Academic journal article Bulletin of the World Health Organization

Differences by Sex in the Prevalence of Diabetes Mellitus, Impaired Fasting Glycaemia and Impaired Glucose Tolerance in Sub-Saharan Africa: A Systematic Review and Meta-analysis/Les Differences Entre Les Sexes Dans la Prevalence Du Diabete Sucre, De la Glycemie a Jeun Anormale et De L'intolerance Au Glucose En Afrique Subsaharienne: Examen Systematique et Meta-Analyse

Academic journal article Bulletin of the World Health Organization

Differences by Sex in the Prevalence of Diabetes Mellitus, Impaired Fasting Glycaemia and Impaired Glucose Tolerance in Sub-Saharan Africa: A Systematic Review and Meta-analysis/Les Differences Entre Les Sexes Dans la Prevalence Du Diabete Sucre, De la Glycemie a Jeun Anormale et De L'intolerance Au Glucose En Afrique Subsaharienne: Examen Systematique et Meta-Analyse

Article excerpt

Introduction

Increasing urbanization and the accompanying changes in lifestyle are leading to a burgeoning epidemic of chronic noncommunicable diseases in sub-Saharan Africa. (1,2) At the same time, the prevalence of many acute communicable diseases is decreasing. (1,2) In consequence, the inhabitants of sub-Saharan Africa are generally living longer and this increasing longevity will result in a rise in the future incidence of noncommunicable diseases in the region. (1-3)

Diabetes mellitus is one of the most prominent noncommunicable diseases that are undermining the health of the people in sub-Saharan Africa and placing additional burdens on health systems that are often already strained. (4,5) In 2011, 14.7 million adults in the African Region of the World Health Organization (WHO) were estimated to be living with diabetes mellitus. (6) Of all of WHO's regions, the African Region is expected to have the largest proportional increase (90.5%) in the number of adult diabetics by 2030. (6)

Sex-related differences in lifestyle may lead to differences in the risk of developing diabetes mellitus and, in consequence, to differences in the prevalence of this condition in women and men. (3) However, the relationship between a known risk factor for diabetes mellitus--such as obesity--and the development of symptomatic diabetes mellitus may not be simple. For example, in many countries of sub-Saharan Africa, women are more likely to be obese or overweight than men and might therefore be expected to have higher prevalences of diabetes mellitus. (3,7) Compared with the corresponding men, women in Cameroon (8), South Africa9 and Uganda (10) were indeed found to have higher prevalences of diabetes mellitus. However, women in Ghana, (11) Nigeria, (12) Sierra LeoneL3 and rural areas of the United Republic of Tanzania (14) were found to have lower prevalences of diabetes mellitus than the men in the same study areas. No significant differences between men and women in the prevalence of diabetes mellitus were detected in studies in Guinea, (15) Mali, (16) Sudan (17) and urban areas of the United Republic of Tanzania, t8 or in a meta-analysis of data collected in several studies in West Africa. (19) Although wide variations in the distribution of diabetes mellitus by sex have been documented in several review articles, (3-5,7,20) the possible causes of this heterogeneity have never been examined in detail.

Like obesity, impaired fasting glycaemia and impaired glucose tolerance appear to be risk factors in the development of diabetes mellitus. (21,22) According to the International Diabetes Federation, the estimated age-adjusted prevalence of impaired fasting glycaemia in WHO's African Region was substantially higher in 2011 than the corresponding global mean value--9.7% versus 6.5%, respectively--and is expected to have risen further by 2030. (23)

Impaired fasting glycaemia and impaired glucose tolerance are reported to be metabolically distinct entities that affect different subpopulations, albeit with some degree of overlap. (22,24) In Mauritius, the prevalence of impaired fasting glycaemia was found to be significantly higher in men than in women, whereas the prevalence of impaired glucose tolerance was found to be higher in women than in men. (24,25)

Differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in much of sub-Saharan Africa have yet to be reviewed. Given the variation in health care, culture, environment, human behaviour and other determinants of health across sub-Saharan Africa, (26) the conclusions drawn from a recent meta-analysis of data from West Africa (19) should not be assumed to apply to the whole of sub-Saharan Africa. The sex-specific prevalence of at least one risk factor for diabetes mellitus--obesity--is known to differ across different parts of sub-Saharan Africa. (7,27)

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