Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study

Int J Environ Res Public Health. 2020 Apr 21;17(8):2876. doi: 10.3390/ijerph17082876.

Abstract

Completed and ongoing implementation activities globally advocate for community-based approaches to improve strategies for type 2 diabetes prevention. However, little is known about such strategies in the African region where there are higher relative increases in diabetes prevalence. We reported findings from the first 8-month pilot phase of the South African diabetes prevention program. The study was conducted across eight townships (four black and four mixed-ancestry communities) in Cape Town, South Africa, between August 2017 and March 2018. Participants were recruited using both random and self-selected sampling techniques because the former approach proved to be ineffective; <10% of randomly selected individuals consented to participate. Non-laboratory-based diabetes risk screening, using the African diabetes risk score, and based on targeted population specific cut-offs, identified potentially high-risk adults in the community. This was followed by an oral glucose tolerance test (OGTT) to confirm prevalent pre-diabetes. Among the 853 adults without prior diabetes who were screened in the community, 354 (43.4%) were classified as high risk, and 316 presented for further screening. On OGTT, 13.1% had dysglycemia, including 10% with screen-detected diabetes and 67.9% with glycated haemoglobin (HbA1c)-defined high risk. Participants with pre-diabetes (n = 208) had high levels of common cardiovascular risk factors, i.e., obesity (73.7%), elevated total cholesterol (51.9%), and hypertension (29.4%). Self-referral is likely an efficient method for selecting participants for community-based diabetes risk screening in Africa. Post-screening management of individuals with pre-diabetes must include attention to co-morbid cardiovascular risk factors.

Keywords: cardiovascular disease; community screening; diabetes risk; dyslipidemia; hypertension.

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / epidemiology
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Pilot Projects
  • Risk Factors
  • South Africa / epidemiology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A