Diabetes poses risk to health gains made in recent years

6 July 2017 - Wits University

Wits researchers contribute to the new Lancet Diabetes & Endocrinology Commission report on diabetes in sub-Saharan Africa.

The report, launched in London in the UK, provides a comprehensive and up-to-date analysis of the burden of diabetes across sub-Saharan Africa, the challenges this burden poses for health systems, as well as potential solutions.

More than 70 experts from around the world, including the Wits researchers, contributed to the report.

The new report proposes that diabetes and its complications have the potential to reverse some of the health gains seen in sub-Saharan Africa in recent years – overwhelming the region’s health systems and crippling patients’ personal finances as they pay for their own healthcare.

According to co-lead author of the Commission and Associate Professor in the MRC/Wits-Agincourt Rural Health Unit, School of Public Health, Justine Davies, “The economic burden of diabetes may be most felt in the South African population.”

The report found that wealthier areas of sub-Saharan Africa seeing more societal changes had the highest costs due to diabetes in 2015, with almost two-thirds of the region’s diabetes costs coming from southern Africa (62%, $12.1 billion), in particular, wealthier South Africa. Less than a tenth of the costs (9%, $1.7 billion) originated from poorer countries in western Africa.

Across countries in sub-Saharan Africa, there are currently huge gaps in healthcare systems’ ability to care for people with diabetes, including a lack of equipment for diagnosing and monitoring diabetes, lack of treatments, and lack of knowledge about the disease among available healthcare providers. These gaps contribute to the fact that half of patients with diabetes go undiagnosed, while only one in 10 (11%) receive the drugs they need.

Davies says: “One of the key findings that came out of this process was how little is known about diabetes in sub-Saharan Africa. Many countries in the region don’t even know the burden of diabetes in their population. For example, 21 countries had no data on prevalence to supply to the most recent WHO estimates for the region. So, we have estimates that are good enough to tell us that prevalence and costs are rising, but they don’t give detailed information necessary for health system planning. This is a major challenge to our research and development community, regionally and nationally.”

“Once you start to look at management strategies, there is even less evidence.” says Davies. “The main reason for treating diabetes is to prevent longer term effects of high glucose, for example, on the cardiovascular system, the eyes, and kidneys.

Most of the guidelines for treating diabetes used in countries in sub-Saharan Africa are based on studies done in people in the USA or Europe, but people in Africa may respond very differently to people in Europe and the USA. In particular, they may be much more sensitive to the long-term effects of glucose due to different genetics, the effects of previous malnutrition on epigenetics, and the effects of a high prevalence of infectious diseases in the region.”

Adds Professor Steve Tollman “this will be the bread-and-butter of primary health care in South Africa and frames much of the health challenge to our envisaged NHI system… indeed, it informs the School of Public Health’s focus on improving nutrition through measures tackling salt and sugar intake.”

In order to counter these issues effectively, the researchers recommend that more research is essential to better understand both the burden of diabetes and find solutions to treating it in the context of Africa. However, it is also necessary to rapidly scale up interventions that have already been successfully trialled in some sub-Saharan African countries, such as community-based care for high blood pressure, patient education, home glucose monitoring, and more education about diabetes for healthcare professionals.

Adds Tollman: “This is a major challenge to South Africa and the region’s health and development community”.

Davies concludes: “We desperately need researchers to focus efforts to address these unknowns if health systems in sub-Saharan Africa are to stand a chance of being able to manage diabetes effectively. Researchers in sub-Saharan Africa are ideally positioned to be able to address these questions that affect healthcare in their countries."

Factsheet

The Lancet Diabetes & Endocrinology Commission on diabetes in sub-Saharan Africa Factsheet:

• As sub-Saharan African countries struggle to cope with the current burden of diabetes, new estimates suggest that costs associated with the disease could more than double and may reach up to US$59.3 billion per year by 2030 if type 2 diabetes cases continue to increase.
• Currently, only half of the people with diabetes in populations in sub-Saharan Africa are aware that they have the disease, and only one in 10 (11%) receive drugs they need.
• The Lancet Diabetes & Endocrinology Commission on diabetes in sub-Saharan Africa Report estimates that the economic cost of diabetes in sub-Saharan Africa in 2015 totalled $19.5 billion, equivalent to 1.2% gross domestic product (GDP). On average, countries in the region spend 5.5% of their GDP on health.
• More than half of this economic cost (56%, $10.8 billion) was on accessing diabetes treatment, including medication and hospital stays – and ­one half of these costs were out-of-pocket (paid for by the patients), putting a huge financial burden on people with diabetes. The remaining economic costs were a result of productivity losses, mostly from early death ($7.9 billion), as well as people leaving the workforce early ($0.5 billion), taking sick leave ($0.2 billion) and being less productive at work due to poor health ($0.07 billion).
• In the projections for 2030, southern Africa is likely to see the greatest increases in annual costs, increasing to between $17.2 and $29.2 billion. However, the authors also predicted substantial growth in costs in eastern African countries (such as Ethiopia, Kenya and Tanzania), increasing from $3.8 billion in 2015 to up to $16.2 billion in 2030.