Diabetes
Diabetes is a chronic condition characterised by persistently elevated blood glucose levels. Worldwide, 589 million adults aged 20 to 79 are currently living with diabetes. In 2024, it caused the deaths of 3.4 million adults. Its prevalence is increasing particularly rapidly on the African continent (1).
What are the different types of diabetes
Diabetes is a condition defined by hyperglycaemia, meaning persistently high blood sugar levels.
Fasting blood glucose should not exceed 1.26 g/L (5). Diabetes is a chronic condition that cannot be cured, but can be managed with appropriate treatment.
The main types are type 1 diabetes and type 2 diabetes. A third type, called gestational diabetes, can affect pregnant women.
TYPE 1 DIABETES
The pancreas no longer produces insulin, or does not produce enough. This hormone regulates blood glucose, or blood sugar levels. Patients must inject insulin every day to regulate their blood glucose.
Type 1 diabetes is much less common than type 2 diabetes. The International Diabetes Federation estimates that around 9.1 million people of all ages worldwide live with type 1 diabetes (1). It particularly affects young children, adolescents and young adults, but can develop at any age.
TYPE 2 DIABETES
The pancreas produces insulin, but in inadequate amounts, and the body has difficulty using it. Some of the sugar carried in the blood no longer enters the muscles, builds up in the bloodstream and can cause complications.
Type 2 diabetes is the most common form, affecting more than 95% of people living with diabetes. It particularly affects adults over 45. The risk of developing type 2 diabetes results from a combination of factors: family history, age, overweight or obesity, low levels of physical activity, an unbalanced diet, a history of gestational diabetes, and various social and environmental factors. A person can develop type 2 diabetes without having all these risk factors.
GESTATIONAL DIABETES
In many countries, this type of diabetes affects more than 15% of pregnant women. One in five births is affected by some form of hyperglycaemia during pregnancy. It involves an abnormal rise in blood glucose towards the end of the second trimester or during the third trimester of pregnancy.
In most cases, it disappears after delivery. However, women who have gestational diabetes have a higher risk of developing type 2 diabetes later in life.
What are
THE RISK FACTORS FOR DIABETES?
Risk factors for diabetes are discussed here only in relation to type 2 diabetes.
For type 1 diabetes, the onset is often sudden and cannot be predicted or prevented.
Type 2 diabetes has several risk factors :
- An unbalanced diet high in refined sugars and vegetable or animal fats, particularly saturated fats, and low in fruit, vegetables and therefore dietary fibre.
- Lack of physical activity, resulting in a sedentary lifestyle.
- Overweight and obesity resulting from a lifestyle that combines an unbalanced diet and physical inactivity.
An unbalanced diet, a sedentary lifestyle, overweight or obesity are risk factors that can trigger the condition, but in most cases this occurs against a background of familial predisposition.
Indeed, in more than half of cases, type 2 diabetes occurs in families with a history of the condition.
What are the symptoms of diabetes ?
The main symptoms are unexplained weight loss, very frequent urination, particularly at night, and excessive thirst, hunger and fatigue.
In type 1 diabetes
symptoms are acute and develop very rapidly.
In type 2 diabetes
the condition is often insidious and can develop without visible symptoms for several years. Type 2 diabetes is described as asymptomatic in its early stages.
Unlike type 1 diabetes, type 2 diabetes is often discovered by chance during a routine check-up or when complications develop.
WHAT ARE THE COMPLICATIONS OF DIABETES?
ACUTE COMPLICATIONS :
There are three main acute complications, caused by a sudden fall or rise in blood glucose, which can lead to coma :
- Diabetic ketoacidosis : mainly affects type 1 diabetes and occurs when the body can no longer use sugar as fuel because insulin is completely absent.
- Hypoglycaemia : can affect people with either type 1 or type 2 diabetes and occurs when blood sugar falls below a certain threshold. It results either from an excessive effect of treatment, for example an insulin dose too high for the amount of food eaten or an overdose of certain oral diabetes medicines, or from overly intense physical activity. The risk increases if food intake is inadequate. This can happen when patients lack sufficient information or face financial difficulties in accessing enough food.
- Non-ketotic hyperosmolar coma : affects only type 2 diabetes and occurs mainly in older people. It is often associated with severe dehydration during infections or when taking diuretic medicines.
Chronic complications :
Poorly controlled blood glucose can progressively damage small blood vessels, which can in turn seriously damage many organs. Diabetes can therefore cause :
- Diabetic retinopathy : damage to the small vessels supplying the retina, leading to reduced visual acuity and potentially blindness.
- Diabetic nephropathy : leads to destruction of the kidneys and is one of the main causes of chronic kidney failure.
- Diabetic neuropathy : damage to nerve fibres causes a loss of sensation, mainly in the legs and feet. Neuropathy combined with poor circulation in the legs promotes foot ulcers, commonly referred to as “diabetic foot”. If these foot lesions are poorly treated, people living with diabetes risk gangrene and amputation.
- Sexual problems : diabetes can affect sexuality in men and women, including infections, fungal infections, vaginal dryness, prostatitis, erectile dysfunction and reduced libido.
Diabetes also affects large blood vessels, damaging the heart, brain and lower limbs. When the largest arteries are affected, serious cardiovascular damage occurs. People living with diabetes have a much higher risk of developing atherosclerosis, meaning small atheromatous plaques of cholesterol on the walls of large arteries.
Over time, the artery may become completely blocked, causing a myocardial infarction. Peripheral arteries are also affected, increasing the risk of stroke. Studies show that diabetes increases the risk of cardiovascular mortality: the risk is two to three times higher for men and three to five times higher for women.
How is diabetes treated ?
Diabetes is a chronic condition and cannot be cured. However, appropriate treatment from the time of diagnosis can control it, keeping blood glucose as close as possible to the target to prevent complications.
For people with type 1 diabetes, medication is essential and involves insulin injections several times a day.
For people with type 2 diabetes, an appropriate diet and regular physical activity are essential components of treatment. Depending on blood glucose, health status and individual needs, medicines may be required from diagnosis or as the condition progresses. Insulin treatment may also become necessary.
Early diagnosis, appropriate treatment and regular follow-up can greatly reduce the risk of complications and improve both quality of life and life expectancy.
What is therapeutic patient education
The World Health Organization (WHO) defines therapeutic patient education as “an ongoing process that forms part of medical care and aims to train patients to acquire the practical skills needed to achieve a balance between their lives and optimal control of their condition”.
In practice, educating patients about their condition is central to successful diabetes care.
It explains key concepts, particularly the chronic nature of diabetes and the need for lifelong treatment, while also helping patients understand its interaction with their social context, which is essential to living well with the condition.
This education explains how to manage diet and physical activity and raises awareness of complication risks. For patients, it is a valuable tool for daily diabetes management and a source of emotional and social support.
« Cancer, diabetes and heart disease are no longer diseases of the wealthy. Today, they affect the populations and economies of the poorest countries even more than infectious diseases. They represent an underestimated public health emergency. »
BAN KI-MOON, former United Nations Secretary-General, excerpt from his closing speech at the Forum on Global Health, 15 June 2009.
Noncommunicable Diseases (NCDs)
Diabetes, cardiovascular diseases, cancer and chronic respiratory diseases are the four noncommunicable diseases (NCDs) identified as priorities by the WHO.
In 2021, NCDs caused at least 43 million deaths, representing 75% of deaths unrelated to a pandemic worldwide.
The four priority diseases account for approximately 80% of these premature deaths (2). According to the WHO :
disease kills
Respiratory diseases kill
Cancers kill
Diabetes killed
Low- and middle-income countries are particularly affected: 73% of NCD deaths, approximately 32 million, occur in these countries.
NCDs are now the leading cause of death worldwide (2).
Diabetes worldwide
According to the International Diabetes Federation, diabetes, across all types, is a chronic condition currently affecting more than 589 million adults aged 20 to 79 worldwide, or one in nine adults (1).
In 2024, diabetes and its complications caused 3.4 million deaths, equivalent to one death every nine seconds.
By comparison, tuberculosis caused approximately 1.25 million deaths in 2023.
Projections indicate that the number of people living with diabetes will reach 853 million by 2050 (1), or one in eight adults, making it one of the leading causes of disability and death worldwide.
Diabetes killed
Diabetes :
an epidemic
in Africa
Diabetes is no longer a condition confined to high-income countries. Indeed, 81% of people living with diabetes live in low- or middle-income countries (1).
These alarming figures explain the statement made by former WHO Director-General Gro Harlem Brundtland in May 2002 at the World Health Assembly in Geneva :
« This provides further scientific evidence of the world’s transition from communicable to noncommunicable diseases. In the twenty-first century, developing countries will experience the greatest impact of this transition. »
Africa will experience the world’s largest increase in diabetes prevalence over the period 2024–2050 (3).
The number of people living with diabetes in Africa will increase by 142% by 2050, from 24 million in 2024 to 60 million in 2050 (3). By then, the prevalence of the condition will exceed 5% of the continent’s population.
Taking Mali, Burkina Faso, the Union of the Comoros and Cabo Verde as examples—four countries in West Africa and the Indian Ocean where Santé Diabète works—diabetes prevalence in 2024 was 4.8% of the adult population in Mali, 4.5% in Burkina Faso, 10.8% in the Comoros and 6.8% in Cabo Verde. By comparison, diabetes prevalence in France was estimated at 6.5% of the adult population in 2024 (1).
NUTRITIONAL TRANSITION,
URBANISATION AND SEDENTARITY lifestyles
Discussion of food-related problems in Africa evokes images of adults with gaunt faces, prematurely aged, and emaciated children with swollen bellies. These all-too-familiar images of famine still emerge in some regions affected by extreme drought or conflict.
However, the predominant trend observed on the African continent in recent years is a transition in forms of malnutrition, from undernutrition to overnutrition. Problems related to overweight now far exceed those related to underweight.
This phenomenon mainly affects cities, where one in four women and one in six men are already overweight. This surge in obesity, affecting both affluent and working-class communities, is primarily linked to an emerging nutrition transition.
This is defined as a gradual dietary shift from a monotonous diet high in starch and fibre and low in fat to a more varied diet that is high in sugars, saturated animal fats and processed foods, but low in fruit, vegetables and fibre.
Fatty products such as oil, mayonnaise and fried foods; salty products such as stock cubes, tomato concentrates and table salt; and sugary products such as sugar and biscuits are increasingly filling African market stalls. These modern stalls are very different from traditional rural markets.
These dietary changes are also very often accompanied by a shift from a physically active to a sedentary lifestyle. Lifestyle changes associated with rapid urbanisation—more office work, motorised transport and the proliferation of television screens and video games for children—reinforce physical inactivity.
- In 2009, Africa’s population exceeded one billion, including 395 million people, almost 40%, living in urban areas.
- By 2050, the total population of African cities will reach 1.23 billion, or 60% of the total population, equivalent to the entire population of the continent today.
- By 2050, West Africa’s urban population is expected to more than double, from 252 million to 526 million. The region’s urbanisation rate will rise from 54% to 72%.
- By 2050, East Africa’s urban population is also expected to more than double, from 164 million to 408 million. Its urbanisation rate will rise from 32% to 48%.
- By 2050, Burkina Faso’s urban population is expected to triple, from almost 7 million to 20 million.
- By 2050, Mali’s urban population is expected to almost triple, from 8 million to 22 million.
- By 2050, the urban population of the Union of the Comoros is expected to double, from 300,000 to 629,000.
- By 2050, Africa is expected to have two additional megacities—cities with more than 10 million inhabitants—bringing the total to six: Addis Ababa and Dar es Salaam.
Overweight and obesity
The increase in overweight and obesity in Africa is linked to rapid changes in food systems and lifestyles. Urbanisation, changes in work and transport, declining daily physical activity, greater availability of highly processed products and food marketing contribute to these changes. They do not affect all populations in the same way. They are influenced by income, gender, place of residence, access to a varied and affordable diet, and social norms concerning weight and health. In Mali, international statistics show that lifestyle-related diabetes risk factors already have a substantial impact, with :
- overweight and obesity affecting 21% of people over 20, with prevalence exceeding 25% among women.
- physical inactivity affecting 19.5% of people over 15 (4).
References:
(1) International Diabetes Federation. IDF Diabetes Atlas, 11th ed. Brussels: IDF; 2025 [accessed 16 September 2026].
(2) World Health Organization. Noncommunicable diseases. Geneva: WHO; 25 September 2025 [accessed 16 September 2026].
(3) International Diabetes Federation. Africa: regional diabetes report 2000–2050. Brussels: IDF; 2025 [accessed 16 September 2026].
(4) United Nations, Department of Economic and Social Affairs, Population Division. World Urbanization Prospects 2025: Summary of Results. New York: United Nations; 2025 [accessed 16 September 2026]. Table A3.
(5) French Diabetes Federation. What is diabetes? [Online]. [undated] [accessed 17 September 2026].
What bread can you eat if you have diabetes ?
People living with diabetes can eat different types of bread. Wholemeal or multigrain breads, which contain more fibre, are generally preferable to white bread because they tend to affect blood glucose less rapidly. White bread can nevertheless be eaten in appropriate amounts as part of a balanced diet.
What are the symptoms of hyperglycaemia ?
The symptoms of hyperglycaemia are those of diabetes :
- Frequent urination, with several awakenings during the night.
- Excessive thirst: a person may drink several litres of water a day, even in cold weather.
- Marked fatigue: even minor exertion may cause tiredness.
- Unexplained weight loss, despite eating normally or even slightly more than usual.
How can diabetes be cured ?
There is currently no treatment that permanently cures type 1 diabetes. Some people living with type 2 diabetes can achieve remission, particularly after substantial weight loss or metabolic surgery. However, remission does not mean the condition has been permanently cured, and medical follow-up remains necessary.
What is the glycated haemoglobin target for someone living with diabetes ?
Glycated haemoglobin, or HbA1c, reflects average blood glucose over the previous two to three months. For many people living with diabetes, the target is below 7%, but this should be individualised according to age, type of diabetes, treatment, risk of hypoglycaemia and health status.
What are blood glucose targets for people living with diabetes ?
Blood glucose targets are agreed with the healthcare team. They depend particularly on the type of diabetes, age, treatment, pregnancy, risk of hypoglycaemia and overall health. Targets can therefore differ from person to person.
For many non-pregnant people with diabetes, the American Diabetes Association’s 2026 standards specify :
- before a meal: 0.80–1.30 g/L, or 4.4–7.2 mmol/L.
- one to two hours after the start of a meal: below 1.80 g/L, or below 10.0 mmol/L.
Individual blood glucose targets should not be confused with the thresholds used to diagnose diabetes.
What blood glucose levels are used to screen for or diagnose diabetes ?
Screening and diagnostic blood glucose values depend particularly on the conditions in which the measurement is taken, for example while fasting or after taking glucose.
- Fasting blood glucose below 1.10 g/L (6.1 mmol/L) is generally considered normal.
- Fasting blood glucose between 1.10 and 1.25 g/L (6.1–6.9 mmol/L) may indicate impaired fasting glucose.
- Fasting blood glucose at or above 1.26 g/L (7.0 mmol/L),, confirmed by a second measurement, is a diagnostic criterion for diabetes.
These values are used for screening and diagnosis : they are not the everyday blood glucose targets for people living with diabetes.
What can a person living with diabetes eat ?
People living with diabetes can eat all types of food. However, some foods may need to be consumed in moderation, depending particularly on diabetes type, blood glucose and treatment. Diet should therefore be tailored to each person’s needs and circumstances.
What are the risks of type 2 diabetes ?
In the short term, acute complications include hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar). Untreated, these can lead to coma.
In the medium and long term, diabetes can damage blood vessels and nerves. It increases the risk of retinopathy that may lead to severe vision loss or blindness; kidney failure that may require dialysis; lower-limb ulcers and amputation; myocardial infarction; and stroke.
What is type 1 diabetes ?
Type 1 diabetes is much less common than type 2 diabetes. According to the International Diabetes Federation, around 9.1 million people of all ages worldwide live with type 1 diabetes. It is caused by a complete lack of insulin production by the pancreas. Treatment requires lifelong insulin injections.
Which carbohydrates should be avoided ?
People living with diabetes generally do not need to eliminate carbohydrates. However, some foods high in simple sugars, such as sugary drinks, sweets and very sugary products, can rapidly increase blood glucose and should be consumed in moderation.
Carbohydrate-containing foods such as bread, cereals, starchy foods, fruit and pulses can all be included in an appropriate diet for diabetes. Their effect on blood glucose depends particularly on the amount eaten, their composition and what else is eaten with the meal.
There is therefore no universal list of “good” and “bad” carbohydrates: the aim is to learn to choose them more effectively and adapt quantities to individual needs. In hypoglycaemia, fast-acting sugars play an essential role in rapidly raising blood glucose.
Which foods are forbidden if you have diabetes ?
No food is strictly forbidden for people with diabetes. Diet should be tailored to each person, considering particularly diabetes type, treatment, physical activity, age and eating habits.
As for everyone, a varied and balanced diet is generally recommended, prioritising vegetables, fruit, pulses and minimally processed or unprocessed foods. Foods very high in added sugars, salt or fat, such as sugary drinks, sweets and fried foods, should be limited.
Living with diabetes does not mean giving up all the foods you enjoy. The aim is to find a balance that fits your needs and treatment.
What is the difference between type 1 diabetes and type 2 diabetes?
Type 1 diabetes is an autoimmune condition: the immune system destroys the insulin-producing cells in the pancreas. It can develop at any age, although it is often diagnosed in children and young adults. Insulin is essential for treatment.
Type 2 diabetes develops when the body uses insulin less effectively and the pancreas progressively fails to produce enough. It can develop at any age, with risk increasing particularly with age and certain genetic and environmental factors. Its management may combine diet, physical activity, medicines and sometimes insulin.
These two types of diabetes differ, but both require care tailored to the individual.
What are the first signs or symptoms of diabetes ?
Diabetes can present with :
– Frequent urination, with several awakenings during the night.
– Excessive thirst: a person may drink several litres of water a day, even in cold weather.
– Marked fatigue: even minor exertion may cause tiredness.
– Unexplained weight loss, despite eating normally or even slightly more than usual.
In some cases, particularly type 2 diabetes, the condition can progress for years without obvious symptoms. It may then be discovered during a health check or when complications appear, such as eye or nerve damage or wounds that heal poorly.
What causes diabetes ?
Diabetes develops when the body does not produce enough insulin, a hormone made by the pancreas, or does not use it properly. Insulin enables glucose in the blood to enter cells and be used as a source of energy.
How can you tell if you have diabetes ?
Diabetes is diagnosed using a blood test that measures blood glucose. Some symptoms may raise suspicion, but only a laboratory test can confirm the diagnosis.
A diagnosis may be made particularly when :
- Fasting blood glucose is at or above 1.26 g/L (7 mmol/L) on two occasions. ;
- • Blood glucose measured at any time of day is at or above 2 g/L (11.1 mmol/L) in the presence of suggestive symptoms ;
- Glycated haemoglobin (HbA1c, reflecting average blood glucose over the previous three months) is at or above 6,5 %.
