ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Lancet Diabetes Endocrinol 2017; 5(8):622-667

The Lancet Diabetes and Endocrinology Commission provides a comprehensive, evidence-based review of diabetes in sub-Saharan Africa, one of the most important emerging diseases and markers of the global epidemic of non-communicable diseases. The authors provide a detailed analysis of the significant knowledge gaps in the global epidemiology and burden of diabetes and its complications in sub-Saharan Africa and emphasize the need to develop local systems to ascertain population representative data. The commission delineates the current health system’s barriers adequate diabetes care delivery in the region, concluding that sub-Saharan Africa remains ill equipped in terms of diagnostic and monitoring tools, adequately trained health care professionals, access to essential therapeutics, and availability of guidelines and disease registries. They add an estimate of the economic burden of diabetes, including direct cost to the individual and indirect cost to countries, including the expected tripling in cost until 2030 and the anticipated inability of health systems in the region to assimilate this financial burden.

Strategies to formulate an appropriate health system response are discussed, including the development of service delivery models that are adapted to the reality of low- and middle-income countries and that enable an effective cascade of care from primary prevention to screening, diagnosis, treatment, and long-term care. A decentralized approach that integrates chronic disease care and borrows from successful HIV care delivery models is suggested and should include task shifting from physicians and nurses to community health workers as well as the use of smart information technology. An appropriate medical, social, and political context is required and may be fostered by aligning the health systems response with global targets (such as the Sustainable Development Goals), and by developing a concerted response from national governments, civil society, third party donors and international agencies such as the World Health Organization, the World Bank, the Global Fund, as well as national (USAID) and international (UN based) organizations.

Concerted action and adequate funding by local, national and international stakeholders to develop effective, affordable, and locally adapted responses to the oncoming epidemic of diabetes and non-communicable diseases in low- and middle-income countries is urgently needed.