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Meta-Analysis
. 2022 Nov 8;12(11):e060786.
doi: 10.1136/bmjopen-2022-060786.

Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis

Davis Kibirige  1 , Nyasatu Chamba  2   3 , Irene Andia-Biraro  4   5 , Kajiru Kilonzo  2   3 , Sweetness Naftal Laizer  3 , Isaac Sekitoleko  6 , Andrew Peter Kyazze  4 , Sandra Ninsiima  7 , Phillip Ssekamatte  7 , Felix Bongomin  8 , Lucy Elauteri Mrema  9 , Willyhelmina Olomi  10 , Theodora D Mbunda  9 , Nyanda Elias Ntinginya  9 , Issa Sabi  11 , Katrina Sharples  12 , Philip Hill  12 , Lindsey Te Brake  13 , Josephine VandeMaat  14 , Reinout vanCrevel  15   16 , Julia Alison Critchley  17 ; PROTID consortium
Affiliations
Meta-Analysis

Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis

Davis Kibirige et al. BMJ Open. .

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.

Keywords: epidemiology; general diabetes; quality in health care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram of selection of eligible studies. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plot summarising studies on the proportion of attainment of an optimal low-density lipoprotein cholesterol goal in percentage. ES, effect size.
Figure 3
Figure 3
Forest plot summarising studies on the proportion of attainment of an optimal blood pressure goal in percentage. ES, effect size.
Figure 4
Figure 4
Forest plot summarising studies on the proportion of attainment of an optimal glycated haemoglobin goal in percentage. ES, effect size.
Figure 5
Figure 5
Forest plot summarising studies on the prevalence of diabetic retinopathy. ES, effect size.
Figure 6
Figure 6
Forest plot summarising studies on the prevalence of diabetic foot ulcers. ES, effect size.
Figure 7
Figure 7
Forest plot summarising studies on the prevalence of diabetic nephropathy. ES, effect size.
Figure 8
Figure 8
Forest plot summarising studies on the prevalence of diabetic neuropathy. ES, effect size.
Figure 9
Figure 9
Forest plot summarising studies on the prevalence of peripheral arterial disease. ES, effect size.
See this image and copyright information in PMC

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