156
VOLUME 7 NUMBER 4 • NOVEMBER 2010
AFRICAN FOCUS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
African Diabetes Leadership Forum calls for activism
around non-communicable diseases
T
he Diabetes Leadership Forum Africa 2010, which took place
in Johannesburg at the end of September, highlighted the
urgent need to address the burden of diabetes and other
non-communicable diseases (NCDs) in the developing world.
To date, NCDs have been overshadowed by the perceived more
urgent priority of addressing infectious diseases such as HIV/AIDS,
tuberculosis (TB) and malaria.
Sir George Alleyne, director
emeritus of the Pan American Health Organisation
, called for
an activist mentality to be brought to the fight, as had been the
case with HIV/AIDS as well as non-health-related issues such as the
civil rights movement in the USA. ‘We should introduce a “fear
factor” to stimulate some much-needed public hysteria. We also
need a surge of commitment to knock on political doors, especially
now that those doors are open with the UN summit on non-
communicable diseases due to take place next September’, he said.
Prof Pierre Lefebvre, chairman of the World Diabetes
Federation
, warned that the current diabetes pandemic has
been described in some quarters as a tsunami. ‘The comparison is
sound insofar as diabetes also has devastating effects in terms of
death and disability. Unlike a tsunami, however, it is not sudden or
unpredictable – and has been slowly developing for half a century.
The wave is still growing and it’s projected that by 2030, in the
region of 910 000 000 people worldwide – more than 15% of the
adult population – will be living with diabetes and impaired glucose
tolerance (IGT). We need to join forces to contain the tsunami.’ Prof
Lefebvre proposed a ‘new Einstein formula’ to help achieve this:
e
=
m
×
c
2
– where
e
=
excellence,
m
=
money/manpower and
c
=
commitment.
Lise Kingo, sponsors of the Forum
, observed that it is
estimated there are currently 12 million diabetics in sub-Saharan
Africa – and only 15% of them are diagnosed. South African health
minister, Dr AaronMotsoaledi underscored that in Africa, most cases
remain undetected, with the result that Africans die of diabetes and
other NCDs at twice the rate of their counterparts in the developed
world. ‘Africa is set to experience the greatest increase in NCDs in
the coming decade, with a projected rise as high as 24%’, he said.
‘A particular challenge is that when it comes to NCDs, we’re not
dealingwith an infectious agent that responds tomedication. Rather,
we’re dealing with a dangerous and very complex organism called
the human being, which is highly resistant to the need to change
diet and lifestyle to meaningfully impact on these conditions.’
Diabetes in sub-Saharan Africa: facts and figures
Prof Ayesha Motala from the Nelson Mandela School of
Medicine of the University of KwaZulu-Natal
quoted some
alarming statistics. ‘It’s projected that diabetes will account for four
million deaths in 2010, or 6.8% of all deaths in the region. This
represents a 5% increase since 2007, at which time diabetes deaths
already exceeded those from HIV/AIDS.’
By 2025, more than three-quarters of all diabetics will live in
the developing world and the greatest increase will be seen in sub-
Saharan Africa. ‘The International Diabetes Federation anticipates a
54%increaseintype2diabetesincidencefortheworldbetween2010
and 2030, but the increase for Africa will be 98% – with the number
of patients increasing from 12.1 million to 24 million. Where IGT is
concerned, the increase for theworld is 37%, but for Africa it’s 76%.’
Data on diabetes in Africa are limited, and until the 1980s the
few studies available showed a low prevalence. ‘Contrary to this
persistent popular belief, diabetes in Africa is no longer rare, even
though the incidence is variable, with a higher prevalence in urban
areas’, said Prof Motala. ‘South Africa is urbanising fast and by
2030, there will be more urban than rural dwellers. This makes
urbanisation an important risk factor in its own right.’
Given sub-Saharan Africa’s limited resources and failing health
systems, diabetes is often only diagnosed when patients present
with complications. ‘Chronic complications are a major cause of
morbidity and increased costs. Diabetes affects nearly all parts
of the body, including the eyes, feet, heart and kidneys. In sub-
Saharan Africa, 4.5 million diabetics have eye disease, 2.23 million
require dialysis, 970 000 have cardiovascular disease and nearly
400 000 have a lost a foot.’
Prof Motala reiterated the point made by others that infectious
diseasestendtobegivenpriority,pointingoutthatAfricahadadouble
burden of both these and NCDs. ‘There is a complex relationship
between HIV and diabetes, with the antiretroviral treatments
required by the former conferring a greater risk of metabolic
syndrome and pre-diabetes. An integrated approach is therefore
important and HIV facilities need to screen for and treat NCDs.’
More optimistically, she feels all is not lost. Prevention works, with
lifestyle modification alone having a 58% success rate in individuals
with IGT. Even secondary prevention is cost effective, slowing the
progression of the disease and delaying the complications. ‘Health
is an essential precursor of economic development, and NCDs such
as diabetes have a major impact not only on individuals and their
families but also on national economies. Despite the challenges
in Africa, there are many examples of good practice in a number
of countries. We’re seeing increasing awareness among both
communities and healthcare professionals, as well as a greater
reach into remote areas.’
Scaling up NCD services in Africa: learning from
HIV/AIDS
Dr Miriam Rabkin, associate clinical professor of medicine
and epidemiology at the Centre for AIDS Care and Treatment
Programs (ICAP), Columbia University, USA
, feels that the
lessons learned from the astonishingly rapid scale-up of HIV
services in sub-Saharan Africa can help strengthen systems for
NCD treatment. Like those with HIV, patients with NCDs also
Progress on NCD risk factor management will depend on public–
private partnerships. We need to draw on the experience of such
partnerships in the infectious diseases area, such as GAVI, GAIN
and Medicines for Malaria, which are making tangible gains
–
Dr Derek Yach, senior vice president: global health policy,
PepsiCo
