Diabetes is growing fastest in Africa, and SA is largely responsible
The weight of the increasing diabetes and obesity epidemic in SA threatens to crush the country’s overloaded health system‚ experts warn.
SA and Egypt are the worst offenders in the rapidly growing diabetes epidemic on the continent‚ according to the first major study in Africa on diabetes and obesity.
Lead author Prof Andre Kengne‚ director of the noncommunicable diseases research unit based at Tygerberg Hospital‚ said their analysis found that diabetes and weight gain had risen between 1980 and 2014.
He said: "Africa is the region in the world where diabetes is growing fastest. It is growing faster than our coping capacity. We want to find a way to get it under control and that is why we are piloting the SA diabetes prevention project."
Nicholas van Rooy is among more than 400 people from seven Cape Town townships who have joined the project.
He is glad that he was diagnosed with type 2 diabetes in 2011 while on medical aid.
"Taking part in this research is like getting a second opinion‚ to see if what I’m doing is working. I have changed my eating habits and I do self-testing at home‚" said the father of two. His sister-in-law and mother-in-law have type 2 diabetes.
Unlike in previous decades‚ type 2 diabetes is also occurring at a younger age.
Kengne said: "This used to be an adult condition and now it is not uncommon to see it in 15-year-olds. If we are only targeting adults‚ we will miss it."
Half the people in SA and most citizens of other African countries with this insidious disease are unaware they have it.
A landmark study on diabetes in sub-Saharan African reported in July that diabetes and other cardiovascular diseases were overtaking HIV/AIDS‚ respiratory infections‚ diarrhoeal diseases and malaria as the leading causes of death.
More than a dozen specialists globally joined the Lancet Diabetes and Endocrinology Commission to produce the report.
The commission noted that health systems "are unable to cope with the current burden of diabetes and its complications".
Co-lead author Professor Justine Davies‚ from King’s College London‚ said: "In most African countries people are dying of type 1 diabetes. It is not being diagnosed and treated."
Viounna Adonis‚ 25‚ from Bellair in Cape Town‚ depends on state hospitals for her survival.
Without treatment for her rarer type 1 diabetes‚ she could have died as a teenager. Adonis was nearly in a coma by the time she was first admitted to hospital.
She said: "I was running and doing netball at school but I started getting tired. I was losing weight and always drinking water and my mummy was scared I must have AIDS or TB‚ or be on drugs."
Her mother took Adonis to hospital‚ where she was admitted. Now Adonis manages her disease at home‚ injecting herself three times a day with insulin.
"I don’t like needles‚ even after 10 years but I look after myself‚" said Adonis‚ who had a baby six months ago.
Research on genetic susceptibility is still in its early stages and not much is known about the genetics of type 1 diabetes in sub-Saharan Africa.
Insulin delivery for people with type 1 diabetes has changed dramatically from boiled syringes for injections‚ to insulin pens and pumps for those who can afford them.
On type 2 diabetes‚ the commission reported being unaware of initiatives using genetics to predict clinical risk successfully.
Genetics may not yet predict diabetes risk but a high body mass index (BMI) does raise red flags.
The African study‚ based on data from more than 1.2-million people‚ proved a positive association between BMI and diabetes rates in men and women.
The South African Medical Research Council and the Imperial College collated the results. From 1980 to 2014 BMI went up steadily‚ tipping nearly half of SA women into the obese risk group (a BMI of 29, when 30 is defined as clinically obese) and nearly half of men into the overweight risk group (25 defines overweight).
On the banting eating revolution in SA — where about 500,000 people have lost weight by adopting the high-fat diet promoted by scientist Prof Tim Noakes — Kengne was cautious.
"We don’t want to throw the idea out but this must be subjected to robust science. People are desperate and want a cure‚" he said.
Having a father with diabetes and being pre-diabetic prompted Noakes’s antisugar and anticarbohydrate crusade. Imperial College’s Prof Justine Davies‚ who is also working with the University of the Witwatersrand‚ said diabetes research was in its early stages in lower-income countries.
Using devices such as smartphones for screening and follow-up were among technologies being flighted.
"Diabetes is not like HIV when you can see when people are not being treated. With diabetes you don’t see the consequences for 10 or 20 years. We need to actively encourage people to manage their condition‚" she said.
New diabetes drugs to lower blood glucose have been found to prevent heart attacks and strokes‚ says Davies, while an artificial pancreas helped young children with type 1 diabetes in a pilot study in the US to automatically monitor and regulate their blood-sugar levels.