Association between diabetes and food insecurity in an urban setting in Angola: a case-control study.

Diabetes is common in urban settings in Sub-Saharan Africa. Household food insecurity has been suggested to increase the chance of developing diabetes among adults. The relationship between diabetes and food insecurity has not been explored in Angolan urban settings so far. This case-control (1:2) study investigated the association between diabetes and food insecurity among adults attending six healthcare facilities in Luanda (Angola) between April 2019 and September 2019. All subjects with fasting blood glucose (FBG) levels ≥ 126 mg/dl were included as cases. For each case, the next two subjects with FBG levels < 110 mg/dl were included as controls, to warrant the achievement of the set 1:2 ratio. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES). A total of 663 participants (221 cases and 442 controls) were enrolled in the study. Median FIES raw score was 7 (IQR 1-8) in cases and 5 (IQR 2-8) in controls (p = 0.09). The distribution of FIES levels (0-3; 4-6; 7-8) was different between cases and controls (p < 0.0001), with highest FIES scores (7-8) recorded in 53.0% of cases and 38.2% of controls. Our findings revealed an association between diabetes and severe food insecurity among adults attending healthcare facilities in the capital city of Angola.

Diabetes and pre-diabetes among adults reaching health centers in Luanda, Angola: prevalence and associated factors.

With the lack of surveys, surveillance program and/or statistical data, epidemiologic studies can provide a better understanding of diabetes in Sub-Saharan Africa. This was a cross-sectional survey to determine prevalence of diabetes and impaired fasting glucose (IFG) among adults attending six health centres in six different districts of Luanda (Angola) during August-November 2018, followed by a case-control study to assess the risk factors for IFG and diabetes in a subgroup of subjects not receiving treatment for diabetes. Factors associated with diabetes/IFG were assessed using a generalized ordered logit model and the effects were expressed as odds ratios (OR1 for IFG/diabetes vs. no IFG/diabetes; OR2 for diabetes vs. no diabetes) with 95% CI (confidence interval). Some 1,803 participants were included in the survey. Prevalence of diabetes was 12.0% (95%CI 10.5% to 13.5%) and prevalence of IFG was 9.0% (95%CI 7.7% to 10.4%). Older age (OR1 = OR2 1.03, 95%CI 1.02 to 1.04), higher weight (OR1 = OR2 1.01, 95%CI 1.01 to 1.03), having measured glycaemia before (OR2 2.07, 95%CI 1.29 to 3.31), feeling polyuria (OR1 1.93, 95%CI 1.13 to 3.28; OR2 2.18, 95%CI 1.32 to 3.59), feeling polydipsia (OR1 1.92, 95%CI 1.16 to 3.18), feeling weakness (OR1 = OR2 2.22, 95%CI 1.39 to 3.55), consumption of free-sugars food/beverages (OR1 = OR2 2.34, 95%CI 1.44 to 3.81) and time spent seated (OR1 1.80, 95%CI 1.17 to 2.76) were associated with increased likelihood of diabetes and/or IFG, while eating vegetables was associated with decreased likelihood of IFG or diabetes (OR1 = OR2 0.69, 95%CI 0.47 to 0.99). In conclusion, the high prevalence of diabetes and IFG, with common unawareness of the disease, calls for appropriate interventions in Angolan urban settings. Further research may evaluate the impact of context-specific factors to enhance intervention strategies and feed the results into local health policies. In addition, such information may be useful for selecting high-risk subjects to test.