Prevalence and Complications of Diabetes Mellitus in Northern Africa

A Systematic Review

Manouk Bos; Charles Agyemang


BMC Public Health. 2013;13(387) 

In This Article


Prevalence of Diabetes, Undiagnosed Diabetes, Impaired Glucose Tolerance and Impaired Fasting Glucose in Northern Africa

Twelve community-based studies provided data on diabetes prevalence and all studies were based on random samples. Six of the eight countries in the Northern African region had data on prevalence of diabetes in the last twenty years (Table 1). The prevalence of diabetes varied across Northern African countries ranging from 2.6% in rural Sudan[17] to 20% in urban Egypt.[10] Ten studies distinguished between urban and rural diabetes prevalence and all of these studies found a higher prevalence in urban areas than in rural areas.[7,9–13,15–18]

Eight studies reported on undiagnosed diabetes.[7,10,11,13–15,17,18] The prevalence of undiagnosed diabetes ranged from 18% in urban Libya[11] to 75% in Tunisia.[13]

Five studies reported on impaired glucose tolerance.[7,10,11,17,18] Four of these studies distinguished between urban and rural areas. Two of these four studies found a higher prevalence of impaired glucose tolerance in rural areas than in urban areas.[10,11] The highest prevalence of impaired glucose tolerance (13.1%) was found in rural Egypt;[10] and the lowest prevalence was found in rural Sudan with a prevalence of 2.2%.[17] One study in Tunisia reported on impaired fasting glucose and the prevalence was 5.3% in men and 5.1% in women, respectively.[13]

Prevalence of Obesity

Ten studies also assessed the prevalence of obesity among their study populations.[8–16,18] Six of the eight studies that distinguished between males and females found a significantly higher prevalence of overweight/obesity in females than in males in Algeria, Egypt, Morocco, Tunisia and Sudan.[8,10,12,14,16,18] The obesity prevalence ranged from 56% in men with higher socioeconomic status in urban Egypt to 6% in men in rural Egypt.[10] The study in Sudan also found a high prevalence of obesity, with a prevalence of 45% in women, but in this study obesity was defined as a BMI ≥25.[18] The lowest obesity prevalence was found in one study conducted in Southern Tunisia. Although this study in Tunisia defined obesity as a BMI ≥25, still they found the lowest prevalence of 5.4% in men and 4.2% in women.[13] By contrast, another study in Greater Tunis region found a high prevalence of obesity with 19% in men and 46% in women, respectively.[16]

Complications of Diabetes in Northern Africa

Nine studies[19–27] on the prevalence of complications of diabetes were reviewed (Table 2). The prevalence of retinopathy ranged from 8.1% in Tunisia[26] to 41.5% in Egypt.[20] Albuminuria prevalence ranged from 21% in Egypt[20] to 22% in Sudan;[24] nephropathy ranged from 6.7% in hospital outpatient clinics in Egypt[20] to 46.3% in hospital inpatients in Egypt.[21] The prevalence of diabetic neuropathy ranged from 21.9% in hospital outpatient clinics[20] to 60% in hospital inpatient clinics in Egypt.[21] High prevalence of neuropathy was also found in Sudan with a prevalence of 31.5% in hospital inpatient clinics to 36.7% in outpatient clinics, respectively.[23,24]