Diabetes mellitus in Zambia and the Western Cape province of South Africa: Prevalence, risk factors, diagnosis and management

Sarah Lou Bailey,Helen Ayles,Nulda Beyers,Peter Godfrey-Faussett,Monde Muyoyeta,Elizabeth Du Toit,John S Yudkin,Sian Floyd

doi:10.1016/j.diabres.2016.05.001

Abstract

AimsTo determine the prevalence of and risk factors for diabetes mellitus and examine its diagnosis and management in the study communities. MethodsThis is a population-based cross-sectional study among adults in 24 communities from Zambia and the Western Cape (WC) province of South Africa. Diabetes is defined as a random blood glucose concentration (RBG)⩾11.1mmol/L, or RBG<11.1mmol/L but with a self-reported prior diabetes diagnosis. For individuals with a prior diagnosis of diabetes, RBG<7.8mmol/L was considered to be an acceptable level of glycaemia. ResultsAmong 45,767 Zambian and 12,496 WC participants the age-standardised prevalence of diabetes was 3.5% and 7.2% respectively. The highest risk groups identified were those of older age and those with obesity. Of those identified to have diabetes, 34.5% in Zambia and 12.7% in WC were previously unaware of their diagnosis. Among Zambian participants with diabetes, this proportion was lower among individuals with better education or with higher household socio-economic position. Of all those with previously diagnosed diabetes, 66.0% in Zambia and 59.4% in WC were not on any diabetes treatment, and 34.4% in Zambia and 32.7% in WC had a RBG concentration beyond the recommended level, ⩾7.8mmol/L. ConclusionsThe diabetes risk factor profile for our study communities is similar to that seen in high-income populations. A high proportion of individuals with diabetes are not on diabetes treatment and of those on treatment a high proportion have high glycaemic concentrations. Such data may assist in healthcare planning to ensure timely diagnosis and management of diabetes.

Highlights

The number of adults with diabetes mellitus in sub-Saharan Africa (SSA) is predicted to rise from 19.8 million in 2013 to 41.5 million in 2035 [1,2,3,4,5]
The aims of this study are to estimate the prevalence of, and identify risk factors for, diabetes mellitus in the study communities in Zambia and in the Western Cape province of South Africa; and to estimate the prevalence of undiagnosed diabetes, to determine the proportion of those with a prior diagnosis of diabetes who are on treatment for diabetes, and to determine the levels of glycaemia in those with a prior diagnosis of diabetes
Among all participants with an random blood glucose concentration (RBG) measurement 524 (1.1%) in Zambia and 9 (0.1%) in Western Cape had missing data for age, 3883 (8.5%) and 788 (6.3%) respectively had missing data for HIV status, and 3536 (7.7%) and 365 (2.9%) respectively had missing data for Body mass index (BMI)

Summary

Introduction

The number of adults with diabetes mellitus in sub-Saharan Africa (SSA) is predicted to rise from 19.8 million in 2013 to 41.5 million in 2035 [1,2,3,4,5]. Extensive data exist to guide diabetes public health policies and health systems planning in high income countries [6,7,8]. Systematic review suggests there are few data from SSA even for diabetes prevalence and risk factors [1,9,10,11,12]. The aims of this study are to estimate the prevalence of, and identify risk factors for, diabetes mellitus in the study communities in Zambia and in the Western Cape province of South Africa; and to estimate the prevalence of undiagnosed diabetes, to determine the proportion of those with a prior diagnosis of diabetes who are on treatment for diabetes, and to determine the levels of glycaemia in those with a prior diagnosis of diabetes

Methods

Results

Discussion

Conclusion