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Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities

Nature Reviews Endocrinology volume 18, pages 219–229 (2022)Cite this article

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Abstract

Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable epidemiological transition fuelled by the pace of urbanization, with disease burden profiles shifting from communicable diseases to non-communicable diseases (NCDs). Information on the epidemiology of T2DM has increased, but wide variations in study methods, diagnostic biomarkers and criteria hamper analytical comparison, and data from high-quality studies are limited. The prevalence of T2DM is still low in some rural populations but moderate or high rates are reported in many countries/regions, with evidence for an increase in some. In addition, the proportion of undiagnosed T2DM is still high. The prevalence of T2DM is highest in African people living in urban areas, and the gradient between African people living in urban areas and people in the African diaspora is rapidly fading. However, data from longitudinal studies are lacking and there is limited information on chronic complications and the genetics of T2DM. The large unmet needs for T2DM care call for greater investment of resources into health systems to manage NCDs in SSA. Proposed health-system paradigms are being developed in some countries/regions. However, national NCD programmes need to be adequately funded and coordinated to stem the tide of T2DM and its complications.

Key points

  • Previously considered rare, type 2 diabetes mellitus (T2DM) is now firmly established in sub-Saharan Africa (SSA).

  • Although prevalence is low in some rural populations, moderate or high rates are reported in many countries/regions, with evidence for an increase in prevalence in some areas.

  • Information on the burden of T2DM has increased, but there is a need for high-quality epidemiology studies using harmonized approaches for sampling, data collection and diagnostic methods.

  • The increase in T2DM in SSA is associated with modifiable risk factors, such as urbanization and obesity, and there is a high proportion of undiagnosed T2DM.

  • Data on the genetics of T2DM are emerging and suggests a greater degree of genetic diversity in T2DM susceptibility in African people compared with other populations.

  • There are large unmet needs for T2DM care and national programmes need to be adequately funded and coordinated; integrated models of chronic disease health care that leverage resources across health-care systems are being piloted in some countries/regions.

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Fig. 1: The prevalence of T2DM in studies from some areas of sub-Saharan Africa.
Fig. 2: T2DM complications in some middle Africa countries.
Fig. 3: Proposed integrated primary care model of chronic care.

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Acknowledgements

K.E. is supported by the Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), USA. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.

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PubMed was searched using keywords including ‘diabetes and sub-Saharan Africa/Africa’, ‘diabetes prevalence and sub-Saharan Africa/Africa’, ‘risk of diabetes and sub-Saharan Africa/Africa’, ‘epidemiology of diabetes and sub-Saharan Africa/Africa’, ‘urbanization/urban/rural and diabetes and sub-Saharan Africa/Africa’, ‘physical activity and diabetes and Africa’, ‘genetics of diabetes and sub-Saharan Africa/Africa’, ‘GWAS and type 2 diabetes and sub-Saharan Africa’, ‘mortality and diabetes and Africa’, ‘HIV and diabetes and Africa’, ‘standards of care and sub-Saharan Africa’, ‘diabetes and … [each country in sub-Saharan Africa]’. Published peer-reviewed reviews and book chapters were included. The World Health Organization (WHO), International Diabetes Federation (IDF), United Nations and World Bank publications were used and their websites were also accessed for relevant information.

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Authors and Affiliations

  1. Inkosi Albert Luthuli Central Hospital, Durban, South Africa

    Ayesha A. Motala & Fraser J. Pirie

  2. Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa

    Ayesha A. Motala & Fraser J. Pirie

  3. Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences University of Yaounde 1, Yaounde, Cameroon

    Jean Claude Mbanya

  4. Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania

    Kaushik Ramaiya

  5. Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institute of Health, Bethesda, MD, USA

    Kenneth Ekoru

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Motala, A.A., Mbanya, J.C., Ramaiya, K. et al. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nat Rev Endocrinol 18, 219–229 (2022). https://doi.org/10.1038/s41574-021-00613-y

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  • DOI: https://doi.org/10.1038/s41574-021-00613-y

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