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Diabetes is a ticking time bomb in sub-Saharan Africa

The implications of high rates of the disease.
Image: Shutterstock

Diabetes is a serious, chronic condition that affects the lives and well-being of individuals, families, and societies globally. It is characterised by excess levels of sugar in the blood.

There are three main types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.

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Type 1 diabetes often begins from childhood. It occurs when the body attacks the pancreas with antibodies. The pancreas is damaged and is unable to produce the hormone, insulin, responsible for regulating the blood sugar level. As a consequence, people with type 1 diabetes rely on daily injections of insulin to survive. Type 1 diabetes constitutes about 5%–10% of all cases of diabetes

Type 2 diabetes occurs mostly in adults from the ages of 20 to 79. It accounts for about 90% of all diabetes cases. In type 2, the pancreas produces insulin, but it is either not enough or the body cells fail to use it – what’s known as insulin resistance. People who are obese have a high risk of developing type 2 diabetes.

Gestational diabetes refers to high blood sugar that appears only in pregnancy, and usually goes away after delivery. But women with gestational diabetes have high chances of developing type 2 diabetes later in their life.

In 2019 about 1 in 11 adults in the world – 436 million people – had diabetes. Of these, 19 million lived in sub-Saharan Africa. Around 60% of them were not aware of their condition.

These numbers are expected to grow exponentially over the next 25 years. The number of people with diabetes in sub-Saharan Africa is expected to more than double to 45 million by 2045. This is because many people are at high future risk of diabetes, otherwise known as people with prediabetes. In 2019, about 45 million Africans aged 20 to 79 years had impaired glucose tolerance, which is a form of prediabetes.

The Global Burden of Disease Study estimates that diabetes is the fifth leading cause of deaths due to noncommunicable diseases in the region. Others ahead of it are stroke, ischaemic heart disease, congenital birth defects, and chronic liver diseases.

The expected rapid rise in diabetes must not be overlooked as it could have devastating health and economic consequences for the region. Most national health systems are unprepared to deal with the growing burden as they struggle to cope with infectious diseases. The Covid-19 pandemic has added to these pressures.

Given that this is a lifestyle disease, governments need to act urgently to encourage changes in behaviour in a bid to manage it.

Implications of high rates of diabetes

Diabetes and other noncommunicable diseases result in people living many years in poor health in sub-Saharan Africa. The average life expectancy in the region is currently estimated to be 64.5 years, with 11% of those years spent in poor health.

One-third of all health loss (measured using disability-adjusted life-years) in 2019 in sub-Saharan Africa was due to noncommunicable diseases such as diabetes. This figure rose from 18% in 1990. Disability-adjusted life-years is a measure of disease burden that captures both early death and ill health.

According to the Global Burden of Disease Study, the proportion of all years of life lost to early death due to diabetes and other noncommunicable diseases increased by more than 68% in sub-Saharan Africa between 1990 and 2019.

Diabetes can lead to death and life-threatening complications, such as severe damage to the heart, blood vessels, eyes, kidneys, and nerves. These complications can lead to heart attacks, strokes, blindness, kidney failure, and lower limb amputation. For example, adults with diabetes are three times more likely to suffer from heart attacks and strokes than adults without diabetes.

Diabetes can also increase the risk of infectious diseases such as pneumonia and tuberculosis. It has also been shown that people living with diabetes who are infected with SARS-CoV-2 are more likely to develop severe Covid-19, to require extended stay in the hospital, to have a greater need for ventilation, and to have higher chances of dying from Covid-19.

Future risks

Sub-Saharan Africa faces unique challenges in combating diabetes. These include the lack of funding for noncommunicable diseases, lack of studies and guidelines specific to the population, lack of medications, differences in urban and rural patients, and inequity between public and private sector health care.

Because of these challenges, diabetes has a more significant impact on health loss in sub-Saharan Africa than any other region in the world.

The International Diabetes Federation estimated the cost of diabetes in sub-Saharan Africa in 2019 to be US$ 9.5 billion, and this will increase to US$ 17.4 billion by 2045.

The rising prevalence of diabetes is linked to the increase in obesity and other lifestyle changes such as poor eating habits and lack of physical activity.

The risk factors for developing diabetes are modifiable, meaning they can be changed. People should be encouraged to eat healthily, be physically active, and avoid extreme weight gain. Such simple lifestyle changes are effective in preventing type 2 diabetes.

Studies over the past two decades have unequivocally shown that lifestyle modification can prevent or delay the onset of type 2 diabetes in people who are at high future risk of the disease. Such studies have been conducted in numerous countries, including the United States of America, Finland, China, India, Japan, and Pakistan. A coordinated multi-sectoral approach within and across countries is needed to stem the tide of diabetes in sub-Saharan Africa.The Conversation

Chinwe Juliana Iwu-Jaja, Public Health researcher, Stellenbosch University; Andre Pascal Kengne, Director of the Non-Communicable Diseases Research Unit at the South African Medical Research Council, Professor in the Department of Medicine, University of Cape Town, and Charles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research Council

This article is republished from The Conversation under a Creative Commons licence. Read the original article.


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Diabetes is a disease for the privileged, a status symbol. This modern disease proves the efficiency of the capitalist system. The system provides consumers with an abundance of affordable calories. The benefits of property rights enable farmers, millers and bakers to flood the market with various food products, and consumers to afford those products. Consumers are spoilt for choice, and some make bad choices.

Diabetes is a manifestation of carbohydrate poisoning. The consumption of too much empty calories from nutrient-poor foods causes type 2 and type 3 diabetes. Dementia is type 3 diabetes. Therefore, dementia is a preventable lifestyle disease.

Evolution prepared humans for a calorie-restricted diet as a hunter-gather. Humans are not genetically adapted to cope with an abundance of calorie-dense foods. Modern man has to manage his health by making healthy lifestyle choices. He has to use his faculties, not to find food, but to restrict his intake of calories.

This implies that people need information and an adequate level of mental capacity to interpret that information, plus the discipline to follow the proper lifestyle.

This is too much to ask for most people. Humans are genetically programed to kill themselves with calories if calories are abundant.

You are almost there, Sensei. It is not so much about calories, because a calorie is not a calorie in nutrition as many people think.

What needs to happen is that people need to restrict their carbohydrate intake. Carbohydrates and specifically refined carbohydrates are so called “empty calories”. Take nutrition rich foods like protein and saturated fat. Other than popular belief, especially main stream medical practitioners and dieticians, saturated fat is not the villain it is currently and used to be made out to be.

The actual villains are the refined carbohydrates, which increases insulin secretion and if it happens for too long, results in insulin resistance (Type II diabetes). Your body doesn’t need carbohydrates at all to survive. You can survive and be a lot healthier with only protein rich foods and saturated fat that you eat.

Even your brain functions better on a carb restricted diet. Your brain and body use the ketones formed when fat is burnt in stead of carbs for energy. If your brain does need glucose, it can obtain it from a process called Gluconeogenesis, which can come from either fat or protein.

Another culprit is poly unsaturated fat, which oxidizes on exposure to UV rays from sunlight and heating – especially repeated heating.

Probably more lives would have been saved by the NCCC and less stress put on hospital beds if instead of banning alcohol and cigarettes, they had banned refined carbohydrates?

Seriously however, some consideration should be put into requiring food manufacturers to define the percentage of total refined carbs making up the product being sold. The current so-called ‘Nutritional Facts’ on packaging seems to be designed to confuse the purchaser rather than educate. Like nicotine and alcohol, there should be a single, clearly visible percentage number which constitutes a health warning. The details can remain there for information in tiny and almost invisible print.

Its a bit technical for most people, that is why I didn’t go there.

Most definitely, calories are not created equal. The consumption of higher-GI carbs increases the levels of the aromatase enzyme in the blood. The aromatase enzyme aromatises testosterone into estrogen. Estrogen is the pregnancy hormone that prepares the body for lactation after giving birth. Most crucially, at a determined level of carbohydrate consumption, a higher level of circulating estrogen leads to increased levels of fat-storage and water retention. If two individuals consumed the exact same amount of carbs, the individual with the higher aromatase levels and estrogen levels will gain weight, while the other one may lose weight. A simple mindless act, like drinking a tablespoon of sugar with your coffee, may have the result that your calory-restricted meal actually increases your body fat levels! I have seen this many times. Consuming one tablespoon of sugar a week, while trying to lose weight, is like driving a formula one racing car with the handbrake up.

Besides causing gains in body fat and water retention, the higher levels of estrogen also suppress testosterone levels via the hypothalamus. This double-whammy of increased estrogen and lower anabolic levels leads to a decrease in muscle mass, a lower metabolic rate, insulin insensitivity, higher blood sugar levels, higher insulin levels, higher body fat levels, an increased risk for the metabolic syndrome, dementia, prostate cancer or breast cancer. The combination of increased levels of estrogen and lower levels of testosterone causes mood problems, depression and “brain fog”.

This harmful process is kickstarted with the consumption of sugar and high Glycaemic Index carbohydrates. Calories from protein or omega 3 fatty acids act as protection against the detrimental effects of omega 6 fatty acids and high GI carbs.

Basically, everything that leads to increased levels of aromatase is bad. The mindful individual who wants to protect his health is in fact trying to control aromatase. If you can successfully manage aromatase, you will have a healthy and happy life. Either you control aromatase in a natural way now, or you will force your oncologist to manage your aromatase levels with chemicals later.

Well said to Henry666 and Sensei. Sensei did differentiate but to others the difference to Type I must be emphasized as the comments do not apply to Type I.

Separately, check some of the numbers above “436 million people”, why did this get so little attention and other stuff including Corona get so much attention.

Our dear, gap-toothed minister of cooperative governance should pay heed and lay off the fried chicken, instead of preaching to those who smoke and drink. She’s a walking diabetes time bomb herself.

If we can have a sugar tax, why not a mieliepap tax? Too many votes will be lost?

What people also don’t understand is that Carbohydrates that causes insulin secretion, gets a double blow, due to the insulin itself and high blood sugar damaging the arterial endothelium. When this happens, the body sends cholesterol to those damaged areas to fix the damage and unfortunately this results in a blood clot forming, which can cause either a heart attack or a stroke.

In the end it was the cholesterol killing or paralyzing the person, but had the damage not take place in the first place, the person wouldn’t have died or become a vegetable.

It’s so simple, yet appears to be so difficult to eat healthy. South Africa had abundance of healthy foods. Yet I see families taking big portions of chips covered with ketchup. They add to this a Russian, loaf of white bread and 2l of soft drinks. Combination of these quick carbs and fats is nothing but a recipe for disaster. I don’t know how much learning needs to go there to kill this temptation…

Natural instinct forces humans to consume high-fat and high-carb foods first. Natural selection favoured the individual who could identify, collect and consume the high-calorie foods. The process of evolution, and the constant fight for survival, programmed the human brain to select high-calorie food. When food is scarce, it is logical for the rational individual to go for calorie-dense fatty food. It is a matter of life and death. Our brains are hard-wired to prefer high-calorie foods.

This message is still delivered to the brain today. Estrogen creates cravings for calorie-dense foods. The rational individual who does not know the nutritional value of food will automatically select the calorie-dense foods because it satisfies his natural cravings. We need lots of knowledge and discipline to overrule this natural instinct.

The abundance of cheap sugars is a deathtrap for uninformed individuals.

It’s also not only a case of education and as an example of this you will find many intelligent and educated people with these problems. It is also a case of our natural instincts to want instant gratification and to procrastinate “I will start my diet next week”.

End of comments.





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