Brazzaville – Africa is expected to experience the highest increase in diabetes globally. The number of people suffering from the disease is predicted to rise to 55 million by 2045—a 134% spike compared with 2021. At 70%, the continent also has the world’s highest number of people who do not know they have diabetes. Dr Bernadette Adeyileka-Tracz, Founder and Chief Operating Officer of Diabetes Africa, a non-profit organization working to improve the health of Africans living with diabetes, explains the challenges in diabetes prevention and care in the continent.

What are the challenges a person living with diabetes faces in Africa?

The number one challenge for a person living with type 1 or type 2 diabetes in Africa is diagnosis: people living with diabetes may not know they have the condition until serious complications develop. That’s because “looking healthy” is not the same as “being healthy.” People with excess blood sugar, particularly in the case of type 2 diabetes, can live without experiencing complications for a long time. However, when these complications do manifest, they present huge problems to livelihoods and add to the burden of already-strained health systems. Blindness, amputation, heart emergencies are not light complications.

In many places across the continent, this challenge is compounded by a lack of testing facilities or training among health workers that would enable them to identify risks early on. The earlier Type 2 diabetes or pre-diabetes can be diagnosed and treated, the better for the person and for the community at large.

The cost and access to medication is of course an acute challenge in Africa. We can add that managing blood glucose levels requires testing blood sugar levels regularly, and this presents challenges on its own: people living with diabetes should receive adequate training on the topic, but also be able to afford it: how can we expect people to test regularly if they must choose between feeding their families and buying test strips?

Diagnosis and testing are the first of a series of cascading challenges. Experts often use what they call the “rule of halves” to describe them: of 100 people living with diabetes, only 50 of them will have been diagnosed. The rest will live with the condition and its consequences without being aware of it. Of the 50 that have been diagnosed, 25 will receive care. The others are unable to seek care, for personal or economic reasons. Finally, among the 25 who receive adequate care, only 12 or 13 will meet their targets in terms of readings or measurements. But in the end, only six of them will have a positive health outcome.

This shows the scale of the challenge in front of us. It’s also possible that in remote and rural areas in Africa a rule of thirds or a rule of fourths applies.

How has COVID-19 made their situation worse?

COVID-19 has certainly increased risks for people living with diabetes. People living with diabetes are more likely to have more severe symptoms of COVID-19. Research is still ongoing, but anecdotal evidence coming from Africa tends to corroborate research done in the United Kingdom and in the United States of America. In the Democratic Republic of the Congo, for example, the analysis of a small sample of 215 people who died of COVID-19 showed that 30% of them had diabetes.

The public response to the pandemic has also had an impact on people living with diabetes. An initial reaction to the pandemic has been to encourage people to stay at home and reduce visits to the hospital. People living with diabetes also chose to stay at home for fear of catching the virus. With the pandemic stretching into 2021, this did not prove to be a sustainable solution.

The sudden global focus on health may have encouraged some people to control their diabetes better and make an extra effort, but in general, COVID-19 and its associated restrictions has meant that people became more sedentary, experienced stress and anxiety and had more difficulties keeping a healthy diet and controlling their diabetes.

Luckily, in most instances, hospitals and healthcare providers acknowledged these challenges and made a special effort to allow people living with chronic conditions to receive face-to-face care. Telemedicine has helped in countries where phone calls and video calls were a workable option, for example in Nigeria and Kenya. However, in other countries, such as Uganda for example, the cost and technical challenges of telemedicine were often prohibitive.

COVID-19 has also been the catalyst for positive changes. Civil society organizations have had an active role in encouraging governments to tackle non-communicable diseases like diabetes to lighten the burden on health systems. In Kenya, the Noncommunicable Diseases Alliance has been actively advocating for essential diabetes medicines to be covered by the National Health Insurance Fund.

How can countries innovate and manage diabetes in a low-resource setting?

It’s difficult to look at diabetes in isolation and ask how we could do more with less. Adequate healthcare demands a basic level of resources and given their impact on the overall system, noncommunicable diseases such as diabetes remain largely underfunded.

This is regrettable because managing health in a low-resource setting would benefit from actions that reduce costly complications, such as early diagnosis and prevention of diabetes. People who stay in the hospital with COVID-19 often have comorbidities. Can we not address these comorbidities at the source?

One of the greatest innovations in a low-resource setting would be to change mindsets: consider investing in keeping people healthy, rather than fixing problems. There will always be emergencies and costly operations that cannot be avoided. But diabetes need not be the cause of them.

This involves an effort to train healthcare professionals, inform and train people who may be at risk, sharing knowledge at a much greater scale, which is what Diabetes Africa aims to do. This would also entail working with commercial organizations, in particular in the food and beverage industry to label products and help people make informed decisions.