Mbanya Jean Claude, Lamptey Roberta, Uloko Andrew E, Ankotche Amos, Moleele Gontle, Mohamed Gaman Ali, Ramracheya Iswaraj, Ramaiya Kaushik, Ndiweni Malusi, Mbaye Maïmouna Ndour, Bahendeka Silver, Kalra Sanjay
Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon.
Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon.
Diabetes Ther. 2021 Jan;12(1):37-54. doi: 10.1007/s13300-020-00958-z. Epub 2020 Nov 9.
The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increasing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treatment with the appropriate type of insulin based on the meal patterns and lifestyle of the individual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient's habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.
撒哈拉以南非洲地区（SSA）的糖尿病患病率正在迅速上升，据估计，患有2型糖尿病（T2DM）的成年人数量在稳步增加。胰岛素治疗是出现严重高血糖患者以及大多数口服降糖药未达目标值患者的首选治疗方法。根据个体患者的饮食模式和生活方式选择合适类型的胰岛素起始治疗，比其他策略更有可能改善血糖控制和依从性。非洲菜肴通常碳水化合物含量高。鉴于这些主要富含碳水化合物的饮食习惯，在确保根据患者习惯及时起始、滴定和维持胰岛素治疗的同时，改变这种饮食模式至关重要。迄今为止，尚无已发表的临床指南指导从业者和患者调整胰岛素以匹配非洲菜肴中的高碳水化合物含量。为填补这一空白，我们回顾了当前的胰岛素治疗实践，并提出了一份基于非洲菜肴的以患者为中心的胰岛素治疗指南。我们检索了截至2019年11月以英文发表的、聚焦于胰岛素选择及其与非洲食物剂量关系的研究。所有提取的文章均由一个专家组进行评审。专家组的建议是，基础-餐时胰岛素方案和预混胰岛素方案最适合控制非洲菜肴餐后血糖。选择胰岛素类型和胰岛素治疗方案时，应考虑进餐时间和成分、餐量、血糖负荷和餐食的血糖指数。应优先评估个体偏好和合并症，并将其作为糖尿病管理的一个组成部分。
