IDF Diabetes Atlas
Diabetes in the Africa region: An update

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Abstract

The Africa Region (AFR), where diabetes was once rare, has witnessed a surge in the condition. Estimates for type 1 diabetes suggest that about 39,000 people suffer from the disease in 2013 with 6.4 new cases occurring per year per 100,000 people in children <14 years old. Type 2 diabetes prevalence among 20–79-year-olds is 4.9% with the majority of people with diabetes <60 years old; the highest proportion (43.2%) is in those aged 40–59 years. Figures are projected to increase with the numbers rising from 19.8 million in 2013 to 41.5 million in 2035, representing a 110% absolute increase. There is an apparent increase in diabetes prevalence with economic development in AFR with rates of 4.4% in low-income, 5.0% in lower-middle income and 7.0% in upper-middle income countries. In addition to development and increases in life-expectancy, the likely progression of people at high risk for the development of type 2 diabetes will drive the expected rise of the disease. This includes those with impaired glucose tolerance, the prevalence of which is 7.3% among 20–79-year-olds in 2013. Mortality attributable to diabetes in 2013 in AFR is expected to be over half a million with three-quarter of these deaths occurring in those <60 years old. The prevalence of undiagnosed diabetes remains unacceptably high at 50.7% and is much higher in low income (75.1%) compared to lower- and upper-middle income AFR countries (46.0%). This highlights the inadequate response of local health systems which need to provide accessible, affordable and optimal care for diabetes.

Introduction

The International Diabetes Federation Africa Region (AFR), comprised of countries in sub-Saharan Africa, has not been spared from the global diabetes epidemic. Indeed, diabetes has become a global public health challenge increasingly affecting the poor and posing serious threats to the economies of all countries [1], [2], [3]. AFR, where diabetes was restricted to anecdotic reports during the last century, has witnessed a surge in rates of the condition [1], [4]. Although infectious diseases outnumber diabetes and other non-communicable diseases (NCDs) as the predominant cause of mortality in the region [5], these are important contributors to the disease burden [6], and are projected to overtake infectious diseases as the leading cause of death in the region within the coming two decades. According to the World Health Organisation (WHO), in 2008 the age-standardised diabetes and cardiovascular disease (CVD) related mortality among 30–70-year-olds was 382 per 100,000 people in Africa, the highest in the world and more than double that of the WHO Region with the lowest rate (Region of the Americas: 169 per 100,000) [5].

This discussion paper on diabetes in AFR describes the prevalence and distribution of diabetes and its risk factors, and examines the impact and management of the disease on the continent.

Section snippets

Methodology and estimates

The full description of the methodology and global estimates of diabetes prevalence for the International Diabetes Federation (IDF) Diabetes Atlas data has been described in detail elsewhere [7]. A list of the countries in the AFR Region is listed in the aforementioned paper.

Prevalence and incidence of diabetes

The common forms of diabetes include type 1 and type 2 diabetes as well as gestational diabetes. There are also less common secondary causes of diabetes including diseases of the exocrine pancreas, such as tumours or pancreatitis, endocrinopathies like Cushing's syndrome or phaeochromocytomas, drug-induced diabetes and infections, which are beyond the scope of this review. In AFR, the paucity of reliable epidemiological data on diabetes, including the absence of diabetes registries, limits the

Risk factors for type 2 diabetes

Driven by rapid globalisation and urbanisation, with subsequent changes in diet and the adoption of sedentary lifestyles, the diabetes epidemic has expanded in line with the worldwide rise in overweight and obesity. In addition, diabetes is rising on a global level but particularly in AFR largely due to population ageing and rapid urbanisation [1], [4], [10], [11], [12], [13].

A complex gene-environment interaction of non-modifiable (genetics, age, gender, ethnicity and family history) and

Impact of HIV/AIDS and tuberculosis on diabetes

Two of the most common infectious diseases seen in Africa, tuberculosis (TB) and HIV/AIDS, not only co-exist but interact with diabetes, with one exacerbating the other [1], [4], [6], [29], [31], [32]. Diabetes increases the risk of developing TB three-fold [29], [31] and it seems that TB may predispose a person to diabetes [31]. Rising diabetes prevalence may hamper TB control efforts by increasing the number of susceptible individuals in endemic areas. The co-morbid presentation of diabetes

Morbidity and mortality

Hyperglycaemia and diabetes contribute significantly to morbidity and premature mortality worldwide [13]. In AFR, diabetes is responsible for a considerable amount of morbidity, mainly attributable to micro-vascular complications [1], [4], [10], [18], [28], [31], [57] and due to poor glycaemic and blood pressure (BP) control [18]. The prevalence varies widely across the continent which is likely due to the heterogeneity of the populations studied in terms of the type and duration of diabetes,

Economic and socio-economic burden of diabetes

The majority (76.4%) of diabetes mortality in the region occurred in people younger than 60 years old compared to the global proportion of 49% [13]. The high burden of diabetes in the working age population has a critical impact on the health of the workforce with far-reaching economic repercussions [49]. In addition to undermining productivity and adversely affecting national economies, the socioeconomic costs of diabetes are devastating as the region simultaneously grapples with

Healthcare expenditure and treatment of diabetes

The healthcare expenditure on diabetes in AFR in 2013 was 4.0 billion USD (Table 1) representing less than 1% of the total global healthcare expenditure allocated to diabetes. Spending on diabetes care in the region is woefully inadequate given the substantial projected rise in cases and the overwhelming burden of premature mortality.

About 90% of health ministries in Africa have a dedicated unit or department responsible for NCDs with 61% funded for treatment and control [63]. However, only 26%

Conclusions

The prevalence of diabetes in AFR is rising and of particular concern is the high burden of undiagnosed diabetes. There is considerable variance in the prevalence of diabetes and its risk factors among AFR countries as well as by urban-rural location and sub-populations which is likely a reflection of the varying pace at which communities are developing. The challenges of diabetes in AFR include the need to stem the rising burden of type 2 diabetes, exacerbated by urbanisation and obesity, and

Conflict of interest

The authors have no conflicts to disclose.

Acknowledgements

The 6th edition of the IDF Diabetes Atlas was supported by the following sponsors: Lilly Diabetes, Merck and Co, Inc., Novo Nordisk A/S supported through an unrestricted grant by the Novo Nordisk Changing Diabetes® initiative, Pfizer, Inc., and Sanofi Diabetes.

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