Type 2 Diabetes

Affiliations.

  • 1 Lady Hardinge Medical College, New Delhi, India
  • 2 Cape Fear Valley, Methodist University
  • 3 VA MEDICAL CENTER, MATHER , CA
  • PMID: 30020625
  • Bookshelf ID: NBK513253

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. According to the International Diabetes Federation (IDF), approximately 415 million adults between the ages of 20 to 79 years had diabetes mellitus in 2015. DM is proving to be a global public health burden as this number is expected to rise to another 200 million by 2040. Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications leading to a 2-fold to 4-fold increased risk of cardiovascular diseases. In this review, we provide an overview of the pathogenesis, diagnosis, clinical presentation, and principles of management of diabetes.

Copyright © 2024, StatPearls Publishing LLC.

  • Continuing Education Activity
  • Introduction
  • Epidemiology
  • Pathophysiology
  • History and Physical
  • Treatment / Management
  • Differential Diagnosis
  • Complications
  • Deterrence and Patient Education
  • Pearls and Other Issues
  • Enhancing Healthcare Team Outcomes
  • Review Questions

Publication types

  • Study Guide

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • View all journals
  • Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • Review Article
  • Published: 04 January 2022

Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities

  • Ayesha A. Motala   ORCID: orcid.org/0000-0003-0517-1784 1 , 2 ,
  • Jean Claude Mbanya 3 ,
  • Kaushik Ramaiya 4 ,
  • Fraser J. Pirie 1 , 2 &
  • Kenneth Ekoru   ORCID: orcid.org/0000-0001-7353-4597 5  

Nature Reviews Endocrinology volume  18 ,  pages 219–229 ( 2022 ) Cite this article

1928 Accesses

17 Citations

11 Altmetric

Metrics details

  • Type 2 diabetes

Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable epidemiological transition fuelled by the pace of urbanization, with disease burden profiles shifting from communicable diseases to non-communicable diseases (NCDs). Information on the epidemiology of T2DM has increased, but wide variations in study methods, diagnostic biomarkers and criteria hamper analytical comparison, and data from high-quality studies are limited. The prevalence of T2DM is still low in some rural populations but moderate or high rates are reported in many countries/regions, with evidence for an increase in some. In addition, the proportion of undiagnosed T2DM is still high. The prevalence of T2DM is highest in African people living in urban areas, and the gradient between African people living in urban areas and people in the African diaspora is rapidly fading. However, data from longitudinal studies are lacking and there is limited information on chronic complications and the genetics of T2DM. The large unmet needs for T2DM care call for greater investment of resources into health systems to manage NCDs in SSA. Proposed health-system paradigms are being developed in some countries/regions. However, national NCD programmes need to be adequately funded and coordinated to stem the tide of T2DM and its complications.

Previously considered rare, type 2 diabetes mellitus (T2DM) is now firmly established in sub-Saharan Africa (SSA).

Although prevalence is low in some rural populations, moderate or high rates are reported in many countries/regions, with evidence for an increase in prevalence in some areas.

Information on the burden of T2DM has increased, but there is a need for high-quality epidemiology studies using harmonized approaches for sampling, data collection and diagnostic methods.

The increase in T2DM in SSA is associated with modifiable risk factors, such as urbanization and obesity, and there is a high proportion of undiagnosed T2DM.

Data on the genetics of T2DM are emerging and suggests a greater degree of genetic diversity in T2DM susceptibility in African people compared with other populations.

There are large unmet needs for T2DM care and national programmes need to be adequately funded and coordinated; integrated models of chronic disease health care that leverage resources across health-care systems are being piloted in some countries/regions.

This is a preview of subscription content, access via your institution

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 12 print issues and online access

195,33 € per year

only 16,28 € per issue

Rent or buy this article

Prices vary by article type

Prices may be subject to local taxes which are calculated during checkout

type 2 diabetes mellitus researchgate

NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 387 , 1513–1530 (2016).

Article   Google Scholar  

World Health Organization. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392 , 1736–1788 (2018).

International Diabetes Federation. IDF Diabetes Atlas, 9th edn . https://diabetesatlas.org/atlas/ninth-edition/ (2019).

Saeedi, P. et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res. Clin. Pract. 157 , 107843 (2019).

Article   PubMed   Google Scholar  

Mbanya, J. C., Motala, A. A., Sobngwi, E., Assah, F. K. & Enoru, S. T. Diabetes in sub-Saharan Africa. Lancet 375 , 2254–2266 (2010).

Atun, R. et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 5 , 622–667 (2017).

McLarty, D. G., Pollitt, C. & Swai, A. B. Diabetes in Africa. Diabet. Med. 7 , 670–684 (1990).

Article   CAS   PubMed   Google Scholar  

Manne-Goehler, J. et al. Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. Lancet Diabetes Endocrinol. 4 , 903–912 (2016).

NCD Risk Factor Collaboration (NCD-RisC)–Africa Working Group. Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int. J. Epidemiol. 46 , 1421–1432 (2017).

Gouda, H. N. et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017. Lancet Glob. Health 7 , e1375–e1387 (2019).

United Nations, Department of Economic and Social Affairs, Population Division . World Population Prospects 2019: Highlights (ST/ESA/SER.A/423) https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf (2019).

United Nations. Prevention and control of non-communicable diseases: Report of the Secretary-General https://undocs.org/en/A/66/83 (2011).

United Nations Development Program. Goal 3: Good Health and Well-Being https://sdgs.un.org/goals/goal3 (2016).

World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020 https://www.who.int/publications/i/item/9789241506236 (2013).

Peck, R. et al. Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey. Lancet Glob. Health 2 , e285–e292 (2014).

Article   PubMed   PubMed Central   Google Scholar  

Nyaaba, G. N., Stronks, K., de-Graft Aikins, A., Kengne, A. P. & Agyemang, C. Tracing Africa’s progress towards implementing the Non-Communicable Diseases Global action plan 2013-2020: a synthesis of WHO country profile reports. BMC Public Health 17 , 297 (2017).

Hall, V., Thomsen, R. W., Henriksen, O. & Lohse, N. Diabetes in sub Saharan Africa 1999-2011: epidemiology and public health implications. A systematic review. BMC Public Health 11 , 564 (2011).

Motala, A. A., Omar, M. A. & Pirie, F. J. Diabetes in Africa. Epidemiology of type 1 and type 2 diabetes in Africa. J. Cardiovasc. Risk 10 , 77–83 (2003).

Levitt, N. S. Diabetes in Africa: epidemiology, management and healthcare challenges. Heart 94 , 1376–1382 (2008).

World Health Organization. Diabetes mellitus: report of a WHO Study Group https://apps.who.int/iris/handle/10665/39592 (1985).

Alberti, K. G. & Zimmet, P. Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet. Med. 15 , 539–553 (1998).

Kahn, R. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20 , 1183–1197 (1997).

King, H. & Rewers, M. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group. Diabetes Care 16 , 157–177 (1993).

Peer, N. et al. Rising diabetes prevalence among urban-dwelling black South Africans. PLoS ONE 7 , e43336 (2012).

Article   CAS   PubMed   PubMed Central   Google Scholar  

Hird, T. R. et al. Burden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban Black South Africans: The Durban Diabetes Study. PLoS ONE 11 , e0161966 (2016).

Agyemang, C. et al. Obesity and type 2 diabetes in sub-Saharan Africans - is the burden in today’s Africa similar to African migrants in Europe? The RODAM study. BMC Med. 14 , 166 (2016).

Price, A. J. et al. Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi. Lancet Diabetes Endocrinol. 6 , 208–222 (2018).

World Health Organization. NCDs, STEPS Country Reports https://www.who.int/teams/noncommunicable-diseases/surveillance/data (2020).

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 37 (Suppl. 1), S81–S90 (2014).

World Health Organization. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation https://www.who.int/diabetes/publications/report-hba1c_2011.pdf (2011).

Shisana, O. et al. The South African National Health and Nutrition Examination Survey, 2012: SANHANES-1: the health and nutritional status of the nation . 72-98 (HSRC Press, 2014).

Ekoru, K. et al. H3Africa multi-centre study of the prevalence and environmental and genetic determinants of type 2 diabetes in sub-Saharan Africa: study protocol. Glob. Health Epidemiol. Genom. 1 , e5 (2016).

Levitt, N. S., Katzenellenbogen, J. M., Bradshaw, D., Hoffman, M. N. & Bonnici, F. The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa. Diabetes Care 16 , 601–607 (1993).

Omar, M. A., Seedat, M. A., Motala, A. A., Dyer, R. B. & Becker, P. The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks. S. Afr. Med. J. 83 , 641–643 (1993).

CAS   PubMed   Google Scholar  

Abubakari, A. R. et al. Prevalence and time trends in diabetes and physical inactivity among adult West African populations: the epidemic has arrived. Public Health 123 , 602–614 (2009).

Werfalli, M., Engel, M. E., Musekiwa, A., Kengne, A. P. & Levitt, N. S. The prevalence of type 2 diabetes among older people in Africa: a systematic review. Lancet Diabetes Endocrinol. 4 , 72–84 (2016).

Hird, T. R. Risk factors for cardiometabolic disease in the eThekwini Municipality (City of Durban), South Africa . Thesis, Univ. Cambridge https://doi.org/10.17863/CAM.13719 (2017).

Erasmus, R. T. et al. High prevalence of diabetes mellitus and metabolic syndrome in a South African coloured population: baseline data of a study in Bellville, Cape Town. S. Afr. Med. J. 102 , 841–844 (2012).

Prakaschandra, D. R., Esterhuizen, T. M., Motala, A. A., Gathiram, P. & Naidoo, D. P. High prevalence of cardiovascular risk factors in Durban South African Indians: the Phoenix Lifestyle Project. S. Afr. Med. J. 106 , 284–289 (2016).

Galbete, C. et al. Dietary patterns and type 2 diabetes among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study. Nutr. Diabetes 8 , 25 (2018).

Levitt, N. S. et al. Increased risk of dysglycaemia in South Africans with HIV; especially those on protease inhibitors. Diabetes Res. Clin. Pract. 119 , 41–47 (2016).

NCD Risk Factor CollaborationFactor. Collaboration (NCD-RisC). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331,288 participants. Lancet Diabetes Endocrinol. 3 , 624–637 (2015).

Rathod, S. D. et al. Glycated haemoglobin A 1c (HbA 1c ) for detection of diabetes mellitus and impaired fasting glucose in Malawi: a diagnostic accuracy study. BMJ Open 8 , e020972 (2018).

Hird, T. R. et al. HIV infection and anaemia do not affect HbA 1c for the detection of diabetes in black South Africans: evidence from the Durban Diabetes Study. Diabet. Med. 38 , e14605 (2021).

American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care 44 (Suppl. 1), S15–S33 (2021).

Mayega, R. W. et al. Comparison of fasting plasma glucose and haemoglobin A1c point-of-care tests in screening for diabetes and abnormal glucose regulation in a rural low income setting. Diabetes Res. Clin. Pract. 104 , 112–120 (2014).

Peer, N., George, J., Lombard, C., Levitt, N. & Kengne, A. P. Associations of glycated albumin and fructosamine with glycaemic status in urban black South Africans. Clin. Chim. Acta 519 , 291–297 (2021).

Abdullah, A., Peeters, A., de Courten, M. & Stoelwinder, J. The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res. Clin. Pract. 89 , 309–319 (2010).

DeFronzo, R. A. et al. Type 2 diabetes mellitus. Nat. Rev. Dis. Primers 1 , 15019 (2015).

Mahajan, A. et al. Fine-mapping type 2 diabetes loci to single-variant resolution using high-density imputation and islet-specific epigenome maps. Nat. Genet. 50 , 1505–1513 (2018).

Liu, Y. & Lou, X. Type 2 diabetes mellitus-related environmental factors and the gut microbiota: emerging evidence and challenges. Clinics 75 , e1277 (2020).

Ahmed, S. A. H., Ansari, S. A., Mensah-Brown, E. P. K. & Emerald, B. S. The role of DNA methylation in the pathogenesis of type 2 diabetes mellitus. Clin. Epigenet. 12 , 104 (2020).

Article   CAS   Google Scholar  

Erasmus, R. T. et al. Importance of family history in type 2 black South African diabetic patients. Postgrad. Med. J. 77 , 323–325 (2001).

Mbanya, J. C., Pani, L. N., Mbanya, D. N., Sobngwi, E. & Ngogang, J. Reduced insulin secretion in offspring of African type 2 diabetic parents. Diabetes Care 23 , 1761–1765 (2000).

Adeleye, J. O. & Abbiyesuku, F. M. Glucose and insulin responses in offspring of Nigerian type 2 diabetics. Afr. J. Med. Med. Sci. 31 , 253–257 (2002).

Asamoah, E. A. et al. Heritability and genetics of type 2 diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis. J. Diabetes Res. 2020 , 3198671 (2020).

Danquah, I. et al. The TCF7L2 rs7903146 (T) allele is associated with type 2 diabetes in urban Ghana: a hospital-based case-control study. BMC Med. Genet. 14 , 96 (2013).

Guewo-Fokeng, M. et al. Contribution of the TCF7L2 rs7903146 (C/T) gene polymorphism to the susceptibility to type 2 diabetes mellitus in Cameroon. J. Diabetes Metab. Disord. 14 , 26 (2015).

Nanfa, D. et al. Association between the TCF7L2 rs12255372 (G/T) gene polymorphism and type 2 diabetes mellitus in a Cameroonian population: a pilot study. Clin. Transl Med. 4 , 17 (2015).

Chen, J. et al. Genome-wide association study of type 2 diabetes in Africa. Diabetologia 62 , 1204–1211 (2019).

Adeyemo, A. A. et al. ZRANB3 is an African-specific type 2 diabetes locus associated with beta-cell mass and insulin response. Nat. Commun. 10 , 3195 (2019).

Scott, R. A. et al. An expanded genome-wide association study of type 2 diabetes in Europeans. Diabetes 66 , 2888–2902 (2017).

Hwang, J. Y. et al. Genome-wide association meta-analysis identifies novel variants associated with fasting plasma glucose in East Asians. Diabetes 64 , 291–298 (2015).

Cole, J. B. & Florez, J. C. Genetics of diabetes mellitus and diabetes complications. Nat. Rev. Nephrol. 16 , 377–390 (2020).

Liu, C. et al. Genome-wide association study for proliferative diabetic retinopathy in Africans. NPJ Genom. Med. 4 , 20 (2019).

Fuchsberger, C. et al. The genetic architecture of type 2 diabetes. Nature 536 , 41–47 (2016).

Ekoru, K. et al. Genetic risk scores for cardiometabolic traits in sub-Saharan African populations. Int. J. Epidemiol. 50 , 1283–1296 (2021).

Martin, A. R. et al. Clinical use of current polygenic risk scores may exacerbate health disparities. Nat. Genet. 51 , 584–591 (2019).

Meeks, K. A. C. et al. Epigenome-wide association study in whole blood on type 2 diabetes among sub-Saharan African individuals: findings from the RODAM study. Int. J. Epidemiol. 48 , 58–70 (2019).

Grieco, G. E. et al. The landscape of microRNAs in βcell: between phenotype maintenance and protection. Int. J. Mol. Sci. 22 , 803 (2021).

Article   CAS   PubMed Central   Google Scholar  

Ying, W. et al. Adipose tissue macrophage-derived exosomal mirnas can modulate in vivo and in vitro insulin sensitivity. Cell 171 , 372–384 (2017).

Matsha, T. E. et al. MicroRNA profiling and their pathways in South African individuals with prediabetes and newly diagnosed type 2 diabetes mellitus. Oncotarget 9 , 30485–30498 (2018).

Goedecke, J. H. & Olsson, T. Pathogenesis of type 2 diabetes risk in black Africans: a South African perspective. J. Intern. Med. 288 , 284–294 (2020).

Goedecke, J. H. et al. Ethnic differences in hepatic and systemic insulin sensitivity and their associated determinants in obese black and white South African women. Diabetologia 58 , 2647–2652 (2015).

Evans, J. et al. Depot- and ethnic-specific differences in the relationship between adipose tissue inflammation and insulin sensitivity. Clin. Endocrinol. 74 , 51–59 (2011).

Crowther, N. J., Cameron, N., Trusler, J. & Gray, I. P. Association between poor glucose tolerance and rapid post natal weight gain in seven-year-old children. Diabetologia 41 , 1163–1167 (1998).

Ekoru, K. et al. Type 2 diabetes complications and comorbidity in sub-Saharan Africans. EClinicalMedicine 16 , 30–41 (2019).

Sobngwi, E. et al. Type 2 diabetes control and complications in specialised diabetes care centres of six sub-Saharan African countries: the Diabcare Africa study. Diabetes Res. Clin. Pract. 95 , 30–36 (2012).

Mbanya, J. C. & Sobngwi, E. Diabetes in Africa. Diabetes microvascular and macrovascular disease in Africa. J. Cardiovasc. Risk 10 , 97–102 (2003).

Hayfron-Benjamin, C. et al. Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study. J. Diabetes Complications 33 , 572–578 (2019).

Burgess, P. I. et al. High prevalence in Malawi of sight-threatening retinopathy and visual impairment caused by diabetes: identification of population-specific targets for intervention. Diabet. Med. 31 , 1643–1650 (2014).

Ojo, A. Addressing the global burden of chronic kidney disease through clinical and translational research. Trans. Am. Clin. Climatol. Assoc. 125 , 229–243 (2014).

PubMed   PubMed Central   Google Scholar  

Crews, D. C., Pfaff, T. & Powe, N. R. Socioeconomic factors and racial disparities in kidney disease outcomes. Semin. Nephrol. 33 , 468–475 (2013).

Naicker, S. End-stage renal disease in sub-Saharan Africa. Ethn. Dis. 19 (Suppl. 1), S1-13-5 (2009).

PubMed   Google Scholar  

Engidaw, N. A., Wubetu, A. D. & Basha, E. A. Prevalence of depression and its associated factors among patients with diabetes mellitus at Tirunesh-Beijing general hospital, Addis Ababa, Ethiopia. BMC Public Health 20 , 266 (2020).

Mohamed, H. G. et al. Association between oral health status and type 2 diabetes mellitus among Sudanese adults: a matched case-control study. PLoS ONE 8 , e82158 (2013).

Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M. & Strong, K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 370 , 1929–1938 (2007).

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385 , 117–171 (2015).

Renzaho, A. M. The post-2015 development agenda for diabetes in sub-Saharan Africa: challenges and future directions. Glob. Health Action 8 , 27600 (2015).

Hove, M., Ngwerume, E. T. & Muchemwa, C. The urban crisis in Sub-Saharan Africa: a threat to human security and sustainable development. Stab. Int. J. Security Dev. 2 , 7 (2003).

Agyei-Mensah, S. & de-Graft Aikins, A. Epidemiological transition and the double burden of disease in Accra, Ghana. J. Urban. Health 87 , 879–897 (2010).

Manne-Goehler, J. et al. Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys. PLoS Med. 16 , e1002751 (2019).

Chan, J. C. N. et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 396 , 2019–2082 (2021).

International Diabetes Federation. Type 2 Diabetes Clinical Practise Guidelines for sub-Saharan Africa: IDF Africa Region https://www.worlddiabetesfoundation.org/sites/default/files/Type_2_IDF_Diabetes_Practical_Guidelines_small_eng.pdf (2006).

World Health Organization. Global Status Report on Noncommunicable Diseases 2014 https://www.who.int/publications/i/item/9789241564854 (2014).

World Health Organization. The Global Burden of Disease: 2004 update https://www.who.int/publications/i/item/9789241563710 (2004).

Lupafya, P. C., Mwagomba, B. L., Hosig, K., Maseko, L. M. & Chimbali, H. Implementation of policies and strategies for control of noncommunicable diseases in Malawi: challenges and opportunities. Health Educ. Behav. 43 , 64s–69s (2016).

Remais, J. V., Zeng, G., Li, G., Tian, L. & Engelgau, M. M. Convergence of non-communicable and infectious diseases in low- and middle-income countries. Int. J. Epidemiol. 42 , 221–227 (2013).

Rabkin, M. et al. Strengthening Health systems for chronic care: leveraging HIV programs to support diabetes services in Ethiopia and Swaziland. J. Trop. Med. 2012 , 137460 (2012).

Njuguna, B. et al. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps. AIDS 32 (Suppl. 1), S33–S42 (2018).

Bekele, H., Asefa, A., Getachew, B. & Belete, A. M. Barriers and strategies to lifestyle and dietary pattern interventions for prevention and management of type-2 diabetes in Africa, systematic review. J. Diabetes Res. 2020 , 7948712 (2020).

Download references

Acknowledgements

K.E. is supported by the Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), USA. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.

Review criteria

PubMed was searched using keywords including ‘diabetes and sub-Saharan Africa/Africa’, ‘diabetes prevalence and sub-Saharan Africa/Africa’, ‘risk of diabetes and sub-Saharan Africa/Africa’, ‘epidemiology of diabetes and sub-Saharan Africa/Africa’, ‘urbanization/urban/rural and diabetes and sub-Saharan Africa/Africa’, ‘physical activity and diabetes and Africa’, ‘genetics of diabetes and sub-Saharan Africa/Africa’, ‘GWAS and type 2 diabetes and sub-Saharan Africa’, ‘mortality and diabetes and Africa’, ‘HIV and diabetes and Africa’, ‘standards of care and sub-Saharan Africa’, ‘diabetes and … [each country in sub-Saharan Africa]’. Published peer-reviewed reviews and book chapters were included. The World Health Organization (WHO), International Diabetes Federation (IDF), United Nations and World Bank publications were used and their websites were also accessed for relevant information.

Author information

Authors and affiliations.

Inkosi Albert Luthuli Central Hospital, Durban, South Africa

Ayesha A. Motala & Fraser J. Pirie

Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa

Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences University of Yaounde 1, Yaounde, Cameroon

Jean Claude Mbanya

Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania

Kaushik Ramaiya

Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institute of Health, Bethesda, MD, USA

Kenneth Ekoru

You can also search for this author in PubMed   Google Scholar

Contributions

The authors contributed equally to all aspects of the article.

Corresponding author

Correspondence to Ayesha A. Motala .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Additional information

Peer review information.

Nature Reviews Endocrinology thanks R. Erasmus, B. Longo-Mbenza and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary information, rights and permissions.

Reprints and permissions

About this article

Cite this article.

Motala, A.A., Mbanya, J.C., Ramaiya, K. et al. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nat Rev Endocrinol 18 , 219–229 (2022). https://doi.org/10.1038/s41574-021-00613-y

Download citation

Accepted : 25 November 2021

Published : 04 January 2022

Issue Date : April 2022

DOI : https://doi.org/10.1038/s41574-021-00613-y

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.

  • Roberta Lamptey
  • Mary Amoakoh-Coleman
  • Kerstin Klipstein-Grobusch

BMC Health Services Research (2023)

Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

  • Jacob M. Gizamba
  • Jess Davies
  • Lara R. Dugas

BMC Infectious Diseases (2023)

Type 2 diabetes prevalence, awareness, and risk factors in rural Mali: a cross-sectional study

  • Abdoulaye Diawara
  • Djibril Mamadou Coulibaly
  • Jeffrey G. Shaffer

Scientific Reports (2023)

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

  • Kate E. Sheffer
  • Majid Ezzati

Nature Medicine (2023)

Quick links

  • Explore articles by subject
  • Guide to authors
  • Editorial policies

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

type 2 diabetes mellitus researchgate

Issue Cover

  • Previous Article
  • Next Article

Research Design and Methods

Article information, literature review of type 2 diabetes management and health literacy.

ORCID logo

  • Split-Screen
  • Article contents
  • Figures & tables
  • Supplementary Data
  • Peer Review
  • Open the PDF for in another window
  • Cite Icon Cite
  • Get Permissions

Rulla Alsaedi , Kimberly McKeirnan; Literature Review of Type 2 Diabetes Management and Health Literacy. Diabetes Spectr 1 November 2021; 34 (4): 399–406. https://doi.org/10.2337/ds21-0014

Download citation file:

  • Ris (Zotero)
  • Reference Manager

The purpose of this literature review was to identify educational approaches addressing low health literacy for people with type 2 diabetes. Low health literacy can lead to poor management of diabetes, low engagement with health care providers, increased hospitalization rates, and higher health care costs. These challenges can be even more profound among minority populations and non-English speakers in the United States.

A literature search and standard data extraction were performed using PubMed, Medline, and EMBASE databases. A total of 1,914 articles were identified, of which 1,858 were excluded based on the inclusion criteria, and 46 were excluded because of a lack of relevance to both diabetes management and health literacy. The remaining 10 articles were reviewed in detail.

Patients, including ethnic minorities and non-English speakers, who are engaged in diabetes education and health literacy improvement initiatives and ongoing follow-up showed significant improvement in A1C, medication adherence, medication knowledge, and treatment satisfaction. Clinicians considering implementing new interventions to address diabetes care for patients with low health literacy can use culturally tailored approaches, consider ways to create materials for different learning styles and in different languages, engage community health workers and pharmacists to help with patient education, use patient-centered medication labels, and engage instructors who share cultural and linguistic similarities with patients to provide educational sessions.

This literature review identified a variety of interventions that had a positive impact on provider-patient communication, medication adherence, and glycemic control by promoting diabetes self-management through educational efforts to address low health literacy.

Diabetes is the seventh leading cause of death in the United States, and 30.3 million Americans, or 9.4% of the U.S. population, are living with diabetes ( 1 , 2 ). For successful management of a complicated condition such as diabetes, health literacy may play an important role. Low health literacy is a well-documented barrier to diabetes management and can lead to poor management of medical conditions, low engagement with health care providers (HCPs), increased hospitalizations, and, consequently, higher health care costs ( 3 – 5 ).

The Healthy People 2010 report ( 6 ) defined health literacy as the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Diabetes health literacy also encompasses a wide range of skills, including basic knowledge of the disease state, self-efficacy, glycemic control, and self-care behaviors, which are all important components of diabetes management ( 3 – 5 , 7 ). According to the Institute of Medicine’s Committee on Health Literacy, patients with poor health literacy are twice as likely to have poor glycemic control and were found to be twice as likely to be hospitalized as those with adequate health literacy ( 8 ). Associations between health literacy and health outcomes have been reported in many studies, the first of which was conducted in 1995 in two public hospitals and found that many patients had inadequate health literacy and could not perform the basic reading tasks necessary to understand their treatments and diagnoses ( 9 ).

Evaluation of health literacy is vital to the management and understanding of diabetes. Several tools for assessing health literacy have been evaluated, and the choice of which to use depends on the length of the patient encounter and the desired depth of the assessment. One widely used literacy assessment tool, the Test of Functional Health Literacy in Adults (TOFHLA), consists of 36 comprehension questions and four numeric calculations ( 10 ). Additional tools that assess patients’ reading ability include the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Literacy Assessment for Diabetes. Tests that assess diabetes numeracy skills include the Diabetes Numeracy Test, the Newest Vital Sign (NVS), and the Single-Item Literacy Screener (SILS) ( 11 ).

Rates of both diabetes and low health literacy are higher in populations from low socioeconomic backgrounds ( 5 , 7 , 12 ). People living in disadvantaged communities face many barriers when seeking health care, including inconsistent housing, lack of transportation, financial difficulties, differing cultural beliefs about health care, and mistrust of the medical professions ( 13 , 14 ). People with high rates of medical mistrust tend to be less engaged in their care and to have poor communication with HCPs, which is another factor HCPs need to address when working with their patients with diabetes ( 15 ).

The cost of medical care for people with diabetes was $327 billion in 2017, a 26% increase since 2012 ( 1 , 16 ). Many of these medical expenditures are related to hospitalization and inpatient care, which accounts for 30% of total medical costs for people with diabetes ( 16 ).

People with diabetes also may neglect self-management tasks for various reasons, including low health literacy, lack of diabetes knowledge, and mistrust between patients and HCPs ( 7 , 15 ).

These challenges can be even more pronounced in vulnerable populations because of language barriers and patient-provider mistrust ( 17 – 19 ). Rates of diabetes are higher among racial and ethnic minority groups; 15.1% of American Indians and Alaskan Natives, 12.7% of Non-Hispanic Blacks, 12.1% of Hispanics, and 8% of Asian Americans have diagnosed diabetes, compared with 7.4% of non-Hispanic Whites ( 1 ). Additionally, patient-provider relationship deficits can be attributed to challenges with communication, including HCPs’ lack of attention to speaking slowly and clearly and checking for patients’ understanding when providing education or gathering information from people who speak English as a second language ( 15 ). White et al. ( 15 ) demonstrated that patients with higher provider mistrust felt that their provider’s communication style was less interpersonal and did not feel welcome as part of the decision-making process.

To the authors’ knowledge, there is no current literature review evaluating interventions focused on health literacy and diabetes management. There is a pressing need for such a comprehensive review to provide a framework for future intervention design. The objective of this literature review was to gather and summarize studies of health literacy–based diabetes management interventions and their effects on overall diabetes management. Medication adherence and glycemic control were considered secondary outcomes.

Search Strategy

A literature review was conducted using the PubMed, Medline, and EMBASE databases. Search criteria included articles published between 2015 and 2020 to identify the most recent studies on this topic. The search included the phrases “diabetes” and “health literacy” to specifically focus on health literacy and diabetes management interventions and was limited to original research conducted in humans and published in English within the defined 5-year period. Search results were exported to Microsoft Excel for evaluation.

Study Selection

Initial screening of the articles’ abstracts was conducted using the selection criteria to determine which articles to include or exclude ( Figure 1 ). The initial search results were reviewed for the following inclusion criteria: original research (clinical trials, cohort studies, and cross-sectional studies) conducted in human subjects with type 2 diabetes in the United States, and published in English between 2015 and 2020. Articles were considered to be relevant if diabetes was included as a medical condition in the study and an intervention was made to assess or improve health literacy. Studies involving type 1 diabetes or gestational diabetes and articles that were viewpoints, population surveys, commentaries, case reports, reviews, or reports of interventions conducted outside of the United States were excluded from further review. The criteria requiring articles to be from the past 5 years and from the United States were used because of the unique and quickly evolving nature of the U.S. health care system. Articles published more than 5 years ago or from other health care systems may have contributed information that was not applicable to or no longer relevant for HCPs in the United States. Articles were screened and reviewed independently by both authors. Disagreements were resolved through discussion to create the final list of articles for inclusion.

FIGURE 1. PRISMA diagram of the article selection process.

PRISMA diagram of the article selection process.

Data Extraction

A standard data extraction was performed for each included article to obtain information including author names, year of publication, journal, study design, type of intervention, primary outcome, tools used to assess health literacy or type 2 diabetes knowledge, and effects of intervention on overall diabetes management, glycemic control, and medication adherence.

A total of 1,914 articles were collected from a search of the PubMed, MEDLINE, and EMBASE databases, of which 1,858 were excluded based on the inclusion and exclusion criteria. Of the 56 articles that met criteria for abstract review, 46 were excluded because of a lack of relevance to both diabetes management and health literacy. The remaining 10 studies identified various diabetes management interventions, including diabetes education tools such as electronic medication instructions and text message–based interventions, technology-based education videos, enhanced prescription labels, learner-based education materials, and culturally tailored interventions ( 15 , 20 – 28 ). Figure 1 shows the PRISMA diagram of the article selection process, and Table 1 summarizes the findings of the article reviews ( 15 , 20 – 28 ).

Findings of the Article Reviews (15,20–28)

SAHLSA, Short Assessment of Health Literacy for Spanish Adults.

Medical mistrust and poor communication are challenging variables in diabetes education. White et al. ( 15 ) examined the association between communication quality and medical mistrust in patients with type 2 diabetes. HCPs at five health department clinics received training in effective health communication and use of the PRIDE (Partnership to Improve Diabetes Education) toolkit in both English and Spanish, whereas control sites were only exposed to National Diabetes Education Program materials without training in effective communication. The study evaluated participant communication using several tools, including the Communication Assessment Tool (CAT), Interpersonal Processes of Care (IPC-18), and the Short Test of Functional Health Literacy in Adults (s-TOFHLA). The authors found that higher levels of mistrust were associated with lower CAT and IPC-18 scores.

Patients with type 2 diabetes are also likely to benefit from personalized education delivery tools such as patient-centered labeling (PCL) of prescription drugs, learning style–based education materials, and tailored text messages ( 24 , 25 , 27 ). Wolf et al. ( 27 ) investigated the use of PCL in patients with type 2 diabetes and found that patients with low health literacy who take medication two or more times per day have higher rates of proper medication use when using PCL (85.9 vs. 77.4%, P = 0.03). The objective of the PCL intervention was to make medication instructions and other information on the labels easier to read to improve medication use and adherence rates. The labels incorporated best-practice strategies introduced by the Institute of Medicine for the Universal Medication Schedule. These strategies prioritize medication information, use of larger font sizes, and increased white space. Of note, the benefits of PCL were largely seen with English speakers. Spanish speakers did not have substantial improvement in medication use or adherence, which could be attributed to language barriers ( 27 ).

Nelson et al. ( 25 ) analyzed patients’ engagement with an automated text message approach to supporting diabetes self-care activities in a 12-month randomized controlled trial (RCT) called REACH (Rapid Education/Encouragement and Communications for Health) ( 25 ). Messages were tailored based on patients’ medication adherence, the Information-Motivation-Behavioral Skills model of health behavior change, and self-care behaviors such as diet, exercise, and self-monitoring of blood glucose. Patients in this trial were native English speakers, so further research to evaluate the impact of the text message intervention in patients with limited English language skills is still needed. However, participants in the intervention group reported higher engagement with the text messages over the 12-month period ( 25 ).

Patients who receive educational materials based on their learning style also show significant improvement in their diabetes knowledge and health literacy. Koonce et al. ( 24 ) developed and evaluated educational materials based on patients’ learning style to improve health literacy in both English and Spanish languages. The materials were made available in multiple formats to target four different learning styles, including materials for visual learners, read/write learners, auditory learners, and kinesthetic learners. Spanish-language versions were also available. Researchers were primarily interested in measuring patients’ health literacy and knowledge of diabetes. The intervention group received materials in their preferred learning style and language, whereas the control group received standard of care education materials. The intervention group showed significant improvement in diabetes knowledge and health literacy, as indicated by Diabetes Knowledge Test (DKT) scores. More participants in the intervention group reported looking up information about their condition during week 2 of the intervention and showed an overall improvement in understanding symptoms of nerve damage and types of food used to treat hypoglycemic events. However, the study had limited enrollment of Spanish speakers, making the applicability of the results to Spanish-speaking patients highly variable.

Additionally, findings by Hofer et al. ( 22 ) suggest that patients with high A1C levels may benefit from interventions led by community health workers (CHWs) to bridge gaps in health literacy and equip patients with the tools to make health decisions. In this study, Hispanic and African American patients with low health literacy and diabetes not controlled by oral therapy benefited from education sessions led by CHWs. The CHWs led culturally tailored support groups to compare the effects of educational materials provided in an electronic format (via iDecide) and printed format on medication adherence and self-efficacy. The study found increased adherence with both formats, and women, specifically, had a significant increase in medication adherence and self-efficacy. One of the important aspects of this study was that the CHWs shared cultural and linguistic characteristics with the patients and HCPs, leading to increased trust and satisfaction with the information presented ( 22 ).

Kim et al. ( 23 ) found that Korean-American participants benefited greatly from group education sessions that provided integrated counseling led by a team of nurses and CHW educators. The intervention also had a health literacy component that focused on enhancing skills such as reading food package labels, understanding medical terminology, and accessing health care services. This intervention led to a significant reduction of 1–1.3% in A1C levels in the intervention group. The intervention established the value of collaboration between CHW educators and nurses to improve health information delivery and disease management.

A collaboration between CHW educators and pharmacists was also shown to reinforce diabetes knowledge and improve health literacy. Sharp et al. ( 26 ) conducted a cross-over study in four primary care ambulatory clinics that provided care for low-income patients. The study found that patients with low health literacy had more visits with pharmacists and CHWs than those with high health literacy. The CHWs provided individualized support to reinforce diabetes self-management education and referrals to resources such as food, shelter, and translation services. The translation services in this study were especially important for building trust with non-English speakers and helping patients understand their therapy. Similar to other studies, the CHWs shared cultural and linguistic characteristics with their populations, which helped to overcome communication-related and cultural barriers ( 23 , 26 ).

The use of electronic tools or educational videos yielded inconclusive results with regard to medication adherence. Graumlich et al. ( 20 ) implemented a new medication planning tool called Medtable within an electronic medical record system in several outpatient clinics serving patients with type 2 diabetes. The tool was designed to organize medication review and patient education. Providers can use this tool to search for medication instructions and actionable language that are appropriate for each patient’s health literacy level. The authors found no changes in medication knowledge or adherence, but the intervention group reported higher satisfaction. On the other hand, Yeung et al. ( 28 ) showed that pharmacist-led online education videos accessed using QR codes affixed to the patients’ medication bottles and health literacy flashcards increased patients’ medication adherence in an academic medical hospital.

Goessl et al. ( 21 ) found that patients with low health literacy had significantly higher retention of information when receiving evidence-based diabetes education through a DVD recording than through an in-person group class. This 18-month RCT randomized participants to either the DVD or in-person group education and assessed their information retention through a teach-back strategy. The curriculum consisted of diabetes prevention topics such as physical exercise, food portions, and food choices. Participants in the DVD group had significantly higher retention of information than those in the control (in-person) group. The authors suggested this may have been because participants in the DVD group have multiple opportunities to review the education material.

Management of type 2 diabetes remains a challenge for HCPs and patients, in part because of the challenges discussed in this review, including communication barriers between patients and HCPs and knowledge deficits about medications and disease states ( 29 ). HCPs can have a positive impact on the health outcomes of their patients with diabetes by improving patients’ disease state and medication knowledge.

One of the common themes identified in this literature review was the prevalence of culturally tailored diabetes education interventions. This is an important strategy that could improve diabetes outcomes and provide an alternative approach to diabetes self-management education when working with patients from culturally diverse backgrounds. HCPs might benefit from using culturally tailored educational approaches to improve communication with patients and overcome the medical mistrust many patients feel. Although such mistrust was not directly correlated with diabetes management, it was noted that patients who feel mistrustful tend to have poor communication with HCPs ( 20 ). Additionally, Latino/Hispanic patients who have language barriers tend to have poor glycemic control ( 19 ). Having CHWs work with HCPs might mitigate some patient-provider communication barriers. As noted earlier, CHWs who share cultural and linguistic characteristics with their patient populations have ongoing interactions and more frequent one-on-one encounters ( 12 ).

Medication adherence and glycemic control are important components of diabetes self-management, and we noted that the integration of CHWs into the diabetes health care team and the use of simplified medication label interventions were both successful in improving medication adherence ( 23 , 24 ). The use of culturally tailored education sessions and the integration of pharmacists and CHWs into the management of diabetes appear to be successful in reducing A1C levels ( 12 , 26 ). Electronic education tools and educational videos alone did not have an impact on medication knowledge or information retention in patients with low health literacy, but a combination of education tools and individualized sessions has the potential to improve diabetes medication knowledge and overall self-management ( 20 , 22 , 30 ).

There were several limitations to our literature review. We restricted our search criteria to articles published in English and studies conducted within the United States to ensure that the results would be relevant to U.S. HCPs. However, these limitations may have excluded important work on this topic. Additional research expanding this search beyond the United States and including articles published in other languages may demonstrate different outcomes. Additionally, this literature review did not focus on A1C as the primary outcome, although A1C is an important indicator of diabetes self-management. A1C was chosen as the method of evaluating the impact of health literacy interventions in patients with diabetes, but other considerations such as medication adherence, impact on comorbid conditions, and quality of life are also important factors.

The results of this work show that implementing health literacy interventions to help patients manage type 2 diabetes can have beneficial results. However, such interventions can have significant time and monetary costs. The potential financial and time costs of diabetes education interventions were not evaluated in this review and should be taken into account when designing interventions. The American Diabetes Association estimated the cost of medical care for people with diabetes to be $327 billion in 2017, with the majority of the expenditure related to hospitalizations and nursing home facilities ( 16 ). Another substantial cost of diabetes that can be difficult to measure is treatment for comorbid conditions and complications such as cardiovascular and renal diseases.

Interventions designed to address low health literacy and provide education about type 2 diabetes could be a valuable asset in preventing complications and reducing medical expenditures. Results of this work show that clinicians who are considering implementing new interventions may benefit from the following strategies: using culturally tailored approaches, creating materials for different learning styles and in patients’ languages, engaging CHWs and pharmacists to help with patient education, using PCLs for medications, and engaging education session instructors who share patients’ cultural and linguistic characteristics.

Diabetes self-management is crucial to improving health outcomes and reducing medical costs. This literature review identified interventions that had a positive impact on provider-patient communication, medication adherence, and glycemic control by promoting diabetes self-management through educational efforts to address low health literacy. Clinicians seeking to implement diabetes care and education interventions for patients with low health literacy may want to consider drawing on the strategies described in this article. Providing culturally sensitive education that is tailored to patients’ individual learning styles, spoken language, and individual needs can improve patient outcomes and build patients’ trust.

Duality of Interest

No potential conflicts of interest relevant to this article were reported.

Author Contributions

Both authors conceptualized the literature review, developed the methodology, analyzed the data, and wrote, reviewed, and edited the manuscript. R.A. collected the data. K.M. supervised the review. K.M. is the guarantor of this work and, as such, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Prior Presentation

Portions of this research were presented at the Washington State University College of Pharmacy and Pharmaceutical Sciences Honors Research Day in April 2019.

Email alerts

  • Online ISSN 1944-7353
  • Print ISSN 1040-9165
  • Diabetes Care
  • Clinical Diabetes
  • Diabetes Spectrum
  • Standards of Medical Care in Diabetes
  • Scientific Sessions Abstracts
  • BMJ Open Diabetes Research & Care
  • ShopDiabetes.org
  • ADA Professional Books

Clinical Compendia

  • Clinical Compendia Home
  • Latest News
  • DiabetesPro SmartBrief
  • Special Collections
  • DiabetesPro®
  • Diabetes Food Hub™
  • Insulin Affordability
  • Know Diabetes By Heart™
  • About the ADA
  • Journal Policies
  • For Reviewers
  • Advertising in ADA Journals
  • Reprints and Permission for Reuse
  • Copyright Notice/Public Access Policy
  • ADA Professional Membership
  • ADA Member Directory
  • Diabetes.org
  • X (Twitter)
  • Cookie Policy
  • Accessibility
  • Terms & Conditions
  • Get Adobe Acrobat Reader
  • © Copyright American Diabetes Association

This Feature Is Available To Subscribers Only

Sign In or Create an Account

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

  • Advanced Search
  • Journal List
  • v.7(2); 2018 May

Logo of jhematol

Prevalence of Anemia in Type 2 Diabetic Patients

Salma m. aldallal.

a Haematology Laboratory, Amiri Hospital, Kuwait

Nirupama Jena

b Department of Biochemistry, Amiri Hospital, Kuwait

The aim of the study was to determine the prevalence of anemia in patients with type 2 diabetes and to assess the risk of anemia according to gender, age and glycemic control.

The study group comprised of patients with type 2 diabetes attending Outpatient Diabetic Department of Amiri Hospital (Al-Asimah Capital area) from January 1, 2016 to December 31, 2017. Patients were divided into groups according to glycemic status and gender. Glycated hemoglobin (HbA1C) values and hemoglobin (Hb) levels were evaluated. The presence of anemia was defined by an Hb level < 13.0 g/dL for men and < 12.0 g/dL for women.

The prevalence of anemia is significantly greater in diabetic females (38.5%) than in diabetic males (21.6%) and in poorly controlled diabetics (33.46%) than those with glycemic status under control (27.9%) (P < 0.05). The average age of patients with anemia was found to be 60.69 ± 0.198 years and the average age of patients without anemia was found to be 54.07 ± 0.121 years. This indicates that the risk of anemia increases with age.

Screening for anemia at the time of diagnosis of diabetes, diabetic medication compliance, awareness of the risk of anemia and other complications in the diabetic patients helps in reducing the prevalence of anemia in diabetic population.

Introduction

Anemia, as defined by World Health Organization (WHO) criteria less than 130 g/L for men and less than 120 g/L for women, is a common blood disorder [ 1 , 2 ] and it is a condition in which the number of red blood cells (RBCs) is inadequate to meet the physiologic needs of the human body [ 3 ]. According to WHO, around half of the cases of anemia in the world are due to iron deficiency anemia (IDA) [ 4 ]. The reports showed that the prevalence of IDA is 2.5 times that of anemia [ 5 ]. In Kuwait, it is estimated that the prevalence of anemia is 3% in adult males and 17% in females [ 5 ].

Diabetes mellitus is one of the major causes of morbidity and mortality worldwide [ 6 ]. Worldwide prevalence of diabetes mellitus is 8.3% affecting approximately 382 million people. In Kuwait, the prevalence of type 1 diabetes is 2.8% among expatriates and 2.3% among natives in the age group of 0 - 20 years. Asian expatriates of the age group 30 - 60 years exhibit higher prevalence of type 2 diabetes than natives at 25.4% [ 7 ].

Diabetes mellitus can be classified into two types based on the insulin dependence. Type 1 diabetes mellitus is also known as juvenile diabetes or insulin-dependent diabetes, resulting from autoimmune destruction of insulin producing beta cells of pancreas. Whereas non-insulin-dependent diabetes, i.e. type 2 diabetes mellitus, results from insulin resistance. This is commonly seen in adults. Another type of diabetes, known as gestational diabetes, can develop during pregnancy, which improves or disappears after delivery, but studies showed that 20-50% cases of these can develop type 2 diabetes later in life [ 8 ].

Patients with type 2 diabetes mellitus are twice more likely to be prone to anemia than the patients without diabetes [ 9 ]. Bosman et al (2001) identified anemia as a risk factor for cardiovascular and end-stage renal diseases in diabetic patients [ 10 ]. Keane and Lyle (2003) [ 11 ] further proved that reduced hemoglobin (Hb) level identifies diabetic patients at increased risk for hospitalization and premature death. Despite these facts, anemia is unrecognized in 25% of the diabetic patients [ 12 ]. Recent studies have shown that the incidence of anemia in patients with diabetes is mostly associated with the presence of renal insufficiency. Thus, diabetic patients have a greater degree of anemia for their level of renal impairment than non-diabetic patients presenting with other causes of renal failure [ 1 , 10 , 13 - 15 ].

Factors suggested as the reason for the earlier onset of anemia in diabetic patients include systemic inflammation, inhibition of erythropoietin release, damage to the renal interstitium, severe symptomatic autonomic neuropathy causing efferent sympathetic denervation of the kidney and loss of appropriate erythropoietin, drugs, altered iron metabolism and hyper glycemia [ 16 ].

Some studies have shown that the diabetic patients with renal insufficiency are at a higher risk of developing anemia than normal diabetics as the ability of their kidneys to produce erythropoietin reduces. Also, the hormone responsible for the production of RBCs is affected by diabetic neuropathy resulting in anemia [ 2 , 17 , 18 ]. Subjects with diabetes also have nutritional deficiencies for cyanocobalamin, folate and iron which may result in different types of anemia. Metformin may interfere with cyanocobalamin absorption, resulting in vitamin B12 deficiency anemia [ 19 , 20 ]. Because of the fact that both anemia and type 2 diabetes share similar symptoms like pale skin, chest pain, numbness or coldness in the extremities, shortness of breath and headache [ 20 ], anemia remains unidentified in most of the diabetes patients. Hence, it is important to identify anemia in the diabetic patients.

To estimate the prevalence of anemia in patients with type 2 diabetes mellitus in one Capital area of Kuwait, we analyzed data from laboratory information system (LIS) for adult patients attending Diabetes Outpatient Department (OPD) during January 2016 - December 2017. Data were analyzed according to gender, age and HbA1C status.

Materials and Methods

This was a retrospective study of patients attending OPD of Amiri Hospital (Al-Asima Capital area) and polyclinics, Kuwait. Data were collected from LIS with the approval of Health Center’s ethics committee.

The study includes adult male and female patients with type 2 diabetes mellitus. Patients were divided into groups according to: 1) glycemic status, i.e. those with well controlled diabetes whose HbA1C level was equal to or less than 7.5% and poorly controlled diabetic group comprising those whose HbA1C level was greater than 7.5%; 2) gender, i.e. male and female; 3) presence of anemia which was considered as per the WHO gender specific criteria, i.e. less than 13 g/dL in men and less than 12 g/dL in women [ 16 ].

Data collection

Data of the study subjects were collected for a time period of 2 years between January 1, 2016 and December 31, 2017. From each case record, the information was collected under the following headings: age, gender, Hb value, and HbA1C value.

Exclusion criteria

Patients with type 1 diabetes mellitus were excluded.

Statistical analysis

Descriptive analysis was used to characterize the study sample by demographics, including gender, age, anemia and HbA1C level. Statistical analysis was performed using SPSS version 20.0. Significance was set as P < 0.05.

This retrospective observational study was conducted at the OPD of Amiri Hospital (Al-Asima Capital area) and polyclinics, Kuwait. A total of 19,059 patients were included in the study, of which 9,957 were males and 9,102 were females ( Table 1 ).

The average age of patients with anemia was found to be 60.69 ± 0.198 years. The average age of patients without anemia was found to be 54.07 ± 0.121 years. The difference in the average age was statistically significant in the patients with anemia and without anemia (P < 0.05). This indicates that the risk of anemia increases with age.

Among these 19,059 patients, 5,655 patients were found to be anemic accounting for 29.7% prevalence of anemia in this population; 21.6% of diabetic males and 38.5% of diabetic females were found to be anemic.

Of these 19,059 patients, 13,038 had their diabetes under control, whereas 6,021 patients were poorly controlled diabetics; 27.9% patients of the well controlled diabetic group had anemia, whereas 33.46% patients of poorly controlled diabetic group had anemia ( Fig. 1 ).

An external file that holds a picture, illustration, etc.
Object name is jh-07-057-g001.jpg

Categorization of patients according to presence of anemia based upon the diabetes control status.

There is a statistically significant relation between prevalence of anemia and gender, i.e. the prevalence of anemia is significantly greater in diabetic females than diabetic males (P < 0.05). The prevalence of anemia is significantly greater in poorly controlled diabetics than those with glycemic status under control (P < 0.05) ( Fig. 2 ).

An external file that holds a picture, illustration, etc.
Object name is jh-07-057-g002.jpg

Prevalence of anemia according to gender and glycemic status in type 2 diabetic patients.

Patients with type 2 diabetes mellitus are twice more likely to be prone to anemia than the patients without diabetes. Bosman et al (2001) identified anemia as a risk factor for cardiovascular and end-stage renal diseases in diabetic patients [ 10 ]. Keane and Lyle (2003) [ 11 ] further proved that reduced Hb level identifies diabetic patients at increased risk for hospitalization and premature death. Despite these facts, anemia is unrecognized in 25% of the diabetic patients [ 12 ]. The current study estimated the prevalence of anemia in diabetic subjects and assessed the risk of anemia according to gender, age and glycemic control.

The prevalence of anemia in this study population was found to be 29.7% which is in contrast with the prevalence reported by Sharif et al (2014) which was 63% [ 6 ]. The huge difference in the prevalence of anemia might be due to the fact that population in this study were mostly poorly controlled diabetics (71.5%), whereas in the current study, 68% of the subjects are well controlled diabetics.

We found that diabetic females were at higher risk of anemia than diabetic males. This finding is consistent with the findings of Alsayegh et al (2017) which reported prevalence as 35.8% vs. 21.3% in diabetic females versus diabetic males [ 21 ]. The possible reason for higher prevalence of anemia in females might be due to poor nutrition, less importance given to their own health due to lack of empowerment. This can be improved by educational interventions such as health awareness programs in the rural areas, provision of iron rich food, prescription of vitamin and iron supplements and knowledge of the diabetic complications [ 22 ].

In our study, the prevalence of anemia is significantly higher in the poorly controlled diabetics. Also, the average age of the patients with anemia is significantly higher than average age of patients without anemia. These findings are in agreement with a recently published study by Mounika et al (2017) which reported poor glycemic control and old age to be associated with the higher incidence of anemia in diabetic patients [ 23 ]. Choi et al (2004) have also shown that the prevalence of anemia increases with the increasing age. The possible reasons for this increased prevalence with age might be due to deficiencies of vitamins such as folate, cyanocobalamin or bone marrow disorders and higher number of comorbidities [ 24 ]. In patients with poorly controlled diabetes, the erythrocyte precursors of the bone marrow might be prone to prolonged direct toxicity to glucose toxicity or the mature erythrocytes can be affected by oxidative stress leading to disturbances in the erythrocyte function [ 25 ].

This prospective observational study found a higher prevalence of anemia in diabetic females and patients with poorly controlled diabetes. Keeping the diabetes under control and proper investigations to identify anemia in diabetic patients at an early stage can reduce the severity of the complications caused due to anemia in diabetic population. Diabetic females and diabetic elderly are the most vulnerable group to anemia, thus care should be taken in terms of their nutrition and supplements. Physicians should be aware of the risk of anemia in these subgroups and should prescribe them with vitamin and iron supplements if required. Medication compliance must be achieved in the diabetic population in order to keep the glucose levels in the normal range. Awareness must be provided to the diabetic population at the time of their diagnosis of the risk of anemia and other complications of diabetes.

Acknowledgments

We would like to acknowledge Amiri Hospital (Al-Asima Capital area) and polyclinics, Kuwait for their kind cooperation in carrying out this study. The authors are thankful to www.manuscriptedit.com for providing English language editing and proofreading services for this manuscript. Special thanks to Mr. Gaurav Gyan Sharma (ATC, Kuwait) for helping in retrieving data from LIS.

Conflict of Interest

No conflict of interest is declared.

Abbreviations

  • Patient Care & Health Information
  • Diseases & Conditions
  • Type 2 diabetes

Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems.

In type 2 diabetes, there are primarily two problems. The pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into the cells. And cells respond poorly to insulin and take in less sugar.

Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in older adults. But the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people.

There's no cure for type 2 diabetes. Losing weight, eating well and exercising can help manage the disease. If diet and exercise aren't enough to control blood sugar, diabetes medications or insulin therapy may be recommended.

Products & Services

  • A Book: The Essential Diabetes Book
  • A Book: The Mayo Clinic Diabetes Diet
  • Assortment of Health Products from Mayo Clinic Store

Symptoms of type 2 diabetes often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. When symptoms are present, they may include:

  • Increased thirst.
  • Frequent urination.
  • Increased hunger.
  • Unintended weight loss.
  • Blurred vision.
  • Slow-healing sores.
  • Frequent infections.
  • Numbness or tingling in the hands or feet.
  • Areas of darkened skin, usually in the armpits and neck.

When to see a doctor

See your health care provider if you notice any symptoms of type 2 diabetes.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Type 2 diabetes is mainly the result of two problems:

  • Cells in muscle, fat and the liver become resistant to insulin As a result, the cells don't take in enough sugar.
  • The pancreas can't make enough insulin to keep blood sugar levels within a healthy range.

Exactly why this happens is not known. Being overweight and inactive are key contributing factors.

How insulin works

Insulin is a hormone that comes from the pancreas — a gland located behind and below the stomach. Insulin controls how the body uses sugar in the following ways:

  • Sugar in the bloodstream triggers the pancreas to release insulin.
  • Insulin circulates in the bloodstream, enabling sugar to enter the cells.
  • The amount of sugar in the bloodstream drops.
  • In response to this drop, the pancreas releases less insulin.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues. The use and regulation of glucose includes the following:

  • Glucose comes from two major sources: food and the liver.
  • Glucose is absorbed into the bloodstream, where it enters cells with the help of insulin.
  • The liver stores and makes glucose.
  • When glucose levels are low, the liver breaks down stored glycogen into glucose to keep the body's glucose level within a healthy range.

In type 2 diabetes, this process doesn't work well. Instead of moving into the cells, sugar builds up in the blood. As blood sugar levels rise, the pancreas releases more insulin. Eventually the cells in the pancreas that make insulin become damaged and can't make enough insulin to meet the body's needs.

Risk factors

Factors that may increase the risk of type 2 diabetes include:

  • Weight. Being overweight or obese is a main risk.
  • Fat distribution. Storing fat mainly in the abdomen — rather than the hips and thighs — indicates a greater risk. The risk of type 2 diabetes is higher in men with a waist circumference above 40 inches (101.6 centimeters) and in women with a waist measurement above 35 inches (88.9 centimeters).
  • Inactivity. The less active a person is, the greater the risk. Physical activity helps control weight, uses up glucose as energy and makes cells more sensitive to insulin.
  • Family history. An individual's risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes.
  • Race and ethnicity. Although it's unclear why, people of certain races and ethnicities — including Black, Hispanic, Native American and Asian people, and Pacific Islanders — are more likely to develop type 2 diabetes than white people are.
  • Blood lipid levels. An increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — and high levels of triglycerides.
  • Age. The risk of type 2 diabetes increases with age, especially after age 35.
  • Prediabetes. Prediabetes is a condition in which the blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes.
  • Pregnancy-related risks. The risk of developing type 2 diabetes is higher in people who had gestational diabetes when they were pregnant and in those who gave birth to a baby weighing more than 9 pounds (4 kilograms).
  • Polycystic ovary syndrome. Having polycystic ovary syndrome — a condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

Complications

Type 2 diabetes affects many major organs, including the heart, blood vessels, nerves, eyes and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious diseases. Managing diabetes and controlling blood sugar can lower the risk for these complications and other medical conditions, including:

  • Heart and blood vessel disease. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels, a condition called atherosclerosis.
  • Nerve damage in limbs. This condition is called neuropathy. High blood sugar over time can damage or destroy nerves. That may result in tingling, numbness, burning, pain or eventual loss of feeling that usually begins at the tips of the toes or fingers and gradually spreads upward.
  • Other nerve damage. Damage to nerves of the heart can contribute to irregular heart rhythms. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. Nerve damage also may cause erectile dysfunction.
  • Kidney disease. Diabetes may lead to chronic kidney disease or end-stage kidney disease that can't be reversed. That may require dialysis or a kidney transplant.
  • Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.
  • Skin conditions. Diabetes may raise the risk of some skin problems, including bacterial and fungal infections.
  • Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
  • Hearing impairment. Hearing problems are more common in people with diabetes.
  • Sleep apnea. Obstructive sleep apnea is common in people living with type 2 diabetes. Obesity may be the main contributing factor to both conditions.
  • Dementia. Type 2 diabetes seems to increase the risk of Alzheimer's disease and other disorders that cause dementia. Poor control of blood sugar is linked to a more rapid decline in memory and other thinking skills.

Healthy lifestyle choices can help prevent type 2 diabetes. If you've received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes.

A healthy lifestyle includes:

  • Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains.
  • Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming.
  • Losing weight. If you are overweight, losing a modest amount of weight and keeping it off may delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight may reduce the risk of diabetes.
  • Avoiding long stretches of inactivity. Sitting still for long periods of time can increase the risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.

For people with prediabetes, metformin (Fortamet, Glumetza, others), a diabetes medication, may be prescribed to reduce the risk of type 2 diabetes. This is usually prescribed for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

More Information

  • Diabetes prevention: 5 tips for taking control
  • Professional Practice Committee: Standards of Medical Care in Diabetes — 2020. Diabetes Care. 2020; doi:10.2337/dc20-Sppc.
  • Diabetes mellitus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed Dec. 7, 2020.
  • Melmed S, et al. Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 3, 2020.
  • Diabetes overview. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/all-content. Accessed Dec. 4, 2020.
  • AskMayoExpert. Type 2 diabetes. Mayo Clinic; 2018.
  • Feldman M, et al., eds. Surgical and endoscopic treatment of obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Oct. 20, 2020.
  • Hypersmolar hyperglycemic state (HHS). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hyperosmolar-hyperglycemic-state-hhs. Accessed Dec. 11, 2020.
  • Diabetic ketoacidosis (DKA). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka. Accessed Dec. 11, 2020.
  • Hypoglycemia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia. Accessed Dec. 11, 2020.
  • 6 things to know about diabetes and dietary supplements. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/tips/things-to-know-about-type-diabetes-and-dietary-supplements. Accessed Dec. 11, 2020.
  • Type 2 diabetes and dietary supplements: What the science says. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/type-2-diabetes-and-dietary-supplements-science. Accessed Dec. 11, 2020.
  • Preventing diabetes problems. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/all-content. Accessed Dec. 3, 2020.
  • Schillie S, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports. 2018; doi:10.15585/mmwr.rr6701a1.
  • Caffeine: Does it affect blood sugar?
  • GLP-1 agonists: Diabetes drugs and weight loss
  • Hyperinsulinemia: Is it diabetes?
  • Medications for type 2 diabetes

Associated Procedures

  • Bariatric surgery
  • Endoscopic sleeve gastroplasty
  • Gastric bypass (Roux-en-Y)
  • Glucose tolerance test

News from Mayo Clinic

  • Mayo study uses electronic health record data to assess metformin failure risk, optimize care Feb. 10, 2023, 02:30 p.m. CDT
  • Mayo Clinic Minute: Strategies to break the heart disease and diabetes link Nov. 28, 2022, 05:15 p.m. CDT
  • Mayo Clinic Q and A: Diabetes risk in Hispanic people Oct. 20, 2022, 12:15 p.m. CDT
  • The importance of diagnosing, treating diabetes in the Hispanic population in the US Sept. 28, 2022, 04:00 p.m. CDT
  • Mayo Clinic Minute: Managing Type 2 diabetes Sept. 28, 2022, 02:30 p.m. CDT
  • Symptoms & causes
  • Diagnosis & treatment
  • Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

  • Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

  • Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
  • The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
  • Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
  • FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
  • Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Let’s celebrate our doctors!

Join us in celebrating and honoring Mayo Clinic physicians on March 30th for National Doctor’s Day.

IMAGES

  1. Pathophysiology of type 1 and type 2 diabetes mellitus which leads to

    type 2 diabetes mellitus researchgate

  2. Understanding types of Diabetes Mellitus

    type 2 diabetes mellitus researchgate

  3. Type 2 Diabetes Mellitus: Causes, Symptoms And Treatment

    type 2 diabetes mellitus researchgate

  4. What Is Type 2 Diabetes Mellitus

    type 2 diabetes mellitus researchgate

  5. (PDF) Should we listen to our clock to prevent type 2 diabetes mellitus

    type 2 diabetes mellitus researchgate

  6. The Early Treatment of Type 2 Diabetes

    type 2 diabetes mellitus researchgate

COMMENTS

  1. (PDF) Type 2 Diabetes: An Overview

    Chronic, non-communicable type 2 diabetes mellitus can cause major long-term consequences, including abnormalities of the heart, blood vessels in the legs, eyes, brain, kidneys, and reproductive ...

  2. (PDF) Diabetes Mellitus Type 2

    Babic-Prvulovic Marijana. Objective. The aim of this work is to analyze the success in treating people with diabetes mellitus type 2 during a 10- day stay within a program of education and ...

  3. Type 2 diabetes mellitus

    Type 2 Diabetes Mellitus (T2DM) is an expanding global health problem, closely linked to the epidemic of obesity and this type, either our body does not create enough insulin or human body cells ...

  4. (PDF) Diabetes Mellitus: A Review

    Type 2 DM or non-insulin-dependent diabetes mellitus (NIDDM), results from insulin resistance, a condition in which cells fail to use insulin properly, with or without an absolute insulin deficiency.

  5. Physiological and psychological determinants of long ...

    Type 2 diabetes mellitus (T2DM) is a highly prevalent metabolic disease, causing a heavy burden on healthcare systems worldwide, with related complications and anti‐diabetes drug prescriptions.

  6. Breakfast Skipping Is Associated With Increased Risk of Type 2 Diabetes

    Background No evidence-based recommendations regarding optimal breakfast frequency and timing and type 2 diabetes mellitus (T2DM) exist for older adults due to limited studies.

  7. Fundamentals about onset and progressive disease character of type 2

    ResearchGate is a world wide web for scientists and researchers to share papers, ask and answer questions, and find collaborators. ... Fundamentals about onset and progressive disease character of type 2 diabetes mellitus World J Diabetes. 2020 May 15;11(5) :165 ... effective in type 2 diabetes and its prediabetic phase, is based on variations ...

  8. Impact of age at type 2 diabetes mellitus diagnosis on mortality and

    Introduction. The IDF estimates that the prevalence of diabetes will rise from 425 million people worldwide in 2017, to 629 million by 2045 [].Type 2 diabetes, conventionally considered a disease of middle and older age, is increasingly diagnosed at a younger age [1, 2].Type 2 diabetes and its associated complications contribute to 8.4% of deaths worldwide, consuming significant healthcare ...

  9. Reproductive Dysfunctions in Males with Type 2 Diabetes Mellitus: An

    The prevalence of erectile dysfunction in diabetes overall was 52.5% (95% CI, 48.8 to 56.2) after adjusting for publication bias, and 37.5%, 66.3% and 57.7% in Type 1, Type 2 and both types of ...

  10. (PDF) Type 2 diabetes mellitus in sub-Saharan Africa ...

    Abstract and Figures. Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid ...

  11. Efficacy of telemedicine on glycaemic control in patients with type 2

    Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder in which the pancreas fails to secrete adequate insulin to maintain glucose homeostasis. Blood glucose levels are normally controlled by a series of anabolic and catabolic hormones, primarily insulin and glucagon, respectively. It is evident that T2DM poses an extensive economic ...

  12. Clinical Research on Type 2 Diabetes: A Promising and Multifaceted

    The chronic complications of type 2 diabetes are a major cause of mortality and disability worldwide [ 1, 2 ]. Clinical research is the main way to gain knowledge about long-term diabetic complications and reduce the burden of diabetes. This allows for designing effective programs for screening and follow-up and fine-targeted therapeutic ...

  13. Pathophysiology of Type 2 Diabetes Mellitus

    1. Introduction. Type 2 Diabetes Mellitus (T2DM) is one of the most common metabolic disorders worldwide and its development is primarily caused by a combination of two main factors: defective insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin [].Insulin release and action have to precisely meet the metabolic demand; hence, the ...

  14. Type 2 Diabetes

    Type 2 Diabetes Mellitus. Type 2 diabetes mellitus (T2DM) accounts for around 90% of all cases of diabetes. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over ...

  15. Type 2 Diabetes

    Excerpt. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. According to the International Diabetes Federation (IDF), approximately 415 million adults between the ages of 20 to 79 years had diabetes ...

  16. Type 2 diabetes

    Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies ...

  17. Mathematical model for assessing glycemic control in type 2 diabetes

    Background: Diabetes mellitus (DM) significantly burdens health services worldwide. As a simple and cost-effective method, the mathematical calculation of HbA1c is coming to be of value in areas ...

  18. Type 2 diabetes mellitus patients' knowledge, attitude and practice of

    Type 2 diabetes mellitus (T2DM) occurs as a result of the individual having insulin resistance or relative insulin deficiency. It involves an interplay of interaction between genetic, environmental and behavioural risk factors. The disease has an insidious onset and may remain undiagnosed for many years (Kiberenge et al. 2010; Yoon et al. 2006 ...

  19. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and ...

    Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable ...

  20. Biomedicines

    Individuals with type 2 diabetes mellitus are at greater risk of developing cancer and of dying from it. Both diseases are age-related, contributing to the impact of population aging on the long-term sustainability of health care systems in European Union countries. The purpose of this narrative review was to describe, from epidemiological, pathophysiological and preventive perspectives, the ...

  21. Literature Review of Type 2 Diabetes Management and Health Literacy

    Diabetes is the seventh leading cause of death in the United States, and 30.3 million Americans, or 9.4% of the U.S. population, are living with diabetes (1,2).For successful management of a complicated condition such as diabetes, health literacy may play an important role.

  22. Type Two Diabetes Mellitus

    Type Two Diabetes Mellitus Type 2 DM is the most commom type representing almost over 90% of the cases. Despite the large No. of available medications, yet, a need for a newer one with much more ...

  23. Prevalence of Anemia in Type 2 Diabetic Patients

    Worldwide prevalence of diabetes mellitus is 8.3% affecting approximately 382 million people. In Kuwait, the prevalence of type 1 diabetes is 2.8% among expatriates and 2.3% among natives in the age group of 0 - 20 years. Asian expatriates of the age group 30 - 60 years exhibit higher prevalence of type 2 diabetes than natives at 25.4% .

  24. Type 2 diabetes

    Causes. Type 2 diabetes is mainly the result of two problems: Cells in muscle, fat and the liver become resistant to insulin As a result, the cells don't take in enough sugar. The pancreas can't make enough insulin to keep blood sugar levels within a healthy range. Exactly why this happens is not known.