World diabetes congress 2006: Diabetes in Africa

Below is a summary of “Diabetes in Africa: the new pandemic,” a report on the 19th World Diabetes Congress held in Cape Town, South Africa, on 3-7 December 2006. The report was originally published on the July 2007 issue of South African Family Practice. The full text of the report is available in PDF format at www.safpj.co.za.

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Conference report summary
www.safpj.co.za/index.php/safpj/article/view/869

Cause of diabetes
The rising prevalence in diabetes is caused by several forces:
• Food industry—Increasing amount of processed foods are provided by global corporations with few quality restrictions on food.
• Media—Food industry markets inexpensive, freely available obesogenic products while new technology encourages sedentary lifestyles.
• Urban environmental planning—Few opportunities exist for safe cycling or walking in cities.
• Cultural beliefs—Obesity may be associated with authority, affluence and wellbeing, particularly in contrast to HIV/AIDS.

Late breaking trials
Three late breaking trial results were presented at the conference:

AFFORD trial
The Atorvastatin Factorial with Omega-3 fatty acids Risk Reduction in Diabetes trial found that patients lipid lowering with atorvastatin 20mg, was found to reduce LDL cholesterol to 2.6mmol/l in 91% of patients and significantly reduce the estimated 10-year CVD risk by 21%. The study highlighted the extent to which type 2 diabetics were under-treated with statins in primary care in the UK. Omega-3 was found to marginally reduce triglyceride levels (5.6%) but not to reduce overall estimated CVD risk.

ADOPT trial
The Diabetes Outcome Progression Trial was designed to compare the efficacy of a rosiglitazone with metformin and glyburide in maintaining glycemic control in type 2 diabetics with the primary outcome defined as failure of monotherapy. Results revealed a cumulative monotherapy failure at five years of 15% with rosiglitazone, 21% with metformin and 34% with glyburide, representing a risk reduction of 32% for rosiglitazone, compared with metformin, and 63% compared with glyburide.

SERENADE trial
This study utilized a fixed dose of Rimonabant as sole treatment for previously untreated
type 2 diabetics with multiple cardio-metabolic risk factors. Efficacy and safety were reported on, with the effect on HbA1c as the primary outcome measure. Results showed a clinically meaningful fall of 0.8% in HbA1c compared with placebo. This was accompanied by significant improvements in a range of cardio-metabolic risk factors (weight, waist circumference, HDL-cholesterol and triglycerides) though not in blood pressure. In taking cost and overall efficacy into account, investigators reiterated that metformin remains the first choice oral anti-diabetic agent.

Actions suggested for poor countries by the conference presentation "The challenge of diabetes in poor countries: Setting an agenda for action"
Integrated actions
• Macroeconomic policy and health. Health and economic development are inter-related. Focus on extreme poverty.
• Strengthen chronic care health systems.
• Increase funding for chronic disease.
• Focus on primary prevention and changing the obesogenic environment.
Specific actions
• Increase awareness of diabetes.
• Collect data on the economic impact of diabetes.
• Define a minimum acceptable global package of care.
• Target primary prevention on high-risk groups with impaired glucose tolerance.
• Support implementation of specific projects and evaluation.

The African Diabetes Declaration 2006
Africa is in the grip of a diabetes epidemic. Diabetes and its complications are largely preventable through relatively simple interventions. Low-cost interventions with proven effectiveness can reduce the impact of diabetes while simultaneously addressing risks for other disease areas. The cost of intervening will be cheaper than the cost of not intervening and an investment in diabetes brings health gains in other disease areas.

The IDF-Africa and WHO-AFRO call on governments of African countries, non-government organizations, international financial institutions and donor agencies, industry, business, unions, citizens, health care providers and all partners and stakeholders in diabetes and related chronic diseases to ensure:

• Adequate, appropriate and affordable medication and supplies for people with diabetes.
• Earlier detection and optimal quality of care of diabetes.
• Effective efforts to create healthier environments and prevent diabetes
• The identification and dissemination of information, education and communication to empower people with diabetes to access appropriate diabetes services and improve self care.
• Equitable access to care and prevention services for people with or at risk of diabetes
• Awareness of diabetes in the community and among health care providers
• A truly integrated approach which utilizes the whole health workforce to address
infectious and non-communicable diseases simultaneously
• Government commitment to reducing the personal and public health burden of diabetes
• Partnership and collaboration within and between government sectors, private sectors, non-government organizations and communities to create community and workplace environments that promote better health.

Date Posted: 3 October 2007