Diabetes in sub-Saharan Africa - from policy to practice to progress: targeting the existing gaps for future care for diabetes

Abstract

The global prevalence and impact of diabetes has increased dramatically, particularly in sub-Saharan Africa. This region faces unique challenges in combating the disease including lack of funding for noncommunicable diseases, lack of availability of studies and guidelines specific to the population, lack of availability of medications, differences in urban and rural patients, and inequity between public and private sector health care. Because of these challenges, diabetes has a greater impact on morbidity and mortality related to the disease in sub-Saharan Africa than any other region in the world. In order to address these unacceptably poor trends, contextualized strategies for the prevention, identification, management, and financing of diabetes care within this population must be developed. This narrative review provides insights into the policy landscape, epidemiology, pathophysiology, care protocols, medication availability, and health care systems to give readers a comprehensive summary of many factors in these domains as they pertain to diabetes in sub-Saharan Africa. In addition to providing a review of the current evidence available in these domains, potential solutions to address the major gaps in care will be proposed to reverse the negative trends seen with diabetes in sub-Saharan Africa.

Keywords: epidemiology; health care systems; medication access; outcomes; pathophysiology; protocols.

Figure 1

Current gaps in diabetes care in sub-Saharan Africa and potential pathways to progress. Abbreviations: HIV, human immunodeficiency virus; TB, tuberculosis; NCD, noncommunicable disease; SSA, sub-Saharan Africa.

Figure 2

Low- and middle-income country government health spending by region. Notes: Reproduced from Independent Task Force on Noncommunicable Diseases: The Emerging Global Health Crisis: Noncommunicable Diseases in Low- and Middle-Income Countries, Task Force Report No. 72. New York: Council on Foreign Relations Press; 2014. Copyright 2014 by the Council on Foreign Relations. Reprinted with permission. Figure data source: Institute for Health Metrics and Evaluation (IHME). Financing Global Health Visualization. Seattle, WA: IHME, University of Washington, 2016. Available from http://vizhub.healthdata.org/fgh/. (Accessed September 1, 2015). Copyright © 2014 by the Council on Foreign Relations®, Inc. All rights reserved.

Figure 3

Differences in pathophysiological presentation of diabetes in HICs and urban setting diabetes compared with rural Sub-Saharan African diabetes. Abbreviations: HICs, high-income countries; BMI, body mass index; SSA, sub-Saharan Africa.

Figure 4

Likelihood of developing type 2 diabetes based on genetic polymorphisms. Notes: Adapted from Corona E, Chen R, Sikora M, et al. Analysis of the genetic basis of disease in the context of worldwide human relationships and migration. PLoS Genet. 2013;9(5):e1003447. Copyright © 2013 Corona et al.

Figure 5

Diabetes management protocols. Notes: Partners in health guidelines for type 2 diabetes management in low- and middle-income countries. Adapted from Kidder A, Kwan G, Cancedda C, Bukhman G. Diabetes. In: Bukhman G, Kidder A, editors. The PIH guide to chronic care integration for endemic non-communicable diseases. Rwanda ed. Boston, MA: Partners in Health; 2011:153–187. Copyright © 2011 Partners In Health. All rights reserved under International and Pan-American Copyright Conventions. Abbreviations: NCD, noncommunicable disease; NS, normal saline; SC, subcutaneous.