Abstract
Diabetes mellitus is a major public health problem in Africa but also presents with some atypical clinical phenotypes that require specific management strategies. However, this part of the world, with its health systems adapted to dealing with communicable disease, faces the challenge of inadequate availability and allocation of resources for noncommunicable diseases that often have a more chronic course. Other major challenges encountered are the lack of adequate education of patients about the disease and its treatment, the late presentation of patients to health facilities, the lack of adequate diagnostic facilities, the unavailability of diabetes medications in some instances and their unaffordability when available, and inadequate data on the actual burden of the disease and treatment coverage. Despite the specificities of diabetes mellitus in Africa, many countries still rely on guidelines essentially used in developed countries.
Nevertheless, there has been significant progress in the treatment of diabetes in Africa in recent years with expansion in coverage and types of diabetes care services. The creation of national diabetes registries, diabetes associations, and national diabetes programs and the adoption of contextualized guidelines for the management of diabetes in several countries in Africa, together with the expansion of the multidisciplinary approach to treatment of this chronic disease, have been increasingly gaining grounds in Africa. However much still remains to be done in this part of the world concerning diabetes management. To this effect, the African regional branch of the International Diabetes Federation, through the African Diabetes Declaration, has summoned governments and agencies involved in diabetes care in Africa to uphold standards of diabetes care with regard to prevention, early detection, availability, and affordability of treatment.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
International Diabetes Federation. IDF Diabetes Atlas. 7th ed; Brussels: International Diabetes Federation; 2015.
Choukem SP, Sobngwi E, Gautier JF. Les particularités du diabète chez le sujet originaire d’Afrique Noire. Sang Thromb Vaiss. 2007;19(10):513–8.
Beran D, Yudkin JS. Diabetes care in sub-Saharan Africa. Lancet. 2006;368(9548):1689–95.
Mbanya JC, Kengne AP, Assah F. Diabetes care in Africa. Lancet. 2006;368(9548):1628–9.
Mbanya JCN, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet. 2010;375(9733):2254–66.
Pastakia SD, Pekny CR, Manyara SM, Fischer L. Diabetes in sub-Saharan Africa – from policy to practice to progress: targeting the existing gaps for future care for diabetes [Internet]. Diabetes Metab Syndr Obes. 2017;10, 247–263. [cited 2017 Aug 7]. Available from: https://www.dovepress.com/diabetes-in-sub-saharan-africa-from-policy-to-practice-to-progress-tar-peer-reviewed-article-DMSO
IDF Africa Region Task Force on Type 2 Diabetes Clinical Practice Guidelines. Type 2 diabetes clinical practice guidelines for sub-Saharan Africa. Dar es salaam: International Diabetes Federation Africa Region; 2006.
The 2012 SEMDSA guideline for the management of type 2 diabetes. J Endocrinol Metab Diabetes South Afr. 2012;17(1):S1–94.
Diabetes Association of Nigeria (DAN). Clinical practice guidelines for diabetes management in Nigeria. Lagos: Diabetes Association Of Nigeria; 2013.
The 2017 SEMDSA guidelines for the management of type 2 diabetes. J Endocrinol Metab Diabetes South Afr. 2017;22(1):1–182.
Kiawi E, Edwards R, Shu J, Unwin N, Kamadjeu R, Mbanya JC. Knowledge, attitudes, and behavior relating to diabetes and its main risk factors among urban residents in Cameroon: a qualitative survey. Ethn Dis. 2006;16(2):503–9.
Choukem S-P, Mbanya J-C. Should we still screen for type 2 diabetes after ADDITION-Cambridge? A low-income world perspective. Diabetes Res Clin Pract. 2013;100(2):282–4.
Echouffo-Tcheugui JB, Mayige M, Ogbera AO, Sobngwi E, Kengne AP. Screening for hyperglycemia in the developing world: rationale, challenges and opportunities. Diabetes Res Clin Pract. 2012;98(2):199–208.
International Diabetes Federation. IDF clinical practice recommendations for managing type 2 diabetes in primary care. Brussels: International Diabetes Federation; 2017.
Association AD. 2. Classification and diagnosis of diabetes. Diabetes Care. 2017;40(Suppl 1):S11–24.
Kiage JN, Heimburger DC, Nyirenda CK, Wellons MF, Bagchi S, Chi BH, et al. Cardiometabolic risk factors among HIV patients on antiretroviral therapy. Lipids Health Dis. 2013;12:50.
International Diabetes Federation. Management of gestational diabetes in the community. Training manual for community health workers. Brussels: International Diabetes Association; 2015.
Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud’homme D, Fortier M, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147(6):357–69.
Dahjio Y, Noubiap JJN, Azabji-Kenfack M, Essouma M, Loni GE, Onana AE, et al. Impact of a 12-week aerobic exercise training program on anthropometric and metabolic parameters of a group of type 2 diabetes Cameroonian women aged ≥50 years. Ann Transl Med [Internet]. 2016 [cited 2017 Sep 4];4(19). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075844/.
Sobngwi E, Ndour-Mbaye M, Boateng KA, Ramaiya KL, Njenga EW, Diop SN, et al. Type 2 diabetes control and complications in specialised diabetes care centres of six sub-Saharan African countries: the Diabcare Africa study. Diabetes Res Clin Pract. 2012;95(1):30–6.
Gautier J-F, Choukem S-P, Girard J. Physiology of incretins (GIP and GLP-1) and abnormalities in type 2 diabetes. Diabetes Metab. 2008;34(Suppl 2):S65–72.
Choukem S-P, Sobngwi E, Fetita L-S, Boudou P, De Kerviler E, Boirie Y, et al. Multitissue insulin resistance despite near-normoglycemic remission in Africans with ketosis-prone diabetes. Diabetes Care. 2008;31(12):2332–7.
Mbanya J-C, Sobngwi E. Diabetes microvascular and macrovascular disease in Africa. Eur J Cardiovasc Prev Rehabil. 2003;10(2):97–102.
Justin-Temu M, Nondo RSO, Wiedenmayer K, Ramaiya KL, Teuscher A. Anti-diabetic drugs in the private and public sector in Dar es Salaam. Tanzania East Afr Med J. 2009;86(3):110–4.
Gill GV, Mbanya J-C, Ramaiya KL, Tesfaye S. A sub-Saharan African perspective of diabetes. Diabetologia. 2009;52(1):8–16.
Gulam-Abbas Z, Lutale JK, Morbach S, Archibald LK. Clinical outcome of diabetes patients hospitalized with foot ulcers, Dar es Salaam, Tanzania. Diabet Med J Br Diabet Assoc. 2002;19(7):575–9.
Sobngwi E, Lekoubou AL, Dehayem MY, Nouthe BE, Balti EV, Nwatsock F, et al. Evaluation of a simple management protocol for hyperglycaemic crises using intramuscular insulin in a resource-limited setting. Diabetes Metab. 2009;35(5):404–9.
Majaliwa ES, Elusiyan BJ, Adesiyun OO, Laigong P, others. Type 1 diabetes mellitus in the African population: epidemiology and management challenges. Acta Bio Medica Atenei Parm. 2009;79(3):255–9.
Whiting DR, Hayes L, Unwin NC. Challenges to health care for diabetes in Africa. J Cardiovasc Risk. 2003;10(2):103–10.
Makame MH, DERI Study Group. Childhood diabetes, insulin, and Africa. Diabet Med. 1992;9(6):571–3.
Castle WM, Wicks ACB. A follow-up of 93 newly diagnosed African diabetics for 6 years. Diabetologia. 1980;18(2):121–3.
Hakeem AO. The dynamics of diabetes care in Africa. J Glob Diabetes Clin Metab. 2017:2(2);1–3.
Kamel NM, Badawy YA, el-Zeiny NA, Merdan IA. Sociodemographic determinants of management behaviour of diabetic patients. Part II. Diabetics’ knowledge of the disease and their management behaviour. East Mediterr Health J. 1999;5(5):974–83.
Beran D, Yudkin JS, de Courten M. Access to care for patients with insulin-requiring diabetes in developing countries. Diabetes Care. 2005;28(9):2136–40.
Ramaiya K. Tanzania and diabetes—a model for developing countries? BMJ. 2005;330(7492):679.
Lekoubou A, Awah P, Fezeu L, Sobngwi E, Kengne AP. Hypertension, diabetes mellitus and task shifting in their Management in sub-Saharan Africa. Int J Environ Res Public Health. 2010;7(2):353–63.
Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al. Task shifting for non-communicable disease management in low and middle income countries – a systematic review. PLoS One. 2014;9(8):e103754.
Kengne AP, Sobngwi E, Fezeu L, Awah PK, Dongmo S, Mbanya J-C. Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa. Pan Afr Med J [Internet]. 2009 [cited 2017 Sep 6];3. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984281/.
Suggested/Further Reading
Mbanya JC, Assah FK, Saji J, Atanga EN. Obesity and type 2 diabetes in sub-Sahara Africa. Curr Diab Rep. 2014;14(7):501. (Emphasizes on the need for concrete interventions on obesity as a major risk factor for type 2 diabetes as a result of changing life style in Africa).
Setel PW. Non-communicable diseases, political economy, and culture in Africa: anthropological applications in an emerging pandemic. Ethn Dis. 2003;13(2):S149–57. (Examines the need for anthropological perspectives on the causes, prevention, and control of NCDs, such as diabetes, in Africa).
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Choukem, S.P., Dimala, C.A., Maadjhou, C., Mbanya, J.C. (2019). Diabetes Management in Africa. In: Rodriguez-Saldana, J. (eds) The Diabetes Textbook. Springer, Cham. https://doi.org/10.1007/978-3-030-11815-0_18
Download citation
DOI: https://doi.org/10.1007/978-3-030-11815-0_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-11814-3
Online ISBN: 978-3-030-11815-0
eBook Packages: MedicineMedicine (R0)