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The African continent is in the midst of a rapid epidemiological transition, facing a "double burden" of persistent communicable diseases and a burgeoning epidemic of Non-Communicable Diseases (NCDs), with Diabetes Mellitus (DM) at the forefront. For healthcare professionals (HCPs), understanding the gravity and unique challenges of this crisis is crucial for impactful clinical and policy interventions.

The Status and Prevalence of Diabetes in Africa

The figures from the International Diabetes Federation (IDF) and the World Health Organization (WHO) paint a concerning picture of a condition that has transitioned from being rare to one of Africa’s major public health threats.

·        Soaring Prevalence: The prevalence of diabetes among adults in the WHO African Region has surged, reaching an estimated 10.5% in 2022 (1). The total number of adults (20–79 years) living with diabetes is estimated at 25 million (2).

·        Undiagnosed Majority: The most alarming statistic is the staggeringly high proportion of undiagnosed diabetes, estimated to be around 73% across the region (2). This means approximately 18 million adults are unaware of their condition, the highest percentage globally (3).

·        Premature Mortality: Premature deaths from diabetes (occurring before the age of 70) stand at 58% in the African Region, significantly higher than the global average of 48% (3). This highlights late diagnosis and inadequate management as major challenges.

·        The Driver: Urbanization and Lifestyle: The rise is largely attributed to rapid urbanization and the resultant adoption of sedentary lifestyles, shifts towards energy-dense diets, and increasing rates of obesity and physical inactivity. Type 2 Diabetes Mellitus (T2DM) accounts for over 90% of cases (4).

Narrowing the Focus: Diabetes in Kenya

Kenya mirrors the continental trend, presenting a critical need for strengthened NCD care.

·        Current Estimates: According to the IDF, Kenya has an estimated diabetes prevalence of 3.1% in the adult population (20-79 years) (5), equating to approximately 813,300 adults living with the condition (as of 2025 projections). The WHO STEPS 2015 survey placed the national prevalence at 3.3% (6).

·        The Undiagnosed Gap in Kenya: The problem of late diagnosis is acute, with an estimated 53.6% of people with diabetes in Kenya remaining undiagnosed (5). This leads to significant morbidity, with many patients presenting with life-threatening complications like gangrene, kidney failure, or diabetic ketoacidosis (7).

·        Geographic Disparities and Earlier Onset: Prevalence is generally higher in urban areas (e.g., studies show Nairobi with higher rates) (8). Moreover, Kenyan patients are often at risk of developing T2DM-related complications at an earlier age compared to those in developed countries (8).

The Challenges for Healthcare Providers

The complexity of diabetes management in Kenya is amplified by systemic and economic barriers that HCPs must navigate:

1.   Late Diagnosis and Advanced Complications: By the time many patients are diagnosed, serious complications are often already setting in. This places a heavy burden on tertiary facilities, where lack of supplies and trained staff exacerbates poor outcomes (9).

2.   Affordability and Financial Burden: The cost of consistent care is often prohibitive. Insulin, test strips, and regular consultations are often paid for through high out-of-pocket expenditure, creating a major barrier to adherence and glycemic control for the majority of patients (7).

3.   Fragmented Care Systems: The health system, still juggling the infectious disease burden, struggles with the transition to effective chronic disease management. There remains a significant gap between national diabetes policy and its effective implementation at the grassroots level (9).

Call to Action for HCPs

The growing burden of diabetes demands a coordinated, multidisciplinary response. HCPs are on the front lines and must champion a shift in strategy:

·        Integrate Opportunistic Screening: Aggressively integrate screening for at-risk individuals (e.g., those with hypertension, obesity, family history) into every clinical encounter at the primary care level.

·        Enhance Capacity Building: Push for increased access to and training in the WHO-led PEN-Plus strategy, which aims to increase access to diagnosis, treatment, and care of severe chronic diseases at district hospitals (3).

·        Patient Empowerment: Move beyond prescription to empower patients through robust, culturally relevant education on nutrition, physical activity, and self-monitoring to improve long-term adherence and outcomes.

References

1.    - WHO Regional Office for Africa. Diabetes. Available at: https://www.afro.who.int/health-topics/diabetes

2.   - International Diabetes Federation (IDF). Africa | Regions. Available at: https://idf.org/our-network/regions-and-members/africa/

3.   WHO Regional Office for Africa. African region tops world in undiagnosed diabetes: WHO analysis. Available at: https://www.afro.who.int/news/african-region-tops-world-undiagnosed-diabetes-who-analysis

4.   - Owolabi MO, et al. Diabetes in sub-Saharan Africa – from policy to practice to progress: targeting the existing gaps for future care for diabetes. Diabetes and Vascular Disease Research. 2017;14(4):259-269. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5489055/

5.   - International Diabetes Federation (IDF). Kenya Diabetes Data & Insights | IDF Atlas. Available at: https://diabetesatlas.org/data-by-location/country/kenya/

6.  - WHO Regional Office for Africa. Diabetes is a family affair in Kenya. Available at: https://www.afro.who.int/news/diabetes-family-affair-kenya

7.  - TRT Afrika. Africa's diabetes crisis: When a foot sore ends in amputation. Available at: https://www.trtafrika.com/english/article/675765abdfc5

8.   - Wamuyu-Maina GW, et al. Prevalence of diabetes and co-morbidities in five rural-and-semi-urban Kenyan counties: 2010–2015. International Journal of Diabetes Mellitus. 2017;5(2):98-103. Available at: https://www.researchgate.net/publication/318239463_Prevalence_of_diabetes_and_co-morbidities_in_five_rural-and-semi-urban_Kenyan_counties_2010-2015

9.   - Gathuru IM, et al. Challenges in policy reforms for non-communicable diseases: the case of diabetes in Kenya. Global Health Action. 2019;12(1):1611243. Available at: https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1611243