Strengthening diabetes care in sub-Saharan Africa: health systems, digital innovations, lifestyle interventions, and socioeconomic dimensions.

Abstract

The prevalence of diabetes, particularly type 2, in sub-Saharan Africa is rising at an alarming rate. This surge has exposed deep structural challenges, including an over-reliance on hospital-based services and strong cultural and faith-based influences that shape health-seeking behaviours. These factors, combined with socioeconomic inequalities and urbanisation, contribute to poor glycaemic control. Several strategies have been proposed to tackle this problem, including task shifting, integrated models that make use of HIV care infrastructure, digital health tools such as SMS reminders, culturally adapted lifestyle and nutrition programmes, community-based and faith-based interventions, and public-private partnerships. Despite these promising approaches, evidence of long-term sustainability, scalability, cost-effectiveness, and the impact of these interventions remains scarce. Additionally, stigma, gender-related barriers, and patient-reported outcomes are insufficiently studied in sub-Saharan Africa. Large-scale, longitudinal research is urgently needed to assess health system strengthening and culturally grounded models. Achieving effective diabetes care will require resilient, inclusive systems that integrate clinical, community, and digital innovations within the sociocultural and economic realities of the region.