Tackling the growing diabetes burden in Sub-Saharan Africa: a framework for enhancing outcomes in stroke patients.

According to the World Health Organization (WHO), more than 80% of worldwide diabetes (DM)-related deaths presently occur in low- and middle-income countries (LMIC), and left unchecked these DM-related deaths will likely double over the next 20 years. Cardiovascular disease (CVD) is the most prevalent and detrimental complication of DM: doubling the risk of CVD events (including stroke) and accounting for up to 80% of DM-related deaths. Given the aforementioned, interventions targeted at reducing CVD risk among people with DM are integral to limiting DM-related morbidity and mortality in LMIC, a majority of which are located in Sub-Saharan Africa (SSA). However, SSA is contextually unique: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians currently limit the capacity of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. This article proposes a theory-based framework for conceptualizing integrated protocol-driven risk factor patient self-management interventions that could be adopted or adapted in future studies among hospitalized stroke patients with DM encountered in SSA. These interventions include systematic health education at hospital discharge, use of post-discharge trained community lay navigators, implementation of nurse-led group clinics and administration of health technology (personalized phone text messaging and home tele-monitoring), all aimed at increasing patient self-efficacy and intrinsic motivation for sustained adherence to therapies proven to reduce CVD event risk.