Type 2 diabetes in a Senegalese rural area(4)

Our study has some limitations. First, as in many surveys, our FBG levels were based on capillary blood measurements, which may have underestimated the prevalence rates[36]: The 2006 WHO/IDF update states that glycaemic values on venous and capillary plasma are identical but that plasma measures are 11%higher than whole blood measures. Second, HbA1c measurements are missing, but would have been important to accurately diagnose diabetes mellitus in our sample. Furthermore, the small absolute number of diabetic subjects makes assessment of the relationship to other variables examined difficult,and it is possible that only gross differences, such as the relation between diabetes and BMI will be , the small absolute number of diabetic subjects with known, treated and controlled diabetes made it impossible to perform trend analysis of age/sex subgroups. Finally, diagnosis of diabetes should not be based on a single abnormal result in an asymptomatic subject, so that future studies on the area should repeat the capillary whole blood glucose test for every subject.

The prevalence of diabetes in the rural area of Tessekere (Senegal) is 4.2%, and of particular concern is the high burden of undiagnosed and uncontrolled diabetes. If the nutritional transition is to develop in this part of the country, diabetes and its complications are certain to become a major health issue within several years. The challenge of diabetes in rural areas of sub-Saharan Africa is to provide accessible,affordable and optimal care for the management of the disease. It is then possible that collaboration with traditional healers would be appropriate and respectful of the populations’ cultural values, and could represent a first step toward an integrative approach combining biomedical knowledge and traditional medicine.

ACKNOWLEDGMENTs

The authors wish to thank all the people of Tessekere municipality who took the time to answer their questions. We also thank the Senegalese chief of staff interviewers who participated in this study: Amadoune Gueye and Babacar Kane.

Background

The World Health Organization estimates that globally, high blood glucose is the third highest risk factor for premature mortality. The increased rising rate of diabetes mellitus is an additional burden to sub-Saharan Africa that continues to bear the brunt of communicable diseases such as tuberculosis and , Africa Region has the highest proportion of undiagnosed diabetes;over two-thirds (66.7%) of people with diabetes are unaware they have the disease. Whereas Senegal is in the top five sub-Saharan African countries in terms of advanced nutritional transition status and dietary composition - which indicates increased risk for non-communicable diseases - few studies have attempted to describe national trends in diabetes and no information exists about diabetes prevalence in rural Senegalese areas.

COMMENTs

Research frontiers

Diabetes was virtually non-existent in West African populations about three decades ago. But today, it is estimated that 4% of urban West African adults have diabetes, and this figure is higher in some countries: 7.7% in Ghana, 4.2%in Kenya, 4% and 7.7% in rural and urban Guinea respectively, 8.8% in Nigeria for example. Identified risk factors for diabetes in sub-Saharan Africa are age,family history of diabetes and intrauterine influence. Urbanization is known as a major modifiable risk factor for diabetes, attributable to nutritional and lifestyle changes and physical inactivity. Finally, in developed countries, psychosocial stress or depressive syndrome might be considered potential risk factors for diabetes.

Innovations and breakthroughs

The study is the first, to our knowledge, to estimate the prevalence of diabetes in a rural Senegalese area. In Tessekere municipality, diabetes prevalence is 4.2%, and that of impaired fasting glucose, 6.6%, corresponding to the high range of prevalence observed in rural sub-Saharan Africa. In the population study, emerging risk factors such as depression and material well-being(identified mainly in developed countries) are not associated with diabetes,indicating that this epidemic is in the early stages in this region.

Applications

It seems necessary to study the determinants of the high prevalence of diabetes observed in Fulani in sub-Saharan Africa. The study also casts doubt on the relationship between emerging factors for diabetes such as depression and material well-being and stages of the nutritional transition.

Peer-review

The introduction provides sufficient background and includes all relevant references. The research design is appropriate. The methods are adequately described. The results are clearly presented. The conclusions are supported by the results.

REFERENCEs

1 World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization, 2009

文章来源：《人类学学报》 网址: http://www.rlxxb.cn/qikandaodu/2021/0105/484.html