Prevalence and Factors Associated with Type 2 Diabetes Control in Sub-Saharan Africa: 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 the control of type-2 diabetes is generally poor in most countries in sub-Saharan Africa. Gaining an understanding of 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. MethodsWe 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. ResultsA total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of glycaemic control was 30%. The highest glycaemic control reported was 60%. The factors significantly associated with glycaemic control were categorized into six groups: sociodemographic (younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family support, coping strategies), lifestyle (dietary adherence, practice of exercise, smoking, alcohol consumption), clinical (family history of diabetes, longer duration of diabetes, presence of comorbidities/complications), adherence (attendance to follow-up, medication adherence), treatment modalities (pill burden, treatment regimen, use of statins or anti-hypertensives, education about diabetes, definition of glycaemic goals), and glycaemic control optimization interventions.ConclusionSub-optimal 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 be taken account of sociodemographic, lifestyle, clinical and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.