Prediabetes in Sub‑Saharan Africa: Pathophysiology, Predictors, and Prevalence

Abstract

Prediabetes – comprising impaired fasting glycaemia (IFG) and/or impaired glucose tolerance (IGT) – is a transitory median interphase between
normal blood glucose levels and diagnostic levels of diabetes. The raised blood glucose levels surreptitiously damage the body’s organ systems
and are often an augury of type 2 diabetes mellitus (T2DM), the two having been found to share similar pathogenesis. Current concepts in the
pathogenesis of prediabetes support a pentad of mechanisms responsible for its development. Majority of the countries in Sub‑Saharan Africa
belong to the low and middle income category, whose population accounts for more than 70% of the 352 million adults (20–79 years) worldwide
with IGT (one component of prediabetes), as at 2017. The presence of prediabetes increases health care related expenditure in individuals
and takes a toll on the workforce. Nigeria (West Africa) is currently among the top ten countries with the highest number of individuals with
IGT as at 2017, and Ethiopia (East Africa) has been projected to join Nigeria in this category by 2045. A PubMed and MEDLINE search was
conducted using the keywords prediabetes, Sub‑Saharan Africa, prevalence, and pathophysiology. Major studies were identified and reviewed.
Numerous large scale studies have revealed that progression from prediabetes to T2DM is not relentless. Structured and intensive lifestyle
modifications aimed at modest weight loss, increased physical activity, and healthy dietary habits have shown to halt or slow the progression
to T2DM, and in some cases, even reverse prediabetes, with such individuals regaining normal blood glucose levels.

Keywords: Pathogenesis, prediabetes, prevalence, prevention, Sub‑Saharan Africa