Prevalence and awareness of diabetes in Guinea: findings from a WHO STEPS

Aims: The aim of the present study was to determine the prevalence of diabetes, and to assess its awareness and related risk factors among adult Guineans.Methods: A population-based cross-sectional survey was conducted on 1 100  adults (46.6% women) aged 35–64 years from Lower Guinea, during September to December 2009, using the WHO STEPwise approach of surveillance of chronic  disease risk factors. Data were collected in three steps: demographic and  behavioural risk factors, blood pressure and anthropometric measurements, and fasting blood cholesterol and glucose testing. A multi-stage cluster sample design was applied to generate nationwide representative data.Results: The mean age of all participants was 47.3 years (SD 8.8), similarly in  Conakry, rural Lower Guinea and urban Lower Guinea. The prevalence of diabetes was 5.7% (95% CI 4.0–8.1). Among participants with diabetes, only 44.0% were aware of their status. In multivariable logistic regression analysis, determinants of diabetes prevalence were urban residency, male sex, age group 45–64 years, increased waist circumference, hypertension and hypercholesterolemia. Male sex, rural residency, age group 45–54 years, no formal education, waist circumference, hypertension and hypercholesterolemia were independent predictors of screen-detected diabetes.Conclusion: The present study found a high prevalence and low awareness of  diabetes, suggesting the need for appropriate actions to strengthen primary  healthcare approaches towards non-communicable diseases in Guinea.Keywords: Diabetes, epidemiology, Guine

Race/ethnicity and challenges for optimal insulin therapy

AimsWe aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. MethodsWe searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: “ethnicity”, “diabetes”, “insulin”, “history of insulin”, “insulin therapy”, “food/rice”, “carbohydrate intake”, “insulin resistance”, “BMI”, “insulin dosing”, “insulin sensitivity”, “insulin response”, “glycaemic index”, “glycaemic response”, “efficacy and safety”, with interposition of the Boolean operator “AND”.In addition, we reviewed the reference lists of the articles found. ResultsThe differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. ConclusionsRace/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed

Sociodemographic inequities associated with participation in leisure-time physical activity in sub-Saharan Africa: an individual participant data meta-analysis

Abstract: Background: Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in sub-Saharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation. Methods: A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction. Results: Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I2 = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P < 0.001; I2 = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I2 = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel. Conclusions: In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA

Association between depression, glycaemic control and the prevalence of diabetic retinopathy in a diabetic population in Cameroon

Purpose: The prevalence of diabetes mellitus is increasing especially in low- and middle- income countries in which 75% of the world’s diabetic population reside. The macro- and microvascular complications of diabetes such as diabetic retinopathy are also set to increase in these populations. The relationship between depression and glycaemic control has been established in high- income countries, but evidence from low- and middle-income countries is scarce. This research aimed to determine an association between depression and glycaemic control and record the prevalence of diabetic retinopathy in a diabetic population in Cameroon. Methods: Analysis of cross-sectional data from the ‘Improving access to HbA1c measurements in sub-Saharan Africa’ study was used. Primary data were collected from six diabetic care facilities in Yaoundé, Cameroon. Participants were aged ≥ 18 years with at least a 6-month history of diabetes. Depression was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D). A CES-D score ≥ 16 was used to identify the presence of clinically significant depressive symptoms. Data on glycaemic control were measured using HbA1c measurements at baseline. The presence of diabetic retinopathy was established through ophthalmoscopy and angiography using the Early Treatment Diabetic Retinopathy Study classification. Results: A total of 261 participants were included in the study, and information on depressive symptoms at baseline (CES-D score) were available for 240 participants. The results of the data analysis found that 60% of the study participants had clinically significant depressive symptoms (CES-D > 16). A weak non-significant positive correlation was found between CES-D score and HbA1c level (p = 0.46, r = 0.05) using the Pearson’s correlation co-efficient. Gender and attendance to a patient support group were significantly associated with the presence of clinically significant depressive symptoms. Poor glycaemic control (HbA1c > 7%) was found in 72.8% of the population. Educational level and insulin use were significantly associated with glycaemic control. The prevalence of diabetic retinopathy was 27.2% (23.4% non-proliferative, 2.5% pre- proliferative and 3.2% proliferative), and the prevalence of diabetic maculopathy was 10.0%. Conclusion: The study found that a large proportion of diabetic patients may be experiencing depressive symptoms for which they are currently not receiving treatment or support. We also found a large proportion to have poor glycaemic control that is known to worsen the vascular complications of diabetes. In light of the increasing epidemic of type 2 diabetes in sub-Saharan Africa, it is important that the recognition of depressive symptoms becomes integrated into future healthcare policies in the nations of sub-Saharan Africa. This research suggests that individuals experiencing depressive symptoms may be more likely to engage in patient support groups. These groups can be beneficial in providing patients with diabetes valuable information, which could lead to better glycaemic control

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Research capacity. Enabling the genomic revolution in Africa.

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