Type 2 diabetes complications and comorbidity in Sub-Saharan Africans

TLDR

Evidence on the spectrum of type 2 diabetes burden in sub‑Saharan Africa is limited, underscoring the need for context‑specific data to guide interventions that reduce morbidity and mortality. The study aims to quantify the burden of type 2 diabetes complications and comorbidities in sub‑Saharan Africa and to highlight the need for public health strategies and health‑care system strengthening to prevent and manage these conditions. The authors assessed cardiometabolic, ocular, neurological and renal complications in 2,784 diabetic patients and 3,209 non‑diabetic controls from tertiary centres in Nigeria, Ghana and Kenya. Among diabetic participants, hypertension (71 %), hyperlipidaemia (34 %) and obesity (27 %) were most common, with cataracts (32 %), diabetic retinopathy (15 %), impaired renal function (13 %) and erectile dysfunction (35 %) also prevalent, and population‑attributable fractions ranged from 6 % to 64 %.

Abstract

BackgroundContext-specific evidence of the spectrum of type 2 diabetes (T2D) burden is essential for setting priorities and designing interventions to reduce associated morbidity and mortality. However, there are currently limited data on the burden of T2D complications and comorbidity in sub-Saharan Africa (SSA).MethodsT2D complications and comorbidities were assessed in 2,784 participants with diabetes enrolled from tertiary health centres and contextualised in 3,209 individuals without diabetes in Nigeria, Ghana and Kenya. T2D complications and comorbidities evaluated included cardiometabolic, ocular, neurological and renal characteristics.FindingsThe most common complications/comorbidities among the T2D participants were hypertension (71%; 95% CI 69–73), hyperlipidaemia (34%; 95% CI 32–36), and obesity (27%; 95% CI 25–29). Additionally, the prevalence of cataracts was 32% (95% CI 30–35), diabetic retinopathy 15% (95% CI 13–17), impaired renal function 13% (95% CI 12–15), and erectile dysfunction (in men) 35% (95% CI 32–38). T2D population-attributable fraction for these comorbidities ranged between 6 and 64%.InterpretationThe burden of diabetes complications and comorbidity is substantial in SSA highlighting the urgent need for innovative public health strategies that prioritise promotion of healthy lifestyles for prevention and early detection of T2D. Also needed are strategies to strengthen health care system capacities to provide treatment and care for diabetes complications.