Increasing Prevalence of Type 2 Diabetes in Sub-Saharan Africa: Not Only a Case of Inadequate Physical Activity

Abstract

In the last 50 years, sub-Saharan Africa has witnessed a significant increase in the prevalence of type 2 diabetes mellitus (T2DM), from <1% recorded in some countries in the 1960s to a regional prevalence of 4.3% in 2012 (compared with a current global prevalence of 6.4%). There is great variability in prevalence of T2DM among the African communities with some countries, such as Réunion, recording an average of 16% and others, such as Uganda registering <1% in rural communities. The greatest increase in prevalence has been registered among urban dwellers. The cause of the rapid increase in T2DM prevalence is not clear. However, studies in both rural and urban areas have found that physical activity is not an independent risk factor for the disease in the region. Physical activity level was found to be adequate in Africa, with 83.8% of men and 75.7% of women meeting the WHO recommendation of at least 150 min of moderate- to vigorous-intensity physical activity per week. The paper argues that the rapidly growing number of people >40 years old, increasing urbanization, adaptation of lifestyle behaviors that accompany urbanization and the interaction of these with a genetic predisposition to T2DM, are plausible reasons for the increasing prevalence of T2DM.

The Epidemiological Features of Amputations at the University Teaching Hospital in Lusaka, Zambia

“…Similar outcomes have been reported in a study done in Zambia [7] where there has been a rapid increase in NCDs, which include mental health, diabetes, cardio-vesicular diseases, road traffic crashes and violence [8][9][10][11]. In relation to diabetes, some authors [12][13][14] have reported that Sub Saharan Africa is experiencing a rapid increase in type 2 diabetes mellitus. Ojuka & Goyaram [12] have stated that the increase is from less than 1% in 1960 to 4.3% in 2012 and currently estimated at 6.4%.…”

“…In relation to diabetes, some authors [12][13][14] have reported that Sub Saharan Africa is experiencing a rapid increase in type 2 diabetes mellitus. Ojuka & Goyaram [12] have stated that the increase is from less than 1% in 1960 to 4.3% in 2012 and currently estimated at 6.4%. Mbanya et al [14] have cautioned that Africa Region is expected to see the greatest increase in diabetes from 19.8 million people in 2013 to 41.4 million in 2035 should the current trends persist.…”

Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults

“…1.84; 3.93) --- 1 Multivariate analysis included age, sex, fat mass index and fat free mass index; and all variables with overall P value <0.2 in the in univariate analyses; body mass index and cohort recruited were not included in multivariable analysis because of collinearity with other included variables. 2 Cutoff point for defining diabetes and prediabetes based on WHO criteria; RRR = Relative risk ratio; 3 Bolded estimates within variables categories has P value <0.05 4 Grip strengths tertile cut offs defined as; 0.0-23.6 for lower; 23.7-30.6 for middle and 30.7-59.6 for upper 5 Waist circumference increase is defined as �88 cm for women and � 102 cm for men 6 Fat mass index tertile cut offs defined as; 0.19-3.03 for lower; 3.04-5.76 for middle and 5.77-22.00 for upper 7 Fat-free mass index tertile cut offs defined as; 11.12-15.61 for lower; 15.62-17.20 for middle and 17.21-24.24 for upper 8 Computation included combination of total time spent in moderate and in vigorous physical activity per week 9 AZT-azidothymidine, ABC-Abacavir and TDF-Tenofovir containing regimen https://doi.org/10.1371/journal.pone.0230723.t003 24 (1.19; 4.21) 1.36 (1.02; 1.81) 2.36 (1.19; 4.64) 53 (1.14; 2.04) 4.08 (2.19;7.61) 1.52 (1.10; 1.11 Diabetes, particularly Type 2, results from insulin resistance and failure of beta-cell function, with the former preceding the latter [34]. Patients with prediabetes (impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)), a transitional state of dysglycaemia preceding diabetes diagnosis by OGTT, have different degrees of both defects (beta-cell function failure and insulin resistance) which may occur together [35].…”

“…Increasing overall life expectancy in SSA further increases the risk of diabetes [4]. Compared to people from high-income countries, inhabitants of SSA seem to be at risk of diabetes at younger age and may have different risk factors including HIV infection [3,5,6]. Scarce data from SSA [7] limits health system responses to non-communicable diseases (NCDs) including diabetes [2].…”

“…(Continued) Multivariate analysis included age, sex, fat mass index and fat free mass index; and all variables with overall P value <0.2 in the in univariate analyses; body mass index and cohort recruited were not included in multivariable analysis because of collinearity with other included variables 2. Cutoff point for defining diabetes and prediabetes based on WHO criteria; RRR = Relative risk ratio;3 Bolded estimates within variables categories has P value <0.054 Grip strengths tertile cut offs defined as; 0.0-23.6 for Lower; 23.7-30.6 for Middle and 30.7-59.6 for Upper5 Waist circumference increase is defined as �88 cm for women and � 102 cm for men6 Fat mass index tertile cut offs defined as; 0.19-3.03 for Lower; 3.04-5.76 for Middle and 5.77-22.00 for Upper 7 Fat-free mass index tertile cut offs defined as; 11.12-15.61 for Lower; 15.62-17.20 for Middle and 17.21-24.24 for Upper 8 Computation included combination of total time spent in moderate and in vigorous physical activity per week…”