Abstract
BackgroundGlobally, the burden of diabetes mellitus has increased to epidemic proportions. Estimates from the International Diabetes Federation predict that the greatest future increase in the prevalence of diabetes mellitus will occur in Africa.MethodsThis article reviews literature on the manifestation of diabetes in adult patients in sub-Saharan Africa highlighting the distinct phenotypes, plausible explanations for this unique manifestation and the clinical significance of comprehensively defining and understanding the African diabetes phenotype.ResultsThere are few studies on the manifestation or phenotype of diabetes in Africa. The limited data available suggests that, compared to the Western world, the majority of patients with diabetes in Africa are young and relatively lean in body size. In addition, hyperglycaemia in most cases is characterised by a significantly blunted acute first phase of insulin secretion in response to an oral or intravenous glucose load and pancreatic beta cell secretory dysfunction, rather than peripheral insulin resistance predominates. Genetic and environmental factors like chronic infections/inflammation, early life malnutrition and epigenetic modifications are thought to contribute to these distinct differences in manifestation.ConclusionsWhile published data is limited, there appears to be distinct phenotypes of diabetes in sub-Saharan Africa. Large and more detailed studies are needed especially among newly diagnosed patients to fully characterize diabetes in this region. This will further improve the understanding of manifestation of diabetes and guide the formulation of optimal therapeutic approaches and preventive strategies of the condition on the continent.
Highlights
The burden of diabetes mellitus has increased to epidemic proportions
Manifestation of diabetes in sub Saharan Africa: Metabolic and immunologic characterization and atypical forms of diabetes Both type 1 diabetes mellitus (DM) (T1DM) and type 2 DM (T2DM) are heterogeneous diseases that are characterized by a constellation of metabolic disorders and vary considerably in clinical presentation and disease progression [20]
A number of reports show that compared to high-income countries, the majority of adult patients diagnosed with DM in sub-Saharan Africa (SSA) are of median age of < 50 years, lean body size and pancreatic beta cell secretory dysfunction characterised by a significantly blunted acute first phase of insulin secretion in response to an intravenous or oral glucose load predominates rather than peripheral insulin resistance [4–12]
Summary
The burden of diabetes mellitus has increased to epidemic proportions. Estimates from the International Diabetes Federation predict that the greatest future increase in the prevalence of diabetes mellitus will occur in Africa. The African continent has the greatest proportion of people with undiagnosed DM and global projections show that it will experience the greatest future increase in the burden of DM of about 156% by 2045 [1]. This growing burden of DM globally and in Africa has been demonstrated by the pooled analysis of 751 population based studies performed in 146 countries from 1980 to 2014 by the Non-Communicable Diseases Risk Factor Collaboration (NCD-RisC) [2]. North Africa was one of the regions with the highest age standardized diabetes prevalence [2]
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