Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study

The worldwide trend in diabetes awareness, treatment, and control from 1985 to 2022: a systematic review and meta-analysis of 233 population-representative studies

Background

With the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels.

Methods

In this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates.

Results

A total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56-63) and ranged from 41% (25-57) in low-income countries to 68% (64-72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42-48) and varied from 37% (31-43) in lower-middle-income countries to 53% (47-59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12-20), which significantly improved and reached 22% (19-25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly.

Conclusion

Despite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.

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.

Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus

Background

Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities.

Methodology

This is an observational case-control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation.

Results

The results obtained in this study showed a median gait assessment score of 21 (17.0-22.5) for group A and 26 (23.5-26.0) for group B which was statistically significant (p < 0.001). There was no statistically significant difference between both groups (p > 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant, p = 0.288.

Conclusions

Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.

Prevalence and Risk Factors of New-onset Diabetes after Transplant in East Africans

Very little is known about the prevalence of new-onset diabetes after transplant (NODAT) in sub-Saharan and Eastern Africans. Most of the data are related to African Americans and to North and South Africans. The aims of this study were to examine the prevalence of NODAT in Sudanese renal transplant recipients, compare it with the published literature, and identify the risk factors for developing NODAT. In total, 150 patients who received a living-related kidney transplant between January 2015 and January 2016 were included in this study. Patients with diabetic nephropathy and pretransplant diabetes were excluded. Follow-up was for 2 years after the transplant. The variables studied were age, sex, body mass index, a family history of diabetes mellitus (DM), pretransplant steroid therapy, dyslipidemia, and hepatitis C virus infection. Twenty- three patients (15.3%) developed NODAT during the study period. The mean age of the patients who developed NODAT was 39 ± 14 years, and the mean time to develop NODAT was 5.78 ± 5.9 months. In the multivariate analysis, the risk factors for developing NODAT were a family history of DM (P = 0.01) and pretransplant steroid therapy (P = 0.01). The prevalence of NODAT in this study was 15.3%, which is in line with the reported literature from North Africa. However, it was significantly lower than the reported prevalence in African Americans.

Risk factors associated with fasting during Ramadan among individuals with diabetes according to IDF-DAR risk score in Atbara city, Sudan: Cross-sectional hospital-based study

BACKGROUND

Ramadan is a holy month for Muslims. The aim of this study was to assess risk associated with Ramadan fasting among Sudanese individuals with diabetes (high, moderate, and low risk) according to International Diabetes Federation in collaboration with Diabetes and Ramadan International alliance (IDF-DAR) Practical Guidelines 2021 risk score.

METHODS

This was a cross-sectional hospital-based study recruited 300 individuals with diabetes (79% have type 2 diabetes) from diabetes centers in Atbara city, the River Nile state, Sudan.

RESULTS

The risk score was distributed as low risk (13.7%), Moderate risk (24%), and High risk (62.3%). T-test showed a significant difference in mean risk score by gender, duration and type of diabetes (p values = 0.004, 0.000, & 0.000, respectively). One-way ANOVA revealed a statistically significant difference in the risk score by age groups (p = 0.000). Logistic regression revealed that the odds of being in the 41-60 years age group had lower probability to be categorized in the moderate risk group of fasting rather than low risk by 4.3 times than being in the age more than 60 years. (p = 0.008), the odds of being in the age group 41-60 years lower probability to be categorized in the high risk of fasting rather than low risk by 8 times than being in the age more than 60 years. (p = 0.000).

CONCLUSION

The majority of patients in this study have a high risk for Ramadan fasting. IDF-DAR risk score is of great significance in assessing individuals with diabetes for Ramadan fasting.

Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.

Knowledge, Attitudes and Practice Among Primary Care Physicians in Sudan Regarding Prediabetes: A Cross-Sectional Survey

Background:

Prediabetes is an important stage before diabetes that can be treated with intensive lifestyle changes. The aim of this study was to assess knowledge, attitudes, and practice of primary care physician in Sudan about prediabetes.

Methods:

A cross-sectional questionnaire-based study was conducted among primary care physicians working at two family and primary health care centers in Khartoum. Data were analyzed using descriptive statistics and expressed as percentages.

Results:

Out of 200 primary care physicians, 189 completed the questionnaire. 60.8% of the participants had satisfactory knowledge about prediabetes and positive attitude towards prediabetes and their practice was relatively good. Knowledge score was significantly correlated with age (P = 0.000), duration of experience (P value = 0.000), the number of working hours per day (P value = 0.001), and the number patients seen per day (P value = 0.001). Logistic regression analysis showed that attending courses relevant to prediabetes revealed statistically significant result in knowledge, and attending such courses were likely to be associated with gaining sufficient knowledge than those who didn’t by 2 times (P value 0.033, OR 2, CI. 1.063-4.079).

Conclusions:

Primary care physicians in Sudan have satisfactory knowledge, attitude, and practice about prediabetes. As they are in the front line in dealing with community, primary care physicians’ efforts can help in slowing down the epidemic of diabetes in Sudan.

Risk Factors of Diabetes Mellitus in Urban Communities in Indonesia (IFLS 5)

Background: Over the last decades, the number of new diabetic cases and the prevalence of diabetes have tended to increase. The diabetes prevalence rate in Indonesia in 2020 reached 6.20%. Purpose: The aim of this study is to examine the relationship between the variables of age, level of education, smoking status, and Body Mass Index (BMI) and the prevalence of diabetes in the urban areas. Methods: This was a cross-sectional study and used secondary data from the Indonesia Family Life Survey (IFLS 5) in 2015. The data was analyzed using descriptive analysis and simple logistic regression. The dependent variable in this study was Diabetes Mellitus (DM); the independent variables were age, education level, smoking status, and BMI. Results: In terms of the respondents’ characteristics, individuals were mainly over 35 years of age (130 respondents, 83.87%). The highest level of education was attained by 93 respondents (60.00%). There was a correlation between respondents who were over 35 years of age, with p=0.01; prevalence ratio (PR)=5.60; 95%Cl=3.64–8.62) and the level of education (p=0.01; PR=1.69; 95%Cl=1.22–2.34) with the incidence of diabetes in urban areas in Indonesia. There was no correlation between the smoking status (p=0.55; PR=0.67; 95%Cl=0.01–2.73) and the BMI of respondents with the prevalence of diabetes in urban areas in Indonesia. Conclusion: The age and the level of education were linked to the incidence of diabetes in urban areas in Indonesia.

Prevalence and associated factors of hypertension among adults with diabetes mellitus in northern Sudan: a cross-sectional study

Background

Hypertension and diabetes mellitus (DM), are highly prevalent worldwide health non-communicable diseases, and are associated with chronic complications. The co-existence of both conditions accelerates the related complications and increases morbidities and mortalities. A cross-sectional study was conducted in Nahr an Nil State (River Nile State) in Sudan between May and August 2018 to identify the prevalence of hypertension and risk factors among patients with DM in that region.

Results

The median (interquartile) age of the 1,973 enrolled patients was 58.0 (50.0‒65.0) years, and 818 (45.6%) were males. The median (interquartile) duration of diabetes was 5.0 (3.0‒9.0) years. Of the 1,973 enrolled participants, 21.7%, 1.3%, 37.1%, and 39.9% were normal weight, underweight, overweight, and obese, respectively. Of 1,973 854 (47.6%) patients also had hypertension. Logistic regression analyses showed that elderly patients (adjusted odds ratio [AOR] = 1.03, 95%; confidence interval [CI] = 1.02‒1.04), males (AOR = 2.96, 95%; CI = 2.15‒4.07), employed patients (AOR = 1.92, 95%; CI = 1.38‒2.70), obese patients (AOR = 1.59, 95%; CI = 1.21‒2.08), and patients with diabetic foot (DF) (AOR = 2.45, 95%; CI = 1.72‒3.47) were at higher risk for hypertension. Conversely, patients with Type 2 DM (T2DM) (AOR = 0.63, 95%; CI = 0.50‒0.80) were at lower risk for hypertension. There was no significant association between overweight, uncontrolled DM, and hypertension.

Conclusion

This study showed a high prevalence of hypertension among patients with DM. Notably, older age, male gender, employment, duration of DM, DF, underweight, and obesity were significant predictors of hypertension among patients with DM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-01983-x.

Dietary knowledge, attitude and practice among type 2 diabetes mellitus patients in Sudan: a hospital-based cross-sectional study

Background

In Sudan, the prevalence of diabetes in adults was estimated at 19.1% in 2015. This study assessed dietary knowledge, attitude, and practices (KAP) of type 2 diabetes mellitus (T2DM) patients in Sudan.

Methods

We randomly selected 238 T2DM patients from a list of 2460 patients from the Jabber Abulizz Hospital. We interviewed them face-to-face using a structured questionnaire. Multivariate logistic regression analyses were performed to investigate the determinants of KAP regarding the recommended diets for T2DM patients.

Results

Majority of the patients demonstrated good knowledge (54.6%), positive attitude (79%); and good practice (58%). The result revealed that patients with formal education had 3.0 (95% CI: 1.6–5.7) times higher odds of having good diabetic dietary knowledge than those with informal education. While patients who had good knowledge and a positive attitude were respectively 4.7 (95% CI: 2.4–8.9) and 3.2 (95% CI: 1.5–6.7) times more likely to follow dietary recommendations than the patients with poor knowledge and negative attitudes.

Conclusion

Irrespective of the socio-demographic position, the good knowledge and the positive attitude towards the recommended diet, all the T2DM patients complied with the dietary recommendations. These findings highlight the need for improving knowledge and promoting positive attitudes towards the recommended diet among T2DM patients.

Prevalent, uncontrolled, and undiagnosed diabetes mellitus among urban adults in Dire Dawa, Eastern Ethiopia: A population-based cross-sectional study

Objective:

Globally, 8.8% of adults were estimated to have diabetes mellitus, with the low-and middle-income countries sharing the largest burden. However, the research evidence for targeted interventions is lacking in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of diabetes mellitus, disaggregated by the epidemiology of diabetes mellitus morbidity and associated factors among adults in Dire Dawa town, Eastern Ethiopia.

Methods:

Data from a total of 872 randomly sampled adults aged 25–64 years were obtained for analysis using the World Health Organization STEPwise approach to non-communicable disease risk factors surveillance instruments. We estimated the prevalence of diabetes mellitus disaggregated by the previous diabetes mellitus diagnosis status and by the current blood sugar level control status. The bivariable and multivariable binary logistic regression model was used to identify correlates of diabetes mellitus, along with STATA version 14.2 for data management and analysis. All statistical tests were declared significant at p-value < 0.05.

Results:

14.9% (95% confidence interval: 12.1, 17.4) of adults aged 25–64 years had diabetes mellitus in the study sample with 58.5% (95% confidence interval: 49.7, 66.7) on diabetes mellitus medication. Among adults currently taking diabetes mellitus medications, 30.3% (95% confidence interval: 19.8, 45.6) had uncontrolled diabetes mellitus. The magnitude of previously undiagnosed diabetes mellitus was 6.2% (95% confidence interval: 4.8, 8.0) in the study sample and 41.5% (95% confidence interval: 33.3, 50.3) among the diabetics. The odds of diabetes mellitus were higher among adults over the age of 55 years (adjusted odds ratio = 2.1, 95% confidence interval: 1.2, 3.6), currently married adults (adjusted odds ratio = 2.3, 95% confidence interval: 1.2, 4.4), and overweight adults (adjusted odds ratio = 1.6, 95% confidence interval: 1.1, 2.1). Adults with primary education (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) and no formal education (adjusted odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) had lower odds of diabetes mellitus.

Conclusion:

The prevalence of diabetes mellitus among adults was high in Dire Dawa, with a third of the diabetics having poor control of their blood sugar levels and, nearly four in ten were previously undiagnosed. Adults who were overweight, currently married, and those over 55 years need to be targeted for regular diabetes health checkups and community-based screening. Also, a mechanism should be instituted to track a patient’s adherence to medications and promote diabetes self-care management.

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.

The prevalence and risk factors of stroke among Sudanese individuals with diabetes: Cross-sectional survey

INTRODUCTION:

Diabetes complications in Sudan were increasing at an alarming rate. The aim of this study was to assess the prevalence of stroke among Sudanese individuals with diabetes.

METHODOLOGY:

This cross-sectional study recruited 283 individuals with diabetes from three diabetes centers in Sudan. Data were collected using a standardized pretested questionnaire, and data were analyzed using Chi-square and logistic regression analysis.

RESULTS:

The average age of participants was 51 (±12 standard deviation) and 35% were aged between 51 and 60 years. Females were 66.8%, and most of the participants (73.9%) were from urban areas and 66.1% received formal education between primary school and university. Body mass index (BMI) classification showed that 34.3% were obese, 31.8% overweight, and 30.4% normal BMI. Diabetes for 1-5 years were observed in 71.7% and for more than 10 years (12%). The majority, i.e., 94.3% had type 2 diabetes mellitus while only 5.7% had type 1. Only one-third of the participants were able to achieve glycosylated hemoglobin (HbA1c) target for diabetes control. The prevalence of cerebrovascular accident (CVA) was 2.5%, hypertension (HTN) was 20%, ischemic heart disease 3.2%, and neuropathy was 45.6%. Chi-square test showed significant association between HbA1c, serum creatinine, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein level, and the presence of CVA. Logistic regression analysis showed HbA1c, and the duration of diabetes are significantly associated with the presence of CVA (P = 0.010, 0.014).

CONCLUSION:

The prevalence of stroke among Sudanese individuals with diabetes was around 2.5%. The main risk factors were HbA1c, HTN, and duration of diabetes.

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.

In transition: current health challenges and priorities in Sudan

A recent symposium and workshop in Khartoum, the capital of the Republic of Sudan, brought together broad expertise from three universities to address the current burden of communicable and non-communicable diseases facing the Sudanese healthcare system. These meetings identified common challenges that impact the burden of diseases in the country, most notably gaps in data and infrastructure which are essential to inform and deliver effective interventions. Non-communicable diseases, including obesity, type 2 diabetes, renal disease and cancer are increasing dramatically, contributing to multimorbidity. At the same time, progress against communicable diseases has been slow, and the burden of chronic and endemic infections remains considerable, with parasitic diseases (such as malaria, leishmaniasis and schistosomiasis) causing substantial morbidity and mortality. Antimicrobial resistance has become a major threat throughout the healthcare system, with an emerging impact on maternal, neonatal and paediatric populations. Meanwhile, malnutrition, micronutrient deficiency and poor perinatal outcomes remain common and contribute to a lifelong burden of disease. These challenges echo the United Nations (UN) sustainable development goals and concentrating on them in a unified strategy will be necessary to address the national burden of disease. At a time when the country is going through societal and political transition, we draw focus on the country and the need for resolution of its healthcare needs.

The Burden of Undiagnosed Diabetes Mellitus in Adult African Population: A Systematic Review and Meta-Analysis

BACKGROUND

The prevalence of diabetes is rapidly increasing in Africa. Type two diabetes may remain undetected for many years, leading to severe complications and healthcare costs. This underlines the importance of understanding the magnitude of undiagnosed diabetes in different populations of Africa. This study is intended to summarize and pool the results of community-based studies to provide a continental level estimate of the undiagnosed diabetes mellitus.

METHODS

We searched MEDLINE/PubMed, HINARI, Cochrane Library, and Google Scholar for community-based studies on diabetes mellitus in Africa. Descriptive information for the original studies was presented in a table, and the quantitative results were presented in forest plots. The Cochran's Q test and I 2 test statistic were used to test heterogeneity across studies. The pooled prevalence of undiagnosed diabetes and subgroup analyses within urban and rural population and diagnostic methods were computed by a random effects model from 2011 to 2017.

RESULTS

One hundred fifty-seven articles were identified through electronic searching using keywords. Of these, seventeen studies, with a total population of 20,350, met the inclusion criteria. A random effects meta-analysis showed that the pooled prevalence of undiagnosed diabetes mellitus in African population was 5.37% (95% CI: 4.57, 6.81). The pooled prevalence from subgroup analyses indicated that undiagnosed diabetes mellitus in the urban population (8.68%, 95% CI: 5.33, 12.03) is twice higher than that in the rural population (3.93%, 95% CI: 2.91, 4.95). The prevalence of UDM by OGTT (8.84%, 95% CI: 1.95, 15.73) was higher than that by the FPG diagnostic method (4.54%, 95% CI: 3.59, 5.49).

CONCLUSION

This study found high proportions of undiagnosed diabetes mellitus in different communities of the African countries. Policy makers must consider diagnostic strategies to improve screening for the undiagnosed diabetes mellitus cases for effective care, which can bring about a substantial reduction in diabetes-related complications and mortality. This review is registered with PROSPERO registration number CRD42018092637.

Adherence to Antidiabetic Medications Among Sudanese Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Survey

Background:

Adherence to antidiabetic medications is crucial for optimum glycemic control and decreasing complications. This study aimed to assess adherence to antidiabetic medications and the associated factors among individuals with type 2 diabetes attending Jabir Abu Eliz Diabetes Centre in Khartoum state, Sudan.

Methods:

This was a descriptive cross-sectional study, recruited 213 individuals with type 2 diabetes, and used a pretested questionnaire. Data were analyzed using the Statistical Package of Social Sciences version 21. Logistic regression analysis was used to check for factors that linked to poor adherence to diabetes medication.

Results:

The median duration of antidiabetic medications use was 8 years; 15.0% were highly adherent to diabetes medications, 44.6% were medium adherent, and 40.4% showed low adherence. Main factors and barriers were medication side effects (18.3%), use of herbal medicine (12.3%), and unavailability of medication (7%). Predictors to nonadherence were gender, and housing status (0.043 and 0.042, respectively).

Conclusion:

Level of adherence to diabetes medication was unsatisfactory as only 15% showed high adherence. Predictors of nonadherence were gender, and housing status. Effective interventions should be implemented to improve medication adherence, like appropriate patient education and involvement in the treatment plan.

Prevalence, risk factors, and glycaemic control of type 2 diabetes mellitus in eastern Sudan: a community-based study

BACKGROUND

Diabetes mellitus (DM) constitutes a global health threat and burden, especially in developing countries. We conducted a cross-sectional study in Gadarif in eastern Sudan to evaluate the prevalence and glycaemic control of patients with type 2 diabetes mellitus (T2DM).

METHODS

We performed a cross-sectional community-based study. Data on blood glucose levels, and anthropometric, demographic and clinical history data were obtained.

RESULTS

Six hundred Sudanese adults with a mean (SD) age of 44.9 (16.5) years were enrolled. More than two-thirds (70.3%) of the study participants were women. The prevalence of T2DM, newly diagnosed T2DM and uncontrolled T2DM was 20.8%, 10.0% and 80.0%, respectively. Logistic regression analysis showed no significant association between education, marital status, body mass index, waist circumference and DM. However older age (AOR = 4.88, 95% CI = 3.09-7.70) and a family history of DM (AOR = 2.58, 95% CI = 1.59-4.20) were associated with T2DM.

CONCLUSION

The prevalence of T2DM is high among the Sudanese population, especially in older people and those with a family history of DM. The high prevalence of uncontrolled DM in this setting is another hidden burden.

Influence of self-efficacy management on adherence to self-care activities and treatment outcome among diabetes mellitus type 2

Background:

High level of self-efficacy and adherence to self-care activities have a positive impact on the achievement of glycemic goal among diabetic patients. In Sudan, there is a gap in knowledge related to self-efficacy management and its influence on adherence to self-care activities and overall disease control.

Objective:

To identify the influence of management self-efficacy on adherence to self-care activities and treatment outcome among Sudanese patients with type 2 diabetes mellitus.

Methods:

A cross-sectional study was conducted at two health care facilities in Sudan from April to May 2016. Patients with type 2 diabetes mellitus were included. Convenience sampling method was adopted. Diabetes Management Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were used to collect data through a face-to-face interview. Logistic regression analysis was performed. A p value <0.05 was considered to be significant. Data were processed using the software SPPS v 21.0.

Results:

A total of 392 patients were included. Respondents classified with high level of self- efficacy across all domains were 191 (48.7%). Moreover, high level of education [adjusted OR 0.5 (0.3-0.7), (p=0.001)] and formal health education on diabetes [adjusted OR 2.4 (1.6-3.7), (p<0.001)], were found to be significantly associated with high level of diabetes management self-efficacy. Patients who had high level of self-efficacy to manage nutrition, physical exercise activity and medication were found more adherent to general diet, exercise activity, and medication taking, respectively. Patients with controlled disease were 87(22.2%). The only predictor of diabetes control was diabetes management self-efficacy [OR 2.1(1.3- 3.5), (p=0.002)].

Conclusions:

Diabetes management self-efficacy was associated with high level of education and receiving health education. Self-efficacy was significantly associated with adherence to self-care activities and glycemic control. Substantial efforts are still needed to empower the patients with self-efficacy and improving adherence to self-care activities through appropriate interventions.

Comparison of serum lipid profile in type 2 diabetes with and without adequate diabetes control in Sudanese population in north of Sudan

BACKGROUND

Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. Dyslipidemia is a major complication of diabetes and an important risk factor for cardiovascular disease (CVD). The objective of this study was to determine the prevalence of dyslipidemia and its co-relation with the glycemic control in individuals with diabetes in River Nile State, Sudan.

METHODS

Individuals with diabetes attended, Naserudin Karamalla Diabetic (NKDM) Centre, in Atbara teaching hospital during study period, who volunteered to participate were included. Only those on treatment for DM for at least one year were included. Venous samples were collected for cholesterol, triglycerides, HDL, LDL, blood glucose and Glycosylated hemoglobin. Participants were interviewed using standardized pretested questionnaire to record medical history and sociodemographic characteristics. Blood pressure, body mass index (BMI) and waist circumference were measured.

RESULTS

A total of 188 individuals were included. The mean age was 49.5 + 13.9 and (128) 68.1% were females. Most patients were having DM for at least 3-5 years 69 (36.7%). Poor diabetes control (HbA1c >7) was recorded in 87.2%, hypercholesterolemia, hypertriglyceridemia and high LDL were identified in 36.6%, 27.7% and 26.6% respectively. In addition, HDL was low in 61.2% of patients.

CONCLUSION

Low HDL is a prominent feature in two thirds of individuals with diabetes, while high cholesterol and high triglyceride were seen in over one quarter.

Prevalence of smoking in Sudanese individuals with diabetes and associated complications: Population-based study

INTRODUCTION

Smoking cigarettes and diabetes are major public health problems in Sudan. Smoking is associated with insulin resistance and can be associated with type 2 diabetes. The aim of this study was to investigate the prevalence of smoking in individuals with diabetes and associated complications.

METHODOLOGY

a descriptive analytical cross-sectional study, included 315 of participants with diabetes. The data collection was performed to gather demographic information, prevalence of smoking and presence of complications. In addition to measurement of blood pressure, weight and height measurement for calculation of body mass index and biochemical tests. Statistical association at p.value of 0.05 was measured using T-test for quantitative data and Chi square test for categorical data.

RESULTS

The overall prevalence of smoking was found to be 33.9%. Smoking was statistically significant associated with being male; increase in age; and being married. HbA1c and triglycerides are significantly associated with smoking (P value = 0.01 and 0.05 respectively); therefore, statistical significance was found with ischemic heart disease(IHD) as well (P value = 0.05). Hypertension, duration of diabetes, low density lipoprotein (LDL), cholesterol and body mass index (BMI) were not statistically significant with smoking.

CONCLUSION

Almost third of the population with diabetes are smokers (33.9%). Smoking is statistically associated with IHD, high triglyceride and HbA1c. Therefore, smoking cessation schemes should be advocated by health authorities and the public in Sudan.

Low levels of physical activity in Sudanese individuals with some features of metabolic syndrome: Population based study

BACKGROUND

The aim of this study was to evaluate the level of physical activity among Sudanese population.

METHODS

A descriptive cross sectional study composed of 323 participants from Khartoum state, Sudan. Data collected using pretested designed questionnaire based on previously validated Global Physical Activity Questionnaire. The demographic and physical measurement including blood glucose, anthropometric and blood pressure.

RESULTS

The Mean age of participants was 35.5. Males were 59.9% and females 47.1% and the prevalence of inactivity was 53.8%. Despite the fact that males are more active than females (P<0.000) physical activity tends to decrease with age but this not statistically significant. Physical activity is significantly decreased with obesity, higher education and doing sedentary jobs (P<0.018, P<0.000 and P<0.000 respectively). While majority of individuals with hypertension and pre-hypertension tend to do less physical activity (P<0.045 and P<0.008 respectively). Logistic regression analysis shown that gender is absolute risk factor for physical activity. Males have more than three times probability of being physically active than women OR3.82 (1.91-7.30). In this study, physical activity was not affected by central obesity (P<0.497), diabetes (P<0.378) and being married or not (P<0.135).

CONCLUSION

Physical activity in Sudanese women was significantly decreased in comparison with men.

Diabetes complications in Sudanese individuals with type 2 diabetes: Overlooked problems in sub-Saharan Africa?

BACKGROUND

Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study is to determine the prevalence of complications of type 2 diabetes across different cities in the country.

METHODS

Individuals with type 2 diabetes, who have been on treatment for DM for at least one year and volunteered to participate, were selected from two diabetes centers in Sudan (Khartoum and Atbara). Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of complications of diabetes.

RESULTS

Four hundred and twenty four individuals with T2DM were included in this study (50.7% males and 49.3% females). Good glycemic control (HbA1c <7) was found in 15.7%. Hypertension was reported in 39.9% and myocardial infarction in 5.9%, while high cholesterol and triglyceride noted in 59.9%, 32.5% respectively. Low HDL was noted in 52.6%. Other complications like peripheral neuropathy, retinopathy and diabetic foot were observed in 68.2%, 72.6% and 12.7% respectively. Factors significantly associated with these complications were longer duration of diabetes (P<0.001), and living in urban areas (P<0.004).

CONCLUSION

High prevalence of complications of type 2 diabetes were observed especially in those with longer duration of diabetes and poor control.

Prevalence and trends of obesity among adult Sudanese individuals: Population based study

AIM

The prevalence of obesity has increased across the globe in particular in Africa. The aim of this study was to determine the prevalence of obesity in Sudan.

MATERIAL AND METHODS

Descriptive, cross sectional study recruited 7239 individuals. Demographic and clinical data were collected by an interview using a pretested standardised questionnaire. Anthropometric measurements including body weight, height and waist circumference have been taken using standardized techniques and calibrated equipment. Body mass index (BMI) has been calculated.

RESULTS

Total of 7239 persons completed the questionnaires; the results showed that prevalence of obesity was found to be 21.2%, with a higher rate of obesity in females than males (26.3% versus 13.8%). The prevalence of central obesity was also higher in women (36.7%) than men (17.6%).The prevalence of overweight was 34.9%. The overall prevalence of overweight/obesity was 56.1%. Obesity determined by BMI was associated with hypertension and diabetes. While central obesity was associated with an increase in age, female, diabetes and hypertension.

CONCLUSION

The prevalence of obesity was 21.2%. Obesity and central obesity have a higher prevalence among Sudanese women. Obesity and central obesity were associated with diabetes and hypertension.

Economic and social impact of diabetes mellitus in a low-income country: A case-control study in Sudan

BACKGROUND

Diabetes mellitus accounts for 11% of total health expenditure worldwide, and most people with diabetes live in low- and middle-income countries. The present study examined the economic and social effects attributed to diabetes in Sudan by calculating out-of-pocket medical expenses and the health and social effects of the disease for people with diabetes (n = 375) and their families compared with a non-diabetic control group (n = 375), matched for age, sex, and residence area.

METHODS

Data were obtained in 2013 in four states within the Sudan, via structured interviews, using instruments from the International Diabetes Federation. Descriptive statistics were used to analyze differences between case and control participants.

RESULTS

The median total annual medical expenditure was fourfold higher for people with than without diabetes (US$579 vs US$148, respectively). Annual mean expenditure was 85% higher for those with diabetes (US$1004 vs US$544). People with diabetes were also significantly more likely to suffer from serious comorbidities, such as cardiovascular disorders and foot ulcers, compared with control participants. Moreover, those with diabetes reported a higher proportion of personal adverse social effects, such as being prevented from doing paid work or participating in education, both for themselves and their families.

CONCLUSIONS

The high economic burden and adverse social effects on people with diabetes and their families in Sudan call for the development of evidence-based policy and program strategies for the prevention and management of diabetes, with an emphasis on low-resource communities.

Prevalence and Risk Factors for Acute Coronary Syndrome Among Sudanese Individuals With Diabetes: A Population-Based Study

Background

Acute coronary syndrome (ACS) is common with diabetes. The aim of this study was to establish prevalence and risk factors for ACS among Sudanese individuals with diabetes mellitus (DM).

Methods

A descriptive cross-sectional study was conducted in Khartoum State and Atabra (North of Sudan). The data collection was performed through pretested questionnaire, in addition to measurement of lipid profile and HbA1c.

Results

Among the 496 respondents, 234 (48.4%) were males and only 15 of them had ACS, while 255 (51.6%) were females and 12 had ACS. Therefore, the prevalence of ACS was 5.44% (95% confidence interval (CI): 3.45-7.44%). The unadjusted risk factors for ACS were age (P = 0.0008864), duration of DM (P = 0.01105) and presence of hypertension (P = 0.0006021). The presence of albuminuria, gender, and body mass index (BMI) was not associated with ACS. In addition, parameters like HbA1c, high-density lipoprotein (HDL), triglyceride and low-density cholesterol (LDL) were also not associated with ACS. Logistic regression analysis showed that duration of diabetes (odds ratio (OR) for below 5 years' history of DM = 0.175 (95% CI for OR: 0.180 - 0.835), P = 0.04051) and hypertension (OR = 2.462 (95% CI for OR: 1.007 - 6.500), P = 0.039) were absolute risk factors for ACS.

Conclusion

The prevalence of ACS is estimated to be 5.44%. ACS in Sudanese individuals with DM was associated with hypertension, increase in age and increase in duration of DM.

Non-Alcoholic Fatty Liver Disease in Africa and Middle East: An Attempt to Predict the Present and Future Implications on the Healthcare System

Non-alcoholic fatty liver disease (NAFLD) encompasses a group of hepatic diseases that range in severity. NAFLD is increasingly recognized as an epidemic among different populations, including those in Africa and the Middle East. The objective of this narrative review is to document the prevalence of and risk factors for NAFLD in Africa and the Middle East and the potential implications on the healthcare systems. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "non-alcoholic fatty liver disease" and "non-alcoholic steatohepatitis", in addition to "prevalence and risk factors for NAFLD", with special emphasis on Africa and the Middle East countries. There were three types of epidemiological studies that included prevalence, risk factors and management/complications of NAFLD. There was noticeable variation in the prevalence of NAFLD among different countries, based on the variation in the prevalence of risk factors (type 2 diabetes, obesity, metabolic syndrome and dyslipidemia) and the diagnostic tool used in the study. However, the highest prevalence rate was reported in some Middle East countries. In Africa, there were few studies about NAFLD and most reported variable prevalence rates. There is an increasing prevalence of NAFLD as a result of the increasing risk factors, particularly in the Middle East, while in Africa, the situation is still unclear. Health providers in these regions are faced with many challenges that need urgent plans.

Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?

BACKGROUND

Diabetic foot ulceration (DFU) is a major health problem across the globe. The objective of this study is to determine the prevalence of DFU and its associated risk factors in Sudanese individuals with diabetes.

METHODS

Three hundred and ten individuals with type 2 diabetes, who have been on treatment for DM for at least 1 year and volunteered to participate, were enrolled in this study. Participants were interviewed using standardized pretested questionnaire to record medical history, socio-demographic, life style characteristics and presence of DFU.

RESULTS

The prevalence of DFU was found to be 18.1% in this cohort (95% CI: 13.78-22.34%). Among different metabolic variants like hypertension, albuminuria, retinopathy, neuropathy, HbA1c, cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride, only duration of diabetes was significantly associated with DFU (P<0.0018) as shown by logistic regression statistical analysis. Even after adjusting for all other potential risk factors, living with diabetes for more than 10 years is associated with an increase in the diabetic foot probability by 3.16 folds (95% CI: 052-10.48 folds increase), P=0.006. The adjusted effect for living with diabetes for more than 20 years on the diabetic foot complication probability is an increase by 1.73 folds (95% CI: 0.39-4.37 folds increase), P=0.005. However, living with diabetes for more than 5 years had a non-significant adjusted effect on diabetic foot probability.

CONCLUSIONS

Prevalence of diabetic foot ulcer was 18.1% and the risk of development of diabetic foot ulcer is increased with duration of diabetes more than 10 years.

The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims

Although there are many studies assessing the influence of religious beliefs on health they do not agree on whether the impact is positive or negative. More so, there is no consensus in the available literature on the definition of fatalism and what it means to individuals. In this phenomenological study we attempt to define what religious fatalism means to people living with diabetes in Khartoum, and how it affects their health beliefs, and how those beliefs affect their sense of coherence and generalized resistance resources, since salutogenesis is the guiding theory in this study. Three Copts and five Sunnis living with diabetes were interviewed, as well as a Coptic clergyman and a Sunni scholar. The semi-structured interviews were recorded and transcribed verbatim for analysis. Thematic network analysis was used to code salient concepts into basic themes, organizing themes and global themes. The empirical findings are thus structured as the three global themes: (1) fatalism and free will; (2) health responsibility; (3) acceptance and coping. Fatalism was defined as events beyond an individual's control where it is then the individual's free will to seek healthy behavior. Thus health responsibility was stressed upon by the participants in this study as well as the clergyman and scholar. There is also the concept of 'God doesn't give one what one cannot handle' that the participants relate to coping and acceptance. This study finds that the meaning of religious fatalism held by participants and religious clergy is not disempowering. The participants believe that they are responsible for their health. The meaning derived from fatalism is related to how they can accept what is beyond their control and cope with their health condition. Religious fatalism contributed to comprehensibility, manageability and meaningfulness in our participants' response to diabetes.

Obesity among Sudanese adults with diabetes: a population-based survey

BACKGROUND

The aim of this study was to determine the prevalence of obesity among Sudanese individuals with diabetes.

METHODS

Demographic and clinical data from 1,337 individuals with type 2 diabetes were collected using a pretested, standardized, interviewer administered questionnaire. Subjects were recruited from three states namely Khartoum, Northern and River Nile States. Anthropometric measurements including body weight, height and waist circumference were determined using standardized techniques and calibrated equipment.

RESULTS

Total of 1,337 subjects with type 2 diabetes from Khartoum and North of Sudan were enrolled in this study and completed the questionnaires; the results showed that prevalence of obesity among individuals with diabetes was found to be 24.5%, with a higher rate of obesity in females than males (29.2% versus 18.1%). The prevalence of central obesity was also higher in women (43.6%) than men (21.8%). The prevalence of overweight was 39.9%. The overall prevalence of overweight and obesity was 64.4%. Obesity was associated with age, sex and blood pressure. While central obesity was associated with an increase in age, female sex and hypertension. Logistic regression analysis showed that female sex and hypertension are absolute risk factors for both obesity and central obesity.

CONCLUSIONS

The prevalence of obesity was 24.5% and overweight was 39.9% among Sudanese individuals with diabetes and more among women than men. Obesity and central obesity were significantly associated with female sex and hypertension.

Frequency of diabetic retinopathy and associated risk factors in Khartoum, Sudan: population based study

AIM

To assess the frequency and associated risk factors of diabetic retinopathy among Sudanese individuals with diabetes attending Makka Eye complex in Khartoum, Sudan.

METHODS

The cross sectional hospital based study recruited 316 individuals with diabetes from Makkah Eye Complex Retina Clinic. Standard questionnaire was used to collect demographic data, medical history and life style characteristics. Blood samples were taken to measure HbA1c and lipid profile. Fundus and slit lamp examination were performed for screening of diabetic retinopathy.

RESULTS

Among 316 participants, 187 (59.2%) were males and 129 (40.8%) were females. The mean age of participants was 58.7±10.5y. The overall frequency of retinopathy was 261 (82.6%). The percentages of the total participants with proliferative diabetic retinopathy (PDR) were 126 (39.9%) and non-proliferative diabetic retinopathy (NPDR) were 135 (42.7%). Importantly, duration of diabetes mellitus (DM) (72.2% of more than 10y), being on oral hypoglycaemic drugs (versus insulin), and hypertension were all significant risk factors for diabetic retinopathy (P=0.00, 0.01 and 0.00 respectively). Complications of diabetes like diabetic foot (17.7%), history of amputation (6.7%) and clinically significant macular edema (CSME) (47.4%) of the eyes were all significant risk factors (P<0.05). Logistic regression analysis showed that duration of diabetes, hypertension and CSME were found to be absolute risk factors (P=0.007, 0.003 and 0.000 respectively). Duration of DM of more than 10y have more than double risk (OR=2.8), while having hypertension triples the risk of retinopathy (OR=3.1).

CONCLUSION

High rates of diabetic retinopathy are noted among individuals with diabetes attending Makkah Eye hospital in capital Khartoum. Urgent strategies are needed to monitor and treat hypertension and optimize diabetes control in individuals with diabetes. More investment in diabetes services is urgently needed.

Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study

Background:

Type 1 diabetes is a challenging metabolic disorder for health authorities in Sudan. The objective of this study was to assess the level of glycemic control and to determine the prevalence of dyslipidemia and complications among individuals with type 1 diabetes in Sudan.

Materials and Methods:

Individuals with type 1 diabetes, who were having the disease for at least 1 year, were invited to participate in this study. Data were collected from two diabetes centers, in the Capital Khartoum and Atbara City, North of Sudan. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic data, and life style characteristics. Blood pressure, body mass index, and waist circumference were measured. Blood samples were taken for measurement of lipid profile and glycosylated hemoglobin.

Results:

A total of eighty individuals with type 1 diabetes volunteered to participate in this study, 37.5% of males and 62.5% of females. Majority of the patients were aged between 40 and 70 years old. There was poor glycemic control (glycosylated hemoglobin >7%), in 83.8%. Age and sex were significant factors associated with poor glycemic control in this cohort. High cholesterol, triglyceride, and low density lipoprotein were seen in 76.2%, 27.5%, and 48.8% of participants, respectively. Low high density lipoprotein was seen in 33.8%. Hypertension was determined in 21.3%. Peripheral neuropathy, visual impairment, diabetic foot, and myocardial infarction were seen in 50%, 48.8%, 18.8%, and 2.5% of patients, respectively.

Conclusion:

Sudanese adults with type 1 diabetes have poor glycemic control, high prevalence of dyslipidemia, and long-term complications.

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.