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Diabetes in Africa: the situation in the Seychelles
- Pascal Bovet, Anne Gabriel, Conrad Shamlaye, Fred Paccaud (3 November 2008)
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Pascal Bovet, MD Ministry of Health, Republic of Seychelles & University of Lausanne (IUMSP), Switzerland, Anne Gabriel, Conrad Shamlaye, Fred Paccaud
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pascal.bovet{at}chuv.ch Pascal Bovet, et al.
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Professor NS Levitt recently reviewed the epidemiology, management and health care challenges related to diabetes in Africa [1], however not including data from the Seychelles. We would like to add some information from the Republic of Seychelles, an island state located 1800 km east of Kenya where more than 80% of the population is of African descent. Based on two independent population-based surveys in 1989 and 2004, the prevalence of diabetes (fasting blood glucose >=7 mmol/l and/or treatment) increased from 6.2% to 9.6% in men and from 6.1% to 9.2% in women [2-4]. The prevalence reached 11.5 % in 2004 when also considering results of the oral glucose tolerance test. The prevalence of obesity increased markedly in the interval [4,5] and overweight accounted for 49% of all cases of diabetes in 2004 [4]. Furthermore, pre-diabetes was found in an additional 22% of the population [4]. Of all cases of diabetes in the population aged 25-64, 54% were aware of the diagnosis [4]. However less than a fifth of diabetic persons under treatment had blood glucose, blood pressure and blood cholesterol below the recommended targets [4]. Furthermore, we found that persons with pre- diabetes already had worsened levels of several cardiometabolic risk factors and were therefore at increased cardiovascular risk [6]. We also confirmed the strong association between diabetes and microalbuminuria in the Seychelles [7] and found a high prevalence of the metabolic syndrome [8]. Our figures further contribute to map the "diabesity" epidemic in the African region. Limited therapeutic control among diabetic patients in the Seychelles is challenging since this occurred while the population is well aware of diabetes following sustained awareness campaigns since the late 1980s and health care, including medications in all major therapeutic classes, is provided at no direct cost through an easily accessible network of health centers. The situation in the Seychelles may provide a good case study for current and future trends in rapidly developing countries in the continent and, possibly, for middle-income countries in other regions. Conflict of interest statement: We declare that we have no conflict of interest References 1) Levitt N. Diabetes in Africa: Epidemiology, management and healthcare challenges. Heart 2008;94:1376-82. 2) Tappy L, Bovet P, Shamlaye C. Prevalence of diabetes and obesity in the adult population of the Seychelles. Diab Med 1991;8:448-52. 3) Bovet P, Shamlaye C, Gabriel A, Riesen W, Paccaud F. Prevalence of cardiovascular risk factors in a middle-income country and estimated cost of a treatment strategy. BMC Public Health 2006,6:9. 4) Faeh D, William J, Tappy L, Ravussin E, Bovet P. Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight. BMC Public Health 2007;7:163. 5) Bovet P, Chiolero A, Shamlaye C, Paccaud F. Prevalence of overweight in Seychelles: 15-year trends and association with socio-economic status. Obes Rev 2008; 2008;9:511-7. 6) Faeh D, William J, Yerli P, Paccaud F, Bovet P. Diabetes and pre- diabetes are associated with cardiovascular risk factors and carotid/femoral intima-media thickness independently of markers of insulin resistance and adiposity. Cardiovasc Diab 2007;6:32. 7) Pruijm MT, Madeleine G, Riesen W, Burnier M, Bovet P. Prevalence of microalbuminuria in the general population of Seychelles. J Hypertens 2008;26:871-77. 8) Kelliny C, William J; Riesen W; Paccaud; Bovet P. Metabolic syndrome according to different definitions in a rapidly developing country of the African region. Cadiovasc Diab 2008;18;7:27. |
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