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Review
. 2019 Feb 14:5:2.
doi: 10.1186/s40842-019-0077-8. eCollection 2019.

Understanding the manifestation of diabetes in sub Saharan Africa to inform therapeutic approaches and preventive strategies: a narrative review

Davis Kibirige  1   2 , William Lumu  3 , Angus G Jones  4 , Liam Smeeth  5 , Andrew T Hattersley  4 , Moffat J Nyirenda  1   5
Affiliations
Review

Understanding the manifestation of diabetes in sub Saharan Africa to inform therapeutic approaches and preventive strategies: a narrative review

Davis Kibirige et al. Clin Diabetes Endocrinol. .

Abstract

Background: Globally, the burden of diabetes mellitus has increased to epidemic proportions. Estimates from the International Diabetes Federation predict that the greatest future increase in the prevalence of diabetes mellitus will occur in Africa.

Methods: This article reviews literature on the manifestation of diabetes in adult patients in sub-Saharan Africa highlighting the distinct phenotypes, plausible explanations for this unique manifestation and the clinical significance of comprehensively defining and understanding the African diabetes phenotype.

Results: There are few studies on the manifestation or phenotype of diabetes in Africa. The limited data available suggests that, compared to the Western world, the majority of patients with diabetes in Africa are young and relatively lean in body size. In addition, hyperglycaemia in most cases is characterised by a significantly blunted acute first phase of insulin secretion in response to an oral or intravenous glucose load and pancreatic beta cell secretory dysfunction, rather than peripheral insulin resistance predominates. Genetic and environmental factors like chronic infections/inflammation, early life malnutrition and epigenetic modifications are thought to contribute to these distinct differences in manifestation.

Conclusions: While published data is limited, there appears to be distinct phenotypes of diabetes in sub-Saharan Africa. Large and more detailed studies are needed especially among newly diagnosed patients to fully characterize diabetes in this region. This will further improve the understanding of manifestation of diabetes and guide the formulation of optimal therapeutic approaches and preventive strategies of the condition on the continent.

Keywords: Adult patients; Diabetes; Diabetes phenotype; Manifestation; Sub-Saharan Africa.

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Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Plausible explanations for the distinct diabetes phenotype in sub Saharan Africa. KPD: Ketosis Prone Diabetes, FCPD: Fibrocalculous pancreatic diabetes
See this image and copyright information in PMC

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