South Africa’s National Diabetes Cohort

Global projections suggest that type 2 diabetes mellitus is set to double from 285 million in 2010 to 592 million in 2040, with sub-Saharan Africa bearing the brunt of the increase and South Africa at the forefront. Prevalence of diabetes, estimated to be between 4-14%, has increased in South Africa since 2013 and is now the 2nd leading cause of death in the country, after HIV. Despite remarkable successes in diagnosis and care of HIV, such as wide-scale use of antiretroviral therapy (ART) for HIV treatment, which significantly increased the average life expectancy from 50 to 60 years between 2003-2011 HIV remains a huge burden in South Africa. Currently, an estimated 7 million people are living with HIV, 48% of which are receiving ART for the disease. In addition to recent economic developments and lifestyle changes that have resulted in increased obesity rates and other risk factors for diabetes, HIV-positive individuals are now living longer and experiencing diabetes and other non-communicable chronic diseases (NCDs). The current “cascade-of-care” model of HIV management of care and treatment is well established across South Africa, but there is limited data on a model for any NCDs, including diabetes. In 2011, given the overlap in co-morbidities between patients with HIV and NCDs, the South African government, in an attempt to leverage the existing HIV model of care and treatment to include services for NCDs, implemented the Integrated Chronic Disease Management (ICDM) model of care for all chronic communicable and NCDs diseases in 42 health facilities throughout the country. The ICDM model has yet to be taken to scale or evaluated with rigorous quantitative methods.

The goal of this research project is to first build a national longitudinal diabetes cohort using novel big data probabilistic linking methods to link serial hemoglobin A1c (HbA1c) and blood glucose laboratory measurements in South Africa’s National Laboratory Services (NHLS) database. This cohort will provide significant opportunities to assess patterns of diabetes laboratory screening, the burden of laboratory diagnosed diabetes, and gaps in the diabetes ‘cascade-of-care’. Furthermore, linkage with our existing national HIV cohort, created with the same record linking methods, will enable assessment of these co-epidemics and outcomes for both HIV-positive and HIV-negative individuals. It will also enable evaluation of the impact of health policy changes, like the ICDM, on diabetes control.

Boston University investigators Alana Brennan (PI)
Matthew Fox
Sydney Rosen
Jacob Bor
Andrew Stokes
Partner investigators University of the Witwatersrand 
National Health Laboratory Service
Health Economics & Epidemiology Research Office
Countries South Africa
Project period 2019-2024
Funder National Institutes of Health (NIDDK)
Contacts Alana Brennan (