A sub-Saharan African perspective of diabetes.
Diabetes mellitus is an important and increasing cause of morbidity and mortality in sub-Saharan Africa. Accurate epidemiological studies are often logistically and financially difficult, but processes of rural-urban migration and epidemiological transition are certainly increasing the prevalence of type 2 diabetes. Type 1 disease is relatively rare, although this may be related to high mortality. This diabetic subgroup appears to present at a later age (by about a decade) than in Western countries. Variant forms of diabetes are also described in the continent; notably 'atypical, ketosis-prone' diabetes, and malnutrition-related diabetes mellitus. These types sometimes make the distinction between type 1 and type 2 diabetes difficult. Interestingly, this is also a current experience in the developed world. As more detailed and reliable complication studies emerge, it is increasingly apparent that African diabetes is associated with a high complication burden, which is both difficult to treat and prevent. More optimistically, a number of intervention studies and twinning projects are showing real benefits in varying locations. Future improvements depend on practical and sustainable support, coupled with local acceptance of diabetes as a major threat to the future health and quality of life of sub-Saharan Africans.
Gill
G V
GV
Clinical Division, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. g.gill@liv.ac.uk
Mbanya
J-C
JC
Ramaiya
K L
KL
Tesfaye
S
S
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000145:classification / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D044342:Malnutrition / Q000150:complications; D015995:Prevalence; D014505:Urban Population / Q000706:statistics & numerical data