Type 2 Diabetes: What Africans Need to Know

By Nr Chinonso Cynthia Ukah. BNSc, RN, RM. Freelance Health Writer and DLHA Volunteer. Medical review by The DLHA Team

 

An African lady performing a finger prick blood glucose check on herself opposite a  pink map of Africa bearing type 2 diabetes label

Human image credit: Freepik
 

Highlights

• Type 2 diabetes prevalence is increasing in Africa, with many cases undiagnosed. 

• Symptoms include increased thirst, frequent urination, unexplained weight loss, and fatigue. 

• Risk factors include obesity, physical inactivity, family history, and age over 45. 

• Childhood malnutrition and other social stressors have been suggested by some researchers as contributory factors for the disease.

• Challenges of diagnosis include low public awareness, cost, healthcare infrastructure limitations and cultural beliefs. 

• Early diagnosis is important for preventing complications and achieving better health management outcomes.

 

Introduction

Diabetes mellitus is a health condition that affects how our body uses food for energy. Unlike Type 1 diabetes, where the body doesn't produce insulin, Type 2 diabetes is different. In Type 2 diabetes, our body produces insulin but not in sufficient amount and even when it produces enough insulin, the cells of the body don't use it effectively. This condition, once thought to be rare in our African communities, is now becoming increasingly common. [1]

 

How Common is Type 2 Diabetes in Africa?

Type 2 diabetes, which was once considered uncommon in sub-Saharan Africa, is now firmly established. The number of people affected is rising rapidly, especially in our cities and towns. In 2017, about 15.5 million adults in Africa had diabetes, with Type 2 being the most common form. [2] What's even scarier is that nearly 7 out of 10 people with diabetes don't even know they have it and this means many of our family members and neighbours might be living with this condition without realising it.

In South Africa, for example, the number of people with Type 2 diabetes almost doubled from 5.5% in 2000 to 9% in 2009. Researchers say it could be higher, with estimates that range from 13% to 26% depending on the specific African community. [1]

 

How do I know if I have Type 2 diabetes?

As an African citizen, knowing that you have diabetes is the first step to preventing the painstaking outcomes that come with the condition. With this knowledge, you can educate yourself further and seek proper medical care; things you wouldn’t do if you had no idea you have diabetes. Here are 3 steps on how you can identify if you or someone you know might have Type 2 diabetes:

Step 1: Know the Signs

Look out for these common symptoms

• Increased thirst (like your mouth is always dry)

• Frequent urination (especially at night)

• Unexplained weight loss (even when eating well)

• Fatigue (feeling tired all the time)

• Increased hunger (even after meals)

• Blurred vision (difficulty seeing clearly)

These signs are common to various types of diabetes, but some symptoms more specific to Type 2 diabetes includes:

• Gradual onset of symptoms (often developing over months or years)

• Tingling or numbness in hands or feet

• Slow-healing wounds or frequent infections

• Darkened skin in certain areas (like the neck, armpits, or groin)

• In women, frequent vaginal (yeast) infections

 

Step 2: Understand the Risk Factors

You may be at higher risk of Type 2 diabetes if you:

• Are overweight or obese

• Are physically inactive

• Have a family history of diabetes

• Are over 45 years old

• Have had diabetes during pregnancy

• Have high blood pressure or high cholesterol [3]

 

Step 3: Seek Medical Testing

If you notice these signs or have multiple risk factors, visit a healthcare provider because only medical tests can confirm Type 2 diabetes. Many people with Type 2 diabetes may not show obvious symptoms at first. That's why it's important to get regular check-ups, especially if you have any of the above risk factors. Your healthcare provider may run these tests on you:

1. Fasting blood sugar test

2. Oral glucose tolerance test

3. Glycated haemoglobin (A1C) test

 

The African Context of Type 2 Diabetes

The roots of Type 2 diabetes in Africa run deeper than just obesity and lack of exercise. [4] The continent struggles with additional significant contributors such as:

• Rapid urbanisation that is changing traditional African diets

• Genetic predisposition in some African populations

• Childhood malnutrition which potentially affects pancreatic function

• Limited access to nutritious foods in some areas, which in turn facilitate oxidative stress and reduced pancreatic function

• Stress from economic instability and social changes [4]

 

How does Type 2 Diabetes affect your Body?

In Type 2 diabetes, your body still produces insulin, but it probably doesn’t make enough or the body cells cannot use it effectively. When the body uses insulin ineffectively, it is called insulin resistance. Think of insulin as a key that unlocks your cells to let glucose (sugar) in. When you have Type 2 diabetes, this key doesn't work properly, so glucose builds up in your blood instead of being used for energy. [4]

If this trend is left unchecked, this high blood sugar can damage your blood vessels and nerves, leading to complications like heart disease, kidney problems, and vision issues. But with early detection and proper management, including lifestyle changes and sometimes medication, many people with Type 2 diabetes still lead healthy, active lives.

 

What Goes Wrong in Type 2 Diabetes?

Type 2 diabetes is a metabolic disorder marked by insulin resistance and relative insulin deficiency. [3] Unlike Type 1 diabetes, it's not an autoimmune condition. Let’s take a look at what happens in Type 2 Diabetes:

• The body's cells become resistant to insulin, meaning they don't respond effectively to it.

• At first, the pancreas produces more insulin to overcome this resistance.

• But over time, the pancreas may struggle to produce enough insulin to maintain normal blood sugar levels.

• Glucose then builds up in the bloodstream, leading to high blood sugar levels causing diabetes.

• The body's cells don't get the energy they need to function properly, despite having enough glucose in the blood.

This process is often influenced by lifestyle factors, such as poor diet, lack of physical activity, and obesity. Genetics also play a role in exposure to Type 2 diabetes. [4] The baseline difference between type 1 and type 2 diabetes is that, unlike Type 1, the pancreas in Type 2 diabetes can still produce insulin, at least in the beginning, but the body can't use it effectively.

 

How is Type 2 Diabetes Diagnosed?

Diagnosing Type 2 Diabetes involves several tests to measure blood glucose levels and assess insulin resistance. These tests help diagnose diabetes and differentiate Type 2 from other forms of diabetes. The basic diagnostic tools include:

1. Blood glucose tests 

This includes random, fasting, and oral glucose tolerance tests. You might have diabetes when you have glucose values in the ranges detailed below:

• Random blood sugar (RBS) above or equal to 200 mg/dL (11.1 mmol/L) with symptoms. 

RBS is determined from a blood sample that is taken from you at any time of the day.

• Fasting blood sugar (FBS) above or equal to 126 mg/dL (7.0 mmol/L). 

FBS is determined from a blood sample that is taken from you after an overnight period of not feeding up to the time of day in which the sample is taken. 

• 2-hour glucose above or equal to 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (GTT)

GTT is performed by taking a baseline blood sample from you after an overnight period of not feeding and every 30 minutes to one hour over 2 to 3 hours after being given a measured portion of glucose (sugar) in water to drink. 

2. HbA1c testing 

This test measures your average blood sugar levels over the past 2-3 months. A level of 6.5% or higher indicates diabetes, while a range of 5.7% to 6.4% suggests pre-diabetes.

 

Challenges in Diagnosing Type 2 Diabetes in African Healthcare Settings

You now know the steps to take if you want to determine whether you have diabetes. However, access to these diagnostic tests varies greatly across the continent, and many cases of diabetes go undiagnosed due to several factors, including:

1. Lack of diabetes awareness among both the public and some healthcare workers [2]

2. Limited healthcare infrastructure in rural areas

3. Cost barriers for diagnostic tests

4. Cultural beliefs that may discourage  or delay seeking medical care

These contribute to the worrisome statistic of nearly 7 out of 10 people with diabetes who don't know they have the condition. Some might be willing to know their health status, but these challenges restrict them.

 

Why is Early Diagnosis of Type 2 Diabetes Important in Africa?

1. It prevents silent damage

Many Africans only discover they have diabetes when serious complications arise. For example, a farmer in rural Kenya might not realise he has diabetes until he develops vision problems that seem to be threatening his livelihood.
 

2. It saves money and lives

Treating diabetes early is much cheaper than managing complications. A study in South Africa found that treating diabetic kidney disease costs 3.5 times more than early diabetes management. [1]
 

3. It keeps families together

Applicable globally as well as in many African communities, a breadwinner's health directly impacts the whole family. Early diagnosis allows parents to manage their condition and continue to support their family’s needs.
 

4. It preserves quality of life

When diabetes is managed early, chronic disabilities and complications can be prevented. For instance, a teacher in Nigeria diagnosed early can maintain her active lifestyle and career with proper care.
 

5. It empowers African communities

Early diagnosis programs can educate entire communities about healthy lifestyles and this benefits even those without diabetes.

 

Common Myths and Misconceptions about Type 2 Diabetes in Africa

• Type 2 Diabetes is a rich person's disease

Diabetes affects people of all economic backgrounds. In fact, in many African countries, it's becoming more common in rural and low-income areas due to changing diets and lifestyles. [4]

• Traditional remedies can cure diabetes

Some traditional medicines may help manage symptoms but they cannot cure diabetes. Proven medical treatments, including medication when necessary, are essential for proper management. However, some traditional practices, like using certain herbs, can be integrated into a holistic care plan under medical supervision. [5]

• Insulin therapy is a last resort or sign of failure

Insulin is a normal hormone that everyone needs; we all have it. For some people with Type 2 diabetes, taking insulin is the best way to manage their blood sugar and stay healthy. It's not a punishment or a sign of personal failure, but a valuable resource for good health.

• You can't eat any sugar if you have type 2 diabetes

People with diabetes can still enjoy small amounts of sugar as part of a balanced diet. The central point is moderation and understanding how different foods affect blood sugar levels.

• Type 2 Diabetes is infectious

Diabetes is not infectious. You cannot catch it from someone else. However, families may share risk factors, like genetics or lifestyle habits. [3]

 

Conclusion

Type 2 diabetes is a growing health concern in Africa, with prevalence rates rising rapidly, especially in urban areas. This article has highlighted the importance of awareness of the symptoms, risk factors, and diagnostic processes for Type 2 diabetes in the African context. It emphasised the critical need for early diagnosis and addressed common misconceptions. When you have culturally relevant information about type 2 diabetes, you will be better placed to make informed and healthy decisions for yourself and your loved ones who may have the condition. Talk with your doctor about type 2 diabetes whenever you have a medical checkup or if you notice any early symptoms of the condition. 

 

References

1. Pheiffer C, Pillay-van Wyk V, Turawa E, Levitt N, Kengne AP, Bradshaw D. Prevalence of type 2 diabetes in South Africa: a systematic review and meta-analysis. Int Journal Env Res and Pub Health. 2021 May 30;18(11):5868. Doi: 10.3390/ijerph18115868. Available from here.

2. Motala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nat Rev Endocrinol. 2022 Apr;18(4):219-29. Doi: 10.1038/s41574-021-00613-y. Available from here.

3. Ismail L, Materwala H, Al Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Computational and Structural Biotechnology Journal. 2021 Jan 1;19:1759-85. Doi: 10.1016/j.csbj.2021.03.003. Available from here.

4. Goedecke JH, Mendham AE. Pathophysiology of type 2 diabetes in sub-Saharan Africans. Diabetologia. 2022 Dec;65(12):1967-80. Doi: 10.1007/s00125-022-05795-2. Available from here.

5. Mohammed A, Tajuddeen N. Antidiabetic compounds from medicinal plants traditionally used for the treatment of diabetes in Africa: A review update (2015–2020). South African Journal of Botany. 2022 May 1;146:585-602. Doi: 10.1016/j.sajb.2021.11.018. Available from here.

 

Related: Management of type 2 diabetes in Nigeria

 

 

Published: August 7, 2024

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