medwireNews: A report shows a rapidly increasing prevalence of diabetes in sub-Saharan Africa, with local health systems unable to cope with the condition and its complications.
Despite a lack of reliable figures for the region, “all estimates point to an increasing burden of diabetes in sub-Saharan Africa” says The Lancet Diabetes & Endocrinology Commission on Diabetes in sub-Saharan Africa. According to the World Health Organization, for example, diabetes prevalence in the Africa region was 7.1% in 2014, an increase of 129% since 1980.
This increase is associated with a financial burden, with the Commission estimating that diabetes cost in sub-Saharan Africa was US$ 19.45 billion (€ 17.08 bn), or 1.2% of the cumulative gross domestic product, in 2015 – with a projected increase to US$ 35–59 billion (€ 31–52 bn) by 2030.
“Putting in place systems to prevent, detect, and manage hyperglycaemia and its consequences is therefore warranted from a health economics perspective,” says the Commission.
The Commission, which comprised more than 70 international experts led by Rifat Atun (Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA), found that rapid demographic, sociocultural, and economic changes are driving increases in the risk factors and prevalence of type 2 diabetes.
“Although not all people with diabetes in sub-Saharan Africa are overweight or obese by western standards,” they comment, “a rapid increase in the prevalence of overweight and obesity is undoubtedly a major driver of the increasing prevalence of type 2 diabetes in the region.”
Diagnosis of diabetes is hampered by poor awareness of the condition, said the Commission, and management is impeded by “inadequacies at all levels of the health system.” These include “inadequate availability of simple equipment for diagnosis and monitoring, a lack of sufficiently knowledgeable health-care providers, insufficient availability of treatments, a dearth of locally appropriate guidelines, and few disease registries.”
To address this, with the aim of managing diabetes and crucially preventing complications, Atun and colleagues recommend decentralizing management from hospitals to community health workers and others who can provide home-based screening and care.
“When health resources are severely limited, difficult choices must often be made in the face of competing priorities,” says the Commission. “Our review of the challenges involved makes it clear that models of diabetes care for use in high-income countries are neither appropriate nor affordable in low-income or middle-income countries.”
Instead, the Commission advises a focus on “widely available inexpensive treatments for prevention of complications alongside strong public health measures” to manage diabetes and prevent further increases in its prevalence.
Commenting on the findings, Shabbar Jaffar and Geoffrey Gill of the Liverpool School of Tropical Medicine, UK, describe the work of the Commission as “a game changer” that should prompt a scale-up of research and control efforts. They emphasize the need for more information, stating: “Improved understanding of the disease in the sub-Saharan African context is also essential to make progress in tackling the impending crisis of diabetes.”
By Catherine Booth
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