title: Prevalence, Risk Factors, and Complications of Diabetes in the Kilimanjaro Region: A Population-Based Study from Tanzania.
abstract: BACKGROUND
  In sub-Saharan Africa, diabetes is a growing burden, yet little is known about its prevalence, risk factors, and complications. To address these gaps and help inform public health efforts aimed at prevention and treatment, we conducted a community-based study assessing diabetes epidemiology.
  
  
  RESULTS
  We conducted a stratified, cluster-designed, serial cross-sectional household study from 2014-2015 in the Kilimanjaro Region, Tanzania. We used a three-stage cluster probability sampling method to randomly select individuals. To estimate prevalence, we screened individuals for glucose impairment, including diabetes, using hemoglobin A1C. We also screened for hypertension and obesity, and to assess for potential complications, individuals with diabetes were assessed for retinopathy, neuropathy, and nephropathy. We enrolled 481 adults from 346 urban and rural households. The prevalence of glucose impairment was 21.7% (95% CI 15.2-29.8), which included diabetes (5.7%; 95% CI 3.37-9.47) and glucose impairment with increased risk for diabetes (16.0%; 95% CI 10.2-24.0). Overweight or obesity status had an independent prevalence risk ratio for glucose impairment (2.16; 95% CI 1.39-3.36). Diabetes awareness was low (35.6%), and few individuals with diabetes were receiving biomedical treatment (33.3%). Diabetes-associated complications were common (50.2%; 95% CI 33.7-66.7), including renal (12.0%; 95% CI 4.7-27.3), ophthalmic (49.6%; 95% CI 28.6-70.7), and neurological (28.8%; 95% CI 8.0-65.1) abnormalities.
  
  
  CONCLUSIONS
  In a northern region of Tanzania, diabetes is an under-recognized health condition, despite the fact that many people either have diabetes or are at increased risk for developing diabetes. Most individuals were undiagnosed or untreated, and the prevalence of diabetes-associated complications was high. Public health efforts in this region will need to focus on reducing modifiable risk factors, which appear to include obesity, as well as early detection that includes increasing awareness. These findings highlight a growing urgency of diabetes prevention in this region as well as the need for treatment, including management of complications.
authors.affiliation: Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, United States of America.|Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.|Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Stanifer
authors.affiliation: Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Cleland
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Gerald Jamberi
authors.initials: GJ
authors.lastname: Makuka
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Egger
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Venance
authors.initials: V
authors.lastname: Maro
authors.affiliation: Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Honest
authors.initials: H
authors.lastname: Maro
authors.affiliation: Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Francis
authors.initials: F
authors.lastname: Karia
authors.affiliation: Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, United States of America.|Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.|Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.affiliation: International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.|Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
authors.affiliation: Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.|International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Heiko
authors.identifier: http://orcid.org/0000-0002-5380-6994
authors.initials: H
authors.lastname: Philippin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D050177:Overweight / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human