Diabetes Mellitus In sub-Saharan Africa Research Articles

Factors influencing diabetes self-care practice among type 2 diabetes patients attending diabetic care follow up at an Ethiopian General Hospital, 2018.

Diabetes mellitus is a global public health emergency in the twenty-first century. Diabetes patients who had to adhere to good self-care recommendation can prevent the complication associated with diabetes mellitus. Self-care management of diabetes mellitus in Sub-Saharan Africa was poor including Ethiopia. The aim of this study was to assess factors influencing diabetes self-care practice among type 2 diabetes patients at Debre Tabor General Hospital, Northwest Ethiopia diabetes clinic follow up unit. An institutional based cross-sectional survey was conducted on systematically sampled 405 type 2 diabetes patients at Debre Tabor General Hospital diabetes clinic from June 02/2018 to June 30/2018. Bivariate and multivariable logistic regression was fitted to identify independent predictors of diabetes self-care practice. A p value of less than 0.05 was used to declare statistical significance. A total of 385 type 2 diabetes patients participated with a response rate of 95%, of which 243 (63.1%) study participants had good self-care practice. The mean ± SD age of the respondents and the duration of diagnosed for diabetes mellitus was 52.28 ± 12.45 and 5.09 ± 3.80years respectively. Type 2 diabetes patients who had a glucometer at home (AOR = 7.82 CI (3.24, 18.87)), getting a diabetes education (AOR = 2.65 CI (1.44, 4.89)), and having social support (AOR = 2.72 CI (1.66, 4.47)) were statistically associated with good self-care practice. Despite, the importance of diabetes self-care practice for the management of diabetes and preventing its complications, a significant number of type 2 diabetes patients had poor diabetes self-care practice. So, to enhance this poor practice of diabetes self-care, provision of diabetes self-care education and counseling on self-monitoring blood glucose should be promote by health care providers during their follow up.

Prevalence, Risk Factors, and Pathophysiology of Dysglycemia among People Living with HIV in Sub-Saharan Africa.

Objective To review available literature on the prevalence, risk factors, pathophysiology, and clinical outcomes of dysglycemia among people living with HIV (PLHIV) in sub-Saharan Africa (SSA). Methods Database search on PUBMED for eligible studies describing the prevalence, risk factors, pathophysiology, or clinical outcomes of dysglycemia in SSA PLHIV. Results Prevalence of diabetes mellitus (DM) and pre-DM among SSA PLHIV ranged from 1% to 26% and 19% to 47%, respectively, in 15 identified studies. Older age and an elevated body mass index (BMI) were common risk factors for dysglycemia. Risk factors potentially more specific to PLHIV in SSA included exposure to older-generation thymidine analogues or protease inhibitors, malnutrition at ART initiation, a failure to gain fat mass on treatment, and elevated serum lipids. There is evidence of higher nephropathy and neuropathy rates among PLHIV in SSA with comorbid DM compared to HIV-negative individuals with DM. Conclusion There is a need for longitudinal studies to enhance understanding of the risk factors for dysglycemia among PLHIV in SSA, further research into optimal therapies to reduce pre-DM progression to DM among SSA PLHIV, and studies of the burden and phenotype of diabetic complications and other health outcomes among PLHIV with comorbid DM in SSA.

Prevalence of diabetes mellitus and factors associated with screening uptake in Kanjongo, Nyamasheke District, Rwanda

The prevalence of diabetes mellitus in Sub-Saharan Africa was 13.7% in 2016 (Werfalli, Engel, Musekiwa, Kengne, & Levitt, 2016), which is higher than 8.7%, the global diabetes prevalence in 2015 (WHO, 2016). Fewer studies explored the factors associated with diabetes early detection for its prevention and control (WHO, 2016). Study objectives were: (1) to determine the prevalence of diabetes mellitus among the population attending the monthly community work in a selected sector, and (2) to identify the factors associated with diabetes screening and early detection. All 383 respondents who were attending the community monthly work were invited to be screened for diabetes and to be surveyed using an interview-guide questionnaire. Out of 383 respondents, 60.3% were female and 39.7% were male. The prevalence of diabetes was 8.6%, and only 27.9% have been tested before. The majority (95.3%) perceived regular testing beneficial, 62.4% perceived themselves susceptible to get diabetes, and 94.8% perceived diabetes as a serious disease. The sources of information were radio and television (89.6%), health care staff (79.4%), mass campaigns (73.1%), Community Health Workers (CHWs) (67.1%), and the neighbors (57.7%). Reported barriers to screening were lack of information (87.5%), delay of health insurance (79.1%), lack of readiness of the health care staff (75.7%), perceived quality of health care (52.2%) and the perceived cost (46.5%). The factors associated with the screening were the age (p=0.01), occupation (p<0.000), the perceived susceptibility (p˂ 0.000), the perceived threat (p=0.005), community sensitization by CHWs (p=0.003), mass campaign (p=0.001), and neighbors (p=0.009). Diabetes prevalence was lower than the Sub-Saharan prevalence estimates. Community sensitization through CHWs, mass campaigns and neighbors, information provision, disease perception, age, occupation, and quality of health care were the predictors of diabetes screening. Decentralized community sensitization and screening programs are highly recommended.

Availability and Affordability of Essential Medicines and Diagnostic Tests for Diabetes Mellitus and Cardiovascular Diseases in Sub-Saharan Africa: A Systematic Review

Background: Diabetes mellitus (DM) and cardiovascular diseases (CVD) pose a significant health challenge in sub-Saharan Africa (SSA). Interventions to improve access to affordable essential medicines and diagnostic tests are needed to reduce morbidity and mortality due to these conditions. We performed this systematic review to evaluate the availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA, where health resources are particularly scarce. Methods: PubMed, Scopus and African Journal Online databases were searched for original research articles conducted in SSA between 2000 and March 2018 with information about availability and affordability of essential medicines and diagnostic tests for DM and CVD. Findings: Twenty cross sectional studies were identified with the majority performed in East African countries (n=12, 60%). Availability of insulin and oral hypoglycaemic agents (OHA) widely ranged from 0-100%. Angiotensin converting enzyme inhibitors, anti-platelet drugs and statins were available in 0-96.5%, 20.8-100% and 3.1-84% of surveyed health facilities respectively. Availability of blood glucose testing, glycated haemoglobin (HbA1c), electrocardiography (ECG) and troponin testing ranged from 6-100%, 20-43.5%, 9.1-81.8% and 0-43.2% respectively. The monthly cost of the majority of the lowest priced generic medicines and diagnostic tests was <3.5 days' wages. The cost of insulin, statins and unfractionated heparin widely ranged from 3.85-18.7 days' wages, 6.5-30.51 days' wages and 38.5-182.36 days' wages respectively. Interpretation: The availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA is suboptimal. Pragmatic solutions are urgently needed to address this challenge. Funding Statement: The authors declare: No funding was received for this work. Declaration of Interests: The authors declare no competing interests.

Prevalence of chronic kidney disease in diabetic adult out-patients in Tanzania

Despite the increasing number of patients with Diabetes Mellitus in sub-Saharan Africa, the magnitude of chronic kidney disease among diabetics has not been well established. A study done by Janmohamed et al. found chronic kidney disease in 83.7 % of diabetics which is relatively higher than the prevalence reported elsewhere. However this study was conducted in schistosoma endemic area along the shores of Lake Victoria. Schistosomiasis has been reported to cause a range of renal diseases. Interpretation of these findings should therefore take into account the possibility of schistosomiasis as a possible confounder.

Glycated nail proteins as a new biomarker in management of the South Kivu Congolese diabetics.

IntroductionDiagnosis and monitoring of diabetes mellitus in sub-Saharan Africa, based on blood analyses, are hampered by infrastructural and cultural reasons. The first aim of this study was to evaluate the diagnostic accuracy of glycated nail proteins for diabetes mellitus. The second aim was to compare the course of short- and long-term glycemic biomarkers after 6 months of antidiabetic treatment. These objectives should support our hypothesis that glycated nail proteins could be used as an alternative glycemic biomarker.Materials and methodsThis case-control study consisted of 163 black diabetics and 67 non-diabetics of the South Kivu (Democratic Republic of Congo). Diagnostic accuracy of glycated nail proteins was evaluated using ROC curve analysis. At the start of the study, glycated nail protein concentrations were compared between diabetics and non-diabetics, using a nitro blue tetrazolium (NBT) colorimetric method. In a subgroup of 30 diabetics, concentrations of glycated nail proteins, fasting glucose (Accu-Chek® Aviva), serum fructosamine (NBT) and HbA1c (DCA-2000+®) were measured at start and after 6 months.ResultsROC analysis yielded an AUC of 0.71 (95% confidence interval (CI): 0.65-0.76) and a cut-off point of 3.83 μmol/g nail. Concentration of glycated nail proteins was significantly higher (P < 0.001) in diabetics in comparison with non-diabetics. After 6 months of antidiabetic treatment, a significant drop in the fasting glucose concentration (P = 0.017) and concentration of glycated nail proteins (P = 0.008) was observed in contrast to serum fructosamine and HbA1c.ConclusionsMeasurement of glycated nail proteins could be used to diagnose and monitor diabetes mellitus in sub-Saharan Africa.

Caseload, management and treatment outcomes of patients with hypertension and/or diabetes mellitus in a primary health care programme in an informal setting.

In three primary health care clinics run by Médecins Sans Frontières in the informal settlement of Kibera, Nairobi, Kenya, we describe the caseload, management and treatment outcomes of patients with hypertension (HT) and/or diabetes mellitus (DM) receiving care from January 2010 to June 2012. Descriptive study using prospectively collected routine programme data. Overall, 1465 patients were registered in three clinics during the study period, of whom 87% were hypertensive only and 13% had DM with or without HT. Patients were predominantly female (71%) and the median age was 48 years. On admission, 24% of the patients were obese, with a body mass index (BMI) > 30 kg/m2. Overall, 55% of non-diabetic hypertensive patients reached their blood pressure (BP) target at 24 months. Only 28% of diabetic patients reached their BP target at 24 months. For non-diabetic patients, there was a significant decrease in BP between first consultation and 3 months of treatment, maintained over the 18-month period. Only 20% of diabetic patients with or without hypertension achieved glycaemic control. By the end of the study period,1003 (68%) patients were alive and in care, one (<1%) had died, eight (0.5%) had transferred out and 453 (31%) were lost to follow-up. Good management of HT and DM can be achieved in a primary care setting within an informal settlement. This model of intervention appears feasible to address the growing burden of non-communicable diseases in developing countries.

The Impact of Provider Continuity Care on Quality of Care of Patients With Type 2 Diabetes Mellitus in the Family Medicine Clinic Of UCTH, Calabar, Nigeria

Background: Diabetes mellitus in sub-Saharan Africa is a chronic and debilitating disease with increasing morbidity and mortality. The increased morbidity and mortality could be attributed to poor approach to management. One of these poor approaches could be lack of continuity of care. Aim: To investigate the impact of provider continuity care on quality of care for adult patients with type 2 diabetes mellitus by comparing the quality of care of the adult patients managed on provider continuity basis and those managed by random care providers. Method: One hundred and twenty six adult patients with type 2 diabetes mellitus were recruited into the facilitybased on cross sectional descriptive study that lasted for four months. Sixty-three adult patients received provider continuity care and sixty-three adults received random care. The quality of care measures used in this study included fasting plasma glucose (FPG), glycosylated hemoglobin (HbAic) and blood pressure (BP) control. The data collected was analyzed using statistical package for social sciences (SPSS) software version 15. Results: Among the study patients, there were more females 72 (57.2%) than males 54 (42.8%). The commonly presented symptoms of polyuria and polydypsia were seen in 76.2% and 35.7% of the patients respectively. There was a significant difference in the glycaemic control using the fasting plasma glucose level between patients with provider continuity care and random care (5.62 ± 2.04 vs. 8.53 ± 3.18) (p 0.365). Conclusion: This study found an association between provider continuity care and quality of care in adult patients with type 2 diabetes mellitus. Consequently, provider continuity care is judged to be more beneficial in the management of type 2 diabetes mellitus in our environment.

Heart failure in sub-Saharan Africa: A literature review with emphasis on individuals with diabetes

Heart failure is the ultimate complication of cardiac involvements in diabetes. The purpose of this review was to summarize current literature on heart failure among people with diabetes mellitus in sub-Saharan Africa (SSA). Bibliographic search of published data on heart failure and diabetes in sub-Saharan Africa over the past 26 years. Heart failure remains largely unexplored in general population and among people with diabetes in Africa. Heart failure accounts for over 30% of hospital admission in specialized cardiovascular units and 3%-7% in general internal medicine. Over 11% of adults with heart failure have diabetes. Risk factors for heart failure among those with diabetes include classical cardiovascular risk factors, without evidence of diabetes distinctiveness for other predictors common in Africa. Prevention, management, and outcomes of heart failure are less well known; recent data suggest improvement in the management of risk factors in clinical settings. Diabetes mellitus is growing in SSA. Related cardiovascular diseases are emerging as potential health problem. Heart failure as cardiovascular complication remains largely unexplored. Efforts are needed through research to improve our knowledge of heart failure at large in Africa. Multilevel preventive measures, building on evidences from other parts of the world must go along side.

Cardiovascular Complications of Diabetes Mellitus in Sub-Saharan Africa

Cardiovascular disease, the major cause of mortality and morbidity in modern societies, is set to overtake infectious diseases in the developing world as the most common cause of death. The increasing prevalence of major and emerging cardiovascular risk factors accounts for the growing burden of cardiovascular disease in the world. Diabetes in all its forms is one of the main cardiovascular risk factors. Two of 3 diabetic patients will die as a result of cardiovascular complications, and approximately 30% of patients treated in cardiovascular intensive care units have diabetes. This review on the cardiovascular complications of diabetes in sub-Saharan Africa is a bibliographical MEDLINE search of published data over the past 2 decades. Diabetes-related cardiovascular disease complications are considered to be rare in Africa but are on the rise and are regularly associated with classic cardiovascular risk factors. Coronary heart disease may affect 5% to 8% of type 2 diabetic patients and cardiomyopathy, up to 50% of all patients. Close to 15% of patients with stroke have diabetes, and up to 5% of diabetic patients present with cerebrovascular accidents at diagnosis. Peripheral vascular disease prevalence varies across sites from 4% to 28%. It is obvious that diabetes mellitus and related cardiovascular complications are gaining more importance in sub-Saharan Africa. The relative contribution of putative risk factors is not well defined, and further research is therefore needed.

Pathogenesis of Type 1 and Type 2 Diabetes Mellitus in Sub-Saharan Africa: Implications for Transitional Populations

The increasing prevalence and incidence of diabetes and its long-term complications in sub-Saharan Africa (SSA) could have devastating human and economic toll if the trends remain unabated in the future. Approximately 90% or majority of patients with diabetes belongs to the adult onset, type 2 diabetes category while 10% have type 1 diabetes in SSA. However, because of the paucity of metabolic and clinical data, a clear understanding of the natural history of both diseases and the classification of diabetes subtypes has been hampered. Nevertheless, we have attempted to provide a concise review of the pathophysiology of both type 1 and type 2 diabetes as well as phenotypic and clinical variations in patients residing in SSA. The limited metabolic data, (albeit increasing), from high-risk and diabetic individuals in the SSA, have contributed significantly to the understanding of the pathogenetic mechanisms of diabetes and the variations in the presentation of the disease. Sub-Saharan African patients with t...

Diabetes in Africa. Pathogenesis of type 1 and type 2 diabetes mellitus in sub-Saharan Africa: implications for transitional populations.

The increasing prevalence and incidence of diabetes and its long-term complications in sub-Saharan Africa (SSA) could have devastating human and economic toll if the trends remain unabated in the future. Approximately 90% or majority of patients with diabetes belongs to the adult onset, type 2 diabetes category while 10% have type 1 diabetes in SSA. However, because of the paucity of metabolic and clinical data, a clear understanding of the natural history of both diseases and the classification of diabetes subtypes has been hampered. Nevertheless, we have attempted to provide a concise review of the pathophysiology of both type 1 and type 2 diabetes as well as phenotypic and clinical variations in patients residing in SSA. The limited metabolic data, (albeit increasing), from high-risk and diabetic individuals in the SSA, have contributed significantly to the understanding of the pathogenetic mechanisms of diabetes and the variations in the presentation of the disease. Sub-Saharan African patients with type 1 diabetes have essentially absolute insulin deficiency. In addition, patients with type 2 diabetes in SSA region also manifest severe insulin deficiency with varying degrees of insulin resistance. Although the exact genetic markers of both diseases are unknown, we believe studies in patients of SSA origin who reside in diverse geographic environments (African diaspora) could potentially contribute to our understanding of the genetic and environmental mediators of both diseases. However, many intrinsic, individual and societal obstacles such as poor education and illiteracy, low socio-economic status and lack of access to health care make uncertain the translation of diabetes research in SSA. In this regard, effective management and/or prevention of diabetes in SSA individuals should adopt multidisciplinary approaches. Finally, innovative health care delivery and educational models will be needed to manage diabetes and its long-term complications in SSA.