| Alisha N. Wade, Innocent Maposa, Godfred Agongo, Gershim Asiki, Palwende Boua, Solomon S. R. Choma, F. Xavier Gómez-Olivé, Eric Maimela, Lisa K. Micklesfield, Shukri F. Mohamed, Engelbert A. Nonterah, Shane A. Norris, Hermann Sorgho, Michele Ramsay, Nigel J. Crowther Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study Journal Article In: BMJ open, vol. 13, iss. 4, 2023, ISSN: 2044-6055. @article{Wade2023,
title = {Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study},
author = {Alisha N. Wade and Innocent Maposa and Godfred Agongo and Gershim Asiki and Palwende Boua and Solomon S. R. Choma and F. Xavier G\'{o}mez-Oliv\'{e} and Eric Maimela and Lisa K. Micklesfield and Shukri F. Mohamed and Engelbert A. Nonterah and Shane A. Norris and Hermann Sorgho and Michele Ramsay and Nigel J. Crowther},
url = {https://pubmed.ncbi.nlm.nih.gov/37105688/},
doi = {10.1136/BMJOPEN-2022-069193},
issn = {2044-6055},
year = {2023},
date = {2023-01-01},
journal = {BMJ open},
volume = {13},
issue = {4},
publisher = {BMJ Open},
abstract = {Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention. Design Cross-sectional study. Setting Community-based study in four sub-Saharan African countries. Participants 10 700 individuals, aged 40-60 years. Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG \<7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis. Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes. Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes.},
keywords = {{Adult, Africa South of the Sahara / epidemiology, Alisha N Wade, Blood Glucose, CollabAuthor(name='AWIGen and the H3Africa Consortium', Cross-Sectional Studies, Diabetes Mellitus* / epidemiology, Diabetes Mellitus* / therapy, Extramural, Humans, Hypertension* / epidemiology, Innocent Maposa, MEDLINE, Middle Aged, N.I.H., National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, PMC10151877, Prevalence, PubMed Abstract, Research Support},
pubstate = {published},
tppubtype = {article}
}
Objectives We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention. Design Cross-sectional study. Setting Community-based study in four sub-Saharan African countries. Participants 10 700 individuals, aged 40-60 years. Primary and secondary outcome measures The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis. Results Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes. Conclusions There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes. |
