Burden of diabetes set to increase across sub–Saharan Africa, potentially diminishing health gains of recent years.
As sub–Saharan African countries struggle to cope with the current burden of diabetes, new estimates suggest that costs associated with the disease could more than double and may reach up to US$59.3 billion per year by 2030 if type 2 diabetes cases continue to increase.

The new report led by researchers from King’s College London, University of Bristol, and Harvard University proposes that diabetes and its complications have the potential to reverse some of the health gains seen in sub–Saharan Africa in recent years – overwhelming the region’s health systems and crippling patients’ personal finances as they pay for their own healthcare.

Currently, only half of the people with diabetes in populations in sub–Saharan Africa are aware that they have the disease, and only one in 10 (11%) receive drugs they need.

The Lancet Diabetes & Endocrinology Commission on diabetes in sub–Saharan Africa provides a comprehensive and up–to–date analysis of the burden of diabetes across sub–Saharan Africa, the challenges this burden poses for health systems, as well as potential solutions. More than 70 experts from around the world contributed to the report.

Co–lead author, Professor Justine Davies from King’s Centre for Global Health said: “What this process demonstrates is that so little is known about diabetes in sub–Saharan Africa, with many countries in the region unaware of the burden in their population. 21 countries had no data on prevalence to supply to the most recent WHO estimates for the region. We have estimates that are good enough to tell us that prevalence and costs are rising, but they don’t give detailed information necessary for health system planning.”

The report estimates that the economic cost of diabetes in sub–Saharan Africa in 2015 totalled $19.5 billion, equivalent to 1.2% gross domestic product (GDP). On average, countries in the region spend 5.5% of their GDP on health.

More than half of this economic cost (56%, $10.8 billion) was on accessing diabetes treatment, including medication and hospital stays – and ­one half of these costs were out–of–pocket (paid for by the patients), putting a huge financial burden on people with diabetes. The remaining economic costs were a result of productivity losses, mostly from early death ($7.9 billion), as well as people leaving the workforce early ($0.5 billion), taking sick leave ($0.2 billion) and being less productive at work due to poor health ($0.07 billion).

To measure the future impact of increased diabetes rates across all sub–Saharan African countries, the researchers modelled three scenarios to show optimistic and pessimistic projections. Their estimates suggest that, in an optimistic scenario, where diabetes death rates and prevalence remain the same for each country, the annual cost of diabetes would increase to $35.3 billion (1.1% GDP) in 2030. However, if these rates increased in line with the projected rise in each countries’ income levels, economic costs would be $47.3 billion (1.4% GDP), and if rates doubled, the costs could total $59.3 billion (1.8% GDP).

Wealthier areas of sub–Saharan Africa seeing more societal changes had the highest rates of diabetes in 2015, with almost two–thirds of the region’s diabetes costs coming from southern Africa (62%, $12.1 billion), in particular, wealthier South Africa. Less than a tenth of the costs (9%, $1.7 billion) originated from poorer countries in western Africa.

The authors of the Commission report conclude that gaps in care include a lack of equipment for diagnosing and monitoring diabetes, lack of treatments, and lack of knowledge about the disease among available healthcare providers.