Academic journal article South African Journal of Psychiatry

Association between Depression, Glycaemic Control and the Prevalence of Diabetic Retinopathy in a Diabetic Population in Cameroon

Academic journal article South African Journal of Psychiatry

Association between Depression, Glycaemic Control and the Prevalence of Diabetic Retinopathy in a Diabetic Population in Cameroon

Article excerpt


Diabetes mellitus is currently one of the most important public health issues of the 21st century affecting an estimated 347 million people worldwide with low- and middle-income countries currently being home to 75% of the world's diabetic population. (1) Sub-Saharan Africa is currently facing an epidemic of type 2 diabetes mellitus, thought to have arisen because of rapid urbanisation, an increasingly ageing population and major changes in lifestyle. (2, 3)

Depression is the leading cause of disability worldwide and is a major contributor to the global burden of disease, affecting an estimated 350 million people. (4) Research has shown depression to be associated with a high mortality in people with diabetes. (5, 6, 7, 8) Patients with diabetes are twice as likely to be depressed compared to those without diabetes. (9) Alongside this, depression can also lead to an increased risk of the vascular complications of diabetes such as diabetic retinopathy, neuropathy and cardiovascular disease. (10)

Diabetic retinopathy is a microvascular complication of diabetes and is the leading cause of blindness in people of working age in Europe and North America. (11) In sub-Saharan Africa, the prevalence of retinopathy in patients with diabetes varies across the continent ranging from 16 in some regions to 55% in other regions. (2) Estimates of prevalence vary according to duration, clinical site and glycaemic control. The contribution to overall blindness in sub-Saharan Africa is unknown, but studies suggest that the proportional contribution may be increasing. (2) Studies to date involving multiethnic populations living in sub-Saharan Africa have found that visual loss relating to diabetic retinopathy is more likely in populations of African origin compared to those of other ethnic minorities living in sub-Saharan Africa. (12)

Literature on depression in people residing in low- and middle-income countries is limited but growing evidence demonstrates the negative impact of poverty and mental health illness on people living in these regions. (13) Much of the research surrounding depression and type 2 diabetes that has been conducted in low- and middle-income countries have primarily been conducted in middle-income economies such as India, China, Mexico and Brazil. (14)

Over the past 50 years, there has been an increased awareness of depression in sub-Saharan Africa. (15) Prior to this, depression was assumed to be non-existent in Africa, and even today, the prevalence may still be underestimated. (16, 17) However, information about depressive symptoms in individuals living with chronic illnesses in sub-Saharan Africa is still scarce. (18) Despite this, research from low-income economies such as Bangladesh and Guinea suggests that anxiety and depressive symptoms are common in patients living with diabetes. (19, 20)

The aim of this research was to analyse the association between depressive symptoms and glycaemic control and record the prevalence of diabetic retinopathy in a clinical sample of patients with diabetes from the 'Improving access to HbA1c measurement in sub-Saharan Africa' project. (21)

Materials and methods

Data were collected from a multicentre hospital cohort involving six diabetic care facilities in Yaounde, Cameroon. This study was performed as secondary data analysis of the 'Improving access to HbA1c measurement in sub-Saharan Africa' study. (22) The empirical study was an interventional study aiming to improve access to HbA1c measurements in sub-Saharan Africa. The empirical research was conducted from 01 November 2008 to 30 April 2012 in Guinea and Cameroon involving a total of 410 diabetic adult patients with both type 1 and type 2 diabetes mellitus and had a 97% response rate.

Secondary data were analysed from a total of 261 of the 410 participants who had HbA1c scores recorded at baseline. The study included participants aged 18 years and older who had at least a 6-month documented history of diabetes. …

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