African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Adis
Abstract
The prevalence of diabetes in sub-Saharan Africa
(SSA) is growing rapidly, and a steadily increas ing 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 treat ment with the appropriate type of insulin based
on the meal patterns and lifestyle of the indi vidual 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.
Description
Research Article
Keywords
African cuisine, Carbohydrate, Insulin therapy, Meal pattern, Type 2 diabetes