Improving outcomes for people with type 2 diabetes in Sub-Saharan Africa

Research question How can we improve management of type 2 diabetes (T2D), particularly in lean individuals, in SubSaharan Africa? Background

Over 20 million people live with T2D in sub-Saharan Africa (SSA). This number will increase 134% by 2045, the largest expected increase of all regions in the world. A key challenge for managing T2D in SSA, highlighted by a recent Lancet Commission, is lack of local data to inform appropriate management.

Increasing evidence, including from our recent NIHR funded studies, shows that diabetes presents differently in SSA compared to high-income countries. One important difference is that those diagnosed with T2D in SSA are often young and lean, in stark contrast to its classical presentation in the old and obese in high income countries. These observations raise important questions, such as: 1) what is making lean individuals susceptible to diabetes, do lifestyle factors play a role?; 2) What is the best way to identify people at risk of T2D in SSA, as most current risk scoring tools rely on age and obesity?; 3) are the traditional approaches to prevention and treatment of T2D, that focus on weight loss and/or metformin (to treat insulin resistance associated with obesity) as effective in this population where a high proportion (40-60%) of those living with type 2 diabetes are lean?

Aims and objectives

The overall aim of our new group is to improve outcomes for people with T2D in SSA by understanding how local factors contribute to increased risk and identifying the best ways to identify and manage this condition. The emphasis will be on lean patients with type 2 diabetes whom we believe will require different management approaches to those who have obesity.

Linked to this is our ambition to develop leaders in diabetes research who, with close links to policy makers, will translate this knowledge into policy and practice. Our specific objectives are to:

1. Determine whether lifestyle behaviours (diet and physical activity) contribute to lean T2D and explore whether current national guidelines for lifestyle change have the same effect in lean and obese individuals.

2. Use data from our research in objective 1 and the literature to co-develop and pilot a new structured education intervention for T2D, incorporating appropriate lifestyle education including for those with the lean phenotype.

3. Investigate whether commonly used low-cost T2D drugs work as well in lean patients as they do in individuals with obesity in SSA.

4. Use existing data from different countries to comprehensively identify the risk factors for lean T2D and integrate these into tools to improve identification of at-risk individuals who should be screened.

5. Strengthen the capacity to undertake multidisciplinary diabetes research that leads to policy translation and practice in SSA. Anticipated impact and dissemination

Our research is addressing major growing challenge of T2D in SSA, where most cases are not detected and those who are diagnosed are poorly managed. This is particularly common in already vulnerable populations in rural areas. The potential to improve health outcomes and well-being, as well as enhance economic productivity, is therefore huge.

Throughout the research cycle, we will work closely with all stakeholders (including the community and policymakers) to disseminate our findings and ensure maximal translation and uptake.