[The burden of diabetes in Africa: a major public health problem]

W.H.O. predicts that there will be some 438 million diabetic patients in 2030, most of them living in developing countries. The IFD estimates that the prevalence of diabetes will rise by 98% in Africa during the next 20 years, with dramatic implications for public health and national budgets of the poorest countries. Type 2 diabetes is the most common form in Africa; type 1 is rarer than in western countries and tends to occur later. Two other forms seem specific to black Africans: ketosis-prone atypical diabetes, and tropical malnutrition-related diabetes. An increasing prevalence of obesity, diabetes and impaired glucose tolerance is observed in all parts of Africa. Several factors contribute to this situation, including aging, dietary transitions and lack of physical activity, all of which are related to rapid urbanization. In Africa, diabetes is associated with a high mortality rate, especially among insulin-dependent patients. Poor metabolic control can lead to severe ketosis and hypoglycemic accidents that carry a poor prognosis. Microvascular complications include retinopathy and nephropathy, and most patients cannot afford hemodialysis. Foot ulcers are frequent, due to trauma and neuropathies. Macrovascular complications are also increasing, with a high prevalence of hypertension. The poor prognosis of diabetes in Africa is related to late diagnosis, poor education, inadequate access to insulin, antidiabetic drugs and glycemia self-monitoring devices, absence of controlled diets, and difficult access to medical care in rural areas. Patient empowerment, knowledge and self-care must be improved. African governments must develop national prevention programs. Special attention must be paid to the prevention of obesity and diabetes. The urban environment, infrastructure, education, exercise and safe nutrition must be part of an overall policy designed to reduce the burden of chronic non transmissible diseases.