Incident Type 2 Diabetes and its Risk Factors in Men and Women Aged 40 - 60 Years from Four Sub-Saharan African Countries: Results from the AWI-Gen Study

Abstract

The incidence of type 2 diabetes in sub-Saharan Africa is expected to increase, but few longitudinal studies have characterised its risk factors. This study aimed to determine the incidence of type 2 diabetes over 33 481 person-years and identify its principal risk factors in middle-aged adults (ie, those aged 40-60 years) from four sub-Saharan African countries. Our findings show a high incidence of type 2 diabetes of 14?6 cases per 1000 person-years (95% CI 13.4-16.0) in a middle-aged sub-Saharan African population. We also highlight regional differences, with the highest incidence observed in South Africa, and the lowest in west Africa, possibly due to differences in obesity prevalence and sociodemographic factors, such as urbanicity. Additionally, we show that various factors at baseline including BMI, waist circumference, triglyceride and glucose levels, male sex, insufficient physical activity, unemployment, hypertension, and a family history of type 2 diabetes are associated with a greater risk of developing type 2 diabetes, with regional contrasts in the association of sex and diabetes incidence likely reflecting regional sex differences in obesity prevalence.