Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and public health implications. a systematic review
Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and public health implications. a systematic review
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DOI：
10.1186/1471-2458-11-564
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发表时间：
2011-07-14
影响因子：
4.5
通讯作者：
Lohse, Nicolai
中科院分区：
文献类型：
--
作者：
Hall, Victoria;Thomsen, Reimar W.;Lohse, Nicolai
背景：全球糖尿病患病率正在上升，撒哈拉以南非洲也不例外。面对各种各样的卫生挑战，撒哈拉以南非洲的卫生当局和国际捐助者需要关于糖尿病流行病学和影响的可靠数据，以便规划和确定其卫生规划的优先次序。本文旨在对撒哈拉以南非洲地区糖尿病的流行病学趋势和公共卫生影响进行全面和最新的综述。方法：我们对1999年至2011年3月在撒哈拉以南非洲发表的关于糖尿病的论文进行了系统的文献综述，提供了糖尿病患病率、结局（慢性并发症、感染和死亡率）、获得诊断和护理以及经济影响的数据。结果：2型糖尿病占撒哈拉以南非洲糖尿病的90%以上，人口患病率从乌干达农村的1%到肯尼亚城市的12%不等。报告的1型糖尿病患病率较低，从莫桑比克的每10万人中4人到赞比亚的每10万人中12人不等。妊娠期糖尿病患病率从坦桑尼亚的0%到埃塞俄比亚的9%不等。糖尿病并发症的患者比例为视网膜病变7-63%，神经病变27-66%，微量白蛋白尿10-83%。糖尿病可能会增加该地区几种重要感染的风险，包括结核病、肺炎和败血症。与此同时，艾滋病病毒的抗病毒治疗增加了肥胖和胰岛素抵抗的风险。糖尿病患者的5年死亡率从4-57%不等。筛查研究发现，以前未诊断的糖尿病患者比例很高（bbb40 %），而以前诊断的糖尿病患者的血糖控制水平较低。获得诊断和治疗的障碍包括缺乏诊断工具和血糖监测设备以及糖尿病治疗费用高。该地区每年的糖尿病总费用估计为670.3亿美元，即每名糖尿病患者8836美元。结论：糖尿病在该地区造成了显著的负担，而且预计还会增加。许多糖尿病患者在获得诊断和治疗方面面临重大挑战，这导致了观察到的高死亡率和并发症发生率。糖尿病与重要传染病之间的重要相互作用突出表明，卫生规划人员有必要并有机会对传染病和非传染性疾病制定综合对策。
Background: Diabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa.Methods: We conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact.Results: Type 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient.Conclusion: Diabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.