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  • Review Article
  • Published:

Reversing the tide — diagnosis and prevention of T2DM in populations of African descent

Nature Reviews Endocrinology volume 14, pages 45–56 (2018)Cite this article

Subjects

Key Points

  • Although African, Caribbean and African-American populations are all groups of African descent, cultural and historical differences mean that strategies for the diagnosis and prevention of type 2 diabetes mellitus (T2DM) in each population require customization

  • In Africa, as T2DM occurs across the entire range of BMIs, enrolment criteria for both screening and prevention trials must consider that even normal-weight African individuals are at risk

  • Both Caribbean and African-American individuals have experienced the twin epidemics of obesity and T2DM; however, Caribbean individuals seem to have worse glycaemic control, lower health literacy and a higher rate of complications

  • When intensive lifestyle interventions are undertaken in Africa and the Caribbean, both the design and outcome must be appropriate for the specific African-descent population enrolled

  • Reducing the rate of undiagnosed T2DM in African-descent populations requires optimization of current screening tests by combining HbA1c with fasting plasma glucose and evaluating new tests such as glycated albumin

  • Large studies are necessary in African-descent populations to identify the risk of T2DM due to genetics, epigenetics and gene–environment interactions

Abstract

Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA1c, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene–environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.

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Figure 1: Correlation between visceral adipose tissue (VAT) and waist circumference.
Figure 2: Regions of Africa exposed to undernutrition.
Figure 3: Diagnostic sensitivity of HbA1c and glycated albumin according to BMI.

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Acknowledgements

The authors acknowledge funding from the Intramural Research Programs of the National Institute of Diabetes, Digestive and Kidney Diseases, the National Institute of Minority Health and Health Disparities and the Center for Research on Genomics and Global Health (CRGGH) (grant 1ZIAHG200362). The CRGGH is supported by the National Human Genome Research Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Center for Information Technology and the Office of the Director at the NIH.

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Author notes

  1. Jean N. Utumatwishima and Stephanie T. Chung: These authors contributed equally to this work.

Authors and Affiliations

  1. Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, 20892, Maryland, USA

    Jean N. Utumatwishima, Stephanie T. Chung & Anne E. Sumner

  2. Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, 20892, Maryland, USA

    Amy R. Bentley

  3. Dietetics Program, University of Maryland, College Park, 0112 Skinner Building, Office 0125 Skinner Building, College Park, 20742, Maryland, USA

    Margaret Udahogora

  4. National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, 20892, Maryland, USA

    Anne E. Sumner

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Contributions

A.E.S. researched data for the article. J.N.U., S.T.C., A.R.B., M.U. and A.E.S. made substantial contributions to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission. J.N.U. and S.T.C. contributed equally to the article.

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Correspondence to Anne E. Sumner.

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Utumatwishima, J., Chung, S., Bentley, A. et al. Reversing the tide — diagnosis and prevention of T2DM in populations of African descent. Nat Rev Endocrinol 14, 45–56 (2018). https://doi.org/10.1038/nrendo.2017.127

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