Africa: a longitudinal study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5059 adults >40 years old. Enrollment took place between November 2014 and November 2015. The study collected population-based data on demographics, healthcare utilization, height, weight, blood pressure (BP) and blood glucose as well as HIV infection, HIV-1 RNA viral load (VL) and ART exposure. We used regression models to determine whether HIV care cascade stage (HIV-negative, HIV+ /No ART, ART/Detected HIV VL, and ART/Undetectable VL) was associated with diagnosis or treatment of hypertension or diabetes, and systolic blood pressure and glucose among those with diagnosed hypertension or diabetes. ART use was measured from drug level testing on dried blood spots.

RESULTS AND DISCUSSION

Compared to people without HIV, ART/Undetectable VL was associated with greater awareness of hypertension diagnosis (adjusted risk ratio (aRR) 1.18, 95% CI: 1.09 to 1.28) and treatment of hypertension (aRR 1.24, 95% CI: 1.10 to 1.41) among those who met hypertension diagnostic criteria. HIV care cascade stage was not significantly associated with awareness of diagnosis or treatment of diabetes. Among those with diagnosed hypertension or diabetes, ART/Undetectable VL was associated with lower mean systolic blood pressure (5.98 mm Hg, 95% CI: 9.65 to 2.32) and lower mean glucose (3.77 mmol/L, 95% CI: 6.85 to 0.69), compared to being HIV-negative.

CONCLUSIONS

Participants on ART with an undetectable VL had lower systolic blood pressure and blood glucose than the HIV-negative participants. HIV treatment programmes may provide a platform for health systems strengthening for cardiometabolic disease.

Epidemiology of prediabetes and diabetes in Namibia, Africa: A multilevel analysis

BACKGROUND

Diabetes is a leading cause of progressive morbidity and early mortality worldwide. Little is known about the burden of diabetes and prediabetes in Namibia, a Sub-Saharan African (SSA) country that is undergoing a demographic transition.

METHODS

We estimated the prevalence and correlates of diabetes (defined as fasting [capillary] blood glucose [FBG] ≥126 mg/dL) and prediabetes (defined by World Health Organization [WHO] and American Diabetes Association [ADA] criteria as FBG 110-125 and 100-125 mg/dL, respectively) in a random sample of 3278 participants aged 35-64 years from the 2013 Namibia Demographic and Health Survey.

RESULTS

The prevalence of diabetes was 5.1% (95% confidence interval [CI]: 4.2-6.2), with no evidence of gender differences (P = 0.45). The prevalence of prediabetes was 6.8% (95% CI 5.8-8.0) using WHO criteria and 20.1% (95% CI 18.4-21.9) using ADA criteria. Male sex, older age, higher body mass index (BMI), and occupation independently increased the odds of diabetes in Namibia, whereas higher BMI was associated with a higher odds of prediabetes, and residing in a household categorized as "middle wealth index" was associated with a lower odds of prediabetes (adjusted odds ratio 0.71; 95% credible interval 0.46-0.99). There was significant clustering of prediabetes and diabetes at the community level.

CONCLUSIONS

One in five adult Namibians has prediabetes based on ADA criteria. Resources should be invested at the community level to promote efforts to prevent the progression of this disease and its complications.

Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa

Objective

The prevalence of type 2 diabetes mellitus (T2DM) is growing in Sub-Saharan countries including South Africa. This is a concern given its appreciable impact on morbidity, mortality and costs with the recent introduction of universal health care in South Africa. The purpose of the study was to assess the knowledge of patients with T2DM attending a typical community health centre (CHC) regarding the management of their disease including risk factors and prevention to guide future initiatives. Typically, patients with T2DM in South Africa are managed in ambulatory care including CHCs.

Method

A quantitative, descriptive study in a CHC. The sample included 217 adults with T2DM who have visited a physician as well as the pharmacy. Face-to-face patient exit interviews were conducted using a structured questionnaire.

Key findings

Females predominated (65%), with the majority of patients &gt;60 years (38.2%) and more than half from the Indian racial category. Most patients did not know how their medication controls their diabetes (79.3%) or did not know any of the side effects (83.9%) from their medication. Less than half of the patients knew how to take their medication, and more than a third of patients indicated that they were not practicing any form of self-care.

Conclusion

The results indicate that these T2DM patients lacked sufficient knowledge regarding the management of their disease. Healthcare managers should consider instigating programmes to improve patients’ knowledge about the management of their disease as part of general initiatives within South Africa to improve the management of patients with chronic diseases in the public sector.

Metabolic Regulation of Methionine Restriction in Diabetes

Although the effects of dietary methionine restriction have been investigated in the physiology of aging and diseases related to oxidative stress, the relationship between methionine restriction (MR) and the development of metabolic disorders has not been explored extensively. This review summarizes studies of the possible involvement of dietary methionine restriction in improving insulin resistance, glucose homeostasis, oxidative stress, lipid metabolism, the pentose phosphate pathway (PPP), and inflammation, with an emphasis on the fibroblast growth factor 21 and protein phosphatase 2A signals and autophagy in diabetes. Diets deficient in methionine may be a useful nutritional strategy in patients with diabetes.

Blood Glucose Monitoring and Its Determinants in Diabetic Patients: A Cross-Sectional Study in Shandong, China

INTRODUCTION

The aim of this study was to explore the status of blood glucose monitoring and its determinants in diabetic patients in Shandong Province, China.

METHODS

This was a cross-sectional survey conducted from 31 August to 12 October 12, in Shandong Province. A multi-stage stratified cluster sampling method was used to select participants. A total of 2183 diabetic patients were included in the analysis. Frequencies and proportions were used to describe the data, and multiple binary logistic regressions were performed to determine factors associated with blood glucose monitoring.

RESULTS

Of the participants, 51.4% tested their blood glucose level more than once a month. The multivariate logistic regression model showed that seven variables were significantly associated with the frequency of blood glucose monitoring: education level, residence, household income, self-reported health, physical examination, anti-diabetic drug or insulin injection, and comorbidity.

CONCLUSIONS

The level of blood glucose monitoring among diabetic patients in Shandong Province is low. Based on these results we recommend that the cost of blood glucose monitoring by professionals in laboratories be reimbursed or at least reduced and that diabetic patients be encouraged to undergo regular physical examinations.

Modifiable and emerging risk factors for type 2 diabetes in Africa: a systematic review and meta-analysis protocol

BACKGROUND

Type 2 diabetes mellitus (T2DM) remains a public health problem in low-income countries, including African countries. Risk factors of this disease in Africa are still unclear. This study will examine the modifiable and emerging risk factors associated with T2DM in Africa.

METHODOLOGY

The study will include a systematic review and meta-analysis of published and unpublished empirical studies, reporting quantitative data only. We will conduct a search on scientific databases (e.g. Global Health), general online search engines (e.g. Google Scholar) and key websites for grey literature using a combination of key countries/geographic terms, risk factors (e.g. overweight/obesity) and T2DM (including a manual search of the included reference lists). We will use the Comprehensive Meta-Analysis Software (CMA) version 2.0 for data management and analysis. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P).

DISCUSSION

The systematic review and meta-analysis will provide a robust and reliable evidence base for policy makers and future research. This may help with identifying and implementing more cost-effective diabetes prevention strategies and improved resource allocation.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered with the PROSPERO international prospective register of systematic reviews. The reference number is CRD42016043027 .

Evaluating several biomarkers as predictors of aortic stiffness in young and older Africans, not consuming alcohol based on self-report

AIMS

Black populations from sub-Saharan Africa have a high prevalence of cardiovascular disease, which places significant strain on public health systems. Aortic stiffness is a prominent risk factor for cardiovascular disease development. We reported earlier that excessive alcohol use predicts aortic stiffness. However, we require a better understanding of other biomarkers involved in stiffness development, beyond alcohol use. Therefore, we determined which biomarkers (metabolic, inflammatory, endothelial activation and oxidative stress) relate to aortic stiffness in young and older black South Africans, self-reporting no alcohol-use.

METHODS

We included cross-sectional data from young (aged 24.7 ± 3.24 years) black adults participating in the African Prospective study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study (N = 216), and five-year follow-up data from older (aged 61.6 ± 9.77 years) black adults (N = 322) participating in the South African leg of the Prospective Urban and Rural Epidemiology study, conducted in the North West Province (PURE-SA-NWP). We excluded all participants self-reporting alcohol use. We determined biomarkers from blood samples, and measured carotid-femoral pulse wave velocity (PWV).

RESULTS

Of all biomarkers investigated in multivariable-adjusted regression analyses, only plasma glucose (R² = 0.24, β = 0.21, p < 0.001) and glycated haemoglobin (R² = 0.22, β = 0.17, p = 0.002) independently predicted PWV five years later in older adults. We found no other associations in young or older black adults.

CONCLUSION

Dysglycaemia independently predicted aortic stiffness after five years in older black adults. Life-course management of body weight and sugar intake are important in preventing early vascular ageing and subsequent cardiovascular disease development in Africa.

The prevalence of type 2 diabetes in South Africa: a systematic review protocol

INTRODUCTION

Type 2 diabetes mellitus is a major source of morbidity and mortality in South Africa, spurred by increased urbanisation and unhealthy lifestyle factors. Local epidemiological data are required to inform health planning and policy. The purpose of this systematic review is to identify, collate and synthesise all studies reporting the prevalence of diabetes in South Africa. A secondary aim is to report the prevalence of impaired glucose tolerance and impaired fasting glucose, conditions which are associated with an increased risk of progression to overt diabetes, and the prevalence of undiagnosed diabetes.

METHODS AND ANALYSIS

Multiple databases will be searched for diabetes prevalence studies conducted in South Africa between 1997 and 2018. Two authors will independently select studies that meet the inclusion criteria, extract data and appraise studies using a risk of bias tool for prevalence studies. Studies with low or moderate risk of bias will be included. Sources of heterogeneity will be explored using subgroup analysis.

ETHICS AND DISSEMINATION

The systematic review does not require ethics clearance since published studies with non-identifiable data will be used. This review will provide best estimates to inform the Second National Burden of Disease study which can guide health and policy planning.

PROSPERO REGISTRATION NUMBER

CRD42017071280.

Burden of chronic kidney disease on the African continent: a systematic review and meta-analysis

Background

Accurate contemporary data on the burden of Chronic Kidney Disease (CKD) on the African continent are lacking. We determined the prevalence of CKD in adult populations living in Africa, and variations by stage, gender, estimated Glomerular Filtration Rate (eGFR) equation, and residence.

Methods

For this systematic review, we searched multiple electronic databases for original studies on CKD prevalence reported from January 1, 2000 to December 31, 2016. Two reviewers independently undertook quality assessment and data extraction. We stabilized the variance of study-specific estimates with the Freeman-Turkey single arcsine transformation and pooled the data using a random effects meta-analysis models.

Results

A total of 98 studies involving 98,432 individuals were included in the final meta-analysis. The overall prevalence was 15.8% (95% CI 12.1–19.9) for CKD stages 1–5 and 4.6% (3.3–6.1) for CKD stages 3–5 in the general population. Equivalent figures were greater at 32.3% (23.4–41.8) and 13.3% (10.7–16.0) in high-risk populations (people with hypertension, diabetes, HIV). CKD prevalence was higher in studies based on the Cockcroft-Gault formula than MDRD or CKD-EPI equations; and in studies from sub-Saharan Africa compared with those from North Africa (17.7, 95% CI 13.7–22.1 vs 6.1, 95% CI 3.6–9.3, p < 0.001). There was substantial heterogeneity across studies (all I² > 90%) and no evidence of publication bias in main analyses.

Conclusion

CKD is highly prevalent across Africa, inviting efforts into prevention, early detection and control of CKD in adults living on the African continent which is particularly important in a resource limited environment.

Trial Registration

Prospero Registration ID: CRD42017054445.

Electronic supplementary material

The online version of this article (10.1186/s12882-018-0930-5) contains supplementary material, which is available to authorized users.

Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti-vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level.

Effect of short and long moderate-intensity exercises in modifying cardiometabolic markers in sedentary Kenyans aged 50 years and above

Objectives

We compared effects of shorter moderate-intensity exercise time (<10 min bouts) on cardiometabolic parameters with the current recommendations among elderly adults.

Methods

Fifty-three sedentary individuals aged ≥50 years were divided into exercise groups1: male and2 female short-duration bouts (M_S and F_S, respectively), and3 male and4 female long-duration bouts (M_L and F_L, respectively). Short-duration bouts consisted three 5–10 min moderate-intensity jogging sessions daily, and long-duration bouts consisted 30–60 min sessions 3–5 days weekly. Cumulative exercise times were equivalent. Physical activity (PA) was measured by log and activity monitors. Fasting venous blood at baseline and 8 weekly intervals was used for blood chemistry.

Results

After 24 weeks, M_S and F_S with total cholesterol (TC) of >5.2 mmol/L and >5.3 mmol/L decreased from 22.2% to 14.8% and from 30.9% to 11.5%, respectively. For M_L, this decreased from 25.9% to 3.7%, while F_L had 0% change. In M_S and M_L, TC/high-density lipoproteins (HDLs) of >5.0 mmol/L dropped from 22.2% to 7.4% and from 22.2% to 15.4%, respectively. In F_S and F_L, TC/HDL of >4.5 mmol/L declined from 19.2% to 7.7% and from 19.2% to 3.8%, respectively. M_S and M_L with fasting blood glucose of ≥5.5 mmol/L declined from 40.7% to 11.1% and from 33.3% to 3.7%, respectively. Similarly, it declined from 46.2% to 0% and 42.3% to 11.5% for F_S and F_L, respectively. There were no differences in the changes between regimes throughout the study.

Conclusion

Bouts lasting <10 min per session are as good as those lasting;≥30 min in improving cardiometabolic profiles of sedentary adults aged ≥50 years.

Reversing the tide - diagnosis and prevention of T2DM in populations of African descent

Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA_1c, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene-environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.

Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies

Background

The 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation.

Methods

We pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of ≥ 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents).

Results

African data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n = 17), Nigeria (n = 15) and Egypt (n = 13); and for diabetes estimates, Tanzania (n = 8), Tunisia (n = 7), and Cameroon, Egypt and South Africa (all n = 6). The age-standardized mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3-21.7) to 23.0 kg/m2 (22.7-23.3) in men, and from 21.9 kg/m2 (21.3-22.5) to 24.9 kg/m2 (24.6-25.1) in women. The age-standardized prevalence of diabetes increased from 3.4% (1.5-6.3) to 8.5% (6.5-10.8) in men, and from 4.1% (2.0-7.5) to 8.9% (6.9-11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃ 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014.

Conclusions

These estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries' efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organization's Global Monitoring System Framework.

The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa

BACKGROUND

The prevalence of diabetes and hypertension has increased in HIV-positive populations, but there is limited understanding of the role that antiretroviral therapy (ART) programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of health care services for diabetes and hypertension.

METHODS

Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes, and hypertension and self-reported data on health care utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index, education, and household wealth quintile.

RESULTS

Mean age, body mass index, hypertension, and diabetes prevalence were lower in the HIV-positive population (all P < 0.001). Multivariable logistic regression showed that ART use was significantly associated with greater odds of blood pressure measurement [adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI): 1.04 to 1.55] and blood sugar measurement (aOR 1.26, 95% CI: 1.05 to 1.51), counseling regarding exercise (aOR 1.57, 95% CI: 1.11 to 2.22), awareness of hypertension diagnosis (aOR 1.52, 95% CI: 1.12 to 2.05), and treatment for hypertension (aOR 1.63, 95% CI: 1.21 to 2.19).

CONCLUSIONS

HIV-positive patients who use ART are more likely to have received health care services for diabetes and hypertension. This apparent ART advantage suggests that ART programs may be a vehicle for strengthening health systems for chronic care.

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.

Alternative indices of glucose homeostasis as biochemical diagnostic tests for abnormal glucose tolerance in an African setting

AIMS

Accurate diabetes diagnosis is important in Africa, where rates are increasing, and the disease largely undiagnosed. The cumbersome oral glucose tolerance test (OGTT) remains the reference standard, while alternative diagnostic methods are not yet established in Africans. We assessed the ability of fasting plasma glucose (FPG), HbA1c and fructosamine, to diagnose OGTT-based abnormal glucose tolerance in mixed-ancestry South Africans.

METHODS

Mixed-ancestry adults, residing in Cape Town were examined between February and November 2015. OGTT values were used to classify glucose tolerance status as: screen-detected diabetes, prediabetes, dysglycaemia (combination of diabetes and prediabetes) and normal glucose tolerance.

RESULTS

Of the 793 participants included, 65 (8.2%) had screen-detected diabetes, 157 (19.8%) prediabetes and 571 (72.0%) normal glucose tolerance. Correlations of FPG and 2-h glucose with HbA1c (r=0.51 and 0.52) were higher than those with fructosamine (0.34 and 0.30), both p<0.0001. The highest c-statistic for the prediction of abnormal glucose tolerance was recorded with 2-h glucose [c-statistic=0.997 (screen-detected diabetes), 0.979 (prediabetes) and 0.984 (dysglycaemia)] and the lowest with fructosamine (0.865, 0.596 and 0.677). At recommended or data-specific optimal cut-offs, no combination of FPG, HbA1c and fructosamine did better than 2-h glucose, while FPG was better than HbA1c and fructosamine on a range of performance measures.

CONCLUSIONS

Abnormal glucose tolerance in this population is overwhelmingly expressed through 2-h glucose's abnormalities; and no combination of FPG, HbA1c and fructosamine was effective at accurately discriminating OGTT-defined abnormal glucose tolerance. Tested non-glucose based strategies are unreliable alternatives to OGTT for dysglycaemia diagnosis in this population.

The Health Systems Barriers and Facilitators for RHD Prevalence: An Epidemiological Meta-Analysis From Uganda and Tanzania

BACKGROUND

Rheumatic heart disease (RHD) is an important and preventable cause of cardiovascular disease.

OBJECTIVES

As part of a recent RHD initiative in Uganda and Tanzania, we systematically reviewed group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD in these countries.

METHODS

Using a systematic review and meta-analysis/meta-synthesis, we searched PubMed, Embase, and grey literature for quantitative and qualitative studies conducted in Uganda and Tanzania that included individuals affected by GAS, ARF, and RHD. We pre-specified 3 sets of outcomes: 1) disease epidemiology; 2) barriers and facilitators to health care; and 3) stakeholder identification and engagement. Study descriptors, outcomes, and interest, and quality assessments were recorded. For the first objective, we conducted random-effects meta-analyses. For the second objective, we produced a narrative synthesis of themes. No studies contained data on the third objective.

RESULTS

Of 293 records identified, 12 met our inclusion criteria (9 for objective 1 and 3 for objective 2). Most quantitative studies were at moderate or high risk of bias, and only 1 of 2 qualitative studies was high quality. We estimated the prevalence of RHD to be 17.9 (95% confidence interval [CI]: 4.0 to 41.2) per 1,000 individuals. The most frequent nonfatal sequelae were heart failure, pulmonary hypertension, and atrial fibrillation. Case-fatality rates in medical and surgical wards were 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively. Barriers and facilitators to GAS and RHD care were identified in the domains of individual knowledge, family support, provider communication and knowledge, and system design.

CONCLUSIONS

RHD remains endemic in Tanzania and Uganda, and symptomatic RHD is associated with high rates of morbidity and mortality. We have identified critical data gaps in the areas of GAS and ARF epidemiology as well as health care utilization patterns and their determinants.

Compliance to self-monitoring of blood glucose among patients with type 2 diabetes mellitus and its influential factors: a real-world cross-sectional study based on the Tencent TDF-I blood glucose monitoring platform

BACKGROUND

To investigate the compliance to self-monitoring of blood glucose (SMBG) among patients with type 2 diabetes mellitus (T2DM) and its influential factors.

METHODS

The real-world SMBG use over 90 days among 415 T2DM patients were recorded by using a blood glucose monitoring platform (TDF-I, Tencent, China). Clinical features including age, sex, duration of diabetes, insulin treatment or not, and use of oral antidiabetic drugs were collected. Poor compliance was defined as the average frequency of weekly SMBG use over 90 days was below the criteria established by the physicians, and otherwise the patients were regarded as with good compliance. Factors affecting the SMBG compliance were analyzed by using independent sample t-test, Mann-Whitney U test, and multivariate logistic regression analysis.

RESULTS

Only 57.6% of patients in the study cohort had good compliance to SMBG. Multivariate logistic regression models showed that only the duration of T2DM and the use of oral antidiabetic agents were independently associated with SMBG compliance; more specifically, patients with longer course of disease had poorer SMBG compliance, and those had used oral antidiabetic agents had poorer SMBG compliance.

CONCLUSIONS

SMBG compliance in T2DM patients needs to be further improved. For patients with a longer course of disease and/or under oral antidiabetic medication, interventions such as patient education should be adopted to increase the SMBG compliance.

Prevalence and determinants of diabetes among older adults in Ghana

Background

Diabetes is one of the leading non-communicable diseases in Africa, contributing to the increasing disease burden among the old adults. Thus, the aim of this study was to determine the prevalence and determinants of diabetes among adults aged 50 years and above in Ghana.

Methods

A cross sectional study based on data collected from Study of Ageing and Adult Health (SAGE) Wave 1 from 2007 to 2008. Data was collected from 5565 respondents of whom 4135 were aged 50+ years identified using a multistage stratified clusters design. Bivariate and hierarchical multivariable logistic regression models were used to examine the association of the determinants and diabetes.

Results

The weighted prevalence of diabetes among the adults aged 50 years and above in Ghana was 3.95% (95% Confidence Interval: 3.35–4.55) with the prevalence being insignificantly higher in females than males (2.16%, 95% CI: 1.69–2.76 vs. 1.73%, 95% CI: 1.28–2.33). Low level of physical activity (Adjusted Odds Ratio [AOR] 2.11, 95% CI: 1.21–3.69) and obesity (AOR 4.81, 95% CI: 1.92–12.0) were associated with increased odds of diabetes among women while old age (AOR 2.58, 95% CI: 1.29–5.18) and university (AOR 12.8, 95% CI: 4.20–39.1), secondary (AOR 3.61, 95% CI: 1.38–9.47) and primary education (AOR 2.71, 95% CI: 1.02–7.19) were associated with increased the odds of diabetes among men.

Conclusion

The prevalence of diabetes among old adults shows a similar trend with that of the general population. However, the prevalence may have been underestimated due to self-reporting and a high rate of undiagnosed diabetes. In addition, the determinants of diabetes among older adults are a clear indication of the need for diabetes prevention programme targeting the young people and that are gender specific to reduce the burden of diabetes at old age. Physical activity and nutrition should be emphasised in any prevention strategy.

Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries

BACKGROUND

Despite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care.

METHODS

We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005-15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We first quantified the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantified the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fixed-effects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment.

FINDINGS

We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2-14) and the median prevalence of overweight or obesity was 27% (range 16-68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11-37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27-63]); (3) had ever been told that they had diabetes (median 27% [IQR 22-51]); (4) had ever been counselled to lose weight (median 15% [IQR 13-23]); (5) had ever been counselled to exercise (median 15% [IQR 11-30]); (6) were using oral diabetes drugs (median 25% [IQR 18-42]); and (7) were using insulin (median 11% [IQR 6-13]). Compared with those aged 15-39 years, the adjusted odds of met need for diabetes diagnosis (measures 1-3) were 2·22 to 3·53 (40-54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was significantly more likely to be met (measures 4-7) in the oldest age and highest educational groups.

INTERPRETATION

Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment.

FUNDING

None.

Prevalence, Risk Factors, and Complications of Diabetes in the Kilimanjaro Region: A Population-Based Study from Tanzania

BACKGROUND

In sub-Saharan Africa, diabetes is a growing burden, yet little is known about its prevalence, risk factors, and complications. To address these gaps and help inform public health efforts aimed at prevention and treatment, we conducted a community-based study assessing diabetes epidemiology.

METHODS AND FINDINGS

We conducted a stratified, cluster-designed, serial cross-sectional household study from 2014-2015 in the Kilimanjaro Region, Tanzania. We used a three-stage cluster probability sampling method to randomly select individuals. To estimate prevalence, we screened individuals for glucose impairment, including diabetes, using hemoglobin A1C. We also screened for hypertension and obesity, and to assess for potential complications, individuals with diabetes were assessed for retinopathy, neuropathy, and nephropathy. We enrolled 481 adults from 346 urban and rural households. The prevalence of glucose impairment was 21.7% (95% CI 15.2-29.8), which included diabetes (5.7%; 95% CI 3.37-9.47) and glucose impairment with increased risk for diabetes (16.0%; 95% CI 10.2-24.0). Overweight or obesity status had an independent prevalence risk ratio for glucose impairment (2.16; 95% CI 1.39-3.36). Diabetes awareness was low (35.6%), and few individuals with diabetes were receiving biomedical treatment (33.3%). Diabetes-associated complications were common (50.2%; 95% CI 33.7-66.7), including renal (12.0%; 95% CI 4.7-27.3), ophthalmic (49.6%; 95% CI 28.6-70.7), and neurological (28.8%; 95% CI 8.0-65.1) abnormalities.

CONCLUSIONS

In a northern region of Tanzania, diabetes is an under-recognized health condition, despite the fact that many people either have diabetes or are at increased risk for developing diabetes. Most individuals were undiagnosed or untreated, and the prevalence of diabetes-associated complications was high. Public health efforts in this region will need to focus on reducing modifiable risk factors, which appear to include obesity, as well as early detection that includes increasing awareness. These findings highlight a growing urgency of diabetes prevention in this region as well as the need for treatment, including management of complications.