Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

Abstract

Background There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo. Methods We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2. Results A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6–32.9). The glycaemic control prevalence ranged from 10–60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control. Conclusion Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study

“…Studies done in different parts of Sub-Saharan Africa revealed that the majority of DM patients had poor glycemic control ( 8 , 9 ). Similarly, different hospital-based studies done in Ethiopia showed that the burden of poor glycemic control ranged 52% -80% ( 10 – 12 ), and diabetes-related burden is expected to be high.…”

Glycaemic control and associated factors among patients living with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a Cross-sectional study

“…8 A recent systematic review of the studies on glycaemic control found: younger and older age, gender, poor socio-economic conditions, place of living, positive family history of diabetes, longer duration of diabetes, treatment modalities and effects, alcohol consumption, smoking presence of comorbidities or complications, and poor management were associated with poor glycaemic control. 9 Contrarily, high diabetes health literacy, positive perceived family support, adequate coping strategies, dietary adherence, exercise practice, attendance of follow-up appointments, and medication adherence were associated with good glycaemic control. 9 In the DRC, very few studies have investigated poor glycaemic control among persons/patients living with type 2 diabetes, as high as 86% in the nearby province of Kwilu 10 and 79.9% in Kinshasa.…”

“…9 Contrarily, high diabetes health literacy, positive perceived family support, adequate coping strategies, dietary adherence, exercise practice, attendance of follow-up appointments, and medication adherence were associated with good glycaemic control. 9 In the DRC, very few studies have investigated poor glycaemic control among persons/patients living with type 2 diabetes, as high as 86% in the nearby province of Kwilu 10 and 79.9% in Kinshasa. 11 Only a few reported factors were found to be associated with glycaemic control among persons living with type 2 diabetes mellitus in the DRC.…”

“…9 Contrarily, high diabetes health literacy, positive perceived family support, adequate coping strategies, dietary adherence, exercise practice, attendance of follow-up appointments, and medication adherence were associated with good glycaemic control. 9…”

“…7 In SSA, it is estimated that only one-third of patients living with type 2 diabetes reached target glycaemic levels. 8 9 The accurate knowledge of factors driving glycaemic control in a particular setting is essential to build up an intervention package to improve glycaemic control. Multiple factors drive glycaemic control in SSA, differing across settings.…”