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Diabetes and endocrinology
Original research
Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis
  1. Davis Kibirige1,
  2. Nyasatu Chamba2,3,
  3. Irene Andia-Biraro4,5,
  4. Kajiru Kilonzo2,3,
  5. Sweetness Naftal Laizer3,
  6. Isaac Sekitoleko6,
  7. Andrew Peter Kyazze4,
  8. Sandra Ninsiima7,
  9. Phillip Ssekamatte7,
  10. Felix Bongomin8,
  11. Lucy Elauteri Mrema9,
  12. Willyhelmina Olomi10,
  13. Theodora D Mbunda9,
  14. Nyanda Elias Ntinginya9,
  15. Issa Sabi11,
  16. Katrina Sharples12,
  17. Philip Hill12,
  18. Lindsey te Brake13,
  19. Josephine VandeMaat14,
  20. Reinout vanCrevel15,16,
  21. Julia Alison Critchley17
  22. on behalf of PROTID consortium
  1. 1Department of Medicine, Lubaga Hospital, Kampala, Uganda
  2. 2Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
  3. 3Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
  4. 4Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
  5. 5Department of Immunomudation and Vaccines, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
  6. 6Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
  7. 7Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
  8. 8Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
  9. 9Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
  10. 10Department of Medical Statistics, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
  11. 11Department of Paediatrics and Child Health, NIMR-Mbeya Medical Research Programme, Mbeya, Tanzania
  12. 12Centre for International Health, University of Otago, Dunedin, New Zealand
  13. 13Department of Pharmacology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
  14. 14Department of Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
  15. 15Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
  16. 16University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
  17. 17Population Health Research Institute, St George's University of London, London, UK
  1. Correspondence to Dr Davis Kibirige; kibirigedavis{at}gmail.com

Abstract

Objective Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes.

Methods We systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the prevalence of five diabetes complications.

Results In total, 109 studies with a total of 63 890 participants (53.3% being females) were included in the meta-analysis. Most of the studies were conducted in Eastern African countries (n=44, 40.4%). The pooled proportion of attainment of an optimal HbA1c, BP and LDLC goal was 27% (95% CI 24 to 30, I2=94.7%), 38% (95% CI 30 to 46, I2=98.7%) and 42% (95% CI 32 to 52, I2=97.4%), respectively. The pooled prevalence of diabetic peripheral neuropathy, retinopathy, diabetic nephropathy, peripheral arterial disease and foot ulcers was 38% (95% CI 31 to 45, I2=98.2%), 32% (95% CI 28 to 36, I2=98%), 31% (95% CI 22 to 41, I2=99.3%), 19% (95% CI 12 to 25, I2=98.1%) and 11% (95% CI 9 to 14, I2=97.4%), respectively.

Conclusion Attainment of optimal diabetes treatment goals, especially HbA1c, in adult patients with type 2 diabetes in Africa remains a challenge. Diabetes complications, especially diabetic peripheral neuropathy and retinopathy, are highly prevalent in adult populations with type 2 diabetes in Africa.

  • epidemiology
  • epidemiology
  • quality in health care
  • general diabetes

Data availability statement

Data are available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2022-060786

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Twitter @PWSsekamatte

    • Contributors DK and NC: conceived the research idea, performed the preliminary screening of titles and abstracts to identify potentially eligible articles and wrote the initial draft of the manuscript; DK, NC, IA-B, SNL, ISe, APK and SN: retrieved full texts and identified the eligible articles; KK, SNL, AP-K, SN, PS, FB, LEM, WO, TDM, NEN, ISa: extracted data from the identified eligible articles; DK and ISe performed the data analysis and interpretation; NC, KK and SNL: performed the assessment of the quality of studies; KS, PH, LtB, JV, RvC and JAC: offered additional data interpretation and supervised this work. All the authors reviewed the different versions of the manuscript and read and approved the final draft of the manuscript. DK is the overall guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.