Diabetes is a ticking time bomb in sub-Saharan Africa

Diabetes is a serious, chronic condition that affects the lives and well-being of individuals, families and societies worldwide. It is characterized by excess levels of sugar in the blood.

There are three main types of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes.

Type 1 diabetes often starts at an early age. It occurs when the body attacks the pancreas with antibodies. The pancreas is damaged and cannot produce the hormone, insulin, which is responsible for regulating the blood sugar level. As a result, people with type 1 diabetes rely on daily injections of insulin to survive. Type 1 diabetes forms approximately 5% -10% of all cases of diabetes

Type 2 diabetes is most common in adults from the age of 20 to 79. It covers approx. 90% of all diabetes cases. In type 2, the pancreas produces insulin, but it is not enough or the body cells use it – known as insulin resistance. People with obesity have a high risk of developing type 2 diabetes.

Gestational diabetes refers to high blood sugar that occurs only during pregnancy and usually disappears after childbirth. But women with gestational diabetes have a high chance of developing type 2 diabetes later in life.

In 2019 approximately 1 in 11 adults in the world – 436 million people – have had diabetes. Of these, 19 million lived in sub-Saharan Africa. About 60% of them were not aware of their condition.

These numbers are expected to grow exponentially over the next 25 years. The number of people with diabetes in sub-Saharan Africa is expected to more than double 45 million by 2045. This is because many people have the future risk of diabetes, also known as people with prediabetes. In 2019, approximately 45 million Africans aged 20 to 79 have impaired glucose tolerance, which is a form of prediabetes.

The Global study of diseases estimates that diabetes is the fifth leading cause of death due to non-communicable diseases in the region. Others before it are stroke, ischemic heart disease, congenital birth defects and chronic liver disease.

The expected rapid increase in diabetes should not be overlooked as it can be devastating health and economic consequences for the region. Most national health systems are unprepared to deal with the growing burden because they are struggling to cope with infectious diseases. The COVID-19 pandemic contributed to this pressure.

As it is a lifestyle disease, governments need to take urgent action to encourage changes in behavior in an effort to manage it.

Implications of high-dose diabetes

Diabetes and other non-communicable diseases lead to people living in poor health in sub-Saharan Africa for years. The average life expectancy in the region, 64.5 years are currently estimated, with 11% of the years spent in poor health.

A third of all health losses (measured by disabled life expectancy) in 2019 in sub-Saharan Africa were due to non-communicable diseases such as diabetes. This figure rose from 18% in 1990. Life expectancy adjusted by disability is a measure of diseases that catch both early death and ill health.

According to the Global Burden of Disease Study, the proportion of all life years lost to early death due to diabetes and other non-communicable diseases increased by more than 68% in sub-Saharan Africa between 1990 and 2019.

Diabetes can lead to death and life-threatening complications, such as severe damage to the heart, blood vessels, eyes, kidneys and nerves. These complications can lead to heart attacks, strokes, blindness, kidney failure and amputation of the lower limbs. For example, adults with diabetes suffer three times more from heart attacks and strokes than adults without diabetes.

Diabetes can also increase the risk of infectious diseases such as pneumonia and tuberculosis. It has also been shown that people with diabetes who are infected with SARS-CoV-2 are more likely to develop erge COVID-19, to require extended stay in the hospital, have a greater need for ventilation and have greater chances dies of COVID-19.

Future risks

Sub-Saharan Africa faces unique challenges combating diabetes. These include the lack of funding for non-communicable diseases, lack of studies and guidelines specific to the population, lack of medicine, differences in urban and rural patients, and inequality between public and private health care.

Because of these challenges, diabetes has a greater impact on health loss in sub-Saharan Africa than any other region in the world.

The International Diabetes Federation It is estimated that the cost of diabetes in sub-Saharan Africa in 2019 will be US $ 9.5 billion, and it will increase to US $ 17.4 billion by 2045.

The increasing incidence of diabetes is related to the increase in obesity and other lifestyle changes such as poor eating habits and lack of physical activity.

The risk factors for developing diabetes are changeable, which means they can be changed. People should be encouraged to eat healthily, be physically active and avoid extreme weight gain. Such simple lifestyle changes are effective in preventing type 2 diabetes.

Studies over the past two decades have shown this unequivocally lifestyle change may prevent or delay the onset of type 2 diabetes in people with a high future risk for the disease. Such studies are in many countries, including the United States, Finland, China, India, Japan and Pakistan.

A coordinated multisectoral approach within and across countries is needed to stem the tide of diabetes in sub-Saharan Africa.

Chinwe Juliana Iwu-Jaja, Public Health Researcher, Stellenbosch University; Andre Pascal Kengne, Director of the Research Unit for Non-Communicable Diseases at the South African Council for Medical Research, Professor in the Department of Medicine, University of Cape Town, en Charles Shey Wiysonge, Director, Cochrane South Africa, South African Council for Medical Research


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