Diabetes surge could slow Africa’s progress toward SDG 3

A team of researchers has warned that diabetes mellitus is becoming a fast-rising public health threat in parts of Africa, with prevalence in four countries approaching global levels and major risk factors clustering around urban living, obesity, unhealthy diets and physical inactivity. Their umbrella review points to a growing non-communicable disease burden that could slow progress toward Sustainable Development Goal 3 (SDG 3), which seeks to reduce premature deaths from chronic diseases and improve health and well-being.

The study, titled “High Diabetes Prevalence and Implications for Progress Toward SDG 3: An Umbrella Review of Four African Countries,” was published in Diabetology. It collects evidence from systematic reviews and meta-analyses on diabetes prevalence and determinants among adults in Ethiopia, South Africa, Nigeria and Ghana, drawing on seven eligible reviews that met moderate- to high-quality standards.

Diabetes prevalence signals a growing chronic disease burden

The review identifies diabetes as an emerging public health challenge across the four African countries examined. The pooled prevalence of 9.0% is significant because it approaches global averages and reflects a disease burden that is no longer confined to older or high-income populations. The study notes that type 2 diabetes, which makes up most diabetes cases worldwide, is increasingly associated with lifestyle and demographic changes, including rising obesity, reduced physical activity and urban dietary transitions.

Africa is expected to experience one of the steepest future increases in diabetes prevalence. International Diabetes Federation projections cited in the review estimate a 156% increase in diabetes prevalence in Africa by 2045, far above projected increases in Europe, North America and the Caribbean. The study warns, however, that such projections remain uncertain because many sub-Saharan African countries lack up-to-date and reliable national data.

The true burden may be higher than reported because many people remain undiagnosed. Screening is limited in many settings, and healthcare access barriers can delay diagnosis until complications appear. Diabetes may therefore be advancing quietly, especially among adults who have limited contact with preventive health services.

The review’s high level of heterogeneity also shows that diabetes prevalence varies sharply between countries and populations. This variation reflects differences in study methods, diagnostic criteria, population characteristics and local risk environments. The authors caution that the pooled figure should be interpreted carefully, but they still identify a clear pattern: diabetes is rising across African settings and is becoming a central concern for public health systems.

The study links this burden to SDG 3.4, which focuses on reducing premature mortality from non-communicable diseases. Diabetes directly threatens this goal because it increases risks of cardiovascular disease, stroke, kidney disease, blindness, nerve damage and premature death. In sub-Saharan Africa, where health systems often have limited capacity to manage long-term chronic illness, late diagnosis and poor treatment access can intensify these complications.

The review also notes that diabetes-related mortality among people under 60 is especially severe in sub-Saharan Africa, reflecting weaknesses in screening, treatment continuity and disease management. This makes diabetes not only a medical issue but also a development challenge, affecting productivity, household finances and health system sustainability.

Urban life, obesity and family history drive risk

The review identifies several determinants that show statistically significant associations with diabetes. Urban residence had the strongest pooled association, with people living in urban areas facing markedly higher odds of diabetes. The finding reflects the role of city environments in shaping diet, mobility and lifestyle.

Urbanization often brings greater access to processed foods, sugar-sweetened beverages and energy-dense meals, while reducing daily physical activity. Work patterns become more sedentary, transport becomes more motorized and traditional diets may be displaced by cheaper, processed alternatives. These changes help explain why urban residence emerged as such a strong risk factor.

Unhealthy diet was another major determinant. The review found a significant association between poor dietary patterns and diabetes, although the authors also noted strong heterogeneity and possible publication bias for this factor. Even with that caution, the broader evidence points to food-system change as a key driver of diabetes risk.

Physical inactivity also showed a significant association. The pooled odds ratio suggests that inactive adults face substantially higher diabetes risk. This aligns with global evidence linking sedentary behavior to obesity, insulin resistance and type 2 diabetes. The authors emphasize that physical inactivity is becoming more common in both urban and rural populations as work, transport and daily routines change.

Obesity was strongly associated with diabetes, reinforcing its role as a major modifiable risk factor. Rising body mass index, increased intake of processed foods and reduced physical activity are contributing to Africa’s diabetes transition. The authors also point to evidence that obesity and lower socio-economic status are not only African concerns but global diabetes determinants, with similar patterns appearing in high-income settings.

Hypertension was also significantly linked to diabetes. This matters because diabetes and hypertension often occur together and jointly raise the risk of cardiovascular complications. The overlap adds pressure to primary healthcare systems, which must manage multiple chronic conditions over long periods.

Family history of diabetes showed one of the strongest associations. Adults with a family history had much higher odds of developing diabetes, underscoring the role of genetic predisposition. The review notes that genome-wide studies have identified genetic variants associated with type 2 diabetes susceptibility in African populations, but it also makes clear that genetic risk interacts with lifestyle and environmental pressures.

Smoking was another statistically significant determinant. While the strength of association varied across studies, smoking remains a recognized contributor to metabolic and cardiovascular risk. The review also points to specific high-risk populations, including adults on long-term highly active antiretroviral therapy, where diabetes risk may be shaped by treatment duration and other health factors.

On the whole, diabetes risk in Africa is multifactorial. It cannot be explained by lifestyle alone or by genetics alone. Socio-economic status, food environments, urban living, healthcare access, family history and behavioral factors interact to shape the burden. That complexity makes one-size-fits-all public health responses inadequate.

Health systems need local strategies, screening and affordable care

The authors argue that Africa’s diabetes response must become more targeted, better funded and more locally grounded. The review calls for stronger early screening and diagnosis, particularly for high-risk groups such as people with obesity, hypertension, family history of diabetes, unhealthy diets, low physical activity and urban residence.

Early diagnosis is essential because diabetes can remain silent for years while damaging blood vessels, nerves, kidneys and eyes. Detecting diabetes earlier would allow health workers to intervene before complications become severe and costly. Yet screening remains limited in many African settings, especially in underserved communities.

Access to essential diabetes services is of vital importance. Many patients face barriers to diagnostic tests, insulin and oral glucose-lowering medicines because of cost, weak supply chains and limited service availability. In some sub-Saharan African settings, fewer than one in five diagnosed patients receive appropriate treatment, a gap that sharply raises the risk of preventable complications.

Integrating diabetes care into primary healthcare is another key recommendation. The authors call for diabetes management to be embedded in existing primary care systems, supported by trained nurses and community health workers. This approach could improve coverage, reduce pressure on specialist services and make care more accessible to rural and low-income communities.

Public health campaigns must also be culturally adapted. The review points to the need for locally tailored health promotion around diet, physical activity and behavior change. Messages must reflect local food systems, cultural norms and economic realities. Advising people to eat healthier or exercise more is unlikely to work if healthy foods are unaffordable, safe spaces for physical activity are unavailable or health literacy remains low.

The authors also stress the importance of tackling socio-economic inequalities. Diabetes is shaped by income, education, access to care and health literacy. In wealthier urban populations, risk may rise through Westernized diets and sedentary lifestyles. In lower-income groups, delayed diagnosis, poor access to care and limited disease knowledge can worsen outcomes. Effective policy must therefore address both prevention and treatment barriers.

The review calls for stronger surveillance systems and national diabetes registries. Reliable data are needed to track trends, identify high-risk groups, monitor treatment gaps and guide policy. The current evidence base remains fragmented, with only seven systematic reviews meeting inclusion criteria across four countries. The authors also note limitations, including inconsistent reporting of determinants, substantial heterogeneity and the exclusion of non-English and unpublished literature.